| December 7, 2015 | Lifestyle
Dr. Eva Andersson-Dubin and Dr. Elisa Port of the Dubin Breast Center talk about the latest breast cancer treatments, the new American Cancer Society mammography guidelines, and lifestyle factors impacting the disease.
The entrance to The Dublin Breast Center founded by Dr. Eva. Anderson-Dublin and her husband.
Dr. Eva Andersson-Dubin established the Dubin Breast Center of the Tisch Cancer Institute at Mount Sinai Medical Center with her husband, the financier Glenn Dubin, to create a comprehensive, integrated program for breast cancer patients. Since its founding fve years ago, the center has treated nearly 100,000 patients, including Sandra Lee. Here Dr. Andersson-Dubin and Dr. Elisa R. Port, codirector and chief of breast surgery at the Dubin Breast Center, discuss how this remarkable medical center came into being and the latest news concerning the disease.
What prompted you to develop the Dubin Breast Center?
Dr. Eva Andersson-Dubin: I had breast cancer when I was 41 years old. So I’m a survivor for 13 years. I developed the Dubin Breast Center because I wanted a more intimate and very patient-oriented place where you could go and get all the care in one place. Breast cancer is unique because there are so many specialties involved—you need a surgeon, radiologist, oncologist, plastic surgeon, pathologist, a geneticist, etc. When you come in, for example, with a lump in your breast, I wanted it so that the surgeon could immediately take your hand and walk you over to radiology, do an image, and decide whether you need a biopsy, and if you do, have the biopsy right then. It eliminates all the extra appointments, extra waiting, and extra anxiety. I also wanted chemotherapy at the center. As we grew, I added other services that, to me, are really important, such as nutrition, psychology, psychiatry, yoga, massage therapy, physical therapy, acupuncture, etc.
When did the center open?
EAD: Five years ago. We have seen close to 100,000 patient visits and serve the tristate area. We are not a center that caters just to the wealthy; we take Medicaid and [those insured by the Affordable Care Act].
You must be proud of the center.
EAD: Yes. It was important to us but also a challenge. The [medical insurance] reimbursement today is so poor, you have to rely on philanthropy to provide excellence of care.
Mount Sinai is at the forefront of innovation in breast cancer treatment. Could you tell us about new developments on the horizon?
Dr. Elisa R. Port: You have to remember that breast cancer is really multiple kinds of disease. For some [types], we have great treatments where the survival is quite high, but for others we have fewer options. One of the trials at Sinai, which is really exciting, is for triple-negative breast cancer [a particularly aggressive form], which is harder to treat. With those patients, we remove a snippet of tumor and develop models where we cultivate the tumor so we can potentially try out different chemotherapy agents before giving them to the patient.
The American Cancer Society recently changed its screening guidelines, pushing the starting age for mammograms to 45, changing the recommended frequency of mammograms, and stating that clinical and breast self-exams didn’t have clear benefits. What are your thoughts about this?
ERP: We’re opposed. Everyone agrees, including the American Cancer Society, that mammograms reduce the risk of dying of breast cancer. The issue is what people choose to prioritize. We know that mammograms aren’t perfect, and there are false positives, and that people get anxious [with those] results. But in our experience, most patients believe this is a reasonable price to pay to make sure you’re doing everything you can to [detect] a cancer early, to improve your chance of surviving, and also to reduce your need for more aggressive treatment.
EAD: Very few people are talking about how waiting and detecting the cancer later impacts quality of life. If [through early detection] you can have a lumpectomy and radiation versus [a later diagnosis that necessitates] more aggressive surgery, plus chemotherapy, that’s a whole different quality of life.
ERP: Understand that [mammograms might not make a difference with] some small but aggressive cancers or some larger, less-aggressive cancers. There’s no guarantee. But in regard to tumor size and delay in diagnosis, for the vast majority of women, we feel that mammograms are important, and most women would agree.
What do you see as the link, if any, between nutrition and breast cancer?
ERP: There is no specific dietary element that increases or decreases your risk of getting breast cancer, but we do know that obesity, and being overweight [in general], increases the risk, and if you’ve had breast cancer, being overweight increases the risk of it recurring. That’s probably related to fat stores being a big source of estrogen production, particularly in post-menopausal women. There is one other lifestyle factor that we think increases the risk of breast cancer, and that’s heavy alcohol intake. Alcohol in moderation is fne, and we equate that to four to fve drinks a week.
What is the role of exercise as a preventive measure?
EAD: Exercise is important, not only [to reduce the risk of developing] breast cancer but also for overall health. Exercise does not have to be running marathons; it can be as simple as walking for 30 minutes a day. I make exercise a part of my day. Instead of taking a cab, I try to walk. I carry a jump rope with me wherever I go, so if I have a few minutes, I can jump 100 to 200 times. I also carry a resistance band with me so that when I’m watching my daughter play soccer, I can do some triceps training. With my girlfriends, instead of doing lunch, we’ll do a walk.