← Lipstick on the Rim
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- [00:01]
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Hey, I'm Molly Sims.
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And I'm Emisha Gormley. We're two girls obsessed with one thing.
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Beauty. And by that, we mean everything that makes you look and feel beautiful.
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We're calling on our favorite health experts, industry insiders and friends to answer all your beauty questions with a drink in hand. Definitely with a drink in hand.
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You're listening to Lipstick on the Rim with Molly Sims. So I have a little bit of a pet peeve that I think you're going to relate to this. I'll be having a great day, feeling good, and someone will say to me, you look tired. And I'm like, I promise you I'm not really tired. But here's what I've learned. My eyelids, they do sit a little low. And once my doctor explained that to me, it actually kind of made a lot of sense. She prescribed me Upnique, the first and only FDA approved prescription eye drop for adults with low lying eyelids. One drop per eye. In the morning and I notice my eyes look more open awake within minutes. It's like just one simple step. That's it. And the results?
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Guess what?
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They last up to eight hours. Learn more about upneek.com that's u p n e e q.com or talk to your doctor. Just a little quick safety note about Upneak oxymetazoline hydrochloride ophthalmic solution, 0.1%. Tell your doctor your symptoms and medical history, including blood pressure, blood flow issues, and heart, brain or eye disease. Drooping eyelids can be caused by other more serious conditions such as a stroke. Do not touch the tip of the Upneak vial to your eye or any other surface. This is not a complete list of risks.
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Wildcard is where big name interviews feel like conversations with a friend. I mean, I can't believe how lucky I've been. You didn't say goodbye the right way,
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McConaughey, she told me.
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I don't think you're Princeton material. I'm nothing if not open, I guess. Yes, I'm Rachel Martin. Watch or listen to Wildcard on the NPR app, YouTube, or wherever you get your podcasts.
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Well, we always love a two timer on the show. Doesn't happen very often, but when it does, you know she's a worthy guest.
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Well, today's worthy guest also has a new worthy book that we are insanely excited to talk about.
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This is going to be one of those conversations that every woman needs to have, but most are probably going to want to avoid. And this is the episode the hour that we're gonna go into what every woman needs to know about breast health. The facts, the fear and the why. It's so much better than you think.
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It's not as scary.
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It's not as you think. She is the chief of breast surgery at Mount Sinai. She's the director of the Dubin Breast Center. She's treated some of the most well known faces, women bodies in the world. She has a brand new book. I actually, a couple of years ago, she's like, I've got an idea. What do you think? It's called the Breast, no pun intended, the Breast Advice. It just came out a few weeks ago on May 19th. It's gonna change the way you think about this topic. We love you, Dr. Port. Welcome back to Lipstick on the Rim.
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Thank you so much for having me.
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Oh my God, you're the best. You've been doing this for over 30 years. You've written one before. What made you write the breast advice?
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A couple of things. You know, I never really. Molly set out in the beginning to write the first book. The first book was really born out of what I thought was a true need. 10, 15 years ago, when women were being diagnosed with breast cancer. What was extremely obvious to me, which was really, really upsetting me, is that the curate and the survival had never been higher. And yet women were coming into my office with more doom and gloom than ever before. The beginning I didn't understand it, and then I figured it out. It was all about the Internet. So in like 2010, 2015 was when women started going more and more to the Internet for information. Not only about breast cancer, but a lot of things. And the Internet when it comes to, you know, these are the days before AI and ChatGPT and all that stuff. So all you were getting was a lot of really like bad Yelp reviews, a lot of doom and gloom, a lot of, you know, desperate stories. And women were coming into my office saying things like asking questions. They were Googling breast cancer and Googling their diagnosis, and they were going down all these terrible rabbit holes that quite frankly had nothing to do with them. Women with early stage breast cancer, Stage zero, Stage one, were asking questions about stage four, and they couldn't differentiate it. So I wrote the first book called the New Generation Breast Cancer Book how to Navigate youe Diagnosis and Treatment and Remain Optimistic in the Age of Information Overload, based on what I felt was a very specific need at that time. Flash forward, it's 10 years hence, and I think there's a new need. I thought There was a new need. Number one, I wanted to update the book. The really incredible reasons for optimism is that, yes, a lot has changed in the last 10 years, all for the better. New technology, new treatments. So there was a need to update the book, but I didn't want to do the same thing in the same, because I think that that moment is passed. And I think the new moment is what I'm observing in my office. And I kind of have my finger on the pulse of what's going on. You know, seeing five to 10 newly diagnosed women every single week, is that where they're getting their information now is other women? A lot of person to person, and a lot of women case to case. And that's great from an experiential standpoint, but what happens is, is that, you know, care has gotten so nuanced that no two cases are the same. So what I noticed is that women were coming into my office saying things like, I'm here because my friend Jane was your patient. You treated her. And I have the exact same thing. And I think to myself, and I'm like, yeah, I remember Jane. It's not the same thing at all. It's really different. And we need to do two different kinds of surgery, et cetera. And so what I'm pointing out is that women get this incredibly important experiential information from each other, but that lives in this silo over here, and then they get the medical expertise from a doctor like me, and that lives over here. And I said, and this is in part born out of some of the stuff I've done with Jill Martin on the Today show. Like, we need to marry those two. Patient experience and doctor expertise, and bring them together. They can't be competing. They're totally complementary. And so the irony is, yes, pun intended, the breast advice is that it's not only my advice. My advice is the medical part. Every single chapter is a patient story, giving their advice. And it's not always the obvious stuff. You know, there's a chapter in there about screening and full body scans. And one woman says, get the full body scan. I think it saved my life. And the other woman says, don't get the body scanned, because it almost ruined my life. So I tried to really present kind of a balanced approach of things that my patients have taught me over the last 25 years. That was really the inspiration behind the breast advice.
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You and I spoke a lot when my daughter was diagnosed a few years ago. Almost crazy to think it was four years ago. But I remember immediately when we first found out, okay, this is what it is. This is what we're dealing with. People want to help you, and so they try to connect you with someone that's gone through something similar. And what I found, and, you know, I had to put my lens on it myself in the way that I couldn't have any negativity. If someone was gonna call me and be like, this is awful. What you're gonna go through is awful. I was like, I don't wanna hear it. I hang up the phone. And to your point, every story is different. Every person is different. But what I talked about so much with you was I. My optimism, I think, is what had to carry us through in so many ways, because I couldn't accept the other stories that I was hearing. I couldn't let that take over my mind. And mind became almost more important over everything else because that positivity is how my daughter was able to approach it. So I think sometimes fear mongering is such a real thing, and sometimes that's how we connect with someone, is sharing that fear, and it kind of starts to feed off of each other. Which is why I think it's so important that there be this community, there be this forum where you kind of have the pragmatic advice, and then you have to look at it and go, okay, I'm gonna power through. I'm gonna get through this. Like, how do I actually apply it without googling and going down the rabbit holes and getting the shit scared out of me? Because I think that is an instinct we do now. Like, we automatically feel like we can be Dr. Port, like, online, and we're not Dr. Port. You know what I mean? But I think my husband always says to me, stop, you're not a doctor. Don't go on chatgpt. Don't talk. Everybody's different.
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Well, I think that's what's so important about this book, is because there's such a fear. We literally just had a conversation. We just had a conversation. We spoke to a woman a few minutes ago, and we were just. It was. We didn't ask me anything. For leukemia and lymphoma with a woman, she was excellent. Somehow it came up that her mother had breast cancer. And she was so honest. I go, are you BRCA tested? And she goes, I'm just. I'm too scared to do it. I'm too scared to do it. But I do breast MRIs. I do.
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Every six months, she does a year.
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Every six months, she does a year. And I go, I thought you Know, to myself, I'm like, I can't wait to tell you to get this book, the Breast Advice.
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It's what you said the subtitle of this book could be it's just not that complicated. And I think that's the thing is it's. Most women feel it is very complicated, right? They think it's this crazy thing, but it really isn't that complicated.
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Let's get into risk, because I think that is where so much of the fear lives. How should a woman actually be thinking about her own personal risk? You've said there are really only a few ways to get into the high risk category. Will you walk us through actually, what moves that needle?
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I love the opportunity to talk about this because this is definitely an area where the fear mongering needs to go away. Breast cancer is the most common cancer that women get. There's more than 300,000 cases diagnosed in America each year. Okay. And it is very common. But here's the thing. About 90% of women who get breast cancer have no antecedent family history. I think that's pretty shocking. So we're all at risk to some degree at about a 10 to 12% level, you guys, that's the average woman's risk of getting breast cancer. Okay? On the other end of the spectrum, you guys just talked about someone who might be BRCA positive. Okay. If you are found to have a genetic predisposition, your risk of getting breast cancer is 60 to 80%. That's over here on the other end of the spectrum. But there's this whole sliding scale in between. Right? And you know, for example, if you have no risk factors, you're 10 to 12%. But if your mother had breast cancer, that might bump you up to 20 or 22%. How do you figure that out? So there is. There are a lot of tools. One of them is online. It's called the Breast Cancer Risk Assessment Tool. And I run it about 20 times a day. And what it does is it asks you a lot of questions that can minimally or majorly affect risk. Okay. Minimally are things like breast density. There's this whole craziness now about how breast density increases your risk of breast cancer. Well, maybe it does by 1%. Okay. Or 2%. It's not like having a mother who had breast cancer, which bumps you up to 20% from the 10%. People get very, very up in arms about childbearing. If you have not had a child, you're at a little bit higher risk for breast cancer than someone who had children a little bit later over the age of 30, who that person is at higher risk than a person who had children under the age of 30. But there's so many other factors that figure into childbearing and when to do it. I mean, why would we ever tell a person you gotta have kids early so that you reduce your risk of getting breast cancer when that added risk is again like 1 or 2%. So the important points to make here is that all these minimal factors, even when you pile them one on top of the other, you will never get to what we call high risk status, which is 20%. And I'll tell you in a minute why that number is important. There are two things that can get you to 20% and above. One is family history of some sort. And the other is if you've had a biopsy of your breast and it showed these funky looking cells, what are called like atypical cells. And there's a few borderline type ish things that if you've got them, it means your cells are making some changes and maybe they're going to make more changes. But the important thing for a woman to know is most women know if they have a family history or if they've had a biopsy. And I think some of the scary stories we've heard out there are these ideas that a woman off the street that never thought she was at increased risk could walk into her doctor's office and like in the wizard of Oz, like behind the purple curtain, the doctor's doing all this stuff and ta da, your risk of getting Breast cancer is 35%. It doesn't work that way. If you don't have a family history, you haven't had one of these biopsies, you're never gonna reach that risk level. It may be 14% or 15%, but not 20 or higher. That I think is a really important message to send.
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So what about all those things that you hear, you know, don't drink alcohol cause that increases your risk. There's all these lifestyle factors that I think again, a little bit of that fear mongering, right? Like oh my God, if I drink, you know, my glass of wine or a cocktail a night, what am I doing to myself? Is that also like a 1% increase? Cause that is something that you hear. Like you go to a doctor's appointment, how often do you drink? And you're like, I feel like I have to lie the glass of my cocktail every day. You know, it's just my thing. And I don't have A drinking problem. But I like to make myself a cocktail.
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Yep. Let's talk about the lifestyle factors. Cause unlike the factors we just talked about before, where you can't really control your family history, and you can't really control your breast density, and you can't really control really, when you have kids, now we're talking about things we can control, right? Alcohol, hormones, weight, Those kinds of things. Okay, here's the thing. We just had our really big luncheon yesterday, and we had a very big expert in nutrition, metabolism, endocrinology. The newest data suggests, contrary to older data, which said drinking in moderation doesn't really affect your health. And moderation we define as like, three to five week. And if you think about it, that the reason why it's moderation is if you're drinking three to five drinks a week, that means you're not having something every single day. Okay, maybe on Saturday night, you have two, then two, three nights go by, you don't have any. That's defined as moderation. What we now know is that as it relates to breast cancer risk and a lot of other things, the safest number is zero. Okay. Which is pretty disheartening.
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Okay.
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And all that means is that if you're drinking one to three drinks a week, you probably are at a little bit higher risk. And again, let's talk about what this risk is. If your Overall risk is 10%, it's the average woman's risk. And you're increasing her risk by. Here's where it gets a little tricky. 10%. That doesn't mean her risk, guys, goes to 20%. That means her risk goes up by 10% of that baseline 10% risk. What's 10% of 10%? It's 1%. So what if I said to you, your risk of getting breast cancer, instead of 10% is now 11%. A lot of women would say, okay, I can live with that risk for this part of my life. That's very pleasurable. And I will say with alcohol, it is a sliding scale, though. One to three is worse than zero. Three to five is worse than one to three. And let's talk about the cocktail O night. You know, the cocktail night is something that I talked about this a lot during COVID You know, it was like a running joke. I'd come home every night, and my husband would make from the working. I was deployed to the emergency room. I was working in the ER Taking care of incredibly sick people. I would literally phone in my drink order on the car ride home and probably drink it right from the blender. We all did what we had to do, right? The problem with a cocktail a night is let's do the math. It doesn't take a genius to know that a cocktail every night is seven drinks a week. And most people who are drinking one every night, even if it's just a glass of wine, that means if they go out on a Saturday night, then it's a cocktail and a glass of wine. So when people drink seven, you know, a drink a night, it quickly becomes seven to 10 a week.
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That's what I was going to say, seven to 10.
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And that's. That can have a major, major impact on health overall. I mean, what is that? How high does it bump your risk? It depends on what health situation you're talking about. But it can raise your risk of breast cancer up to maybe 14%. You know, increase it by 20 or 30 or 40%. So I just don't think that's healthy on a lot of different fronts. But everyone's gotta make their own decisions based on what they're prioritizing. I am not a big like, you know, draconian lifestyle person. And I have had lots of patients like this who say, I'm gonna do every single thing I can to reduce the risk of getting breast cancer or having my cancer come back. And you know, it's a control thing. There are things you can control and if you wanna do everything you can to control it, that is one thing you can do. But you know, we can't control everything. And it's just one factor in the overall picture. The other one is weight.
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Right?
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So being overweight or obese increases your risk of getting breast cancer and increases your risk of recurrence. So, and I think we actually talked about this the last time we were on. It was like a really kind of almost newer topic, the GLP1s. And it's really important to give women with breast cancer and even women at high risk the tools to be able to lose weight. Weight. My personal feeling is it's almost impossible to lose weight for a woman over the age of 40. And it's almost impossible for a man to lose weight over the age of 50, say more than like £20. I think it's impossible. You basically have to starve yourself and run a marathon every day. And it's not practical or feasible for people who work, for people who have full time jobs or two jobs, or single parents or whatever. It's not possible. Can you imagine, Steven, tools to try to lose the weight if they want
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to what about genetic testing?
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It's a very, very important tool to define risk. Genetic testing is not only for BRCA anymore. It's not just for brca. We can test for a panel of different genes. There's other ones, just to name a few. Chek 2, Palb 2, ATM, P53. These are all genes that increase the risk of breast cancer and other cancers. And the reason why the test is important is because. And remember the story you told before, people saying, I'm so afraid, you know, I don't want to get tested. Knowledge is power. And there are more options for women with genetic testing. You know, I do think a lot of women hesitate to get tested because they feel like they're going to be bullied or pressured into doing surgery, like preventive surgery to remove their breasts or what have you. And it's going to be a source of tension and press, and that's just not the case. We have really good screening options for women with BRCA who are not interested or ready to do preventive surgery.
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Well, that's what this woman on the call that we just had, she was saying that that's part of the reason she doesn't want to do the BRCA testing is because she fears that it's a tension point in her house. She was like, I don't know that I would want to do a double mastectomy. And then we also touched on hormone replacement therapy. She was talking about how she's menopausal and she's afraid of estrogen because the studies used to say, don't take estrogen. It can, you know, be bad for you if you have a family history. And now it's the opposite. And she goes, well, what happens in 10 years? Is that going to change again? So what are your thoughts on hormone replacement therapy?
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I have a lot of thoughts on it. And I think that, as you guys probably know, 20, 30 years ago, hormone replacement therapy was developed and is an incredibly important tool to address menopausal symptoms. And there's so many.
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Right.
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And people experience menopause in so many different ways. What happened was what kind of canceled out all that was about 20 years ago, a study came out called the Women's Health Study that showed an increased risk of breast cancer with hormone replacement therapy and an increased risk of heart disease. And that led people, both doctors and patients, to run for the hills overnight. You saw just a drop in people taking hormone replacement therapy, saying it isn't safe. And also they added the black box labeling, you know, which is pretty scary. A black box label to a drug puts it at the highest possible risk for a person taking it. I don't think I would electively take a medication that had a black box label in it. But the big question is why? And the answer is, is that the study that was done was super flawed. First of all, they looked mostly at hormone replacement therapy. Get this, guys in women in their 60s, okay, who are at higher risk of breast cancer and higher risk of heart disease to begin with. Who starts hormone replacement in their 60s? That ship has sailed by our 60s, right? Women are looking at it 45, 47, 50, right? That's when they're suffering the most. If you've made it to 60 with no hormone replacement therapy, who would start then? So they studied essentially the wrong group of patients and probably overestimated risk. So that led to this very recent thing where they repealed the black box label. And what's gone on now is the pendulum swung in the other direction where people are saying, give me back my hormone replacement therapy. Everyone should be on it. And my feeling is we should group women into three groups. Women who have almost no identifiable risk of breast cancer, women who have some risk of breast cancer like you were talking about this person with a mother, and women who actually have breast cancer. The groups at the extremes are super easy. If you are a woman who has no underlying risk of breast cancer, okay, and you are suffering from menopausal symptoms, absolutely, hormone replacement therapy should be an option for you. Here's the thing. Every single medicine has risks. And there is an increased risk of breast cancer, albeit a small one with hormone replacement therapy that you kind of just have to accept, again, 10% to 12%, 12% to 14%. It is a marginally increased risk. That's the reality, okay? There is no medicine that has no side effects. And the thing I worry about today is so many people are saying, yes, get on hormone replacement therapy. Yes, they oversteed the risk, but there are risks, okay? So the first group of women who have no real identifiable risk for breast cancer. If they need hormone replacement therapy and want to do it and are educated about the risks, they should be on it, okay? On the other end of the spectrum are women who've had breast cancer themselves. And as we know, most breast cancers are hormonally fed. And many women with breast cancer are on, on anti hormonal agents, and you can't do both. So really, that's the one group, women who've had breast cancer, where we think that hormone replacement therapy is probably a non Starter. That's really every study that's been done that's looked at hormone replacement therapy in women who have had breast cancer has shown higher risks of recurrence. Now, I will say there's some cool new options for different kinds of hormone replacement therapy that may not have those risks. And so we're very optimistic in looking at those. It's very exciting. Now we get to the middle group. You have other risk factors for breast cancer. You have a mother, you've had another biopsy and it's shown something borderline. What do we do with that? My answer is you deal with it on a case by case basis. I do have patients who are at increased risk for breast cancer for some reason who are suffering from hormone related deprivation. And if they say to me, look, I get it, it adds to my a little bit throwing fuel on the fire, I do think they should have that option. Remember one thing, it's also, again, a sliding scale in terms of time.
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Right.
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Being on it for a couple of years is not a huge risk compared to five years, compared to 10 years. So I sometimes say, why don't you go on it for a couple of years and get over the worst of it and see how you do. But I think that middle group is a group where you really need expert guidance and you really need a specialist to spell it all out for you. And I really do think the empowerment is not telling women there's no risk here. We're too smart for that. That's the empowerment. Give them the information and let them decide.
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for years, a deranged man in Wichita known as the Poet stalked Ruth Finley. He sent her letters, gifts and poems. The Wichita police put everything they had into Ruth's case, but got no more. The Poet was always two steps in front of us and we just didn't know why.
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And the city was already living in
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fear under the watch of another monster who called himself btk. And he also had a thing for poetry. Could we really have two different people? But no one could have guessed how this would end.
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B
That's one of those Hitchcock endings that
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we did not expect from from Sony Music Entertainment and New Metric Media. This is the Poet. I'm Rachel Brown coming July 1st to the binge search for the Poet. Wherever you get your podcasts to start listening today, subscribers to the Binge can listen to all episodes all at once, ad free.
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- [34:07]
A
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- [35:11]
B
stress is sometimes, you know, you read things, hear things. That stress can actually be sometimes almost worse for your health. And I don't wanna say stress causes cancer, but both my mom and dad, my dad is still alive. He's 88, has been healthy, works out every day of his life. He has beer here and there, but my dad's never been drunk at 88 years old, not once. My mother, I can tell you, the one time she got drunk. It was peach schnapps. She thought she was drinking peach juice. She was L. But that was the only time my parents drank. But my parents lived very stressful lives. They immigrated with a newborn baby at 40. My father struggled a lot when they first moved, you know, making a life with this wife and child. And my father is. He does lean more towards an anxious, stressed out personality. My question is, is do you think stress plays into it? Because on the flip side of it, I sometimes find when I am stressed, I'm like, I need a cocktail to take the edge off. So again, how does that play into it? What are your thoughts in stress and how it can impact your health and potential cancer risk?
- [36:22]
C
There's a whole chapter on stress that I write. And the chapter starts, 95% of the things I worry about never happen. You see, worrying works. It's tongue in cheek that it doesn't. So. So here's the thing. We know that stress has impact on health. And emese, you nailed it when you said things like, because there's probably direct effects on the immune system in some way, but there's also indirect effects because people who are stressed out don't sleep well, they drink, they take up other habits that are unhealthy.
- [37:01]
A
Right?
- [37:01]
C
I'll tell you, my patients who are smokers try to tell a patient who's diagnosed with breast cancer to stop smoking. She's like, no, you're taking away the main coping mechanism that I have. I'm like, okay, we'll work on this after your surgery and after you're diagnosed. So people turn to unhealthy behaviors to cope with stress, right? So stress definitely affects overall health both directly and indirectly. But here's what I would have to say to you, okay? I just got back from an incredibly moving trip to Poland where I visited the sites of where, you know, many of my family members perished and my grandfather, you know, lived and so forth. And I sat at a table with 90 and 96 year old Holocaust survivors. Okay? There are kinds of stress that, thank God and I pray none of us ever know. Being a prisoner of war, being in a work camp for four years, being a hostage, These are things that take stress to another level. And you know what? When you look at these groups of people, people who are exposed to very, very, like, life threatening, stressful situations for long periods of time in general, there's no evidence that they have higher risks of cancer. And so I think it's. Yeah, it's super interesting data. And I would just say that you know, stress is. We know it has some effects on health. Again, even if it's just indirect, the sleeping, the smoking, the unhealthy behaviors. But the thing I worry about the most is try telling a stressed out person not to worry. It's only gonna make it worse. It's a little bit, like, patronizing, and it's a little bit kind of like, insensitive. You know, I don't tell my patients with breast cancer, don't worry. That's their natural response. But what we try to do is replace the worry with positivity, and we'll go back to what said in the beginning. Emoshey. There's so many rooms for so much room for optimism in all these situations. And you just try to replace that, you know, even if it's temporarily.
- [39:15]
B
Right. Mind over matter.
- [39:16]
A
Mind over matter. Guidelines around mammograms have changed so many times in the last decade. Different organizations say different things. Can you set the record straight on what guidelines a woman should follow?
- [39:27]
C
I think we are, well, moving past guys, a one size fits all approach approach. So let me give some basics, right? The basics are if you have no other risk factors, why you should start earlier, or whatever the general guidelines are, start at age 40 and do them yearly for as long as you're healthy to have them. Okay. And it is yearly. You're right. The guidelines have shifted so much, and it's very, very confusing. And by the way, the guidelines even now don't even agree with each other. Like the United States Prevention Service Task Force, which is one source of guidelines differs from American Cancer Society, right now, they're not the same. So what's a woman to do? In general, it's starting at age 40 and every year after the data shows that gives you the best chance that if you're diagnosed with breast cancer, it will be picked up early. That's the highest chance. And that shows survival benefits, benefit of 15 to 30%, depending on the age group. Some women need to start younger. We use the general guideline of if you have a family history, you start 10 years before your youngest relative was diagnosed. So if my mom was diagnosed at 45, I might start at 35. You guys asked about genetic testing, and we talked about how, you know, you don't have to just do not pass go. Do not get your breasts cut off. We start those women much earlier with screening. You can have an MRI at age 25 and a mammogram starting at age 30 and do that every year. We add ultrasounds on very liberally for women with dense breasts, and that's very common in the 40 to 50 year old age group. I'm very, very kind of like tired of hearing about dense breasts. Increased risk of cancer. Increase this, increase that 50% of women in the 40 to 50 year old age group have dense breasts. That's normal. So I think we need to normalize having dense breasts. I really do, as a young woman especially, and not stigmatize that. It does mean that it might be harder to detect a cancer on a mammogram. So for those women, it's very, very smart to add an ultrasound to make sure less is slipping through the cracks. And we also add ultrasounds for our women who are at increased risk for breast cancer. When you start getting to the 20% risk level and or a BRCA mutation carrier, that's when we often add on the kind of highest level of screening, which is breast MRI. Breast MRIs do pick up cancers that mammograms miss. The reason we don't recommend them for everyone in screening is they are associated with a pretty high what we call false positive rate. So you see something and then that leads to more testing and biopsies and things like that. So you don't want to be doing screening MRI in the general population. It just probably the yield is very low in terms of cancer detection.
- [42:41]
A
Let's talk about what happens when you get the diagnosis. The word cancer still stops people in their tracks. How do you have that conversation? And I think when people do get the diagnosis, everyone goes straight to chemo. Everyone goes straight to like all of these different.
- [42:58]
B
The darkest side.
- [42:59]
A
The darkest side, the treatments.
- [43:00]
C
I hope the word is out that there's not a one size fits all approach. And I want to emphasize the whole first half of the book is about breast health. A lot of the things we've been talking about, risk screening, some things that every woman should read, I think and know about. The second half of the book is about a diagnosis of breast cancer. And as I mentioned in the beginning, it's one of the reasons that I wanted to update the book because so much has changed. Even in the last 10 years. We have more treatment options than ever before. And the chapter on chemo is titled Longer and Stronger versus Dialing it Down. Okay. And I think that's the big misconception here. Everybody thinks that when we do research, all we're doing is looking for stronger treatments and more like scorched earth approaches.
- [43:51]
A
Right.
- [43:51]
C
It's actually not. In the last 10 to 20 years, the focus on breast cancer Research has been more about how can we pull back on some of the more toxic treatments and yet achieve the same results, like who still needs them and who can be spared of the more serious treatments. And we've done a really, really strong job of that. For example, right now we're giving 30% less chemotherapy than we were 10 and 20 years ago. And that's because we have a test called the oncotype test. There's another one called the mammaprint, which we run on an individual's tumor of only a certain type. Okay. This is for women with estrogen progesterone positive HER2 negative cancers. It's a subtype of breast cancer. With those women, we're not quite sure if they need chemotherapy or not. We run this test and it spits out what's called a recurrence score. Recurrence score is a low, intermediate, or high risk for recurrence. And a lot of women are falling in the low to intermediate risk, which shows that they don't benefit from chemo any more than just anti hormonal medication. And so that's one area a lot of women will choose to have a lumpectomy instead of a mastectomy or a bilateral mastectomy. I think on the surgical front. The other exciting thing is a study came out about a year and a half ago showing that now not every single woman needs her lymph nodes checked under her arm, which was like a must in all women with invasive cancer two years ago and before. And so I just think we're constantly moving the line in the sand. The word that we use is de escalating treatment. And I think to your point, when someone's diagnosed, because the narrative is still, oh my God, I'm gonna need all of these very toxic treatments, it can be scary. And I think that they're often pleasantly surprised that they don't need certain things. I will say this is a perfect reason to make a plea for the imaging. Right. The only reason you can dial down stuff is if it's early detection.
- [46:17]
B
Right.
- [46:17]
C
If you're detected with a late stage cancer, there is no dialing down. You're getting the kitchen sink thrown at you.
- [46:24]
B
Your book is full of real patient stories and you said it's the heart and soul of the book. Tell us about some of them. I mean, we personally loved the story about the two women who met in the waiting room the day before their surgery.
- [46:39]
C
I knew you were gonna say that, and I'm so glad you did because it harkens back to what you said before about finding your people emoshey. You were talking about what you did to insulate yourself with your daughter and how you find your people who are gonna reflect optimism. And how these two women who are kindred spirits, found themselves by chance, but maybe not. And how in the book they said one of them needed chemo, the other didn't. And the one who needed chemo was in the grocery store one day and she literally says, people are dumb. They say the dumbest things. And she said, this woman came up to me in the produce section and said, I've never known anybody to have treatment as long as you. And the patient says, I put the fruit down and walked away. You know, these are stories where I think that, you know, before I wrote the book, I found myself repeating these incredibly insightful, empowering stories person to person. Right. Hannah Storm did a beautiful interview on how she didn't end up needing radiation to the point we were making before for her cancer, where a lot of women do because of new testing. Jill Martin and Chris Everett provided their very, very public stories already about genetic testing. But then there are a lot of women in there who told their stories anonymously. I have two men in the book who were diagnosed with male breast cancer who both wanted to get the word out about awareness of male breast cancer. I felt like I really picked people who really could impact the most people as it related to the subjects that I wanted to present.
- [48:38]
A
It's so important. I mean, I wish everyone could have you as a doctor. You're incredible. It's called the breast all you need to know about breast health screening and treatment. Dr. Lissaport, I won't ask you, but you did give very good advice as a 10 year old last time. She said you don't, you don't have to figure it all out at such a young age. Still holds true.
- [48:57]
C
Absolutely. I mean, this is like, you know, the publishing of the book and being here with you guys who are incredible. I mean, you don't even know how many people heard our last thing and came up to me and the information you're getting out there. This is just another highlight of my career which is happening, you know, after I've been doing this for 30 years. So I would say sign on to stuff to young people that where it's a slow burn, where it's really not the quick hit, where you build a career and credibility and a work ethic over the course of decades. Really, the success is really in the long haul.
- [49:42]
A
100% agree.
- [49:43]
B
We love you so much.
- [49:44]
A
We Love you. Make sure and follow Dr. Alyssa Port on Instagram. It's D R Elissa. E L I S A P O R T. The book is everywhere. The breast. I love. I love the. I love the name.
- [49:56]
B
I remember we talked about the name. We sat the last time and you're like, the breasts.
- [50:00]
C
Together.
- [50:00]
A
We were together. You're like, I got it. The breast advice. We were like, brilliant, Brilliant.
- [50:05]
C
I feel like the first time I was on with you guys may have been the first time I even said it publicly.
- [50:10]
B
So good. It was so good.
- [50:11]
A
It's so good.
- [50:12]
B
Well, I'll see you next week.
- [50:13]
A
You'll see you next.
- [50:14]
C
Yeah, exactly.
- [50:15]
A
I'll see you soon. But thank you. And this is great. Love you.
- [50:19]
B
I love. I love you. Love this.
- [50:21]
A
We love our breasts. We love our boobs. We love our breasts.
- [50:24]
C
Love you guys so much. Love you guys and thank you so much.
- [50:27]
B
Breast friends right here.
- [50:28]
A
Friends right here. We'll see you guys next week. Thanks for listening to Lipstick on the Rim with Molly Sims and my Ride or Die Emisha Gormily. We are so excited to bring you guys along on this journey with us. You can find us on Instagram and TikTok at Lipstick on the Rim and Molly B. Sims or you can go to my blog where you can dive just a little bit deeper into my favorite products, trends and more@mollysims.substack.com and don't forget to check out our video episodes on my YouTube channel, Molly Sims. This podcast is production with Sony Music. I wanted to give a special thanks to my team, Rosie Cummings, Ken Orion, Sophie Kevorkian and everyone at Sony Music. Don't forget to listen and follow wherever you get your podcast so you never miss out on the fun.
- [51:09]
C
Sam.