Breast Cancer: An Oncologist's Personal and Professional Battle

Hey y'all, it's Nikki. Nikki Moore for More Stories. Before we begin this podcast episode, we want to emphasize that the content discussed here is for informational purposes only and should not be considered as medical advice. Our guest today, dr Natalie Johnson, is an oncologist and breast cancer survivor who will be sharing her personal experiences and insight. While Dr Johnson is an expert in her field, it's important to consult with your own healthcare provider for any specific medical concerns or questions you may have. Every individual's medical situation is unique and what may have worked for one person may not be suitable for another. The information shared in this podcast is not a substitute for professional medical advice, diagnosis or treatment. Please consult with a qualified healthcare professional regarding any medical conditions or decisions about your health. Thank you for understanding, and now let's dive into our conversation with Dr Natalie Johnson. Hey y'all, it's Nikki Moore for More Stories and, as the intro says, we are so glad that you're here and I'm super excited to share my next guest. I have so many reasons why I'm super excited and we're going to get into it. Dr Natalie Johnson is a practicing surgical oncologist and medical director of the Legacy Cancer Institute and the Legacy Breast Health Centers in Portland, oregon. She grew up on St Thomas in the US Virgin Islands. Her mother instilled in her a love of the arts and she was enrolled in ballet classes and attended plays and operas and musicals. Dr Johnson began her professional life as a dancer with the Ballet Theater of the Virgin Islands and she spent a summer in New York City with the Alvin Ailey American Dance Theater. After that summer, however, she decided medicine was probably easier. She later said, and enrolled in Howard University, where she earned a bachelor's degree in radiation therapy technology in 1980. Dr Johnson attended the Medical College of Virginia, graduating in 1986, and completed her residency in a surgical internship at the University of Southern California. She moved to Portland in 1992 and began a long tenure at OHSU, though she remained on staff at USC in the Department of Surgery until 1995. At OHSU, dr Johnson rose from surgical clinical instructor in 1992 to a full professor by 2004. She began her work with Legacy in 1996, serving as a medical director and organizer, as well as a board member for the Legacy Good Samaritan Foundation. She has a deep understanding about how the complexities and the interrelation between patients and providers, health systems, society factors and the environment contribute to disparities in healthcare, all of which impact, access, quality outcomes and trust. Dr Johnson has received 18 honors and awards over her career. She was recognized as Portland's top doctor for six consecutive years and in 2017 she was recognized as Oregon's top surgical oncologist. Most notably, in 2017, she was awarded the prestigious Oregon History Makers Medal, which is regarded as one of Oregon's most prestigious honors. Dr Natalie Johnson is known for her empathetic treatment style based on her personal experience with cancer. In 2013, she herself was diagnosed with her two positive breast cancer, an aggressive type of the disease. She chose to have chemotherapy before surgery and credits the experience with giving her a deeper understanding of what her patients go through. Dr Natalie Johnson is married to Dr William Johnson and they have two beautiful, grown children. Listen, I'm not only excited because this doctor is a wonderful expert in her field and she's done wonderful work. Just reading about the testaments from her patients, she's a class act. I'm not just excited because of that, but because of my personal experience with Dr Johnson. She's not only someone that I was able to call on during my journey, but she's also family, and that's why this particular episode is so special to me. So I look forward to having you listen to this episode and learn some things and stay along with us for this. It's good to have you here. Let's get into it. Dr Natalie, the first thing I want to say to you is thank you. First of all. Thank you for everything. Thank you for being someone that I could reach out to when I was going through my journey, and how kind and nice you were. It just made my journey just so much easier. You can imagine you can imagine but many people cannot imagine to be diagnosed with breast cancer. I had my care team already, but to have someone that's family and someone that I can trust and I can pick up the phone or email and ask a question, I mean I don't take that for granted at all. So I want to tell you personally just thank you for that. That meant a lot to me, to my family, and then just thank you for agreeing to do this. I'm excited. This is probably. I've been excited the whole week just thinking about this. So I just want to tell you thank you and we appreciate you being here today.

Well, you know it's just been my pleasure and you know I feel so blessed to be able to help. So, yeah, you are so welcome and blesses me be able to help others.

Yeah, it's awesome, so let's get into it. Let's just get into it. Can you start by sharing your personal journey of becoming a non-colleges and how your own diagnosis has influenced your career and approach to patient care?

So I grew up in St Thomas in the Virgin Islands and you know, they're just. You know, I think they want to go into medicine. When I was in high school, I had a couple of role models, both surgeons, who allowed me to watch and see what it was like. But in high school, when I went to Howard University and got there and realized how long it would take to be a doctor, I thought, oh, my God, I'll be fed. It's 14 years. You know, when you're 15, you think, oh, that seems forever. Well, I got an undergraduate degree in radiation therapy technology, which was my first sort of intro into oncology. So that's what I did for undergrad. And then I worked a couple years and the children realized, you know, I really do want to go on to medicine. So this is one of the things that I'd like to share is that sometimes people think you were just successful at everything you do, but actually when I applied for medical school, I didn't get in the first time. In fact, I applied to over 50 medical schools and I just got into one and it took me three and a half years. So I felt like, you know, god opened the right door for me at the right time and the fact that it wasn't easy. I didn't take it for granted. Like I think I'm the only person in my class who never missed a single lecture, I sat up right up front. I was so happy to be there. And at one point I went for an interview at the University of Maryland and there was someone there who looked at me and said some people are just not meant to be doctors. And I remember thinking you don't even know me, you don't know my capability, it's all also to me. You don't let other people set your boundaries. You know, if you want something, you go for it. So I ended up graduating second in my class and I got one of the highest board scores in the country, and this is somebody who had such a hard time getting into medical school. So just because something's hard doesn't mean you don't belong there. So, I like to share that.

What a testament of resilience, because you could have given up. You could have just given up and went and said I'll do something else, but you kept at it.

Yeah, I just I know I have what it takes to do this. So, I'm thankful and I feel blessed that I got the opportunity. So always be ready to take advantage of your opportunities, right, right, of course you know, when I got there then I was already. I had a passion for oncology, so I ended up going into surgery and ultimately surgical oncology. So that's kind of been my journey. I've always loved breast cancer. My mother had breast cancer when I was 12. And I don't know I consciously went into. You know love breast because of that, but I'm sure it played a role.

Yeah, yeah, awesome. I'm just. I didn't know that about that you had had. You were trying to get into medical school so many times and then look at this. Look, that's the power of resilience and that's how God is. If you keep going, he'll bless you, he'll open the door. If you just do the work, he'll bless you, and I'm a true believer of that. How has that influenced your approach to your patient care? Like, how did, when you were diagnosed, how did that guide you in working with your patients?

So I think, when I first realized I had breast cancer, my prayer was that I only have something that I wouldn't need chemotherapy for. But that's not what I got, and I think, and I believe, god allowed it because through that I have been able to minister to so many other people Absolutely People who are afraid to have chemotherapy. You know, I had one person who told me I don't know anybody who had chemotherapy and lived, and I was like, girl, hey, I can't have chemotherapy. I think it looked pretty good. Right, you did. And I said yes. So the fact that I had been through it gave her the trust and courage to be able to walk through it herself. And I also think it's one thing to tell people what their experience is going to be like based on hearing it from others, but then it's a different thing to actually pull on the shoes and wear them. So I feel like I was always empathetic, but now I truly understand, at a different level, what it's like, how, when you first start chemo, the first one, I was like I got this, this is not bad. And then each one got harder and harder until I was so thankful to be at the very last one.

Yeah, I had someone tell me that.

It's to come back from it, like it makes the mile for your energy to come back.

Yeah, I know I feel like, even after we're going on two years, three years, and I feel like I still like I just I'm still dealing with some residuals of the chemotherapy. But it's interesting you're saying that someone said they didn't know anyone that lived. I had so many people reaching out to me telling me not to do chemotherapy. I had people sending me stuff to take, all the natural things do not listen to your care team, and I'm like I want to do what the women that did before me that lived. I want to do what they did. I'm going to follow that. I mean you know what I mean. So I had a lot of people telling me that too, not to do chemotherapy and not to listen to your your care team. And you know, and when you're, when you're diagnosed, at that particular time you don't know where to go and who to listen to and who to trust. So that's why you know I mentioned earlier that just being able to call you and talk to you and trust you and listen to my care team it was such a blessing for that and for individuals that don't necessarily have that. You have to listen to people and you have to trust someone. You have to trust someone and your care team is the best people to listen to, right? Yeah, yeah, yeah. You know we're right at the end of breast cancer awareness month and it's a it's a significant time to educate and to inform. What, what message would you like to convey to women, to men that are listening, about the importance of early detection and seeking care?

So early detection is so critical, because the smaller you find a tumor, the easier it is You're at, the less therapy it usually takes. So even though it seems scary, cancer is survivable. We have so many survivors now. But a critical part of that is not where and getting your screening on time, and it's following up Right?

Yeah, I have family and I have family members that just refuse to go get checked because of fear, because of fear, and I want them to hear that that early detection saves a lot. I believe I was at stage two, even though I had triple negative which, as you know, is very aggressive. I feel, because I went and I got checked early, it saved my life and. I'm a true believer of that. I'm a true believer of that. So tell us, natalie, when you were going through your your journey, what are some challenges you face doing your treatment and recovery, and how did those experience shape you to understand the disease even more? What are some of your things that you went through that you can share with us?

Well, I think a couple of things. One of them is just the practicalities of being able to work and like your bills. And so, as a physician, you know I used to focus more on you know you got to get this, need this treatment, you need this surgery you need but even though I would listen but to understand that you know there are times when you miss work and then you have all these bills coming in, sure the practicalities of that and how to help people navigate that a little better, like trying to coordinate things through. They don't have to take so much time off from work in order to come in and get things done, and so raising that awareness to me was really important. And I think the other thing was just learning to live with uncertainty, sure, and to walk in faith. Because you know, as as a physician, I went through cancer, but I also close being people that where the cancer returns, and so you know that is something you always hold. You never know if that's going to happen to you or not, but you can't live in fear. So it's a learning to walk in faith. So I've always had faith, but having cancer made me really focus on where is my hope, where is my faith and how do I live in today and the present and not worry about what may or may not happen in the future? And so it's something that I try to help my patients with as you come out of the active therapy and you move into survivorship, how you deal with the fear currents.

Sure, you know. It's interesting that you you know you mentioned that about worrying about it coming back, because I really do. I really do worry because of the genetic test that I took and the fact that I do have the BRCA gene. So I do live sometime in a state of worrying, but I only stay there for only a certain period of time. I don't wallow in it. It's not part of my everyday process. It is a thought you know I would be, I wouldn't be telling the truth if I didn't, you know, say that I think about it, but I don't stay in that because I live my life, I enjoy my life, I'm thankful for the time that God has given me. But it is a it is a constant thought sometimes during the day and then I snap out of it. What would you say to someone like myself that does have the BRCA gene, that did have triple negative and that does worry about it returning after a certain period of time?

So one. I think there's some new therapies that are particularly work wonders for people that have a BRCA mutation, but there's actually really good therapy if that were to happen. And I think every cancer survivor, if they're honest, worries about that from time to time. But, like you said, it's going to come. That's normal, but you can't stay in it.

You can't stay there.

You know you're saying whatever it is. Some people meditate, some people go to nature, whatever helps to refocus, and even your present is super important.

Yeah, doing your journey. What did you do to kind of help you do your emotional challenges? What are some things that you did you know outside of your? What are other things that you do you did during that time?

So I connected with the family and remembering how important that is to love people in your life and, I think, growing to also to understand that some people that you thought would be like right there and with you, like didn't show up. And other people you've never even dreamed right. Support came out and you know, it was just interesting to learn and to go across this night. You know and some people it's not completely love Sometimes it's hard. They don't know how to talk to you about what you have or what to do to help you, and so their absence is more to do with their discomfort. Right, you know that they wouldn't help, but it's a growth in love and relationship. So, focusing on all the positives and looking for the silver lightings, right, what's it think that I did? and remembering to take that vacation, sure sure To do things like Rift today yes, putting things off that you want to do, and do them and do them, and do them.

And you know some people. You know it's interesting you said that too that there were individuals that you would have thought would have been close to you doing this journey and they didn't show up. And you know, I'm glad that you just said that to me, because I just had a really good God just spoke to me when you said that, because there are individuals in my life that didn't really show up and maybe it was because it was too hard, maybe it was hard to watch and that was the way that they dealt with it. So I thank you for that because it resonated, because there were individuals that didn't necessarily show up, but there were a lot of people that I wouldn't have thought would have been there and they came through for me. So that's just a very interesting way of looking at it. You know I mentioned earlier to you that I have family members that are not interested in being tested or going to see a doctor or talking about it, particularly because I have the Brock Eugene. I talk to a lot of my family members. You know breast cancer affects individuals from diverse backgrounds. Can you speak to the importance of raising awareness within our community and how we can ensure the education and screening and treatment are accessible to everyone. And when I say, you know our community, people of color, a lot of times we don't want to go to the doctor, we're not interested in engaging in that. Can you speak to that a little bit?

Yeah, it's so important, like you said, with the Brock Eugene. A lot of people physicians and providers included think about Ashkenazi, jewish people having a high incidence of the Bracka mutation, but actually African Americans have it just as much or more. And the thing about it is, if you know you have that mutation, you get covered more screening, so like you can get covered breast MRIs they pay for it because it's standard of care for screening. It also increases your risk for other things like prostate cancer for men and pancreatic cancer, and we're actually curing people with pancreatic cancer. We know they have that risk and we're screening them. We find it early, early detection, like we talked about, and then we can get the tumor out before there's even any symptoms. So you know it's really it hurts that our people don't go go through the genetic testing. It's almost like you're worried that people are gonna find out more about us. There's somehow there's something negative attached to it when we could saving each other by family going and getting tested and saying I have this gene, so that they're on task for screening and early detection and more cures. So I always love to take the opportunity to say that knowing whether you have an increased risk is very, very important, and now you know there are new drugs that can help you with a cure, so it's important to know.

Yeah, absolutely, absolutely. Mental health. You know breast cancer can have a significant impact on our mental health and how do you address the psychological aspect of care for your patients and what resources do you recommend when someone is going through things and they need to address also their mental health and staying healthy there?

Yeah, it's really important. In fact, people that have significant depression after the cancer treatment have a worse out. So it actually impacts your risk of recurrence and your overall health. So I always tell people you know it's not like. It's fun. Obviously, you know, and you're going to have times when you feel down if you have to go through chemo. Sometimes you look at the mirror and you just can't believe it's you. Yes, a lot of physical changes in that impacts you and just not having to seem energy, but you cannot stay in those spaces. So I always tell people it's OK to have some down days, but if you find that you're in that you're just sitting in that space that we need to get you help. And there are many resources. I'm fortunate at my Cancer Institute we hired a clinical psychologist so all of our patients have access to what immediate need. Yeah, until we can transition to community resources, a lot of our social workers are also trained in psychosocial health, so they are supportive and nowadays there are lots of resources online. So I think, especially for people of color, trying to connect with somebody that you culturally feel more aligned with is important and you can find those resources online and most of them are affordable.

Yeah, yeah. What about research and new advancements and breakthroughs? Is there anything you can share with us about anything that you witnessed during your career and how these advancements have impacted patient outcomes? What are things like really good things you can share with the listeners that you've heard about?

So, ovia, over the course of my career there have been some amazing advances in the treatment of cancer Well, all types but breast and specific. Because I remember there's a drug called Herceptin and it used to be that her two positive breast cancer was the most deadly cancer breast cancer and that's the type that I had actually. And I remember a young woman who was in her 30s and the breast cancer had spread to her liver and she didn't really have much time left and this, her septum, came out and she went from you know being just a couple of weeks from passing away, to having all of it resolve and she lived like another five years just based on that drug. And now you know people that have her two positive breast twins with the cure rates are so much better. I just hope and pray we can find the same thing for triple negative, because we've made advances but we still have more to go to go. But you know the drugs for BRCA mutation carriers. Those have made a huge difference for people with, you know, advanced disease, both breast, prostate and pancreatic cancer. The same drug works for all of them. So it's just amazing to see you know the advances and surgically, you know what we can do the cosmetics of the type of breast surgeries can do. It's just amazing. It's so much better than it did when I started, even 20 something years ago, 20 something.

Yeah, I mean I just remember as a kid, a young teenager, whenever you heard about breast cancer was just tied to a death sentence, right, yeah, as soon as you would hear it, you would just automatically think that that person or that woman or man was going to die. And it just seemed to me what a for my where I stand, that there has been beautiful and wonderful progress and in this, in this journey. So I'm glad you're speaking to that, cause I think when people, when people are going through this, they want to hear some really good news about this. You know, when it comes to navigating through the challenging journey of breast cancer treatment, the support of family can truly be invaluable. I know it was for me. The emotional and practical assistance that your family can provide makes a huge difference in your wellbeing and your overall experience. If I didn't have my, my husband, next to me during chemo, or my daughter or my son or my friends and talking to you and my cousins, I just I think I don't know if I would have made it. Can you share with us how your family support and involvement played a role in your own journey and recovery?

I think you just said it all. You know the relationship, like you know, with my husband. You know, and you, you always know they love you but you really know they love you and you, you know bald and you know changes and just the way about your body, your, your wish for infancy is like back up Right. All these things that you're walking through and when they just hold you and walk through you with it, you know that that's love and and just you know, having the opportunity to have critical conversations with your children, some of the things that you don't say on a day to day basis but just walking through that you pause to say you know how much I love you and you know, express so many beautiful things with your family and, like you say, your friends, you know the things that you don't always make clear is such a beautiful time to do that.

Yeah, absolutely, and to all the listeners, natalie's husband is my cousin, so go, cousin. You know that's how family, so of course you know I've got to give him props and I'm. He's a wonderful husband and I'm just so proud of you guys. As we wrap up this interview, what message would you like to share with with listeners doing this last? What are we on? We're on the 29th, so we're getting close to the end of October, but what would you like to share with listeners doing the last days of breast cancer awareness month? What advice would you or words of encouragement do you have for those currently facing breast cancer, or support, supporting a loved one? As you know, I have a friend of mine that had a very young daughter that was going through the journey and actually she's actually back on the road again. It returned, and so what, what? What kind of encouragement would you have or advice for someone that's new in this?

Okay. So I think there are a couple of things I want to say, especially for around people of color. One is that in survivorship, one of the best things you can do for yourself is to get exercise. So just getting 30 minutes of exercise at least five times a week and it doesn't have to be running, it could be a good walk, it could be neat getting on a treadmill, it could be an exercise cycle, it could be dancing but doing that 30 minutes at least five times a week reduces your risk of the cancer recurrent by 40%. Wow, that's almost as much as chemotherapy and some of the other drugs that we give. So, and you have to do that yourself. So that's one thing I really, you know, tell my patients all the time Wow, 40%, 40%. Just getting exercise, just keeping active Right, that's a big one. And for communities of color. A lot of us, you know crap a little weight on, and it's not about how much you weigh, it's more about the exercise, right? That's really important. So to be moving and not living a sedentary life is huge. I also want to reiterate about knowing your family history and getting genetic testing, because if you have a mutation, you get so much more coverage for screening. So you know people worry about out of pocket, but you get more coverage if you know you have that. So I think that's hugely important. We totally can do a better job at that. And then the last thing is that a lot of women have black women get estrogen positive breast cancer, and I'm trying to raise awareness because there's a test that's commonly done on estrogen positive breast cancer called Oncotype DX, and it's used to decide whether you should get chemotherapy or you don't need it, but it's not as accurate in black women, so it's so there's another test called mammupril that's more accurate for black women. So I just want to raise awareness so that you know if you're getting tested. If you have estrogen positive breast cancer, to ask your physician about that and sometimes taking the estrogen blocking drugs before you have surgery can help confirm that that's all you need to do and you don't need chemotherapy. So a lot of times people get taken straight to surgery and they don't get that cost of the you know endocrine therapy. It's called to make sure that it's safe not to do chemotherapy. Yeah, yeah, yeah.

Wow. What do you like to do for fun, Natalie? You know you're a busy, busy, busy lady, but what do you like to do for fun and how do you keep yourself grounded?

So I love going for good walks with my husband and I love to turn out some music and get my dance on. To me that's fun.

Me too. I'm a big dancer. I my knees are not holding up like they used to, but I can still. You know, I can still do it. Drop it like it's not, I just don't know if I can get up, though, like I used to so you know, again, I'm just. I have to tell you that I am just so thankful. Undoubtedly, you've made such a profound impact on many lives. I know for a fact that you have, and I know that you've made a very big impact on my life when I was going through my journey, and you continue to make a big impact in my life, and I just, besides having you here to give your professional advice, I also just wanted to honor you. So this is a way for me to honor you and to ooh, I'm getting choked up. I'm really getting choked up because, again, you know, when you go through something like this, you know you have to be grateful to the fact that you have people around you that can tell you it's going to be okay and this is why it's going to be okay, and you did that and you played that role in my life, and so this is again another way to honor and to thank you on behalf of myself and my family.

Oh, nichelle, thank you so much. May God continue to bless you, and let me tell you that you have taken your journey and you are helping others in so many ways, not only through social media, but with this podcast and just your spirit of light, and one of the things that I always do is I actually sing to my patients all the time, and I would just like to thank you and encourage you to continue to let your light shine, and I'm going to let it shine. This little light of mine, I'm going to let it shine, this little light of mine. I'm going to let it shine. Let it shine.

All right, thank you so much. I would love if you would come back and honor us with your presence. I appreciate everything that you do. Okay, yeah thank you.

Thank you for the invitation.

You're absolutely welcome. Okay, love you. Tell what you must say. Okay, I'll talk to you soon, bye, bye.