Fact vs Fiction: An Exclusive Interview with Breast Cancer Expert Dr. Elisa Port
Learn what one of the most common misconceptions of breast cancer is, the latest on the Cancer research front, recommendations for when you should begin breast screening, and how to best support and fund cancer research in our interview with Dr. Port!
Elisa Port, MD, is chief of breast surgery at Mount Sinai Medical Center and director of the Dubin Breast Center, a state-of-the-art breast center in Manhattan that opened in April 2011. She sees and consults with approximately two thousand patients and performs between four hundred to five hundred surgeries a year. Not only is she highly cited in print and digital media, but she has made appearances on Today, The Early Show, ABC World News Tonight, Fox News, and NBC news. Most recently, she authored a book, The New Generation Breast Cancer Book, which debunks myths and helps to guide women with their cancer diagnosis.
Can you tell us a little about your book, The New Generation Breast Cancer Book?
I wrote the book because of what I felt was a change in what I was seeing in my office, which was based on a change I was seeing in the world. Specifically, I saw that more and more, women who were newly diagnosed with cancer were feeling very hopeless and pessimistic. Despite cure rates for breast cancer being higher than ever, this sense of doom and gloom was prevalent and consistent from patient to patient.
I realized that many women, after being diagnosed with cancer, are turning to the internet for more information. The internet is increasing the availability of information, however it is providing too much information and with no filter. Therefore, patients are experiencing an information overload and are reading about treatments, outcomes, and/or unique circumstances that are not relevant to their specific diagnosis. As a newly diagnosed patient, you are unable to dissect what is and is not relevant and may become disheartened.
My book sets out to guide women and to provide them with relevant, quality information that will help them to process their diagnosis and to decide what the best course of action is, based on their diagnosis.
The Fact vs. Fiction Luncheon and Symposium at the Dubin Center just passed. Can you tell us more about this event?
Like my book, the “Fact vs. Fiction Luncheon and Symposium” seeks to educate and guide women with quality information. Each year the event takes on different tones and raises money for the Dubin Breast Center. This year, the sold-out luncheon was broader in scope, focusing on women’s health more generally. So, there were a number of specialists on the panel (from a plastic surgeon to a gynecologist), all who deal with different areas of women’s health.
To start off the event, we like to poll our audience to see if they can discern between facts and fictions pertaining to women’s health. Our audience mostly consists of highly educated women and an informed patient population. Surprisingly, we found that 4 out of 5 of our questions yielded split answers with high percentages on each side. For example, many women believed that breast implants either cause or increase your risk of getting breast cancer, which is a myth. This exemplifies the very issues that access to too much, non-quality information can cause. Additionally, this misinformation reinforces the importance of providing more quality information through tools, like the symposium and my book.
What is the latest on the breast cancer research front?
I’d say the latest on the cancer research front is early diagnosis through increasingly accurate imaging technology. Early detection = higher cure rate and less invasive treatments. So, as technologies continue to advance so does our ability to detect cancer earlier through imaging.
Additionally, I’d say the approach to treating cancer has progressed remarkably over the years. Today we are using targeted therapy, as we realize that breast cancer (and cancer in general) is not 1 disease, rather there are different subtypes. So, we are now treating based on the type, which allows us to focus in on the specifics of someone’s unique disease, rather than treating everyone’s cancer the same.
What inspired you to get into this field of medicine?
I started out in surgery and just loved the field of surgery. Specifically, I loved that it combined both the mental and the physical. You are using your hands and body when performing surgery, and simultaneously, you are thinking every step of the way. At the end of the day you are exhausted physically and mentally. I found that there were few fields aside from surgery that you can engage on those levels.
Later, I completed a fellowship where I did 2 years of cancer research. I was fascinated by the disease and found that I love taking care of women. There is a communicative aspect – it requires conversation and counseling. You have to present the science and specifics of the disease to each patient and then help her with weighing the options. This requires you to get to know and understand each patient on a personal level. The right course of action for one person may not be right for the next person.
Was there a defining moment that drew you to breast cancer research?
Really, I’d have to say that the defining moment for me was meeting some of the people that I was exposed to in the practice of researching and treating cancer.
What is the best way to really contribute to cancer research and funding?
The best way is to access specific individuals that are doing the work. For example, find a specific center that you want to donate to. There are so many centers and such a need for funding, so take the time to find one that you connect with. There is so much more than cancer research that fundraising helps to support.
For example, at the Dubin Center, we believe that treating women means treating more than just their cancer. So, some of our fundraising goes to help sustain services that insurance companies won’t cover. For example, we have therapists, yoga instructors, massage therapists, and other service come into the center. We’ve found that services like these are invaluable, as they alleviate stress, relieve pain, and help to promote overall well being and a positive environment, which is important when fighting a disease like cancer.
Once you’ve found a center you connect with, you can try to locate a contact person. If you are donating a substantial sum of money, you can ask to be updated on how the funds are allocated. But, if you are unable to donate a large sum of money there are still a number of ways that you can help, such as volunteering or organizing a fundraiser in your community to raise more money.
When should women begin screening and when should they schedule their first mammogram?
Many mixed messages have been sent to the public regarding when to start screening. The American Cancer Society was the 1st to change their recommendation. Then, the US Prevention Service Task Force changed theirs, but their changes were different from the American Cancer Society! Most professional organizations have NOT changed their recommendations, and continue to recommend mammograms starting at age 40, and yearly after that for women of average risk for breast cancer.
The aforementioned organizations changed their recommendations based on concern about anxiety and false positives, but they failed to prioritize the most important benefit of screening mammography: the reduction in the risk of dying from breast cancer. And there are other benefits of early detection that make early screening so important. As a surgeon, I know that finding a cancer at a smaller size may allow women to have less extensive surgery (a lumpectomy instead of mastectomy, for example). In addition, smaller cancers are associated with a lower likelihood of spread which may mean avoiding more aggressive treatment.
I recommend mammograms starting at 40 for general risk, and yearly there after. This is what most professionals still believe. Clear cut evidence shows that your risk of dying from breast cancer is reduced dramatically when your start screening at 40. If you do develop breast cancer between 40-49 your risk of death is 10-20% less than if you were diagnosed later.
In addition to mammograms, I tell women: “Do Examine Yourself!!!” All women should be comfortable and familiar with what is normal for them.
When is the best time to perform a self-exam?
The best time to perform self exams is:
- Pre-menopausal women – 1 week after period is the optimal time.
- Post menopausal women – it doesn’t matter when – you just need to do it once a month.
- Pregnant women – once a month – but understand that your breasts are going through many changes so not all are alarming.
Can you tell us some signs to look for?
Breasts vary from person to person, so it is important to keep an eye out for changes that are new for you. Once you start examining yourself regularly, you’ll quickly become acquainted with what your normal is, which should make it easier to recognize when something seems different.
Some signs you should look for include:
- New lumps.
- Skin changes – dimpling or indentation.
- Lumps under your arm pit.
- Skin or nipple changes – discharge, blood, crusting.
- Thickening/reddening of skin.
What is one of the biggest misconceptions about breast cancer?
This is a tough question because there are a number of misconceptions that are circulating. In fact, I’ve dedicated a section in the back of my book that distinguishes fact from fiction.
However, I’d have to say that one of the biggest misconceptions is that if you don’t have a family history you are not at risk. 85-90% of women who get breast cancer have no history of breast cancer! This is why it is so important to conduct self exams and to stay up-to-date on your screenings.
What advice do you have for someone who has just received a cancer diagnosis?
The first thing to do is to start researching where you want to get your care. Get with a Dr. you trust as soon as you can. I recommend going to a major medical/academic center and/or a surgeon that specializes in breast cancer. This can be restrictive geographically, but that is where you’re going to get your best start and care. For most women – surgery is usually the 1st step.
Do you have a favorite quote or motto?
Do the right thing.
I always tell my residents that the most important thing is to do the right thing. That can mean a lot of different things. But, overall the intention should always be to do what is best for your patient, so doing the right thing should mean doing the right thing for your patient.