Dr. Kassem === [00:00:00] I went to Purdue Electrical Engineering. And then, you know what I wanna tell you, I knew that. Okay. Because I did uhoh. My husband's an electrical engineer. Okay. I just, I can tell. Yes, . There you go. I can just tell. Yeah. There's a, there's air around you guys and I will lump you all, all together. Just like you guys lump us all physicians into one. Yeah. Yeah. Is this thing on? Hey guys. Welcome back to another episode of the Summits podcast. Thank you from Joy. Thank you for joining us from wherever you get your podcast, and if you happen to be visiting us or viewing us on the Heroes Foundation YouTube channel. Thank you for doing. If you haven't already done so, hit that little subscriber button and the little notification bell so you can be notified when new episodes like this one drop. We would appreciate it. [00:01:00] It's absolutely free. Doesn't cost you a single cent. Uh, today we are joined by Dr. Noal Kasem, uh, from the IU Health. Welcome to the Summit Podcast. Thank you. Thank you for having me. Mm-hmm. , why don't you provide our guests a little background info, a little introduction on yourself. Sure. So I am a breast oncologist, so I treat breast cancer patients, um, and I see patients at IU North. Um, just actually three minutes away from here. Yeah. Um, I also, I am the director of the I U H Cancer Prevention Program. Um, in that I see patients who, for the most part, do not have cancer, but have a genetic predisposition, which means they're just at a higher risk for getting cancer based on their genetics and to determine someone that's at higher risk. Or is there different screenings or things like that that that put them into that category? Yeah, so high risk means different things, so we can, someone can be high risk based on certain [00:02:00] things. For example, I'll just, because I'm a breast oncologist, I'll just use. As an example. So women may be deemed at high risk based on their mammogram, so how dense their breasts are. But, um, the high risk patients I see is all based on genetics. So it's patients usually based on family history. We, you know, something kind of says, okay, there's something being passed down through generations, um, and so let's get this person tested, and then that test comes back positive, which means there's definitely something that's being passed. Two generations increasing the risk for cancers. I'm gonna take a step back. Yeah. And we're gonna go back to the early years. At what point, growing up did you say, you know what, I, I want to be a doctor. I've always loved biology. Okay. So, um, I'm not sure I can specify a time. Sure. I wanted to become a doctor, but I've always been fascinated by biology, human biology specifically. Um, genetics, always for some reason. Um, so I did a lot of [00:03:00] science courses, um, and then it was really as I got into after college is kind of when I really wanted to, to become a doctor. And it was actually during my time as a researcher that I decided I really loved the aspect of, of seeing patients in clinic. So you'd already finished undergrad? And didn't go straight into med school. No. And it wasn't until after you were doing your some research. Yep. Then it, then it triggered. Interesting. Okay. Cause that's, yep. Typically you would think, and maybe I'm wrong, but most people go straight from undergrad then to med school and then go on. Most people do. What research were you doing that triggered that? So, to become a doc, so I was doing breast cancer research, but actually, um, I did research and my fascination with oncology started. When I was an undergrad, so I worked in a, uh, in a, a lab where we were doing pancreatic cancer research. Okay. So it was just, um, looking at those cells under the microscope. That was kind of what intrigued me about cancer in general. Um, and then as a researcher, I was doing [00:04:00] breast cancer research. You know, I'm in the lab all the time, but I got to go in and, and see breast cancer patients as part of one of my projects. And it was then that I was just hooked. Where, uh, did you go to under. I, U P U I. Okay. I've been here my whole life in Indie . Mm-hmm. . Nice. Yep. Um, and was biology your major? Yes. Okay. Mm-hmm. . Were you doing research as part of like with I U P Y or was Uh Oh, gotcha. Yes. So no. So actually it was a job. Okay. So I finished undergrad, got my master's in biology. And then, um, I did, so I did tissue harvesting for a while. Okay. Um, which essentially was, uh, you've heard of tissue donation? Mm-hmm. organ donation. It was something similar. Yep. Yeah. Um, and then I started doing breast cancer research at IU with the Okay. With actually one of the breast oncologists now, Dr. Brian Schneider. Mm-hmm. . Um, and it was during that time that I, that I started seeing breast cancer patients. Okay. Were you on campus at IU or was it at I, at iu? At Simon Cancer [00:05:00] Center. Simon Cancer Center. Okay. So, how far out from undergrad were you when you decide, okay, I'm gonna go to med? Two years. Okay. It's not that tough. I've never three years out. Okay. And then when you went into med school, did you already know what path you wanted to take in terms of what medicine you wanted to practice or, oh, I was as direct as they come. I, I went in knowing, I, I knew what medical school I wanted to. I, I wish I could have done my medical school in two years because I knew I wanted to do internal medicine and I even shortened my internal medicine residency because I knew I wanted to do oncology. Yep. Yeah. There was never a wavering in my path. So, lemme ask you this. , obviously we've never been through, never went through medical school. Um, was that a good thing or a bad thing? I mean, in the religion. Why? I asked like when you have, when you're going through residency and you have different rotations mm-hmm. that don't apply to that. Mm-hmm. , I could see that potentially being a bad thing. Like you're like, I don't really care about the, I mean not you don't, don't care, but like, you're just not as interested in it and so it depends on the person. Yeah. I was always interested. Okay. In what I really did not like is, I didn't like how [00:06:00] regimented it was. It was not in my personality, but everything else I enjoyed. I did the best I could because the truth is I knew I'd not just be treating cancer patients. Right? Sure. So I have family members asking me questions. Even for my cancer patients, I have to treat other aspects of their care. So I was always interested in everything and it's the human biology. So I. I never struggled to, to be interested. Right. Recently the sjp Heroes Cancer Research Fund mm-hmm. Asked a program of the Heroes Foundation, uh, that funds different research projects, selected you as our SJP fellow. Mm-hmm. So, congratulations. Thank you. Um, why don't you share with us a little bit about that particular project and, and what it is that the, the funding is gonna be used for? So I kind of mentioned earlier my, uh, clinical interest in patients with hereditary cancer syndrome. So essentially, um, you've heard of patients like with brca, you know, the B R C A mutations. Mm-hmm. . Um, these patients are at high risk, for example, for breast, [00:07:00] ovarian and pancreatic cancer. And there's other, many, many other genes that we know increase patients at high risk for cancer. So my project is really based on identifying patients who have a hereditary cancer. , um, and trying to figure out what barriers prevent them from passing on the information to their family members so that the family members may also get tested and find out whether or not they're at high risk. Right. And the project actually focuses on the disparity that we've seen. So I'll backtrack a little bit. So about 10% of cancers are diagnosed, so we're talking all cancers here. Due to, or as a result of a genetic mutation that's passed down through generations. Um, and in, in what we like to do, and we know that prevention, cancer prevention is the best way to help reduce the mortality and the [00:08:00] morbidity related to cancer. So we try to essentially find those family members who have these genetic mutations and get them to cancer. so that if they are to develop cancer, we're catching it early. Right. And what we noticed is black patients were less likely to have family members undergo this testing. Okay. Hmm. And so to us that was a very important thing to dive into, to understand why is that the case? Mm-hmm. . Um, because for example, in breast cancer, specifically, black women are more likely to die from breast cancer compared to white. So I think the benefit of understanding why are black patients less likely to have family members undergo testing matters a lot in terms of helping prevent cancer in the first place. Sure. For these patients. Yeah. Um, maybe a dumb question, but I know pancreatic cancer has a pretty high, um, death rate, I guess you [00:09:00] could say. Mm-hmm. , and I think a lot of that has to do with, you just don't, you don't start to see any symptoms until it's already much later on. Would or could this help with that? And I guess the next question is, while you may discover that someone is more predisposed to, um, being diagnosed with breast or uh, pancreatic cancer due to some genetic or hereditary factor, but then how do you test for it? Is it there isn't, I don't, I don't think there is a, a screening for it. Is there yet for pancreatic cancer? At least for hereditary pancreatic cancer. So some of my patients who I see in clinic who I know for example, have an increased risk for pancreatic cancer, we actually send them to a high risk pancreatic cancer screening clinic. Okay. Um, at iu. , um, where the, the patients actually will undergo screening, and that's done in two different ways. An mri mm-hmm. , essentially it's a big machine that takes all your images, um, or [00:10:00] an e u s, which is a scope that goes down. Okay. And they use an ultrasound to look around. Okay. So right now we're limited by essentially those two modalities. There's a lot of. Going around now trying to identify other ways to screen for pancreatic cancer. Yeah. I mean, everyone's looking for that holy grill. Yes. Blood, simple blood test that can detect everything, but we're, we're not there yet. Not yet . Yeah. Um, what, what would you say drives you day in and day out, uh, with this particular project, or maybe in general? I am passionate about cancer prevention. I've, I've seen, I've. Cancer do terrible things to, to people and their families and their lives. And I, I truly believe that trying to catch cancer before it develops or before it becomes too late, um, for cure is, is, is something I'm extremely passionate about. Um, and, and I really believe that trying to find people who are already [00:11:00] predisposed to, to getting cancer is, is a good place to start. Yeah. Mm-hmm. , so we. The, the bucket of cancer prevention is multifaceted. Mm-hmm. . So it's the obvious, you know, don't smoke, watch what you eat. Yep. Exercise, but then it's beyond those, which is some of the things that you're talking about here. Mm-hmm. . Um, I think as we look at our, some of our prevention programs and how do we better educate the public mm-hmm. um, it probably, and I'm, again, I'm gonna say the obvious here, makes sense to work with you guys more closely to say, , we've got some of the, the obvious things down that mm-hmm. , maybe people still don't practice, but it's things that are more commonplace. But what other things are out there that people need to be aware of that might help further educate them? And, and to your point, it's, um, regardless of race or whatever, it, it's, it's, um, drilling into the fact that there are things that people should be looking out for. And that maybe it's, again, I'm, I'm oversimplifying, but is it this simple conversation with [00:12:00] their doctor to find out or to do some. Not genetic. Is it genetic test testing? Yeah, you're right. Okay. Yeah. Uh, so I, I will tell you, it's amazing how many people I talk to that are not sure of their family history. Sure. So I think if there's a place to start is knowing your family history or, or trying to, to, to gather your family history, um, that's probably a really good place to start before you talk with your provider because it's, it's really. you have to remember, you know, when you're seeing your provider, you have so much time to see them. And if you're trying to remember who in your family had what cancer, it gets really hard. So what I tell, what I tell my patients is put that on paper. Mm-hmm. , you know, gather that, all that information, um, and then talk to your provider. Yeah. And then I, I think it's up to the provider at that point to decide whether or not this person may or should get genetic testing. And there's always resource. I have a genetic counselor that works with me. Um, we have a, we have the Cancer familial, the familial [00:13:00] cancer clinic, iu, where people can go and get counseling before getting genetic testing. Yeah, that, that's gonna be my next question is how commonplace is genetic testing and. How easy is it for, for anyone to have that testing done? Yeah, it depends. It depends on what kind of genetic testing we're talking about. Yeah. Because some people will say, oh, I had genetic testing. I had 23 and me mm-hmm. So that to me is, yeah. You know, it, it, sure it is a test, but it, it's not as comprehensive as many people think it is. Right. So, . Uh, so it just, it depends. Yeah. Um, and it is available. I mean, it, I do have a good, uh, 23 AME story that we'll talk about later. , you, you, I know you mentioned bringing your family history. Mm-hmm. , when you're talking about these things, how far out on the family history do you, do you go like your third, fourth cousin kind of thing, or is it your direct. Your parents, grandparents kind of in that line. What, what should the scope be? It's a good question. Um, I, I think so. If you can get to your grandparents. Okay. I think that's a good. , that's good [00:14:00] enough for us. Okay. Um, it, it gets really hard if the family's really, really small. Mm-hmm. . Yeah. And then depending on personal history, we sometimes will just recommend it based on just that. Okay. So it, it really just depends, but it, it's really helpful to be able to see, you know, who in the immediate family has had a cancer, at what age it was diagnosed. Um, and for example, let's say someone's aunt has had cancer. Well, I'm interested to see how. , other ants this person has, right? Mm-hmm. , because that tells me a lot. Okay. So, and I know it varies case by case, but let's say you have a patient and you do the genetic testing. Mm-hmm. , and it comes back with a couple red flags or a red flag. Mm-hmm. , what's the process from that point? So before, um, the i u H program was started. Um, so when you say red flag, I wanna clarify. So that means a positive genetic test, correct? Yeah. Which means that, okay, so I am, I'm telling you, I'm telling this person that you have a [00:15:00] hereditary cancer syndrome of some sort. That there's a chance that your siblings have the same genetic mutations that your children may have that genetic mutation. It used to be that we didn't really have a place for these patients to go. Now with the program that we have, um, these patients can be seen in our clinic. We develop a plan for their surveillance, which means, you know, what imaging do we need to do, we use guidelines to help with that. and then we continue to see them as often as we need to based on the genetic mutation. Yeah. Does it automatically trigger some other series of tests, or just depends? That's That's it For the most part. It's it. Okay. Sometimes if the test comes back negative and there's still suspicion, then we may do more expanded testing, which means we test for more genes. Right. Um, but outside of that, there is not that many tests that we do afterwards. Okay. And then is there a recommended. Age or age group that you would want people to get genetic tested? I, I can [00:16:00] assume that it's maybe 18 to 25, but yeah. Uh, it's depends on the genetic mutation. Okay. So some genetic mutations, uh, predispose, even kids as young as eight years of age. Okay. . And so for those, you know, sometimes we try to test as young as possible. Um, majority though, and I really focus mostly on the adult patient, patient population, so I'm not gonna speak that much about the pediatric. Sure. Um, at 18 is when we start telling people, you know, as, as, as long as they can make their own decisions, I think is, it depends on also the genetic mutation is when we would recommend. Okay. But sometimes, you know, for a genetic mutation, we would typically not recommend any surveillance until, for example, the age of 20 or 25. Sure. So, you know, we give people a little extra time before they get the testing done. Right. So what is your cancer story? I am not sure I have one. Um, I have [00:17:00] seen many, many, many cancer patients with all kinds of cancers. Um, I've seen. I've had cancer in my family. Um, but if you are asking me what got me to do this, uh, it started in a Petri dish. Okay. Uh, so I was fascinated. You know, I told you that I did pancreatic cancer research as an undergrad, and till this day it's, it's really amazing to me watching those cancer cells under the microscope. I never, at that point, I had not met a cancer patient. Okay. So it was the fascination started with science, and then once I started seeing what it did to people, I think is what made me really want to be an oncologist. Yeah. So taking the lab experience, getting in front of the patient and that human element taking over. Yes. Yes. And that's what triggered it. Yep. And, and seeing the relationship that forms between an oncologist and a patient. I, I, it's, it's really precious and I, and, and to be honest with you, I don't know if I've seen the. [00:18:00] Kind of relationship with other specialties. Right. At least as a resident, as I went through my medical training. Yeah. Well then as an oncologist though, you know, having probably had to say this to a patient, you know, the gravity of, of someone hearing you have cancer. Yeah. Um, e even today, even if it's a, you know, knock on wood, a, a, a highly successful or highly success rate, uh, type of cancer. It's still pretty jarring to hear it. Um, and, and I think you, you've been around that enough now to, to understand what that, the gravity of those words mean to a patient. And so I think that's probably something that, um, and I'm not trying to put words in your mouth, but, um, the gravity of the situation, it adds to that passion or add to that fuel to. to what you're doing. Absolutely. It's, it's not just that initial, but also after you know it, it never leaves. Sure. A person, it never [00:19:00] leaves that family. And to me, that, that's just so impactful and it just never goes away. Well, we appreciate what you're doing. Thank you. Mm-hmm. , um, how can we be of more help to you? I appreciate the funding. You have no idea from sjp because without it, I can't do my. So I'm, I'm really thankful to everyone that, that helps make this happen. Well, we're happy to do it. Uh, we're excited to see how everything goes, and thank you. And, and hopefully we'll get to the next stage and, and, uh, continue the momentum. Thank you. Thanks for joining us today on the the Summits podcast. We appreciate you coming in. Thanks for being, thank you for having me. All right. Thanks guys for tuning into this episode of the Summits podcast. We appreciate you guys tuning in from wherever year podcast. Don't forget you YouTubers, if you're on the Heroes Foundation YouTube channel, hit that subscription button absolutely free, won't cost you a dime. Any questions that you guys have for us, um, about this project or, uh, genetic testing in general, throw it in the comments section. We'll do our best to get you some answers. Until then, don't forget beat Cancer.[00:20:00]