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00:00I see a lot of people wearing pink in here. A lot of people wearing pink in here today.
00:06We have any survivors in here? Anybody? Oh, whoa. See, that's what I'm talking about.
00:12That's what I'm talking about. All right, so what I have to say about this is I have a lot of family
00:18members that have survived breast cancer, and it has been a journey. It's a journey.
00:26So, this is about prevention. What we're going to be talking about today is prevention
00:33and getting people to be aware of symptoms and signs. So I want to start, I want to start
00:41with Dr. Stewart. Tell us what is the real cause, the root cause of breast cancer, and what do
00:54you think is one of the biggest things that African-American women can do to try to prevent
01:00it after you tell us what it truly is and what causes it.
01:03So let's just start with the most basic.
01:06Stop. Real close.
01:08What's that?
01:08You got to be real close because everybody out there is doing this and that, and we got to,
01:12you know, you got to be real close, real close.
01:15All right. Does everybody hear me?
01:17There we go.
01:17Yeah, there we go.
01:18All righty. So breast cancer in its most elemental form is when you have normal cells that have
01:25changes in the genes in the DNA, and they become abnormal. Now, these abnormal cells form tumors
01:32which can grow and then even spread to other parts of the body. Okay, so that's cancer in general.
01:38Now, we do know that there are several things that increase a patient's risk for breast cancer.
01:43Family history is a big component of it.
01:49Got a little feedback over here.
01:52There we go.
01:53Must have been my dancer that threw off the speaker.
01:57And obesity. So yeah, Dr. Avey, I heard you talk about a donut when I walked in the door.
02:02My secretary has got a laugh out of that.
02:05Obesity. But then we're also beginning to understand the mechanism by things such as stress and exposure
02:12to trauma also increase the risk of breast cancer.
02:15So before, we just thought it was a general concept.
02:19Didn't really have any science behind it.
02:20But what we do know is that stress, living in food deserts, not having access to exercise space
02:27and green space actually causes genetic changes.
02:31All right.
02:31So you get what we call methylation of the genes.
02:35And that causes imprinting that happens not only in your generation but the future generation.
02:39So those are the basic kind of underpinnings of the way that we think about how breast cancer starts today.
02:45Okay. So what you're telling me is sedentary lifestyle and how I eat totally affects my breast cancer risk.
02:54Totally does.
02:55Okay. Now one thing I want to say about cancer, he mentioned the fact that these tumors grow.
03:01Anybody know why cancer is called cancer?
03:02These cells come together and when they form the tumor, they hold together like crabs.
03:10And they hold together and grow and grow and grow.
03:12And if you try to pull crabs out of a barrel, they suck together.
03:14And that's how these cells are.
03:16And that's why cancer is called cancer.
03:17So we learn something new every day, right?
03:19Yeah. So, you're a handsome guy.
03:25She's much more beautiful than you are handsome.
03:28So I think you go ahead and hand that microphone over there for a second.
03:31Please introduce yourself and tell everybody.
03:33We've worked together for many years, so I'm going to let her do that.
03:35Good afternoon. My name is Lindsay Levingston.
03:38And I am a breast cancer survivor of two years and four months.
03:43Praise God.
03:45Do you want me to tell my story?
03:46Sure.
03:47My testimony. So I was working in New York City in media, a TV news reporter and anchor.
03:53And the summer of 2019, I was in the shower and I felt a lump in my right breast.
04:00And I immediately scheduled a well woman exam to have it checked out.
04:05And that well woman exam included several tests.
04:10My very first mammogram at the age of 37.
04:13I was in a biopsy, a biopsy, and that biopsy determined that the lump that I felt in my right breast was cancerous.
04:20So I relocated back home to Houston to seek treatment.
04:25And I boarded what I refer to as a very fast-moving train to remission.
04:29So my breast surgeon laid out a plan that would include chemotherapy, radiation, lumpectomy and radiation.
04:39So I started my chemotherapy journey, and that was 15 rounds.
04:45But midway during that chemotherapy journey, I took a genetic test.
04:51Because a family member told me that breast cancer runs rampant on the paternal side of my family, which I had no idea about.
04:58Which is why it's important to know our family history.
05:01So I took a medical genetic test after about my fifth round of chemo.
05:29And that revealed that I carried the BRCA1 gene mutation, which puts me at higher risk for breast and ovarian cancers.
05:38So that completely changed my course of treatment.
05:41So 15 rounds of chemotherapy, I rang the bell.
05:45And then I had a bilateral mastectomy, breast reconstruction, and what's called a salpingo-oophorectomy to remove my fallopian tubes and ovaries to reduce my risk of ovarian cancer.
05:56What I always forget to mention is that my breast surgeon really focuses on treating the whole woman.
06:02So I did fertility preservation before I started chemo.
06:06So I froze some eggs before I started everything.
06:10So I've been poked, prodded.
06:12Yes.
06:13Picked apart, but I'm alive.
06:15And you're here.
06:15To tell my testimony.
06:16You're here, absolutely.
06:18Absolutely.
06:18I don't look like what I've been through.
06:20Yeah.
06:21Yeah.
06:21You look great.
06:22And congratulations.
06:24So doc, now she mentioned a lot of things in there that you're going to have to explain.
06:29Okay?
06:30So first, let's talk about BRCA.
06:34What does that mean?
06:36Okay?
06:36And then let's talk about this whole concept of why you have to remove things.
06:41And then also, she found the lump in the breast.
06:48And the breast cancer, the council, was kind of getting away from self-breast exams.
06:54And I was a little bit concerned about that.
06:56So I know it's multi, because nobody knows a woman's breast than a woman, right?
07:03So her own breast.
07:04So why do we have that kind of step back a little bit?
07:07And then the mammogram, it changed too.
07:11See, there you go.
07:13You set up.
07:13All right.
07:14So I got seven.
07:15You set up two minutes.
07:17All right.
07:17So let's think about, let's focus on the self-breast examination, because that is something that needs to be done monthly.
07:24Doc.
07:25All right, I'm not close.
07:26It needs to be done monthly by a woman.
07:30Again, typically in the shower.
07:32Okay?
07:33That's because the skin is wet, and you can move along, and you can fill any lumps.
07:37Now, Dr. Ambier mentioned the fact that there have been some, I won't call them skips, but changes in recommendation with respect to screening.
07:46So the United States Preventative Service Task Force considers how we should screen for a number of things, right?
07:55They have been prostate cancer, breast cancer, so on and so forth.
08:00So they, they, in 19, excuse me, in 2009, suggested that we change our mammogram screening paradigm from starting at 40 to starting at 50.
08:14But not only did they suggest we start at 50, but they suggested that we start at 50 and get them every other year.
08:21Well, I don't think you're 50.
08:28Yes.
08:28So, Dr. Ambier, all right.
08:31Hold on one second.
08:32Can y'all hear anything, honestly?
08:33No, no, no, no, no.
08:35Okay, so you know what, y'all might have to go, y'all might have to go back, because see these speakers, you're not getting that.
08:42Are y'all hearing better back there?
08:45Okay, you can hear, okay, all right, okay.
08:50You can hear, okay.
08:52Okay, if you could turn off the mics a little bit, too.
09:00Okay.
09:01All right.
09:02I'll, I'll turn mine off when I'm not talking, so we won't have feet.
09:06Okay.
09:07Okay.
09:09And so, this change in recommendation, which was clearly less aggressive than previous recommendations, caused some concern.
09:16I feel like I'm talking in a club.
09:21So, they changed the recommendations to things that were less aggressive, okay.
09:27And so, if we kind of think about screening and the way they think about screening, they think about screening for millions and millions of patients.
09:35We think about screening for us and our family members.
09:37So, of course, we want to be more aggressive.
09:38So, their rationale was that if you have more screening, you're more likely to pick up benign lumps that subsequently result in biopsies that can subsequently result in complications, okay.
09:55Now, the way that I think about it and think about breast cancer and African Americans is that I understand the fact that our risk of breast cancer is much higher before the age of 40, okay.
10:09I think about the fact that a lot of the genetic tests, such as BRCA1 and BRCA2 mutations, we think that there are other mutations, which are primarily,
10:20BRCA1 was initially found in the Ashkenazi Jew population in 1994, I believe, the year was, okay.
10:27And so, we've not really delved into genetic components and genetic risk factors as deeply as we should have in the black population.
10:37Now, when we think about that, we think about family history.
10:41And Candace Henley, who runs the Blue Hat program out of Chicago, was diagnosed with colon cancer at 35.
10:47And so, her story is, is that, yes, her father died of colon cancer very early, but nobody talked about it.
10:55So, her tagline is, family secrets kill families, okay.
11:00Family secrets kill families.
11:02So, make sure you have those conversations.
11:05If grandma had breast cancer, then you need to talk to your doctor.
11:08And when you talk to your doctor, you need to know, A, which she did a lot, B, what age she had her diagnosis, and B, what her treatment was.
11:16Because that kind of determines our, the way that we think about breast cancer, right.
11:21So, if you say grandma had breast cancer when she was 55, then we know that your risk of having breast cancer is slightly decreased relative to her having breast cancer at 37.
11:33Now, what we really know about breast cancer today is that, by and large, if you have cancer that is not spread to other parts of your body, then surgery is the best option, okay.
11:50Now, I've been at this almost 20 years, and the way that we think about surgery for breast cancer has changed significantly, okay.
11:59And so, back in, you know, back when I first started, if you had a large tumor, you would do a large operation, okay.
12:06Just do a bigger operation to match the tumor.
12:09Now, we think about giving women chemotherapy up front, which is what we had, to shrink the tumor down so that we have a much better outcome.
12:20Now, what we have suggested, again, based on data from studies in which we were underrepresented, is that lumpectomy, taking the lump out, and radiation therapy is equivalent to having a mastectomy in terms of overall survival, okay.
12:39Now, if I think about the biology of cancer, that to me makes a lot of sense, right.
12:43And so, taking the cancer out early will prevent cells from spreading to other parts of the body, setting up shock, and killing patients, okay.
12:54Sorry, that's my jam.
12:56So, at any rate, we understand.
13:01He just said that's my jam.
13:04I love it.
13:05That's the 318 coming out at me.
13:06So, at any rate, we do know that treating patients early with surgery, stage 1, stage 2, provides superior outcomes to having a large mass that is spread to the lymph nodes, okay.
13:20And so, in today's, in today's readings, you know, we think that a woman who has stage 1 or stage 2 breast cancer, 95% of them will be alive in five years.
13:31We're just that good at it, okay.
13:33But when we think about black women, okay, we know that our death, we know that black women's death rates are 41% higher than white women.
13:4541%, okay.
13:48And so, we have to think about this differently, right.
13:52We have to think about the way that we, that we counsel about screening.
13:56We have to think about the way that we counsel about family history.
14:00We have to think about the way that we talk about prevention in order to humiliate this.
14:05Let me ask a quick question.
14:07So, we talk about the social determinants of health, right.
14:10We talk about where we live, where we love, where we work, where we play.
14:12It makes a difference.
14:13We know that black women are dying from everything over their white counterparts, right.
14:17It's a big deal.
14:18The difference between a mammogram and an MRI of the breast.
14:25I've seen some stuff to say that white women are getting these, these doctors to push through these MRIs, which are the most, more sensitive than the mammograms.
14:36And they're being picked up earlier.
14:38And that is attributing to their success rate and not death rate than the mammogram that we can't, because we can't really have a doctor that looks like us, to push this through, to an insurance company to pay for it.
14:51So, mammograms definitely have a higher sensitivity to pick up tumors, but, you know, I'm of the proponent that it's a lot easier for a woman to get a mammogram than to get an MRI.
15:07Sure.
15:07I mean, they honestly park their car valet, get their mammogram, and roll out, right.
15:14That's just the way that happens.
15:16An MRI is, you get to sit in a magnet, have all of these pictures taken, and then you get pictures of things that might or might not be clinically important, okay.
15:25So, the data to date suggests that MRIs are useful for women who are at high risk, okay, i.e. a strong family history.
15:36But outside of that, I think that in our populations, trying to flood people through MRIs might actually lower our screening rates.
15:47And so, I am a big fan of mammography.
15:51Now, there are a number of studies that actually try to answer that question, right.
15:57They try to answer that question.
15:58And so, we think of things like the TMS study, which we talked about last week, in which we're trying to see if two-dimensional or three-dimensional mammography is, which one is superior or if they are equivalent, okay.
16:13And then there's the wisdom study, that again, we talked about, and we've had people here from San Francisco to talk about the wisdom study,
16:21and we're trying to understand how we create, I call them smart screening paradigms for cancer.
16:28So, how do you screen for breast cancer in a woman who has a family history of X, Y, and Z?
16:35How often should they get screened?
16:37And are there other modalities that they need to employ, such as chemo, what we call chemopreventative therapies,
16:45i.e. taking a pill to block estrogen to decrease the incidence of breast cancer?
16:51Um, I was, I was trying to text, to try to tell them to turn the music down, so we might have some reprieve.
16:59Okay, I got, I did get a text message back that said, no, but I bet it, but it's okay, but it may be okay.
17:05It may be okay, I put, I put, I put a bigger, a bigger foot in it, all right, so we'll see.
17:10Um, so, when you got that diagnosis, what was the first thing that came to your mind, and what was the first thing you did, like, emotionally?
17:23Tell me about this emotion that you got when you first got that diagnosis.
17:26The day I received a call from the radiologist, he actually left a message and said, please call me back, I have some news to share.
17:37You don't leave that on a voicemail, right, as you're waiting for your results.
17:40He called back and I said, I'm sorry, Lindsay, it's breast cancer, and I said, what?
17:45He said, I'm sorry, Lindsay, it's breast cancer.
17:47And I just went numb.
17:48I didn't even shed a tear, I just couldn't accept it.
17:51And for several days, I could not articulate the C word.
17:55I just, because I didn't think that it could happen to me at the age of 37, because I didn't know that I had a family history of it, which is why it's so important that we know our family history.
18:04On both sides, we think it's just maternally driven, but mine is paternally driven.
18:09That's a big point.
18:10Right, because men are affected by breast cancer on my dad's side of the family.
18:14Several men are affected by prostate cancer.
18:17But to answer your question, the emotions were very dry and numb.
18:22And it really hit, I'll tell you, Dr. Hebert, when it really hit me, when I, the nurses took me on a tour of the chemo suite, I was treated at Texas Oncology in Houston.
18:32They took me on a tour of the chemo suite, and that's when it hit me, and then I just started crying.
18:38So I said, I'm going to go through this.
18:40I'm going to lose my hair, and I don't know what to expect.
18:44When you enter into the space of unknown, how your body will react is so scary.
18:49But I put my faith in God, and he powered me through.
18:57And I forgot to mention that I was diagnosed with triple negative breast cancer, which affects black women, as you both know, at a higher rate.
19:05And so it's a very aggressive form.
19:07The cancer cells just keep moving and keep moving.
19:09So we had to attack quickly with aggressive chemotherapy.
19:13Neoadjuvant.
19:14Look at me.
19:14I know my medical term.
19:15There you go.
19:16There you go.
19:17Neoadjuvant chemotherapy to shrink the mass, as you mentioned, Dr. Stewart.
19:21Dr. Stewart, if there's a woman out here right now that knows that she's felt alone.
19:29Now, we know, we hear all the stories.
19:32Black women have dense breasts.
19:34Black women have, you know, fibrocystic chains, fibroadenomas, blah, blah, blah.
19:38Now, so we get, black women will get lost in that, saying, I'm not going to go get checked because I've had this fibroadenoma, fibroadenoma, fibroadenoma, this breast, this whole thing, my whole life.
19:51What would you tell that woman to do if she knows she's got a lump, but she thinks it's fibroadenoma, which is a benign to her?
20:00Right.
20:01So you have to go to your primary care doctor right away.
20:05Now, having said that, you're your own best advocate, okay?
20:12Now, I'm going to tell you to advocate for a biopsy of that, okay?
20:16Which nowadays just entails getting a little needle stuck in it, having them sucking some cells out, and then licking it in her body.
20:22That still sounds painful, the way you said that.
20:24Yeah, so.
20:26Yeah, so.
20:27Good.
20:28I'm glad you said that.
20:29There are women here that said it doesn't hurt, so that's good.
20:32Yeah, so, and the reality of it is, is that that little stick helps you understand how you can get that tumor treated early, all right?
20:42Yeah.
20:42Now, so advocate for yourself.
20:46Tell your primary care doctor that you need to be sent to someone so that you can get this biopsy done, okay?
20:52And that's typically a cancer surgeon, such as myself, who has the capabilities of doing that in the clinic.
20:59Secondly is, um, waiting does not help you, okay?
21:05Waiting does not help you.
21:08Get treated or get evaluated right away.
21:11Now, one of my heroes in surgery was a guy, LaSalle De LaFalle, has a wing named after him in Houston, in Anderson.
21:19Yeah.
21:20Taught me a lot from when I was a medical student at Howard, that he had women who were college professors who would come in with masses that they knew they had for months and years, okay?
21:33Because it's, it's a part of the denial, right?
21:36The part of the denial is, is that the more you know, the smarter you are sometimes, the more you get, you know?
21:42Yes, yes.
21:43And so they, they knew the score, and so they waited until late to come in.
21:48Let me tell you, in the 1980s and the 1990s, that was a decision not to live.
21:54That was a decision not to live.
21:56And so we have to be proactive, and, um, again, we have to make sure that we are advocates for ourselves, but also advocates in the community.
22:04Yeah.
22:05What do you have to say about men, with, men with breast cancer?
22:09Because y'all know, remember Shaft?
22:10Yeah.
22:11Richard Roundtree?
22:12Yeah.
22:13Yeah.
22:13And Matthew Nose, uh, Beyonce's daddy.
22:16Yes.
22:16Yes.
22:16Okay?
22:18Montel, Will, Montel Jordan or Montel Williams?
22:22This is how we do it.
22:24I know the talk show.
22:26Yes.
22:26So Montel Williams.
22:27Right.
22:28So, what do you tell the men?
22:30What are the same self-breast exam?
22:31What, what, what do we do?
22:33So, men account for about 1% of breast cancers, but self-breast exams are important in men also.
22:41So, here's kind of the scores that if you match a man's breast cancer, same stage, with a woman's breast cancer, they'll do equally as well.
22:51Now, the problem is, is that, at least I've never had a mammogram, right?
22:57We don't have screening, right?
22:59And so, we typically present with later stage disease.
23:03Now, an interesting point is that, you know, we talked about BRCA1, BRCA2 mutations.
23:09It's impact on breast cancer risk, but there's also prostate cancer risk, okay?
23:19So, I'm sure in your family, you had men who had breast cancer and men who had prostate cancer, right?
23:25That's a red flag.
23:27That's a red flag.
23:29Well, we have one minute left, and I want to give it to you, because, you cannot know, look, she's a TV woman.
23:37We, like I said, we work together.
23:38So, I want you to just, you end it, you wrap it up.
23:43You tell these women and men what they need to hear.
23:45So, I'm the founder of Survive Her.
23:47I felt a calling over my life to create an organization to inform, inspire, and to empower beyond the month of October.
23:54So, through Survive Her, I talk about the, knowing your family history, take that genetic test, both men and women.
24:03And number two, ladies, advocate for yourself.
24:06If you feel something, say something.
24:08If you feel something that's abnormal, schedule that appointment, don't wait, because early detection saved my life.
24:13Had I waited, who knows what my prognosis would have resulted in.
24:18So, number one, take that test.
24:21And if you feel something that's abnormal, get it checked out.
24:26And I also want to add, too, Dr. Hebert, Dr. Stewart, too.
24:30I appreciate spaces and places like this that continue to elevate the conversation,
24:34because we don't talk about why Big Mama passed away, or Uncle Pookie, but we need to talk about it.
24:41Because I didn't know that I'm the 14th Levingston to have been diagnosed in my family.
24:46But no one was talking about it.
24:49So, it's so important that we continue these conversations.
24:52I have written a piece for Essence.
24:54It will be published in the September-October issue about survivorship.
24:58I'm so excited, so please check that out.
25:00But I've also written a three-part series, The Anatomy of a Survivor.
25:04It's on Essence.com.
25:05I also wrote a piece for National Minority Health Month about the importance of genetic testing.
25:11That's on Essence.com.
25:12So, thank you so much.
25:13Thank you very much.
25:15If you leave your doctor with questions, or you don't feel comfortable talking to your doctor, get a new one.
25:22Because if the doctor makes you feel bad about saying what you need to say, and they don't want to hear it,
25:28you need to get a new doctor, because it will save your life.
25:32Thank you both very much for coming.
25:35I think we may have a question or two.
25:38A question.
25:39Look, breast cancer surgeons are very expensive, so I'm telling you, you better ask now.
25:45They make money.
25:46Can you speak about the research that just came out about parabens and what's on the day?
25:57Oh, yes.
25:58The hair, the hair, the perms, and all that.
26:03Look, this is a big question.
26:06This is a big one.
26:07It's a big one.
26:11So, look, he's choosing his words wisely.
26:14It's a little complicated.
26:18Parabens are everywhere.
26:20You've got a plastic water bottle.
26:24There.
26:26Hair products.
26:27There.
26:30The way that I kind of look at this with my epidemiology hat on is that, you know, deli meat.
26:36But we do know that those chemicals do lead to cancer risk, but we have to evaluate them, I believe, in a way that's been done very differently than what we've done before.
26:50So, we have to actually have large populations of people.
26:53We call them cohorts.
26:55Draw their blood.
26:56Look for paraffin levels.
26:57Follow them over time, because that helps us understand whether it's a chicken or egg that causes these effects.
27:03That's a very important point, and we learned that through COVID.
27:08Something is either causal or temporal.
27:12Because I wear brown shoes today, every time I wear my brown shoes, my nose starts to run.
27:18But I cannot say that wearing those brown shoes caused my nose to run.
27:24That's a very specific concept that you've got to understand, especially when you look at science.
27:29Because if it's not a double-blind placebo-controlled trial, it may not be very accurate.
27:34And just because you can put that and say, this happened, and then this happened, it doesn't mean this caused this.
27:42All right?
27:43So, that's a...
27:43So, we've got to get more studies.
27:45But I will tell you, it's probably better to avoid all of it than to say, well, maybe it might be, maybe it's not.
27:54That's what I think about it.
27:55What do you think?
27:55That makes sense?
27:56Hey, thank you for the mic.
28:01My name is Dr. Alexi.
28:02I'm a fellow physician.
28:04I'm also a fellow breast cancer survivor, and I'm a breast cancer advocate.
28:07And this weekend, we've been out here talking about the importance of black women enrolling in clinical trials.
28:13There's been recent data that showed that black women's breast cancer cells are distinctly different from white women's breast cancer cells.
28:19And we know we only represent 3% of the women who are represented in breast cancer clinical trials.
28:25So, I would love for both of you to comment on and speak to our audience about the importance of black people enrolling in clinical trials,
28:32how they can change our outcomes, and that we should not be afraid of them.
28:35So, can it be...
28:36Okay, I'll say it.
28:38I'll say it.
28:39You go first.
28:41So, you know, when John Bonnet came on, I said that that's my jam.
28:46Clinical trials, that's my jam.
28:48That's what I do.
28:49That's what I think about.
28:50That's what I publish about.
28:52And so, yes, this is true.
28:54We specifically look.
28:55And women who participated in surgical trials for breast cancer.
29:00Lola Fayangio and I, back when Lola was a junior faculty,
29:04now she's running breast at the breast service at the University of Pennsylvania,
29:07looked at that, and we saw that, yes, African-American women have lower participation rates than do other women.
29:14Now, we found some interesting relationships there in terms of education, socioeconomic status.
29:22Some of those were very different than what we would have thought that they would be.
29:27But then it caused us to think about, hey, we understand that there's a patient role in a rolling on clinical trials,
29:35but there's also a provider role in things such as implicit bias can affect our ability to get on a clinical trial.
29:44Correct.
29:45The way that a clinical trial is designed might prevent us from getting on to a clinical trial.
29:50And so, yes, that is an area that we need to continue to be very active in.
29:55We need to think about how we employ adjunct measures, including the use of patient navigators,
30:05in order to help our patients navigate the complex health system that we live in in this country.
30:11I will say, oh, go ahead, baby.
30:13I wanted to share a resource, TOUCH, which is the Black Breast Cancer Alliance,
30:19has an initiative called When We Trial, whenwetrial.org, I believe it's the website.
30:26And it's encouraging black women, more black women, to sign up for clinical trials.
30:30So please check that out, whenwetrial.org.
30:34And I just want to wrap up by saying it's very important.
30:38Right now, I know you've heard of Tuskegee, you've heard all these things,
30:42but if you do not get involved in clinical trials,
30:46we will never know, as black people, what works for us or not.
30:52I have a clinical trial facility, I put 300 black people in a COVID vaccine trial.
30:58You know how hard that was?
31:00But they had to trust me.
31:02So we have to do more to get that information out.
31:05But when you get in the clinical trial, you are a superwoman.
31:08You are a superwoman because what you're doing is risking yourself to help somebody else.
31:14And that's what we have to have, or we will never get out of this place that we're in.
31:18Thank you so much.
31:19I appreciate you.
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