Podcast with Dr. Wanda Curlee
Program Director, School of Business, American Public University
and Dr. Kathleen Shriver
Faculty Member, School of Business
Technological improvements in the healthcare field are helping to improve the quality of medical care for patients. Artificial intelligence (AI) is especially useful in analyzing healthcare data.
When APU business professor Dr. Kathleen Shriver was diagnosed with breast cancer, little did she know how much artificial intelligence would be used to help her doctors diagnose and treat her cancer. In this episode, Dr. Shriver shares her experience with Dr. Wanda Curlee about how the medical profession uses AI to predict cancer risk, detect cancer early, assess the best treatment options and customize treatment.
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Dr. Wanda Curlee: Welcome to the podcast Innovations in the Workplace. I’m your host, Wanda Curlee. Today, we are going to be chatting about artificial intelligence in healthcare from a very personal perspective.
My guest is Dr. Kathleen Shriver, who is an associate professor in the Business Administration program at American Public University. She has many years of teaching experience. Recently, she has had to deal with breast cancer. I want to thank her for chatting about this very personal topic.
Kathleen, welcome to Innovations in the Workplace and thank you for joining me.
Dr. Kathleen Shriver: My pleasure, Wanda, and thanks for setting up this podcast on this emerging concept.
Dr. Wanda Curlee: Great. You recently have gone through quite a scary experience. I too went through cancer when I was 18. That was many, many, many years ago.
I am sure that technology has changed since I had cancer. When first diagnosed, what technology did you see that helped you and your doctor?
Dr. Kathleen Shriver: I think things have changed quite a bit, Wanda, since your experiences. I would have to say the first use of AI in my case was the genetic testing. My sister was diagnosed with breast cancer in November 2019 after an MRI, and her doctor recommended genetic testing. So when the MRE11A mutated cancer gene was found, all of my siblings were tested and I found I have the gene too.
So I met with the genetic counselor in January, and after providing more information on my family history, my mom and my grandmother both died in their 40s from cancer, and my good lifestyle as they said, I felt pretty good that the algorithms that showed 10% or less of my chance of developing cancer. Most of the population is at 20% risk, so I felt pretty good about that number.
But yet, something was nagging at me. And I just did not let it stop me from asking my doctor to schedule a mammogram in February for me, instead of waiting until my traditional May. And I really, I was determined to be proactive in my care.
Dr. Wanda Curlee: So what was found with that mammogram, may I ask?
Dr. Kathleen Shriver: The mammogram found nothing, and I even had the new 3D-imaging mammogram, which really is intense when it’s doing the X-rays. And they could not find the cancer, because my tumor was hiding in a milk duct and the mammogram cannot see through those.
Dr. Wanda Curlee: Oh. Interesting. Interesting.
Dr. Kathleen Shriver: Yeah. And I had no idea. I learned a lot through this experience. And so because of that, the radiologist, after he read my mammogram and heard about my sister, he recommended to my doctor to go further and to do the MRI.
And I went ahead and did that and unfortunately found the cancer then. Unfortunately, but fortunately, because we found it early. I was happy.
Dr. Wanda Curlee: So was artificial intelligence, commonly called AI, part of determining how you would be treated?
Dr. Kathleen Shriver: Yes, I would say that. There’s several AI platforms for evaluating the mammography images. And I found from the radiologist, he shared all of the screens with me and was pointing out the different things. And it was really interesting. I did learn a lot.
And with going then further with the MRI, it was the same radiologist who did the study of it. And he was the one who found the tumor and ended up recommending going for the ultrasound and then a biopsy.
So a lot of AI there that was really helping me. And it was like a whirlwind because I went for the first, the mammogram in January, and by the middle of March, I was already having surgery. It was like boom, boom, boom. The doctors here just got me through it, which was wonderful.
Dr. Wanda Curlee: Excellent. Excellent. So you talked about the radiologist using AI. So did any of the other doctors use AI, and did it help them communicate with each other?
Dr. Kathleen Shriver: I would say first with the radiologist, and that was just the regular radiologist who would read the mammograms, MRIs, ultrasounds. My radiologist oncologist also use[d] AI.
And I learned more with that because when I went from the radiologist going back to my regular doctor, and he was the one who said, “You know what? Let’s get all this going,” and approved the ultrasound and the biopsy.
And he referred me to our local Levine Cancer Center. And I met with the surgeon who also used AI. So it was almost like having…I had five second opinions without me having to go anywhere else because they all got together and looked at all my results, used the AI tools, and made recommendations for the next steps along the way for my treatment.
It was really quick, and I was fortunate because I had my surgery two days before all the hospitals in North Carolina were closed due to COVID-19. And I could not believe cancer surgeries are considered elective surgery now, which —
Dr. Wanda Curlee: Really? Wow.
Dr. Kathleen Shriver: Yes, that and heart surgeries. How can that be elective when you really need it? But that was the ruling. So I was fortunate.
Dr. Wanda Curlee: Well, you had good karma, it sounds like. So how did insurance — and this is a little bit off the topic of AI — but how did insurance act with all the AI and different things that the doctors were proposing?
Dr. Kathleen Shriver: Well, I did have to get pre-approval for everything. I think the longest wait that I had though was for the very first mammogram because the insurance said, “You can only get one once a year and you aren’t at your year cutoff yet,” because I usually go in May.
My doctor pushed it and he got them to approve it, and he got them to approve the MRI the very next week. And once the MRI results came in, insurance was really good. They approved the ultrasound, the biopsy, all the surgery, everything was approved. I’m still getting the bills in and still paying things here and there, but for the most part, I have to say about 80% of my costs have been paid for with my insurance so far, and because I did get the preapproval.
Dr. Wanda Curlee: Wow. That’s great to hear. So where was AI used in your actual treatment?
Dr. Kathleen Shriver: Let’s see. In the actual treatment, I would have to say AI was involved in every stage of my journey, from the genetic testing to the imaging, to the biopsy surgery, and then determining what my method of treatment was going to be going forward.
The big thing after the surgery, because the surgeon actually used a machine to follow where he was going to be doing the incision and removing the tumor, doing my lymph nodes, all of that was AI. Machines were on me and just following him. So it guided him the whole way, which I didn’t even realize it until afterwards and he told me all the things that were going on while I was sleeping.
So going from the surgery and then going into the radiology treatment, my oncologist with the radiation part, she was able to calculate the number of radiation treatments that were going to be done on me by measuring me and determining where the radiation was going to be located with the machine. Very precise. She let me know how many doses were going to be in, all of that.
And it was all based on the MRI scan, the surgery, how big the tumor was, all of that. And she used all of those tools to determine what my treatment was going to be.
Dr. Wanda Curlee: Yeah. AI is amazing with data and trying to put things together and coming up with recommendations, but ultimately, it is the doctor’s decision on what to do.
Dr. Kathleen Shriver: Yes. Yes. It is. It is.
Dr. Wanda Curlee: But it’s nice to know that you have something in the background because us, as humans, couldn’t take all that data. It would take many people in a room trying to put all the stuff together and then communicating. And we all know that sometimes a team doesn’t communicate well.
Dr. Kathleen Shriver: That’s true. I know when I was doing the genetic testing, the counselor was telling me that there’s over 100 types of cancers with different genetic variations. If someone had to do that, just a human doing that, she said it would take, well, she said forever, but we know it’s not forever.
And she told me to opt for getting at least 81 of the known cancer genes, to get those studied. And fortunately, out of all those 81, I only came up with the one, the breast cancer gene. And it doesn’t mean I’m not going to get any other type of cancer, but at least I know I’m kind of low-risk on that. So that was an interesting thing with the diagnostics for the genetics.
Dr. Wanda Curlee: Wow. That’s absolutely amazing. So how did you know that AI was being used?
Dr. Kathleen Shriver: Well, I think honestly I did not know that AI was being used and I didn’t realize just how important it was in my diagnosis and my treatment. As I told you previously, if you asked me about AI, the first thing I thought about was Spielberg’s movie in the early 2000s, “Artificial Intelligence.”
So when you asked me about the podcast, I started reading. I was given so much material from the nurse navigator. At the time I thought, “Oh goodness, this is overkill. I just don’t have time to read all this.” But, after you asked me about this, I went back and I started reading the materials, and that’s how I found how much AI was being used in my treatment.
And just, for example, when they did the pathology report for my cancer, they found, and this is through the AI testing, I have a very high positive estrogen count. And because of that, I am a candidate for the estrogen-reducing medication.
I’m sure you’ve heard of Tamoxifin and Arimidex. Those are different ones. There are so many. I think there was 10 different drugs that they told me now are available. And they use it, and if you have side effects, then go to the next drug and try to get you through that.
And one of the interesting things that I found that really kind of made the difference in what my treatment was, my oncologist, the medical oncologist, sent the tumor to another lab to conduct a second type of test on the tumor, and that was called an onco test. And the scores determined how you were going to be treated.
So if you were under 18, it meant you had a low recurrence of cancer, so they would give you the medication and you had to take it for five to 10 years. If you were 19 to 30 on the score, you had to get radiation, and then the medication for five years, which, I was 21, so I did the radiation for almost six weeks, and now I’m on the medication for the next five years.
And if you were over 30, you were considered high-risk, so that meant chemotherapy, radiation, and then the medication. And it all is worked out with the radiologist and the medical oncologist.
Dr. Wanda Curlee: Wow. It’s amazing how they can pinpoint it to such accuracy on what treatments you need and medications. That’s amazing.
Dr. Kathleen Shriver: And it wasn’t available even 10 years ago. I found that out, that they were guessing, and now it’s really getting precise. So I am fortunate.
Dr. Wanda Curlee: Did you feel comfortable with technology doing your diagnostics or even helping the doctors with diagnostics?
Dr. Kathleen Shriver: Yes. I definitely did. The doctors and the nurses, they shared the scans with me. They explained everything that was on there. They explained everything they were going to do. I was able to watch the actual ultrasound and the biopsy on the screen. I could monitor all of that.
And even when I was going through the radiation treatments, they put a little monitor to the side. I was able to see how much of a dosage was actually going in and how long it was going to be and all of that. So I was very comfortable with that.
During surgery, I mentioned before about the doctor using the machines the whole time. And one of the things that was new was being able to locate, through the AI machine that was in there, they had injected the dye and they were able to put the dye near where the tumor was and follow that dye to see where it was located and where it would go up in my body.
They were able to just take out a few lymph nodes, I guess in the past they would take out more of them and just totally remove them. He was able to just pinpoint three of those, take out a piece of those, and thankfully no cancer in those three. So it never spread. It really stayed self-contained. So I was lucky with that.
Dr. Wanda Curlee: Wow. Amazing. That’s just absolutely amazing where technology is taking us, especially AI. How about the AI suggesting of treatment, as you mentioned before, were you comfortable with that?
In reading a lot of the things that the nurse had given me, I found that artificial intelligence is beginning to help predict the cancer risk, like they did with my onco test. They are helping detect cancer earlier. They’re coming up with new drugs. They’re improving the treatments that we’re getting now.
I was really surprised to learn how researchers are studying AI to further personalize and customize care for an individual patient. They did mention about AI doctors, but I’m not ready for that yet. I still need that personal contact with my healthcare provider. I did two telemeds and it was okay, but I think I’d rather be in the doctor’s office instead of doing it on the computer. So that’s my personal preference.
Dr. Wanda Curlee: Hey, in the future, it might be chatbots doing your telemedicine, and you may not even realize that it’s not the doctor. So yeah, chatbots seem to be taking over in many areas, even in healthcare. So do you see AI becoming more important in the treatment of cancer care, or about the same?
Dr. Kathleen Shriver: I think it’s definitely moving us in the right direction. I think the way that doctors are treating cancers in 10 years, it’s going to be much different than today, just like it was with 10 years ago when I’m reading stuff from 10 years ago.
And one of the things that my medical oncologist had shared with me was AI is not really broadly used in the oncology world, but it is being studied in several areas. And I think it could be very useful, especially in the clinical setting. We’re now having electronic health records, and we’re getting data from so many patients.
Dr. Kathleen Shriver: I was asked to be part of a genetic testing with the group that did my testing, Ambry Group in California, and they are keeping track of everyone. They’re trying to collect the data after you get the testing done.
And everyone in my family agreed. We can’t go back and try to get any results from my mom or my grandmother or my aunts who had cancer, but we are starting now as a family and we are keeping track of who may get cancer, who doesn’t.
I sent my sons to be tested. Fortunately, both of them came back with a negative MRE11 gene, which means it stopped then with me. So I don’t have to worry about my granddaughters to a greater degree than I would have before. They don’t have that cancer gene. So that’s another testing positive for my family.
And yeah, I think that AI is going to help diagnose quicker, more accuracy because, as we said, the human will take forever to get a test done, but the machines and the computers can do it so much quicker. And I really think AI is going to help us get to a cancer cure much quicker than if we just went with the traditional methods of doing studies. It’s going to be positive going forward.
Dr. Wanda Curlee: So Kathleen, you mentioned about the advancements of diagnostics and treatment with AI. Do you see AI eventually helping doctors and researchers and everybody else to find a cure for all the various types of cancer?
Dr. Kathleen Shriver: I think that AI will definitely help. Cancer has historically been difficult to cure. You can’t use a pill or an injection.
In my case, I just wanted the tumor removed and quickly learned it was not the same as getting your tonsils out. There was a few extra steps involved before I could even get that done, and afterwards with the post-operative care.
I think that patients diagnosed with an early-stage cancer, they can be more optimistic about their prognosis, as I was. I believe attitude is a big part of the healing process. And I kept telling my husband, “Don’t worry, we’re getting through this, be positive.”
So he did all the worrying for me. I just kept going forward, just kept working. And I don’t think artificial intelligence can resolve all the ambiguities that are surrounding early cancer diagnosis, but I think the AI can help explain them.
I think it’s important for patients and their doctors to really communicate about the best form of treatment. And one thing that I would have liked to see was it would be really helpful if AI could provide same-day diagnosis and treatment.
I know I waited almost four days to get my results each time. And the waiting period I think was the worst, not knowing what you had and what your treatment was going to be.
One interesting fact that my medical oncologist told me is that for every centimeter of a tumor, you’ve got 1 billion cancer cells.
Dr. Wanda Curlee: Wow. That’s amazing.
Dr. Kathleen Shriver: Yeah. My tumor was about 1.75 centimeters. So I had lots of cancer cells and that was one of the reasons to do the radiation, just to make sure that no other little cancer cells were floating around and just to make sure that I was okay.
So when you think about it, every day counts with a fast-progressing disease. And pathology labs don’t have same-day results. A lot of the pathology labs, the ones that we used in Charlotte, we only had two pathologists working during the COVID-19. The other ones were closed.
So these two people were trying to do all the pathology for our whole area in Charlotte, which that was a lot. So I guess, four days to get my results wasn’t too bad.
Dr. Wanda Curlee: No, that’s better than it was. It used to take me two to three weeks.
Dr. Kathleen Shriver: Ooh. Okay. So I guess I really can’t complain about four days, and especially during COVID. I did have to travel outside of my little area. I had to do an hour drive each way to go and get my radiation treatment, because only one location was open in like a 50-mile radius of where I live.
Instead of having the three centers open, they merged them all into one and they did not open up again until July 1st, I think it was. So they were closed for a couple of months. And I wish they were open sooner, but it was not to be.
Dr. Wanda Curlee: Yeah. COVID is putting some dents in everything that we’re doing these days, unfortunately. Yes. Yeah, I actually heard serendipitously that more people are dying of heart attacks because they don’t want to go to the ER.
Dr. Kathleen Shriver: Right. They’re petrified. They don’t want to go and they’re not going for their treatments that they should be going for, and that’s not good either.
But you did ask me about, as for a cure. Again, I think that the early detection treatment, it’s going to help. I also think with AI, it’s going to enable people not to view a diagnosis of cancer as a death sentence. I mean, whenever you heard cancer when we were younger, it was all, “Oh my goodness, how long do you have?”
Well, it’s not like that anymore. Now it’s, “Whoa, how long has it been since you were diagnosed or since you were treated?” So a little bit different mindset there, which is good.
Dr. Wanda Curlee: Yeah. It was 40 years ago, by the way, and yes, most people thought I wouldn’t survive. Knowing that AI was being used, did it increase or decrease your stress during your journey with breast cancer?
Dr. Kathleen Shriver: Well, I have to say that the past few months, they have been stressful; however, I did tell you my husband took most of that stress. But the team of the doctors, the practitioners, the nurse navigator who explained everything along the way, although I didn’t realize it was AI being used to the extent that it was, it did make the diagnosis and the treatment process a more positive experience for me.
And I have to say it also helped that you were hired as the Program Director for the Business Department because you did reduce my workload, because I was doing the interim work from September until March. So I was very happy to see you on board.
And I think one last thing that I would say with that, with the stress, my last visit with the surgeon and with the nurse navigator, they told me on my last visit, because I don’t have to go for six months now, I’m a breast cancer survivor.
And I really need to celebrate this good news and to let people know don’t be afraid to go to the doctor if you think something is wrong. Be proactive. Take care of yourself. You have to be your own best advocate. And that’s what’s been important and I think that’s what got me through this whole journey, as we called it, with the breast cancer.
Dr. Wanda Curlee: Yeah, absolutely. I can see if you really think something is wrong and your doctor’s kind of pushing you back saying nothing’s wrong, as you said, be your own advocate. Push. Because today with AI, no matter what you have, AI is going to help you along your journey for healthcare.
Dr. Kathleen Shriver: Yes, it definitely is. It definitely is.
Dr. Wanda Curlee: So Kathleen, if you had a crystal ball —
Dr. Kathleen Shriver: I wish I did.
Dr. Wanda Curlee: Yeah, I know, we all do. In five, 10, 15 years, how do you think cancer treatment will be changing because of AI? And I know you’re not a healthcare specialist, but what would you like to see? What would you envision AI doing to help with cancer treatments?
Dr. Kathleen Shriver: I think the biggest thing is I think that AI will eventually get us to that point where we may have cancer diagnosis without invasive procedures to find out that you do actually have the cancer. To go in and do a biopsy, that it may be able to do some type of X-ray or something to alleviate us going through getting the first incision and then going back again and getting the surgery, and just doing it in a quicker time, as we talked about with the pathologists, that you waited a couple of weeks and here I complained about four days, but if you can get it quicker…
I mean, look at even COVID. I did have to [have] that COVID test before I could go and do any of my treatments. And I was thinking about that, okay, so I did the COVID test the one day, but what if I went and saw somebody and I got it again, do I have to go and get tested every day?
With the quicker tests and with the different ways, I think that AI is going to help with getting the cancer diagnosis, the treatment. I look at how my radiation was that was very pinpointed and very precise when I went.
And I think about my mom from when she was 40, and it was just like you zapped the whole area, and a lot different. I just had a couple little spots that had to be radiated. I think that’s going to help, that AI is going to even pinpoint it even more, and I think it’s going to be positive for everybody.
Dr. Wanda Curlee: Yeah. I see healthcare evolving quickly with AI, hopefully in the correct direction. Because we have drug manufacturers and pharmaceutical companies using AI to develop, as you said, drugs that are just done for you. It’s not mass-marketed, it’s drugs done for you. That’s amazing in my opinion.
Kathleen, thank you very much for joining me today for this episode of Innovations in the Workplace and sharing your very personal story.
Dr. Kathleen Shriver: Oh, you’re welcome, Wanda. And I really appreciate you letting me bring this topic to everyone’s attention, just knowing that, hey, it’s not a death sentence. You can do something about it.
And the sooner you find it, the better off you are because it will go quickly. And I don’t have to go back for a while and I know what to watch for and what to do, and hopefully, this helps others to make sure that they pay attention too.
Dr. Wanda Curlee: And thank you to our listeners for joining us. You can learn more about this topic and similar issues in artificial intelligence by reviewing the APUS blogs. Stay well.
About the Speakers
Dr. Wanda Curlee is a Program Director at American Public University. She has over 30 years of consulting and project management experience and has worked at several Fortune 500 companies. Dr. Curlee has a Doctor of Management in Organizational Leadership from the University of Phoenix, a MBA in Technology Management from the University of Phoenix, and a M.A. and a B.A. in Spanish Studies from the University of Kentucky. She has published numerous articles and several books on project management.
Dr. Kathleen Shriver has more than 40 years of professional experience; almost 30 years was acquired at the Buffalo City School District in New York. She was directly involved with the business management and operation of the organization in dealing with staffing, budgets, data analysis, and overall management functions of the Instructional Division. She also spent time working with graduate students from area colleges, who were completing thesis papers on the Buffalo City Schools.
Her educational background includes an associate degree in Applied Science in Paralegal Studies from Hilbert College in NY and a bachelor of science degree in Management from Houghton College in NY – both accomplished in traditional campus settings. She earned her Master of Business Administration (MBA) online at Baker College and a Doctor of Business Administration (DBA) online at Northcentral University.
For the past 11 years, Dr. Shriver has been an online adjunct instructor, mentoring students in business, organizational management, and leadership courses, primarily at the graduate and doctorate levels.