“I may be the expert in cancer, but you are the expert in you.”—Elisa Port, MD

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Dr. Elisa Port is Professor of Surgery, Icahn School of Medicine at Mount Sinai; Chief of Breast Surgery for the Mount Sinai Health System; Director of the Dubin Breast Center; and Director of the Center of Excellence for Breast Cancer at the Mount Sinai Tisch Cancer Center, a NCI-Designated Comprehensive Cancer Center. She is remarkably well qualified to provide guidance for prevention and treatment of breast cancer, and runs a model program at Mount Sinai in New York (←we’ll get into why I say that).

She has just published a terrific book that centers around the concept of informed optimism. Many of her patient stories are integrated.

We tried to cover the waterfront during our conversation including:

—4 Ws for reduction of risk: weight, walking, wine, and working out (especially in Nature, “green exercise”)

—Only 10-12% of women will ever develop breast cancer during their lives

—Role of adipocytes (fat cells), aka estrogen and inflammation factories

—Misinformation (underlying the need for this book)

—Pervasive myths of magic supplements, with safety issues of unregulated intravenous drips and others when analyzed turned out to be crushed up, dried house plants

—Total body MRI: mixed results from her patients

—Breast cancer on the rise in young women. Dr. Port relates about recent patients diagnosed in their 20s. Some without BRCA or other pathogenic mutation. Why?

—Mammograms in non-dense breasts pick up 80-90% of breast cancer. It’s the 40-50% women with dense breasts, which the scan is trying to find a polar bear in a snowstorm, is a problem. The problem with false-positives.

—Use of AI with mammography for increased initial detection, prevention, detect high-risk in women with a “normal” mammogram, and risk of heart disease (see my recent Ground Truths and piece in The Lancet on this important topic)

—Mount Sinai provides Transpara AI (the one validated by the big Sweden trial of >100,000 women) to all women getting mammograms FOR FREE. That is the best validated AI tool in medicine today!

—How a mammogram saved a patient’s life, not about breast cancer!

—Hormone replacement and birth control pills. How to assess benefit and risk in women young and older? Differences in the hormone risks.

—Tamoxifen for primary prevention in high-risk people. Reduction of breast cancer in 50% or more in these women. In some subgroups reduction as high as 80%!

—GLP-1 drugs may reduce breast cancer risk and this may not just be related to weight loss

—Lack of utilization of Genetic testing (it could be your father). I disagreed with respect to use of polygenic risk scores, as I wrote about in SUPER AGERS

—“I just wanted to scream out on top of the mountain about genetic testing, family history, and early screening.” Tennis legend Chris Evert

—The lack of our ability to assess the immune system in the clinic and how that could change the face of prevention and very early detection of breast cancer

An infographic summary I made on Dr. Port’s book with the help of NotebookLM

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Thank you YOUR DOCTOR KLOVER, Diane Romero, Bob Fleischman, Danielle, MagnaAnimus, and 450+ others for tuning into my live video with Elisa Port! Join me for my next live video in the app.

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