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Welcome to The Breastcancer.org Podcast, the podcast that brings you the latest information on breast cancer research, treatments, side effects, and survivorship issues through expert interviews, as well as personal stories from people affected by breast cancer. Here’s your host, Breastcancer.org senior editor, Jamie DePolo.
Jamie DePolo: Hello, I’m Jamie DePolo, senior editor at Breastcancer.org. I’m podcasting live from the 2024 San Antonio Breast Cancer Symposium. I’m very excited to be joined by Dr. Don Dizon, professor of medicine and professor of surgery at the Brown University Cancer Institute, where he is also the director of the Pelvic Malignancies Program and head of community outreach and engagement at the Legorreta Cancer Center. At this year’s conference, he was part of a panel entitled Sex, Drugs, and Rock and Roll, where he discussed sexual health.
Dr. Dizon, welcome to the podcast.
Don Dizon: Thank you so much. I’m glad to be here.
Jamie DePolo: So, to start, could you just summarize what you talked about in your presentation?
Don Dizon: Right. I mean, I think this is a very unique session, obviously titled provocatively, but I think it’s always important that we cover issues beyond just diagnosis and treatment, and my talk in that vein was about sexual health, and not accepting this idea that unfortunately is still out there, that people should be grateful to be alive after an experience with breast cancer, that sexuality is an inherent part of being a human being, and not something that we should accept as gone.
Jamie DePolo: Or almost an afterthought?
Don Dizon: Afterthought, but even if it’s different, that doesn’t…you don’t have to accept it. So, if sexuality is important to you and your partner, then it’s something we should help you regain.
Jamie DePolo: Okay, and I know a lot of people…it’s viewed as an afterthought sometimes by oncologists, I’m not knocking oncologists, but it’s just, the focus is so much on getting rid of the cancer that then, what happens after sometimes is an afterthought, and a lot of people are maybe embarrassed or hesitant to bring it up with their oncologist. So, how do we address that?
Don Dizon: Yeah, I mean, I think what I go around letting my colleagues know, whether they’re physicians, or advanced practice providers, or surgeons, or medical oncologists, it’s the same thing. When you meet someone for the very first time, if you just open the door, even if they’re not ready to walk through it, people will remember that you are open to this kind of a conversation. So, as part of our initial assessments, when we’re getting to know people, we always take a social history. We always take a family history. We always want to know, who’s in your life and what kind of relationships do you have?
Are you married? Are you married to a man or a woman, both, neither? Okay. But as part of that, it would be very easy for one to say, what you’re about to go through can affect who you are sexually. If that ever is an issue, just know that, you know, I’m open to hearing more, because I can say that some of our work at Brown, looking at distress, for example, for people newly diagnosed with breast cancer entering a multidisciplinary clinic, sexuality is not one of the first things people think about in the immediate aftermath of that kind of a diagnosis, and you know, what’s been called sort of acute survivorship, that time when someone is being treated actively for that cancer.
But at some point, it does come up, and at that point, our patients, women and men, diagnosed with breast cancer who are undergoing treatment, shouldn’t have to worry or be confused about who’s going to be open to hearing about this. So, if we just bring it up, just say, I’m going to ask you about it, if you don’t want to talk about it, that’s fine, but when you do, I’m here, people latch onto that. And when it becomes an issue, then, and they’re ready to talk about it, they know who to go to, even if it is just, I hear you, let me refer you on to somebody who can help more than I can. That’s still very important.
Jamie DePolo: Absolutely. What about if the patient is open to discussing, what if the partner is not? How do we address that?
Don Dizon: That’s a very difficult dilemma. You know, when I started doing this work, you know, in the late 1900s, like I like to say, I only and exclusively talked to the person diagnosed with cancer, because it was their sexuality that was put at risk, that they were trying to rediscover, or reclaim, I should say, that it didn’t matter to me what the partner wanted. But that’s really just like treating one side of a coin, you know, and I realized very quickly that both people have to be engaged in this.
So, I do welcome the partner to come in. It’s always a worrying sign when they don’t, when I hear from, you know, the person seeing me, you know, they just want to move on, or it’s not something that they’re willing to discuss. It points to bigger issues that probably I am not the person that they should be seeing around couples. So, I am very aware of my own boundaries, and one of those boundaries is being a couple counselor. So, I am quick to recommend or suggest that they go into couple’s therapy in addition to, you know, the work around sex after cancer.
Jamie DePolo: And one final question, I know your work focuses on the LGBTQ+ community, which a lot of others do not. What about somebody in that community who has a provider who, how do I say it, is perhaps not giving off the most welcoming signs? Should that person kind of look for another provider? How do we address that, and I’m thinking especially of people in more remote areas who don’t have a lot of options.
Don Dizon: You know, the whole issue of LGBTQ healthcare, it’s something that in the current environment is worrisome. You know, you may be living in a state where it’s not safe for you to, you know, come out as gay, or lesbian, or even trans. So, you know, I think the major issue that people who are a part of the sexual and gender-minoritized community is, they need to be comfortable in their treatment and with their treatment team, as does everyone else.
And if they cannot feel that they are open or can be their true selves while going through probably one of the most life-threatening and scary experiences of their life, it behooves them to find someone else. Now, if they are in a rural community, if there is only one oncologist in the area, and the next town over is four and a half hours away, you know, that is the unfortunate circumstance that a lot of people find themselves in, and it’s not solely restricted to the LGBTQ community, you know?
And I think what we can do most for people who are, basically living that way is point them to online support communities who can be their backing, who can be their sounding board, and who can hopefully provide them the strength to speak up for themselves.
Jamie DePolo: Dr. Dizon, thank you so much. I appreciate your time.
Don Dizon: Thank you so much.
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