Chapters Transcript Video Optimizing Women’s Cancer Care AI, Robotics and Precision Medicine Welcome to Doc to Doc where we explore the latest advances shaping cancer care for the coming year. In this episode we're looking ahead to 2026, a year already shaping up to be transformative for women's cancers. We'll explore the greatest new approaches in breast cancer surgery, from precision guidance oncologic techniques to de-escalation strategy that improves outcomes with minimizing invasiveness. We'll also take a closer look at the newest advances in robotic surgery with gynecologic oncology, where next generation platforms, enhanced imaging, and artificial intelligence are changing the surgical experience for both patients and surgeons. Welcome to Baptist Health Doctor Doc, a podcast built for innovation and collaboration by physicians for physicians. Hello, my name is Doctor John Diaz, and I'm the chief of gynecological oncology with Baptist Health Miami Cancer Institute, and I'm joined by my colleague and friend Doctor Marin Habibi, chief of breast surgery with Baptist Health Miami Cancer Institute and deputy chief of breast surgery for Baptist Health Cancer Care. Doctor Habibi, welcome. Thank you. Good seeing you. Thanks for having me. So Doctor Habibi, what's the greatest new approaches in breast cancer surgery as we head into 2026? So there's a lot of um new advancement in the, in the breast surgery in the past several years and especially in the um in in this year. Uh as you know, the advancement in the AI has really shaped the breast imaging tremendously. We can do the detection much better now with the advancement of the AI in it. So we are now using also AI in the surgical planning. So there are some companies that we use the MRI findings and then we create a volumetric size of the tumor prior to the surgery. So a lot of times when when you look at the MRI or you look at the breast imaging and that you, when you look at the size of the lesion compared to the size of the breast and thinking that. You need to do a mastectomy with a volumetric measurement, you actually look at, uh you can decide to see whether you can do an advanced oncoplastic lumpectomies instead of the mastectomy. So that um uh you know, introduction of AI in the surgical planning is really helping us tremendously. Um, and then with the combination of the systemic therapy, we are also now optimizing more and more the order of whether you do the surgery first or you do the systemic therapy first. So that will help to really de-escalate, or I will call it actually optimize the surgical planning as well as the systemic therapy um according to the specific characteristics of the tumor for the patient. It's amazing to see where we've come. When I was a medical student rotating through breast surgery, we're doing these radical mastectomies, uh, which are quite deforming. And now it seems we have a very tailored approach, uh, with the same oncologic benefit, but much better cosmetic approach and a much easier recovery for patients. Absolutely, it, it is. So the breast surgeon it used to be very, very simple, you know, one diagnosis, one therapy. And, and now it becomes so much nuances into it, so trying to really find the best, um, the, the least amount of surgery that is really necessary to, to achieve the oncologic outcome that you like, as well as preserve the cosmosis as much as you can, um, it is, it is becoming a very, very, very interesting field by, by, by all the researchers. You know, I always have an interest in robotics, and so I know that robotics is starting to make its entryway into breast surgery. Where do you see that leading? Yes, it is. Uh, so there are, I actually got some training in, in Italy for the, for the robotic, uh, you know, mastectomy as well. Uh, so it is a, it is a technique that you use the, you know, um, the robot, uh, to, to perform a mastectomy. At this juncture, um, here in the States, it's, it's investigational when it comes to the treating the cancer. In Europe, they, they do use it for the therapy. They, you essentially, you use it a several centimeter incision on the lateral aspect of the chest wall, and then you do the robotic surgery. The, the dissection is very nice, but as you know, the breast, there is no cavity, so you have to create a cavity by injecting and dissecting and that, that plane that you want. So in the, in the pelvis or in the abdominal cavity, that, that will really help to to do the robot. So for the breast it's not the case. And then when we, when we consider the nipple sparing mastectomy, which is what, what the robotic surgery does, so we can hide the incision instead of the lateral position underneath the breast, so almost achieve the the. Same level of, of the cosmetic or one can make an argument a little bit better because you can hide the incision. So it's a technique that is, is doable and I think, you know, so if a day comes that we need to do them, we can do them, but I think the, the, the way that it really reshaped the GYN oncology um it, it's not gonna be like that in the, in the breast surgery, but it is a technique that is doable. You're right. I mean, it has completely transformed the way that we perform pelvic surgery, both GY and neurology. Uh, I was fortunate to see that transformation, uh, and so robotics continues to expand and it's really allowed us to do these complex procedures that before required a huge midline incision. Patients required multiple hospitalization stays. We had an increased risk of complication rates, particularly, uh, in women where we're getting these soft tissue infections, wound infections, and so it's really, uh, expanded what we've done, uh, as a fellow, I used to start my rounds at 4:35 in the morning to do all of my wound care before I could even see the rest of the patients, and, and that's been completely eliminated from our field, uh, so it really revolutionized what we've done. Uh, additionally, it's allowed us to do things we would never think of, particularly in fertility sparing. You're able to identify these vessels, preserve them in a way that just, you couldn't see them in the past, and now with the augmented visualization, the ability to move your hands robotically the way you would in an open surgery, how it's natural for us to operate, uh, and it's been fantastic. And I wanna say, I mean, you are one of the, you know, one of the biggest leaders in, in this field. Um, I can say that it, it, I would say even it's better than open surgery. The, the visualization that you have deep in the pelvis is, is better than a surgery, uh, better than an open surgery, and also the way that really stabilizes the, the movements, uh, it really gives a, a, a tremendous amount of advantage to the treating surgeon and for the patients, uh, ultimately to get the, you know best. Benefit out of it. Absolutely there's no more tremor, uh, and it's a great way and as we continue to evolve, we now have a residency program, uh, with FIU for general surgeon. We have one coming from Joan. It's a great way to teach surgery for the residents. You can really see the anatomy, uh, you can really allow them to progress through these procedures both with simulation before they even get on the robotic platform, uh, and allows us almost like when you learn how to drive a car and you have. Uh, the instructor on the other side with the steering wheel and instead of brakes, you know, you can do that with robotics. Uh, so it's been fantastic, and we've had robotics now for 15 years. It's evolved tremendously, but what's coming next is really inspiring, you know, we're gonna have the ability now, to your point, to map out our surgeries before we do them, to overlay the images, to really see what the boundaries are of our dissections need to be. Um, we are now starting to introduce telehealth therapy. And so the other day I had the opportunity I was in my office, my colleague had a question the robotics. And you send me a Zoom in link, link basically. I could go in, I could see exactly what they're doing in the robotic platform and kind of walk through the steps. So it's really interesting and been exciting to be a part of this. It would be great to have a, a unit in your office that you can actually manipulate a little bit that what's going on and it's very doable theoretically, you know, there's no reason not to have it. So the technology is there um and one of the things you know we're in a big urban area in Miami we have great robotic surgeons in our community so patients have access to these skilled surgeons but in underserved communities in rural communities where you may not have an expert in these different areas, um, these patients either had to have a traditional procedure with the complications come with it but now you could potentially have the robotic platform there have an expert surgeon somewhere else in the country doing these highly complex procedures. The patients don't have to travel, they can recover in their own home, so it's really amazing what's coming that's fantastic, yeah. So it's been an exciting couple of years in breast cancer research and 2026 is shaping up again to be another exciting year. So what are some of the major advances, trials that you see coming you're excited about target therapies, immunotherapies? How is that coming together in the management of this disease in several, several ways, so. We had a very exciting 2 or 3 studies that was published last year to show that so in the in the context of the breast cancer surgery, one of the elements that we do is the sampling the lymph nodes. It's called sentinel lymph node biopsy, and there's been. After what you mentioned, the radical mastectomy, uh, led into the axillary dissection and then led, you know, a little bit later into sampling the lymph nodes, sentinel node biopsy. So the question was, can we even de-escalate further than that? So, can we just omit the sentinel node biopsy? So we had. Um, several studies were published in the past, you know, year or so, and it is really shaping the, the management in 26 in a way that you can potentially de-escalate even the sentinel node biopsy for a selective group of patients that they have a smaller tumor, well behaving tumor in the consultation with the radiation oncology and medical oncology, that which, which makes it very interesting to even de-escalate the sentinel node biopsy. Another area that I think is very interesting is these MRDs and looking at the circulating tumor DNAs and how that is really playing a role into the spectrum of the management. And that is going to be this year and the, you know, er coming years, I think it's going to really play a big role in the way that we, we, we manage the patients, we follow the patients, and that is going to really would be very, very interesting. Yeah. So we're starting to incorporate that into our practice, you know, it's a novel technology, and I think the most exciting thing is the de-escalation component, you know, we've adopted maintenance therapy for many of our diseases and it's great because we've improved outcomes, but probably we're continuing this treatment longer than some patients derive benefit and while it is maintenance therapy and it's very well tolerated, everything we do has some side effects and so I'm starting to use it in my practice to your point, the patient's having some difficulty with their maintenance therapy. And their circular DNA is negative, can we potentially de-escalate treatment and stop these therapies a little bit earlier and still maintain the same oncologic benefits. So it's really an exciting part. Um, and again, we've seen that in our field. Going back to robotics, I love talking about robotics, you know, um, and it's exciting to see what's happening in breasts, but it's exciting to see what's coming now with AI, you know, everyone's talking about artificial intelligence and how is that's gonna happen, and I don't see that it's gonna take over our jobs. We're not gonna have AI performing the surgeries, but it's certainly gonna complement what we do, uh, and when I talk to patients and my colleagues, you know, I think it's very similar to what we have in our cars with lane assist and if your car kind of drifts a little bit, it warns you, hey, you're getting too close to the lane. It has that front crash prevention. That's what we're gonna start to see. And so we're still gonna be performing the surgeries, but AI is gonna help us to say, hey, here's the warning there, we're getting too close to some critical structures, right? And we're gonna be able to inject different dyes. It's gonna light up the uterus for us. It's gonna light up the vessels, and with adding that preoperative mapping to know exactly where that tumor is, it's really gonna guide us. So I don't think we're gonna be replaced as surgeons, at least not in our lifetime, but we're starting to see that introduction to improve oncologic resections. Uh, perhaps less radical surgery, you know, sometimes we just go by anatomical margins of what we need to remove, but if we can do less with the same outcomes, that's better for patients. And to certainly guide surgeons as to, all right, these are those dangers, you're getting close to where you may get into trouble, uh, so it's really fascinating to see how that's coming along. Absolutely, the AI, uh, I agree with you, is not going to replace, but it is going to tremendously help us and to provide a better care. And it's impacting us from all aspects of the breast care, from the helping the breast imagers to really detect lesions that are not even really readily visible. So with the machine learning, now the AI can help breast radiology. Is to almost predict that area is going to have breast cancer two years down the road. It's, it's tremendous. The surgery, as I mentioned, helps with the mapping, and the further, I think that one of the biggest areas that the AI is going to help is to shorten. The time frame from the discovery of medications to the bedside application of it. Um, it, but by essentially finding the specific molecules that can work best, it really will decrease the time frame of from the discovery to the clinical practice tremendously, and I think that would be a, a huge, huge improvement in the, in the way that we treat cancer. Absolutely. So one of the things that we continue to evolve as we do this, you know, there's always the naysayers and say, well, is it safe to do these novel techniques you've talked about compared to traditional, you know, bigger is better, open was better, uh, and as we do these clinical trials, we've been able to demonstrate that in fact, no, a tailored approach can be better, a minimalist approach can be better, and we've done this with an endometrial cancer. We had two trials, the GOG lab 2 trial and the Dutch trial that demonstrate that yes, minimalive surgery is safe and has better perioperative outcomes. Patients can start adjuvant treatment earlier and patients get back to their regular lives early. I mean, my patients go home the same day after hysterectomy. When my mom had a hysterectomy, she was in the hospital for 5 days, uh, so very different. And now we're looking at cervical cancer, you know, we had some early data that showed that maybe it wasn't appropriate. We have the ongoing ROC trial which participated in to compare robotic surgery to open, uh, and preliminary data has shown that it's probably gonna be safe now with these new modified techniques, uh, that we're using that. So it's a really exciting time in GYN cancer care. That's awesome. Yeah, I wouldn't even call it a de-escalation, I call it optimization. So because you're really right, finding the right treatment for the right patients, sometimes we actually escalate the therapy for the person that would benefit from it, and then we de-escalate for the folks that they don't get benefit from it. So that optimization, I think is gonna be the, the, the name of the game going forward. We're really seeing the translation to that personalized medicine optimizing. So as we gear up in 2026, what are you most excited to see maybe that's gonna be thinking coming out this year, the national meetings or research you know it's kind of coming to fruition at the end of the year? I think, I think one of the most, uh, you know, uh things that are, I'm really looking forward is this MRDs, the circulating tumor DNAs. It started several years ago. The studies are, are now shaping up and to really give us some guidance how we can use them, how we can use that, you know, sequencing tumor DNA to really change. Change the management going forward, I think that is going to be really an area that I think is going to shape and of course with the with the immunotherapy, with the other therapies that we have, um, the outcomes are really good, but we want to see whether, OK, can we really tailor the immunotherapy, for example, for the folks that they really get the maximum benefit and then not give it to the ones that they don't. And that that element I think is going to be just more, you know, you know, honed in and fine tuned as we go. As usual, breast cancer is a little bit ahead of us, right? So we borrowed sentinel lymph nodes from you. In fact, the first paper, uh, was a paper that I wrote, but my co-author was one of our breast surgeons, that's Sloan Kettering that guided us through that and kind of the same thing we're seeing in therapeutics, you know, we're really excited about immunotherapy and GYN cancers. We're really excited about anti-drug conjugates or antibody drug conjugates, these ADCs. We've had 3 that have been approved in GYN cancer in the last 2 years, and these were first generations, uh, and we were fortunate at Mammy Cancer Institute to have those 3 drugs on trial. So our patients. Derive those benefits before they came to market. Well, now we have this 2nd generation of ADCs that are coming through. We have several clinical trials that's trying that and to your point, you know, this really is precision medicine. We're looking to see what is the target. Uh, these antibody drug conjugates are taking that payload straight into the cells. Uh, in the first generation you got really a few percentage of the drug in there and it was still effective. So this next generation with different limeric binders and different payloads, I think is really going to push forward and we're gonna see some pretty big breakthroughs in the next couple of years that I'm very excited about. Yes, they're fantastic. ADCs are, uh, you know, uh, play a, you know, a big role in the, in the, in the breast as well. And the other factor that does, uh, I think is interesting is the oral serges. So these are the, like a, a, a, a, a class of medication that are anti-hormone, but they are disruptive, des destructive of the receptors, and the effect has been very, very interesting, and I think the, you know, coming, you know, in coming years, the research will, will show that they, they really can potentially play a very big role. And as usual, we're borrowing what you guys have done and sort of look at that in GYN cancer. So it's very exciting from the surgical technique. You guys are way ahead of the game with the robot for sure. So we kind of wrap up today's discussion. It's clear that 2026 is gonna be an amazing year with new innovations, refined techniques for women's cancer care. Um, precision medicine is really coming to fruition now. Innovations in cancer surgery, next generation sequencing, and new robotic platforms that are coming to market that are going to push. The old robot, which has served us well for the last 15 years, but innovation and competition is always helpful. So, you know, as we get ready for this, what's your one take-home message to women in our community? What are the things that you really want them to focus on for their health for 2026? So I think, um, doing a screening test, I think is incredibly important. The earliest that you can find any of the cancers, the, the therapy would be significantly easier and the. The chance of cure would be significantly higher. I think that would be incredibly important. I think in, in Miami, we have the, the most advanced therapy that they can get anywhere in the world. So in that sense, they really, the care is here and they, they, they, they, I would say my recommendation is to uh have the system uh have the screening test to detect the cancer if, if it's, you know, happening and we can, we can help them. Yeah. Again, you guys are ahead of us in GYN cancer, uh, as you know, we still have very limited screening ability for GYN cancers. The only effective screening we have is Pap smears to help prevent cervical cancer, and that's been great, and we've done a great job in reducing the number of cervical cancers in the United States, uh, and catching them earlier and earlier, but we still haven't done a great job in HPV vaccination. Uh, and the US really lags behind the rest of the developed world for getting HPV vaccine for our patients. So, you know, any opportunity again, I talked to women and parents, you know, they should be vaccinated against HPV to help prevent HPV related cancers, and we actually have effective screening for cervical cancer, but as you know, we don't have effective screening for head and neck cancers which they're also at risk for. And the idea is if we can get this vaccination for both boys and girls before HPV exposure or the onset of sexual activity, uh, it's most effective, and if you do it before the age 14, you only need 2 injections as opposed to 3. luckily the FDA had changed. The age limit, so now it's approved to 45, um, but still we see very low vaccination rates and it's such an important thing. I mean, cervical cancer really is a disease that we should be able to eliminate between vaccinations and screening, and we're seeing still 14,000 cases a year, which is low, but still 14,000 too many cancer cases for this. I agree with you 100%. Well, Doctor Bibi, thank you so much for joining us on today's Doc to Doc. I learned a lot. I think it's really gonna be an exciting time for 2026 for women's cancer. Uh, it's also an exciting time for Miami Cancer Institute and Baptist Health Cancer Care. We have the region's first women's cancer center that the building is up and we're hoping to move in here 2027, uh, and that's gonna be great for women in South Florida. It's really gonna transform the way care is delivered. Uh, devoted just to women in one roof we have ourselves, our colleagues in plastic surgery, medical oncology, uh, and it's gonna really be a home run for women in South Florida. Absolutely, thank you so much for having me. I really appreciate it. To find out more about the topics covered on BaptistHealth.to doc, please visit physicianresources.baptisthealth.net. Created by
