Dr. Elisa Port, THE BREAST ADVICE: All You Need to Know About Breast Health, Screening, and Treatment
[0:00]Welcome to Totally Booked.
[0:02]I'm Zibi Owens.
[0:04]I've interviewed more than 2,000 authors on this show
[0:07]and learned endless amounts about storytelling,
[0:10]reinvention, and life itself.
[0:11]Because when you talk about books,
[0:13]you're really talking about life.
[0:15]So get ready to hear from today's best authors,
[0:18]the best-selling and the not yet discovered.
[0:20]Come find your next great read and the story behind it.
[0:24]Enjoy.
[0:26]Dr. Alisa Port is the Chief of Breast Surgery at Mount Sinai
[0:31]and a leading expert in the field of oncology,
[0:33]with decades of experience and a reputation
[0:35]for compassionate care.
[0:36]She has dedicated her career to advancing breast cancer
[0:39]treatment and empowering patients.
[0:42]Dr. Port's work is informed by cutting edge research
[0:45]and deep personal stories.
[0:47]And the breast advice is a culmination of her life's work
[0:49]and a testament to her unwavering commitment
[0:51]to improving the lives of those affected by breast cancer.
[0:55]I've known Dr. Port for a long time
[0:57]and she is a powerhouse and the go-to person
[1:01]for anybody with breast cancer in New York, for sure.
[1:04]And I'm sure elsewhere as well.
[1:07]But Dr. Port, oh my gosh, she's amazing.
[1:09]Next, we'll have Dr. Margie Lockman talking about midlife.
[1:13]Dr. Margie Lockman is the Minnie and Harold Fireman Professor
[1:18]of Psychology at Brandeis University,
[1:20]where she directs the lifespan lab,
[1:21]a leading expert on adult development and aging.
[1:24]Lockman is one of a small group of scholars
[1:26]to study midlife from a lifespan developmental perspective,
[1:30]which is fascinating.
[1:32]Welcome, Dr. Port.
[1:34]Thank you so much for coming on.
[1:36]Totally book to talk about the breast advice.
[1:38]All you need to know about breast health, screening,
[1:41]and treatment, congratulations.
[1:43]Thank you.
[1:44]So thrilled to be here.
[1:46]The scene's a smidge in this process.
[1:50]Okay, talk about the book and why in your busy, busy life
[1:55]you've decided to also write a book and market a book
[1:58]and all the rest.
[1:59]Yeah, I mean, you know, so Zibi, the bottom line is is,
[2:03]you know, I did write a book 10 years ago.
[2:05]And that was a different time in a different place.
[2:08]And people did start asking me 10 years ago, 2015,
[2:13]what are you going to update the book?
[2:14]Because guess what?
[2:15]The news flashes the spoiler alert is,
[2:17]thank God the book needed updating
[2:20]because there's so many amazing things
[2:22]that have happened in the last decade in breast cancer
[2:25]that new treatment options, new scans, new information.
[2:31]And so it had become outdated.
[2:34]And so I did start thinking about another book,
[2:38]but I wanted to do something that was more relevant to this time.
[2:42]And the relevance is that patients I found were getting more
[2:47]and more information from other patients than ever before.
[2:53]It used to be the internet.
[2:54]Now they talk to each other.
[2:56]And that experiential part of the breast cancer experience
[3:00]and between patients.
[3:02]I wanted to leverage that.
[3:04]So the key thing about the title, the breast advice,
[3:09]it's not just my advice.
[3:11]It's advice from patients who've been through it that exemplify
[3:15]and I think illustrate each particular scenario.
[3:20]You know, to give you an example, there's one chapter
[3:22]and how does the woman decide with breast cancer?
[3:25]One pectomy or mastectomy.
[3:26]Well, there's two stories of two different women
[3:30]who made two very different choices.
[3:32]And I hope readers will read this and say,
[3:36]yeah, that really resonates with me or that really resonates with me.
[3:39]So I just, you know, I'm old now.
[3:43]I've been doing this for 25 years and I wanted to pay forward
[3:48]all the incredible wisdom that I've heard from patients
[3:52]over the years and incorporate that into a new book.
[3:56]Amazing.
[3:57]I was so surprised, by the way,
[3:58]almost dropped the book when Amanda Katz
[4:00]had so many sections in here, which is amazing.
[4:03]She's my step sister's wife.
[4:07]So what is that my step sister-in-law?
[4:09]Thank you, step sister's wife.
[4:11]I think that's the sister's wife.
[4:12]Something like that, which was amazing.
[4:15]And I, you know, was front-row seat to what was happening with her.
[4:19]Tell me a little bit about how you went about profiling
[4:22]specific patients while on patients and all of that.
[4:25]Yeah, first of all, you know, over the years, obviously.
[4:29]I'm very lucky that I have a memory like an elephant.
[4:34]Thankfully, none of that has left me.
[4:36]And so I really do remember very, very specific cases
[4:40]that are incredibly impactful for me.
[4:43]Not only because of the story and what happened to them
[4:46]or their case medically, but also just the way
[4:49]the things that they've said to me are articulated.
[4:52]And there are definitely patients that I say,
[4:55]God, I wish this person could stand in front of a roomful
[4:58]of people and tell them because they have such incredibly
[5:02]wise, smart things to say.
[5:04]Amanda was a very specific case, for example,
[5:07]where she was just really clear about what she wanted.
[5:10]And, you know, there is an increasing number of women's
[5:13]who are opting not to have reconstruction.
[5:16]Yeah.
[5:16]And so I just thought she's amazingly smart, amazingly articulate,
[5:22]was very clear about what she wanted, had the perspective
[5:25]of working in a plastic surgeon's office.
[5:28]So I just, I thought her story was amazing.
[5:31]And, you know, the other thing is this I called on a bunch
[5:34]of people who wanted to tell their stories
[5:37]but didn't want it to define them.
[5:40]And so there are people in there who are anonymous, you know,
[5:44]of the two men, one, you know, male breast cancer chapter,
[5:49]I took two men and one of them really wanted to tell his story
[5:53]and is very out about it and wants to be a role model and wants
[5:57]people to call him and, you know, wants to put a story out there
[6:00]and the other one had really wanted to put a story out there
[6:03]but didn't want it to, didn't want to be identified.
[6:06]And so there are some anonymous or I guess pseudonym stories
[6:10]where people told their stories under a different name.
[6:14]Obviously the more well-known people who've already told their stories
[6:18]are in the book as well.
[6:19]And I set out really to identify different stories
[6:24]and different people that I knew would really be impactful
[6:29]and would really, and the stories are so beautifully told
[6:36]and these people are so articulate that that really I say
[6:41]the patient stories are the heart and soul of the book.
[6:43]They really are.
[6:44]And I couldn't believe I did not know that, I mean,
[6:47]now I sound ridiculous.
[6:48]Stacy from Sosaico had breast cancer and they she treated her.
[6:53]Yes, she's very involved, you know, in the in the space
[6:58]before the book.
[7:00]She's spoken in a couple of our things.
[7:03]She's obviously was an inspiration all along and has been a guru
[7:07]and a lifestyle coach and inspirational along and I will tell you
[7:10]to be one of the two things that I've told her this many times.
[7:13]There are two things.
[7:14]The one thing about her that I found that I really wanted to include
[7:19]her is not just because of her platform.
[7:21]It's because she has really, really incredible things to say.
[7:24]And she said two things that I thought were super valuable.
[7:27]And by the way, patients, you know, were in the book
[7:30]sometimes more than once depending on the story.
[7:34]She was very, very, very honest and transparent about not having
[7:40]had a mammogram in a long time.
[7:42]And I feel like someone like her who is a health guru to admit
[7:46]that is incredibly moving and impactful.
[7:51]And it even if it leads to a few other women saying,
[7:55]yeah, I was so afraid I hadn't had one.
[7:57]So to get back on the wagon of screening, it will have been worth it.
[8:01]So I thought that was incredibly honest.
[8:04]And that that was one thing.
[8:06]And the other thing she said, which I thought, and she said,
[8:09]you know, this may be a controversial thing to say,
[8:11]but I'm going to say it and we included it, which is, you know,
[8:15]she says, you know, I'm not so sure having your partner or
[8:19]imposing on your partner or your wife or your husband or
[8:21]or whatever, they're for every single chemo is like the best idea.
[8:26]You use your friends.
[8:28]I had a village.
[8:29]We made bracelets.
[8:30]We, you know, we went through magazines.
[8:34]We ordered in junk food.
[8:35]She goes and they presented me back to my partner.
[8:39]And I thought that was a really beautiful thing to say,
[8:43]to eliminate things like guilt and, you know,
[8:47]people have jobs and they have kids and they have other things
[8:50]going on.
[8:51]And so I just think the idea of maybe the significant other
[8:56]doesn't have to be there 24, 7, 365 was really, it gives
[9:03]people room and permission to, you know, to know that, you know,
[9:07]this the process shouldn't be about guilt.
[9:09]And so I really love that she said that.
[9:11]That was great.
[9:12]You start out.
[9:13]You said, you know, so many people get breast cancer.
[9:15]Everybody's asking, why me?
[9:17]There is no, and you said something like 90% of the people
[9:19]have no family history of breast cancer.
[9:21]So everyone is just coming to you saying, why why?
[9:23]And it sounded like there were about three things that we can
[9:27]do within our daily lives to control, not control necessarily,
[9:30]but have had correlations with the incident.
[9:33]The breast cancer, namely weight, alcohol and exercise.
[9:38]Can you talk about those factors?
[9:40]Sure.
[9:41]I mean, I think, I think it's all about your 100% right.
[9:44]You know, the phrase I use in the book is vegetarian triathletes
[9:49]get breast cancer too, and Cheeto eating diet coke drinkers
[9:54]sometimes don't.
[9:56]So when a woman gets breast cancer, there's really no
[9:59]difference.
[10:00]to say, this is what you did to give it to yourself. But there are things that you can do to
[10:07]optimize your chances of not getting it, that are in our control. That doesn't mean that if you
[10:14]do those things, you're completely off the hook and you still need to get screened.
[10:18]Maintaining a healthy body weight, which as we know, there is a lot of definitions of this,
[10:23]but as much as we want to preach self-love at any size and any shape, there are boundaries
[10:32]where if you cross that line, weight becomes a health issue. If you are a person who, because of
[10:40]your weight, is on, make believe, a cholesterol medication or a borderline diabetes medication
[10:48]or a blood pressure medication or a heart medication, okay, that if you did not weigh as much,
[10:55]you wouldn't be on those medications, then yes, weight is affecting your health.
[11:00]And so we have to be a little bit objective about as much as we preach self-love and there's a
[11:07]lot of, you know, there's a big range of normal, but there are places and BMI is one way to measure
[11:15]that or hip to waist ratio. There's a lot of ways to measure being overweight or obese,
[11:20]but the thing we need to know about weight is that everyone thinks that fat stores are kind of like
[11:25]these passive blobs of tissue that just sit on their bodies or hang on their bodies. They're not
[11:31]fat stores are incredibly what we call metabolically active. They make things. They make inflammatory
[11:39]agents that get secreted in the blood. Everyone talks about the anti-inflammatory diet and the
[11:44]anti-inflammatory this or that and inflammation causes cancer. Well, fat stores making pro-inflammatory
[11:52]agents that get secreted in the bloodstream. They also make hormones, believe it or not. So
[11:58]it posts menopausal women where the ovaries aren't making so much estrogen anymore. Fat stores can
[12:04]be one of the predominant sources of estrogen and 70 percent of breast cancers are fed by hormones.
[12:11]So these are the kind of direct and indirect reasons why maintaining a healthy body weight increases
[12:20]your risk of getting breast cancer and be if you have breast cancer increases the risk of it coming
[12:24]back. It's a very teachable moment to improve lifestyle or whatever it is to reduce risk.
[12:31]Alcohol is not a fun one to talk about because you know a lot of people enjoy a drink and I think
[12:38]that that's fine. I'm not a particularly draconian person in my own lifestyle and I don't like to
[12:45]preach that. But it is true that the newest data shows unfortunately. We used to say in moderation,
[12:51]everything's fine and no risk, okay? We do now know that zero is better than moderation,
[12:59]which we define is three to five drinks a week. How much better? Less than a percent.
[13:05]So if a woman's risk of breast cancer is let's say 10 percent and she drinks three to five
[13:11]drinks a week, maybe it's 10.3 percent or 10.5 percent. So it's not a lot to move the needle
[13:19]and I'm not a person who you know who says yeah that's you know gonna I'm gonna change my
[13:25]lifestyle for that. But if a woman does say to me I want to do everything I can to decrease my
[13:33]risk of getting breast cancer or decrease my risk of it coming back. I say here here there's
[13:38]here's one thing you can do. We roll exercise kind of into the weight thing. It's super important.
[13:45]It also for my patients who get breast cancer. It's really an important part of their recovery
[13:50]and rehabilitation, movement, range of motion, all those things, strength training. It's just
[13:57]it is rare. Also it's very tied into weight. It's very rare. I talk about in the book. This woman
[14:03]comes in. She's very skinny like classic Upper East Side New Yorker and I'm like you know you got
[14:08]to hold off on the exercise. She goes I don't exercise. I'm like there's no one like you off this
[14:14]planet. It does not exercise. It is you know so it's usually tied into that you know so amazing.
[14:22]Well when you see patients there's one patient you talk to who was so tired after she went home
[14:28]and you know and she said to you you know you this is the beginning of your career but then you
[14:33]hadn't really armed her with the post that you hadn't really armed her with the post operative
[14:39]things about lifestyle necessarily and that could you perhaps arm patients with more than just the
[14:46]nuts and bolts of the of the surgery but more of the lifestyle more of what to expect. You now
[14:53]have this whole book where you've given everybody everything they could possibly want to know and
[14:58]feel. What emotionally should women know about this if it's their diagnosis, their friends diagnosis,
[15:05]not just in the recovery but really how to how to cope. Yeah I mean there's a whole chapter as
[15:13]you know called how to be a breast friend to someone who's going through it and let's just agree that
[15:19]I use the best breast you know plan words and pun way too much in the course of the book but
[15:28]it's allowed it's totally allowed I like it I like it but the point is is that that chapter is devoted
[15:38]to giving people guidelines based on the just extraordinary amount of feedback I get from my
[15:47]patients about what helped them and what didn't especially zippy to your point as it relates to
[15:55]their tribe of people their community of people you know a lot of women talk about they have very
[16:02]very you know a lot of the people who latch onto this thing have been to them's been through
[16:07]it themselves and so that chapter is divided up into here's how to be a breast friend if you've
[16:13]been through it yourself there are different parameters if you haven't okay to give you an example
[16:20]if you've been through it yourself the last thing you should say for example is tell your doctor
[16:28]to order you this test and this test I had them because that may not be right in the newly
[16:35]diagnosed person's case you know I think the take-home message of the book is optimism and
[16:40]optimism is born out of appropriately born out of the fact there's so many new treatment
[16:47]options that there's no more one size fits all so even a person who seems to have the exact same
[16:53]thing it's going to differ in nuanced ways as it relates to what we recommend medically so for
[17:02]for the person who's kind of already had it the thing you need to do is kind of step out of your
[17:08]own diagnosis and be there again as a listener as a guidance and and to say this is what I
[17:14]experienced it's perfectly relevant to say you know it was tiring when I had my bilateral
[17:20]mastectomy or I was in the hospital and I ended up being there in extra days like experiential part
[17:26]is not something I can give someone right as a person the person who hasn't been through it shouldn't
[17:31]feel like just because they haven't been through it themselves they don't they also don't have
[17:35]a lot to offer I think what that group can make the mistake of doing is saying things like
[17:42]well if it were me I would just and I think what I have found is that you know no one really
[17:51]knows when the rubber meets the road what they're going to do you really don't and I actually think
[17:58]it's you know patience come into my office all the time and ask me like it's some secret answer
[18:04]that I'm keeping to myself what would you do and I always say to them look I'm the expert in the
[18:09]cancer but you're the expert in you and what I would choose for myself so one example I give
[18:15]is I say I am a truly flag waving workaholic that's all I'm interested in I love my work I
[18:23]love my patience I love working in the OR I love writing this book it really is all about work for
[18:28]me all the time if someone told me I could have a small surgery like a lumpectomy on a Thursday
[18:36]take Friday off and be back and work operating myself on my patience on Monday I think that's what
[18:43]I would do a lot of people with listen to that story say that is the craziest motivation I have
[18:49]ever heard right so you know the decisions a person makes for themselves the doctor doesn't have
[18:55]some secret private choice that's the right choice it's really what's right for the person
[19:00]and so you have to when you're there as a person supporting is not say I did this you should do
[19:08]what I do or if it were me I would do that because you just don't really know have you always
[19:15]been a workaholic is this what were you like as a kid no I think I think I was a late bloomer
[19:22]academically in a lot of different ways I mean I did great in high school I did fine in college
[19:28]and then went on to medical school the time where really kicked in was in surgery residency
[19:35]where you're in a obligatory workaholic but I really found my passion in my place and my people like
[19:42]I really it was exhausting and we were on call I was I was up all night long every other night
[19:48]for five straight years and I always wanted to be in the hospital and taking care of patients
[19:54]and learning more so that was really where it it really came
[20:00]And it has been ever since then, you know, that's amazing.
[20:03]Well, when you find a gift in what you're uniquely suited for,
[20:07]it's pretty amazing.
[20:08]I don't know how you did so little sleep.
[20:10]I mean, that's got to have some health effects, no?
[20:13]It does.
[20:14]And I have to tell you, for sure as it be,
[20:17]it's a weed out factor in this job, you know,
[20:21]in the sense that surgery residency is really exhausting.
[20:26]And you have to really, you have to be cut.
[20:28]Just like other, I mean, there are other jobs, you know,
[20:31]people we know, for example, you know, other jobs that also
[20:35]are that that involves a lot of sleep deprivation,
[20:38]whether someone's working on a deal or working on a, you know,
[20:41]in law firms, et cetera, I hear about these associates
[20:44]and what they're doing and, you know, or startups, right?
[20:48]Everyone says they're sleeping on the couch in their office.
[20:50]So when you're engaged in something that's really all
[20:54]encompassing, whether it's a project or medicine or whatever,
[20:58]ours is a little bit longer than most people.
[21:00]It's really kind of a lifetime, but it really is,
[21:04]it's a calling and a passion more than a job.
[21:08]And, you know, we just, the good, the good work you can do,
[21:14]it feeds on itself.
[21:15]It really does, you know, doing good in the world
[21:19]and helping people and saving lives.
[21:23]I guess, you know, you say that is so, it just, you know,
[21:27]it is really, really important work.
[21:30]And I just feel like it's so worth it, you know?
[21:34]The effort is really, really rewarded.
[21:37]Well, I would say all of your patients and their families
[21:40]and friends and loved ones and everybody
[21:43]gets to come down the pike to your services.
[21:46]Thank you from the bottom of their hearts.
[21:48]And it's just amazing.
[21:51]Thank you so much.
[21:53]And Dr. Port, thank you for taking the time to also
[21:56]put this amazing book together.
[21:57]It's user friendly, it's, you know,
[22:00]it feels like really friends are telling you what to do,
[22:03]but then also the best expert ever,
[22:05]which is the best combination, right?
[22:07]Or, yeah, the best combination.
[22:09]There you go.
[22:10]I'm so glad you're drinking from the collage.
[22:13]There you go, there you go.
[22:15]Well, thank you and thank you so much for having me.
[22:18]Oh, it's my pleasure.
[22:19]Thank you, thanks for everything.
[22:21]All right, bye, Dr. Port.
[22:23]Bye.
[22:24]Thank you for listening to totally booked
[22:26]with Zibi, formerly momstone have time to read books.
[22:29]If you loved the show, tell a friend, leave a review,
[22:32]follow me on Instagram at Zibi Owens
[22:35]and spread the word.
[22:36]Thanks so much.
[22:38]Oh, and bye the books.