Episode 15: Population Health and Cancer Prevention

We are a resource for learners, including every member of the live strong cancer institutes on track educational pipeline from middle school to residency, we are growing collection of interviews, talks and experiences, the uncover, the myths and the uncertainties of cancer and careers in cancer in order to empower and inspire generations of thinkers and leaders.

This is cancer. An education and empowerment podcasts by the live strong cancer institutes.

Hello, Kristen went here with this month’s cancer awareness segment. This month is breast cancer awareness month, and we’d like to take a few moments to discuss breast cancer and simultaneously preview next month’s episode, which will feature the unique needs of young adult cancer survivors ages 18 to 39.

Rebecca immunos is a breast cancer survivor on LCIS young adult advisory board. And she sat down with LCIS pharmacist and young adult cancer caregiver, Laura Cannon, to talk about her breast cancer diagnosis and a few of the hurdles faced specifically by young adult cancer survivors. What or if any, did you all have issues advocating for yourselves to get your cancer diagnosis from the get-go?

I think a lot of times in healthcare cancer diagnosis in young adults is not something that’s always. So I would love to share on that. So my name is Rebecca Munoz and 2017, I was diagnosed with invasive ductal carcinoma, which is breast cancer. Um, and I was told that it was triple positive, which means, um, it was estrogen progesterone, and her two positive.

I was actually in my final year. Of my undergraduate studies when I got diagnosed. Um, so it was pretty challenging. I had actually done a self exam in may, the year that I got diagnosed and I felt a lump and I kind of shared it with my husband and my mom. And I said, Hey. You know, we have a really strong history family cancer.

I think this is what it is. And of course they wanted to settle my nerves and know it’s probably not that, um, I actually waited a few months to actually go into a provider and that was a women’s health clinic. And I mentioned, Hey, I have a really strong family history. Give me my maternal grandmother.

And aunt had both passed from breast cancer. And so I said, I really want to have this looked at my challenge and frustration was that the provider very confidently said right off the get go. This is just a cyst. It’s nothing to worry about while, you know, it’s something that I, you know, admired that she was trying to keep me calm.

I would have liked to have a little bit more transparency and said, Hey, well, we’re going to check this out and not just give me false hope. She did request a mammogram, which is not typical for women under 40 to just get them regularly. And so at that mammogram appointment was when the radiologist did bring me in.

After the re the imaging was done. Um, and privately kind of shared with me. He said, I can’t really give you the official results. This is something your provider has to share with you. But what I’m looking at does seem like breast cancer. It was frustrating because it was just written off as something that was very.

You know, my Newt and that wasn’t the case. And I think it’s also challenging because as a young adult, if you don’t have a whole range of doctors, I think that that is a challenge where it’s, who do you go to first? I was lucky in the fact that, you know, I’m a female. So I went to my women’s health doctor because it was in my breast.

Had it been anywhere else or anything else? I don’t know that I would have gotten results that quickly. Thank you for sharing that. So often two weeks, we don’t prioritize taking care of ourselves in general, right. Or going to that annual doctor’s appointment and getting just a physical exam or baseline lab work too.

So that’s also a great point in that we’re not always as young adults invested in the health care system. Right. You said sometimes. This cancer diagnosis is your first real time being in the healthcare system because we’ve been in transition. We’ve been in college or graduate school or moving cities.

And so we’re not often well-established. And that’s a really great point to bring up about who you go to for. Thank you to Rebecca and Laura for this important conversation. If you or someone, you know needs help facing breast cancer. Now the Susan G Komen foundation@komenkomen.org. The live strong foundation@livestrong.org or here in Texas, the breast cancer resource center at BC R.

Dot O R G are all incredible resources with a wealth of information. Look for more of this discussion. That includes Rebecca Laura, and two more members of the LCI young adult advisory board. Next month, right here on cancer uncovered, I will let our brilliant student associate and this month’s host Sarah Mann.

take it from here. Thank you, Sarah, for your incredible work and dedication to the mission of the live strong cancer Institute. Uh,

Hello, and welcome back to cancer uncovered. My name is Sarah and I’m a new host on the podcast. I’m a senior at the university of Texas at Austin, and I currently work as a student associate for the live strong cancer institutes. Thank you for being here and listening to this important discussion about population health and cancer prevention, but Dr.

Kiran Shokar chair of department of population health professor of population. And associate Dean for community affairs, uh, Dell medical school, Dr. Shokar came to Dell med and may of 2021 from the Texas tech university health sciences center and El Paso, where she served as a professor of family and community medicine, director of cancer prevention and control in the center of emphasis for cancer and vice chair of research in the department of family and community matters.

She completed her training as a primary care physician in the UK before she moved to Texas 25 years ago for a faculty position at the university of Texas medical branch in Galveston. She’s here today to tell us more about population health, her research in cancer screening and prevention, and as usual her insight into her own career path.

Hi Dr. Shakar and welcome to the cancer uncovered. Thank you so much for being here. Can you start by telling our listeners a little bit more about yourself and your background? Hi, I’m Navkiran Shokar. I go by Karin. I’m the chair of population health at Dell medical school. I started in may. Uh, my core, I’m a primary care physician, the primary care physicians who are trained in taking care of people from birth to the end of life.

We used to dealing with all the major problems that people have. We’re used to dealing with a lot of them certainty because usually when it’s. To interface with the healthcare system. They see a primary care physician. First, if they’re fortunate enough to have one. So we’re used to people coming with symptoms that may be something or may not be something.

So we really are kind of putting all the pieces together to figure it out. What might be wrong with that person if they have an illness or if this is just a normal part of something that happens. And then from us, we direct people to the relevant specialist if that’s needed. So that’s a big chunk of who I am.

Another major component that is very important to me is cancer prevention. So cancer is a very common disease. It’s something primary care physicians deal with a lot we’re involved in diagnosing it. We’re involved in helping patients through their cancer journey. And we’re also involved in screening and prevention.

The bulk of my career on the research side has really focused on how to do that better, especially the cancer prevention and early detection. So a lot of my work over the past two decades is focused on that. That’s amazing to hear about. So we were wondering, what does population health mean to you and how is it different than healthcare in the traditional.

To me, health is a very broad concept. It’s not just taking care of people when they’re sick. It’s what people are doing, how they’re living every day. So it’s prevention. Wellness. And it’s more than just the physical, it’s the mental, it’s the social relationships. It’s wellbeing beyond just sickness care.

Population health is a relatively new kind of. And the bitch that has come into more use in the healthcare setting. It means different things to different people, depending on their perspective. But to me, what it means is really that we’re taking care of all segments of people that live in a defined area or defined.

City or catchment area or country, however you want to define the geographic area, but it’s everyone that lives in that. So it’s not the people that are accessing healthcare. It’s not the people that are in the hospital, just them it’s everyone. So it’s really everybody that lives in that area, regardless of how, or whether they access the health system.

The way population health to me is different is that we’re using all the tools across different sectors. So yes, it does involve the health care system, but it doesn’t just involve the hospital. It involves clinics. It also involves the community. So individuals living in the community that are helping us to define their priorities and helping us to learn about their barriers.

And there’s a lot of community organizations that are focused on different aspects of people’s lives that also touch health, so is working with them. And then the third piece is public. Traditionally public health and the health care system have not necessarily integrated as much as there is potential for.

So I think there’s a lot of room to rethink how we engage with them using public health tools, to really sharpen our focus and improve and maximize our impact. So something. I, my background that was really helpful in this is that I’m trained in public health. I have a master’s in public health and I’m also an MD as an MD.

I’m a primary care doctor. So I feel like I’m someone with my kind of training is really uniquely qualified to be thinking about population health, because we have those sets of experiences and all those fears that really influence a person’s wellbeing. So to me, that’s what population health is. It’s thinking about all those people when I live, work and play and learn, but it’s also bringing those tools and disciplines together for public health and the health care system.

So what is cancer prevention and early detection and why is it so important? So there’s a lot of interventions that we can do and screenings tests. That’s what we call them to diagnose cancer early and also to even prevent it. The problem is that population is not participating in that to the extent that we would, like there are a lot of evidence-based interventions that can happen that have shown.

That they can prevent cancer and cause it to be diagnosed early when cancer is diagnosed early, that’s when we really have the biggest impact in terms of length of life, quality of life and treatment treatment is much simpler earlier in cancer, and sometimes you can even treat. There’s a lot of exciting research that has happened on the prevention side, but also on the treatment side.

And the treatment side gets a lot of attention. The problem is the treatment side is it’s very expensive and the results are often not as good as we would like. So. To me, I really passionately believe that we need to focus way more effort and coordination on prevention and early detection. And that’s what I’ve tried to do or the last two decades.

So I’m really hoping to bring that expertise to Dell med and join forces with the people that are already here. So what work have you done in cancer prevention and early detection and how did you first become interested in this topic? You know, as I mentioned earlier, I’ve been a researcher for 20 years.

So during that time of really focused on cancer prevention, initially when I was starting out as a young investigator are focused on colorectal cancer. And the way I got interested in colorectal cancer prevention and screening was through my role as a teacher and an educator. So when I first became a faculty member at UTM MB, one of the things that I had expertise in because of my training was doing colonoscopies and sigmoidoscopy.

These are tests that are usually done by a gastroenterologist that help to visualize the colon. Directly through a small endoscope or a flexible tube. When I started, it was a faculty member. I became responsible for training their family medicine residents in doing that. So as I got more interested in it and developed a training kind of program hands-on experience for residents, learning how to do.

And I became really interested in colorectal cancer. And as I read more about screening, I realized that there were really large differences in the uptake of that test and the prevention of colorectal cancer across different racial, ethnic groups. And so I was really kind of perturbed about that. And, um, at the same time I was doing a master’s in public health.

So I use that question. That I had about why that was, and as a kind of focus of the research I had to do as part of my master’s. And so that grew over time, I’ve gone received a lot of funding and research to understand first why that is when I lived in literature, I found that, you know, there really wasn’t a lot of information.

About why the uptake of screening tests for colorectal cancer prevention was so low in certain groups. And so I started with basic research about asking people and I did some in-depth interviews. Then I designed a survey and I built the knowledge base in that area, using the methods. I was learning, doing that initial research and designing programs to address what you’re hearing and what you’re learning is.

Wow. It’s really interesting to hear about your research and impact in this field. And on a similar note, how are you involved in creating new programs and what are some of the challenges of this work? What I realized is that there’s a lot of barriers to why people don’t do these kinds of tests for prevention, and they’re not just relevant for cancer.

They’re relevant for cardiovascular disease, diabetes. So of this is transferable over time, I developed a very robust program that was not only learning about why it was happening, but shifting focus to thinking about what can we do about it and what kind of interventions can we do? Where do they need to happen?

How do we put them together? So they’re effective when I moved to El Paso and west Texas. It became clear that the set of barriers that people have when they’re coming into the healthcare system is very different to the set of barriers that people have when they’re not even in the healthcare system.

So I focused a lot on populations, experiencing disparities, lack of inch health insurance in the U S is a major, major source of disparity, but that’s not all of it, but definitely not. All of it. There are lots of. Cultural beliefs, barriers, economic barriers that people have, even people that have insurance.

So just having insurance is not the silver bullet. It’s not because people still, even people that are insured still don’t participate in the kinds of behaviors that will be really good for their health or in preventing disease or in wellness. So it’s very, very complicated. Three put together programs that were implemented in the community.

Specifically for uninsured populations and populations that didn’t have access to care. A lot of my work over the last decade has been among Hispanic populations in west, Texas, both urban and rural or learning about how to effectively put together interventions that really work. And, you know, we’re very fortunate in that our results are really.

Effective. And the reason is, and I go back to this is because we really did a lot of preparatory work to really understand what the community. I felt what the community believed and how the community wanted to be helped and designing programs to address that it’s not easy. It’s a lot of work, a lot of preparatory work.

Um, but it’s worth the effort because we put together programs in colorectal cancer and breast and cervical cancer for screening. And they have really, really high uptake. People are doing the tests and it was. Because we put together these programs that were very responsive to the needs as they sold them.

Not as we, as researchers sold them. Could you tell us more about the specifics of conducting this type of community-based research to address cancer health disparities? So the approaches we talked to interventions in the community. Well, to really use the collaborative approach with community organizations and people working in there that really understood the population.

We did a lot of cultural tailoring of everything of the interventions that we did so that they felt the population felt that they were very relevant to them and they trusted them and everything was of course, bilingual. I mean use community health workers. Now, community health workers are really, really interesting and can be a very effective model for delivering health interventions that they’re trained to do.

And the reason is that they usually are the community health workers are usually from the community that they are serving. So that really helps to build. It also gives you a lot of insights as a researcher into how your program might be perceived and how you can improve it and make it more relevant for the population that you’re serving.

So that’s very important for disparity populations, you know, minorities of any kind, not just racial, ethnic, but sex and gender minorities, et cetera, that we made a lot of adjustments based on the input that we received UTL for. Awesome. It’s been great. Hearing more about your background and about your research.

Um, I’d like to switch gears a little now and speak more broadly about leadership and what qualities it takes to go far in this field. So, first off, what have you learned are important qualities of a leader, humility, building trust, building relationships, transparency on this. Ability to admit when you’re wrong and being able to culture that in your team, that it’s okay to be wrong.

And the last thing I think I would say is having a growth mindset, a learning mindset that everybody isn’t perfect all the time, even leaders make mistakes. The question isn’t did you make a mistake? But the question really is how did you respond to. And kind of nurturing that view and kind of culture, I think is very important because that’s how teams are successful.

You have to accept what happened. Okay. How do we learn from those? How do we move on and doing that? I think develops a culture within your group that. Okay. When things go wrong or when we don’t want them to go wrong, we don’t encourage them to go wrong, but when they do it’s okay, but what can we do different?

And I just find that to be a lot more of an effective way to lead than being negative about mistakes, and then having everyone being very. Clear about what the vision is, being able to communicate the vision and making sure that people feel aligned with that vision and recognizing that sometimes people just aren’t a good fit for what you’re thinking of doing and just acknowledging that and helping them to adapt or to move on if that’s needed.

I really think that a good leader. Everyone that’s on the team to enjoy coming into work and passionately believing in what they do. Because if you have that, you have 85% of what it takes to be a successful team. So creating that culture and environment. Is really important and related to that is being inclusive, having teams that are diverse and not just in their background, but in how they think well, how they’re trained, all of that, I think just makes for a really strong team.

What would you tell to learners who are considering a career in healthcare? There’s a lot of opportunity in healthcare. I think that it’s very important that anyone considering health. Really kind of answers that question very carefully about why they’re doing it. And that’s important because if you want to be happy and I would say that for any career, actually not just for healthcare, if you don’t feel passionately connected to the reason that you’re choosing a career.

Then you’re really not going to be happy. You know, there’s a lot of time, energy, money, commitment that goes into being successful in whatever career that you choose. So in healthcare, in particular, it’s very, very challenging. It can be really tough it’s but it’s also very rewarding. So examining your reasons why you’re picking that career is really important.

You know, whether it’s nursing, it’s social work, it’s being a physician, being a nurse practitioner or a PA whatever health-related field that you choose. I think that applies to, so that would be my number one, two, and three pieces of advice for anyone considering a career in health care. If someone asked me, what would you have done this.

An 18 year old, would you still have picked medicine and the absolutely 100% with the health? Um, I can’t think of anything else I could do just because that first reason, the reason why you would want to do it, if that is strong, you’ll when you’ll overcome any adversity and the difficult times, and it doesn’t feel like work because you’re doing something you really believe in, you’re passionate about and you feel like you’re making a difference.

Yeah, I would encourage everyone to ask themselves that question. And it’s such a rewarding profession and specialty, whatever you choose to do within the health care. And that’s what keeps us all going. That’s what kept us all going this last year, year and a half when it’s been so difficult on so many levels with everything that’s happened and I’ll be happy to talk to anyone that wants to discuss.

Why they’re doing it, what it’s really like talk to people that are in the field. Cause sometimes when you’re a student, you pick things, they sound good, but when people get into it, they realize, oh, it’s not what I thought it was. So, you know, being informed and talking to people that are doing it, following someone around, seeing what they do day to day, it may, it may sound really glamorous.

I mean, there’s lots of crews that sound really great to me. But then when you look at what people are doing on a day to day basis, it’s not quite so exciting. So yeah. So going in with your eyes open, I think is a good thing. And for our last question, if you can go back and think about why you decided to pursue a career in healthcare, what made you choose this field?

So I just try to imagine going back to 18 year old me, it was two. Just to help people. I had had some experiences with issues myself as a child, nothing serious, but just having that experience as a patient and what it felt like to feel better or to not worry about something that had happened. I wanted to be able to do that for other people right now.

I would say that other than the last 30 years, Again, it’s just, I just passionately believe that everyone has a right to reach their potential. And often in our society and community, there are lots of different reasons why that doesn’t happen, but one of them is health and wellbeing, wellbeing, especially everyone should have equal access to an opportunity to feel.

And it’s so much more than just healthcare. It’s about having healthy relationships. It’s about feeling respected. It’s about feeling safe. It’s about all those other things. And so I would say that my thinking has really transitioned and as I kind of reflect on my different experiences, so I trained in the UK.

I worked as a physician there for. The week before I came here, even there where there’s everyone has a free, at the point of access, health care, there’s still health inequities and health disparities. So what does that tell you? It tells you that it’s more than just the healthcare system. It’s about all the social drivers of health.

It’s about personal responsibility and personal behavior. It’s about education. It’s about how. Get treated as a society in general. It’s about how you get treated in the health care system. So I would say I have a much broader kind of understanding of health and a lot of health is wellbeing are the simple things.

It’s feeling compassion from the people that you interact with in the healthcare system. It’s about being respected and feeling important and trust. That’s the biggest thing. You don’t have trust and it’s very, very home to feel. Good. Well, thank you so much, Dr. Shocard has been amazing. Getting to hear from you.

If you have questions for Karen show car, or have any other cancer questions that we can uncover, please email us at live strong cancer institutes at Dell med dot U, Texas dot. And please make sure institutes is plural. You can find out more about the live strong cancer institutes@dellmedthatyoutexas.edu, and about the live strong cancer institutes clinic at UT health, austin.org.

You can also follow our chair and director Dr. Gail Eckerd on Twitter at S. Occurred. It’s spelled E C K H a R D T. If you enjoyed this episode, please make sure to subscribe. I’m Sarah and this is cancer uncovered. Thank you for listening. .