Elisa Port: Discuss THE BREAST ADVICE Book

**Eric Topol** (0:01)
Let's start our conversation.
Well, today, I'm really privileged because I've got with me Dr. Elisa Port, who heads up breast surgery at Mount Sinai Hospital, and she has a great book, The Best Advice, or The Breast Advice, about its prevention, its screening and treatment. And so we're gonna get into that, and so it is really a delight, Elisa, to welcome you to Ground Truths.

**Elisa Port** (0:45)
Thank you so much for having me. It's really an honor and a privilege.

**Eric Topol** (0:49)
Well, this book is gonna be out next week.

**Elisa Port** (0:54)
Yes.

**Eric Topol** (0:55)
Really a stunner because it's got so much great information about breast cancer. And I thought we'd start with, it's always good for remembering things when you have, as you had the three Ws or the four Ws, about, we know there's a few hundred thousand cases of breast cancer a year in the United States. And the survival rate has improved so much now. Yes. 90%.
But there are the big ones that, the lifestyle things you can do to reduce the risk, even though only 12% of women throughout their whole lifespan will have breast cancer. But those 12%, we wanna make sure that they don't show up. So tell us about the three Ws or the four Ws.

**Elisa Port** (1:42)
Yeah. I mean, thank you so much. I think one of the things that is really interesting about this book is, of course, it's a guide for navigating a diagnosis of breast cancer. But the whole first half of the book, Eric, as you say, is about breast health, right? And the interesting thing is, I always say, it's just not that tricky. Breast health is, what's good for your breast is good for the rest of you. So, the main factors that we focus on, the four W's are weight, walking, wine, are, you know, those are the three main ones. And I add the fourth one, which is working out, right? And let's talk about the first three first. So, the main lifestyle factors that could put you at the lowest possible risk for getting breast cancer based on lifestyle load, number one is weight, and number two is alcohol intake. It turns out there had been a lot of mixed data about alcohol. It turns out where people said, ah, if you drink in moderation, it probably doesn't affect your risk that much. It turns out that the safest amount of alcohol as it relates to breast cancer risk is zero. That doesn't mean that you're bumping your risk up so dramatically if you drink in moderation.
If someone has, I always say, we have to live our lives and so to have a glass of champagne at your son's wedding or this person's celebration, it's like be a human, be a person. So to have a couple of drinks a week, especially if you enjoy that, really shouldn't bump up your risk too much.
I say that it's just a question of being, I think, aware. What a lot of people say is, yeah, I don't drink that much, I just have a glass of wine with dinner every night.
But when I see a patient who's diagnosed with breast cancer and we start digging deeper, it turns out that's seven drinks a week. Then when you take that person and you find out they also go out on a Saturday night and then they have a cocktail, and then they have a glass of wine, now you're getting into seven to 10 What I tell people is, it's just be mindful and self-aware and honest about what your alcohol consumption is.
If there is room for improvement, there's room for improvement.
That's that. As it relates to weight, weight is another big one. It turns out that everyone thinks fat stores in our bodies are just like these passive blobs of tissue that kind of just hang off of us. They're not. They're extremely metabolically active. And one of the things most people don't realize is that in post-menopausal women, right, we all think that when you're post-menopausal, your estrogen, your ovaries have kind of shut down production, right? Factories closed, no more estrogen production. But we're still women, right? Our voices don't deepen, we don't grow beards. So where's that estrogen coming from? It comes from other sources. It can come from the adrenal glands, it can come from the skin, and it can also come from fat stores. Fat stores are one of the biggest sources of estrogen production. So it doesn't come as some surprise that if you have an extensive amount of fat stores and you are producing more estrogen that is then released in the bloodstream, that could increase the risk of breast cancer recurrence.