Ologies with Alie Ward - Surgical Oncology (BREAST CANCER) with Donna-Marie Manasseh

Episode Date: October 9, 2018

(Bonus: I bleeped any curse words so you can share this episode with your kids and your grandma.)Yes, October is Breast Cancer Awareness month but Dr. Donna-Marie Manasseh spends 12 months a year as a tumor hunter, saving lives. She is brilliant, uplifting, hilarious and a hero, quite honestly. She sat down in her Brooklyn office to talk about prevention, diagnosis, prognosis, when to get screened, what to do if you feel something weird, how to look forward to mammograms, how men can help family members stay informed, self-care and how she unwinds. Also: getting help with boob honkery, and rubbing rocks on your pits. This episode might be required listening for literally ... everyone. All the people.Dr. Donna-Marie Manasseh is the Chief of Breast Surgery at Maimonides Medical CenterA few Breast Cancer Awareness resources: cancer.org, breastcancer.org, komen.orgA portion of Patreon donations this month were donated to breast cancer research.More episode sources & linksSupport Ologies on Patreon for as little as a buck a monthOlogiesMerch.com has hats, shirts, pins, totes!Follow @Ologies on Twitter and InstagramFollow @AlieWard on Twitter and InstagramSound editing by Steven Ray MorrisMusic by Nick Thorburn

Oh, hey. It's your brother-in-law who's so much more chill since he stopped drinking and started making ceramics, alley board, and you're listening to another episode of Allergies. So man, woman, child, pumpkin, whoever you are, if you open this to listen to it, congratulations. You're not fearless, none of us are fearless, especially in the face of really scary stuff, but you are empowered and curious and, quite frankly, a responsible person. I don't care how many empty water bottles you have in your car or that you sent jeans through the wash with gum in the pocket.

You're on it. You're about to get so informed and I have great news. This episode is uplifting as f**k it really f**k as. The info is so good that I'm bleeping the cuss words so that you'll make sure to send it to your moms and daughters and brothers. Maybe you'll show your uncle how to work the podcast app because breast cancer affects us all. We might be at risk for it.

We might love people who are and thisologist is amazing. She made me feel so much less scared and more hopeful and more empowered. But before we hop into it, just some nuts and a couple of bolts. Okay, thank you to everyone who donates to the patreon.com oligies page, which helps me pay an editor and lets me prioritize making these episodes every week. And thanks to everyone who gets themselves some goods at oligiesmerch.com. There's hats and pins and shirts. There's backpacks.

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Thank you. Okay. Surgical oncology, two words. What do they mean? It means being a tumor hunter and it's badass. So surgery comes from the ancient Greek for hand work. Who knew? And oncology also Greek is derived from tumor or mass.

So this surgical oncologist is the chief of breast cancer surgery at Maimonides Medical Center's breast center in the Burrow Park neighborhood of Brooklyn, New York. I don't know my way around Brooklyn, but I thought if you're on the East coast, that would mean something to you. But she graduated from Harvard Medical School. She's been working in this field for 22 years. She is in word, a boss. So I happened to be in New York and I got myself there with my little recording kit

and I let the nurses in the waiting room know that I was there to see this doctor. And as I took a seat next to this tidy stack of magazines and started leafing through them, a patient and her husband were leaving the office and he was carrying this folder of paperwork and we made eye contact and she gave me kind of a sympathetic smile. And it was the first of many times I tried not to cry during this. I had literally not even gotten past the waiting room door to interview this doctor. So I have never had breast cancer. I've never had a scare.

And I know women my age and younger who have been diagnosed who have been treated who are marching on and we all see the October breast cancer awareness marketing and I wanted to talk to someone who does this all 12 months out of the year to learn about her life and her work. She's passionate. She's inspiring. She's so, so funny. She's not only approachable as this like sparkling amazing human, but she makes a very scary

topic approachable too. We talked about boobs and boobs touched on boobs also heads up. The term woman is used a lot to discuss breast cancer patients. But of course, breast cancer happens to men, it's to non binary patients, trans patients as well. And we talk about that too. So you'll hear about different kinds of breast tissue, who should get screened when genetics deodorants making your body less hospitable to tumors and most importantly learn about

why being your own advocate might save your life and others. So fling your bra or someone else's across the room and get cozy for a heartwarming boob honking chat with surgical oncologist, Dr. Donna Marie Manasse. Now so you have been a doctor. You are a surgical oncologist. Yes. Right. So how do you deal with breast health and breast cancer and matters of that nature?

Everything breast at all times. All breast. All breast all the time. How did you, how did you choose this field of medicine and how did you choose medicine in general? When did you know like, I'm going to be a pretty good doctor. So I'll start with, when did I choose medicine? My father will tell you I was two.

Two? He would say I was two. I will say I was about five. That's still really early. Yeah. So there was a mechanic, a very good one, and I wanted to be a mechanic. My mother said no. I figured out the human body was the next best thing, but I love working with my hands.

I've always had this guardian angel complex, you know, coming in and swooping in and trying to save someone. And I wanted to do that with my hands. And so I think that's where my choice in being a doctor came in. At about 10, my aunt had heart disease. I thought about heart surgery for a very long time, bought all the heart things you can buy, tried to read up everything that had to do with the heart. But felt at about, I'd say the middle of my residency, or actually slightly just before

my residency, I spent time with a surgical oncologist, someone who deals with all types of cancer in the body. And I just felt that his connection with patients and just that relationship you had with a cancer patient was really special. Specifically, Brest, unfortunately, came to me because the woman who would have been my mother-in-law was diagnosed with breast cancer during the time I was in research. And I had a very, very close relationship with her. And just felt that during that time, about two weeks before she died, it came to me that

that's what I should do. And I spoke to her about it, and she said, I think this is exactly what you should do. Just to note, when you hear that soft kind of sparkly chime, that denotes times during the interview that I thought I was going to lose it and start crying. But I kept it together in front of the stranger. Brest surgery is unique. Unlike other surgeries where you see a medical specialist, they send you to the surgeon, and then after that, the surgeon's like, you're fine, I'll see you later.

With Brest, it's a lifelong relationship. We are the ones, after a woman gets a mammogram, that kind of starts steering the ship. We have the individual have surgery. We recommend the medical oncologist. We recommend the next steps. And even though it's a team effort, there's this continuing of care that happens, and there's an attachment that happens between the surgeon and the patient that I think is very unique to breast surgery versus other types of surgery.

With other kinds of cancers, is it monitored for the span of your life like breast cancer is or is breast cancer a little bit tricky that way? It depends. So other cancers, for the most part, are monitored for a very long time, depending on how early your stage was. Depending if you're an early stage, you would be treated, and the expectation would be if everything is OK in five years, depending on the cancer, that you would not need to follow up.

Things that are later stage, unfortunately, that may spread. We want to keep a closer eye on for a longer period of time. And that's actually a good thing because it means that we can treat something. So before we dive further, let's just have a quick meet the boobs segment. So please pretend that I'm wearing like a beige 1980s suit and a wide tie, and I'm talking into a game show microphone as I run through breast anatomy in like four seconds. So you may know them as the milk producing glands, they're the lobules, and there are about 20 to 40 of them making up each lobe.

How many lobes in a breast? If you said that adult females have about 15 to 20, you want a few more seconds of this segment. They're passages connecting the lobes and the nipple, the ducks. Now lymphatic vessels help flush things out and fight infections, and that stroma is on deck as the fatty tissue and ligaments that surround it all. You get all that? OK, but we all know a breast is not just a collection of milk plumbing.

Breast is different. If you go into the whole nature of breasts, it's not just a physical thing. There's a whole social political background to breasts. Breasts have a very different meaning than say you're colon. And so I think because of that, there's a longer lifelong relationship. Even though for most breast cancers that are early stage, after five years, you're pretty much OK, but most women don't want to break that bond because either they think we're a good luck charm or it's a very touchy subject to breasts.

Women identify their breasts in very unique ways, from sexual to feeding their children to part of their identity in some way. It's kind of what makes us a woman versus a man in some respects to some people. And I think because of that relationship, when you're taking care of that part of someone's body, they cling to you longer and feel, you know, just in case, let me just continue to see this person. So I think that's what makes it a little bit more unique. Do you think treating breast cancer or addressing breast cancer is different in America because

of our cultural relation to the breast, where it is breast are so sexualized, like you can't show a female nipple on Instagram, but like you can show just dozens of male nipples in one picture. It doesn't matter. Do you think that that hinders or helps the way that you're able to do outreach and treatment? That's a good question. I probably would say a little bit of both. I think that it helps because previously in decades, a lot of women died from this disease

because of the tremendous fear associated with what we did for women with breast cancer. Decades ago, we were to remove an entire breast and disfigure a woman, actually. Today we have so many options for treating breast cancer, including even if we do remove the breast, the reconstruction options are incredible. I always challenge my male interns to tell me which one do they think is real and not, and they always get it wrong. Which is, I'm glad, I have great plastic surgeons. But I think because how we see the breast and the way we are in this country, I think

earlier decades, it was a hindrance. I think today because women are much more empowered and women are much more independent, not defying themselves just by that particular area, I think that it helps because we speak up a lot more. The reason breast cancer has so many options is because we've done so much research. The reason we've been able to do so much research is because we have so many advocacy groups that raise money for research. The reason we have so many advocacy groups is because we are talking about our breasts.

We are not going to sit quiet and say in the corner, I don't want to deal with this, I don't want to address this. We tend to pull the sisterhood together and say, I'm here if you need it. It's not a dirty little secret anymore. In that vein, how important is getting the word out about self-exams? I'm a big advocate of self-exams. In fact, when I do my little outreach programs, I always make the following statement that if you look at the literature, it will tell you doing a monthly self-exam is useless.

It's not going to help you find anything. It hasn't been proven to change survival whether you do it or not. I say from a common sense perspective, when you do a mammogram, you are not guaranteed because your mammogram is negative that until your next mammogram happens that you'll have a cancer. Any time after that mammogram, and the only way you're going to find it is if you actually examine yourself. I always tell women, a self-exam is very cheap.

You can use your hand, you can use somebody else's hand, don't really care who does it, don't care where you do it, but just have it done because you will find something. In fact, people do come in that have felt something and will say, I just had a mammogram because mammograms are not made by God. Basically, they're not perfect. Use all the tools that you have in general for your health to try to diagnose things as early as possible because cancer is best treated the earlier it is. If you do a mammogram and you feel something, don't say my mammogram was negative, I'm

good. No, something's not right. You're only going to figure that out if you examine yourself. Some women aren't comfortable with their breasts. I say, get a spouse, get a girlfriend, I don't care, get the dog, I don't care, get somebody to examine you. If they feel something is just off, see a healthcare provider and I hopefully will tell you it's nothing.

They ought to have an app for that. I think there should be an app. I do. I'm trying to work on the app, but I can't figure out the hands part of it. There's no hands on phones yet. I mean, like a task rabbit, just come over. Just come on over. Just palpate my boobs.

And then let me know. It can be anything. Send an emergency text message to me. It'd be good. Let me know. Now, can you break down some stats? What are we at currently with how many people get breast cancer? What are survival rates like?

And also, how has that changed since you started practicing? So if you look at the statistics, like the American Cancer Society puts out, still over 250,000 women per year diagnosed with breast cancer. In the U.S.? In the U.S. Unfortunately, about 40,000 still die of the disease. It's tricky because what people don't recognize is that breast cancer is made up of very different types of breast cancer. It's not just one type of breast cancer.

There's a spectrum. So remember all those different things that make up a boob. So different types of tumors can occur depending on the location in the breast. So a ductal carcinoma may start in a duct and a lobular carcinoma in a lobe. Some have not spread to the surrounding breast tissue, but others called invasive HAV, which is why early detection is clutch. So how does this cancer even start though? Well, Dr. Manasi is incredibly gifted at explaining things in understandable terms.

And she's also, incidentally, hilarious. And so the incidence of breast cancer has increased more so because our technology is better at picking up the smallest little detail. And in our bodies, there are probably cancer cells circulating all the time. Because remember, a cancer cell is a normal cell that just went a little quirky. And your immune system, you know, is quirky, funky cells. Yeah, just a little wacky. And so the police, otherwise known as your immune system, go around and take care of

them. When they don't take care of them, or worse, when those cells recruit the police to their side, so now you have dirty cops, then they take over. Then the cancer cells grow. They're not foreign invaders, they're actually your own cells. And so these cells, as they circulate, if they get destroyed, great. If they don't, they grow. And so if we're picking up some of these cells that are actually really, really early, like

haven't figured out how to invade, but on a mammogram they show up, and on my biopsy it shows up, now I'm treating you as a cancer patient. Whereas before mammogram is, believe it or not, some of these we didn't pick up and may not have done anything. So because of better awareness and early detection, we're seeing more cancer patients, but better prognoses for them if treated early. But the problem is, once we know about it, we don't know exactly which ones really will do something or which ones won't.

We're not there yet. I think we will get there. But for now, we have to go with what we have. And we can't just assume somebody has something that's probably not going to be an issue and God forbid it's something later. Can you break down? Let's have lump 101, boob lumps, break it down because I know that you can have a fibroid, you can have a cyst, you can have a tumor.

And I know that there's probably a lot of confusion if people feel something like, what are we dealing with and how do you tell the difference and what should someone know? So the basic rule number one is if you, which I tell my high school girls to do, if you examine yourself regularly, be familiar with your breasts. Anything different than what you're used to feeling is a problem, a problem that needs to be investigated. There is no, this is exactly how cancer presents. There are many different ways it can present.

Sometimes it presents with a lump or a mass. Sometimes that lump or mass feels like what we think should be benign, but it's not. Just because of the features of the cancer. Sometimes it presents with the breast being red and there's no mass. Sometimes it presents with the nipple being an innie when it's usually an outie. Sometimes it doesn't present with anything at all. So I always tell women the best thing to do is to be familiar with what you're used to feeling like and if the breast just feels different and do it around the time of the

middle of your cycle. So not because your breasts get lumpy during your cycle, but do it at the time when it's the middle. You're more likely to feel if there's any kind of a change. PS, if you're ever like, why do my boobs hurt sometimes? Why boobs? Why? Okay.

I just looked it up and they are in cahoots with your ovaries. Clearly, they're making mischief. They're making hormones. So estrogen's like, oh my God, let's elongate these ducks, let's have a baby. And progesterone is like, hell yes, I'm on board. I'm going to increase the number and size of these lobules so we can get ready to feed this baby we're going to have. And after ovulation, progesterone is ready to party, makes blood vessels enlarge, fill

with fluid. These things are engorged, they're tender, they're swollen. These are like, do you love this? And you're like, no, I'm literally studying abroad in Portugal for a year. I'm not having a baby, maybe ever, definitely not this month. And your ovary's like, okay, fine, I'll try again in another 28 days until menopause. And that's why your breasts change throughout the month. Also, there are benign cysts and fibroids.

But if you notice anything that's off, get it checked, doctor's orders. And you can have things like cysts and benign stuff for sure, but it's better to have someone investigated and prove that that's what it is instead of saying it's probably that and letting it sit. Now you were talking about cells get a little wacky and kind of don't get caught in time. So how much do you think lifestyle or just like stress management or nutrition is a factor in trying to stave off cancers, particularly breast cancer? So if you consider that the immune system is what we use to fight off cancers and other

evil spirits in our body, then stress and all the things that we're talking about nutrition actually affect that. So sitting here in New York, it's hard for me to tell everybody, try not to be stressed children, but it really does play an incredible role. In fact, if we were able to live like Buddhists and not be stressed, we would eliminate the three top killers of humans. Like disease, cancers. So even when you think of mental health disease, Alzheimer's, these things are all kind of

have some degree of stress because what stress tells your body is you need to be a constant state of activity. And anything in constant state of activity eventually is going to wear itself out or not be as good. And so think about it as your immune system gets worn out and can't look, I can't do it. Your immune gets basically burned out. And so it can't now protect you in any particular way.

As far as I'm concerned, I'm also Jamaican. So nutrition is everything. We are not at the point yet in medical science to say, oh, you can treat this cancer with bananas. However, we do know that fried foods, red meat, there are certain things, pork, there are certain things that are inflammatory foods, things that make your body stay in an inflamed state. We'll definitely go further into this on a future rheumatology episode on inflammatory

disease. But quick rundown of foods to avoid according to a Harvard University medical site. Refined carbohydrates like white bread, pastries, pasta, all of the things you eat when you're sad. French fries and other fried foods, soda and other sugar sweetened beverages, red meat and processed meat like hot dogs and sausage, also margarine, shortening, lard. Now we all see these items and they're like in the nodoi bad for you column because we've heard for years and they're calorie dense.

So it's easy to say, I make my own choices. I don't care about the calories. But when you look at it from a, well, my tissues hate this and it impairs my ability to clean my body of cancer standpoint. Yeah, that's a whole new ball game. So that's a good point, Doc. That inflamed state basically is creating a fertile soil for bad wacky cells to continue to grow.

That's where nutrition comes in. And I think if you look at some of the chemo therapeutics, the drugs we use to treat some of these cancers, some of them come from trees. Like the Pacific U tree is a tree that we use to create one of our chemo drugs. It's very effective. So Dr. Manasi is talking about the chemotherapy drug with a brand named Taxol, cute, fun, quick history. So in the early 1960s, a 32 year old botanist named Arthur Barclay collected samples in

the forest of Washington state to be screened for possible anti-cancer properties, grabbed some bark from a conifer that was otherwise like pretty useless to the lumber industry. Nobody cared about it. Now two doctors, Dr. Wall and Dr. Muni, found that among 30,000 botanical samples, the Pacific U had a negative effect on tumor growth, which is positive effect on your boobs. So later a doctor by the name of Dr. Susan Van Horwitz figured out exactly why it worked. So the active compounds cause cancerous cells to rip apart their own DNA and they die. Now after decades of testing, the medicine was approved by the FDA in 1994.

It's known generically as paclitaxol, I think. And it can also treat ovarian cancer, lung cancer, cervical cancer, pancreatic cancer. So that's just one way a plant can save a life. So another reason to believe in the words of Clyboan. So you can extrapolate to think that if I eat enough broccoli, if I need a certain, a good fruits and vegetable diet, plant-based diet, that I'll get the benefits of some of those items instead of being in an inflammatory state. Now you're in an anti-inflammatory state.

So even if you have a cancer cell floating around in your body, it won't grow. That's the difference. I think in breast cancer health, and I think cancer in general, we were first attacking the cancer cells. I think we've switched to fixing the soil. Oh, that's so interesting. Which is cool, right? Yeah.

So that's something that you've seen change a lot since you've been in practice? Absolutely. I think it's a wonderful time for cancer medicine right now. The amount of discoveries with respect to how we look at the disease, with respect to the treatment of this disease, has changed more in the past, I'd say, 15 years than the past century. That's crazy. What do you owe that to?

A couple of things. I think technology is one. If we don't have the technology to be able to look at these cancers in a specific way, we now can look at the genetics of a cancer and target therapies for that. I think, as I said before, the advocacy is a big deal. You need funding and money to fund these research items and to develop these technologies. And I think Coleman is a perfect example, has raised a ton of money, along with many other organizations, research foundation, et cetera.

These funds go specifically to research, which then allow people to develop the ideas they have and to look at and understand the cancer cells and what they're doing and develop ways to treat them. Because we've gotten so good at trying to finally understand what it's doing, we now can figure out, oh, hey, this drug that we developed may be good for this situation. How do you feel about genetic screening, like the BRCA? Is it BRCA2? BRCA1 and 2.

How does that impact the decisions that you make and also the prophylactic, like double mastectomies or partial hysterectomies? How much do you see people just saying, you know what, I've got the gene, I lost someone in my family, let's go? So I'll tell you a story. But first I'll say, I'm a big advocate in knowing your genetic health. I think more information is always better. I think in order for you to survive and live well, it's all about knowledge and information.

And so what we used to say is if you have the right family history, meaning either you're a certain heritage, Ashkenazi Jewish heritage, or if you have a number of women in your family with breast cancer at a young age, you're a potential candidate for having this gene, let's check you. Now I think what we would more say is, personally I think almost every woman should probably be tested if possible. That's kind of hard to do. But I think somebody in the family has got to be that index person, right?

Somebody's going to be that first person. We haven't caught up from an insurance coverage perspective to allow that to happen, unfortunately. There are those things out there like 23andMe and those type of genetic type stuff, which I think is important, but I think it's more important for listeners to recognize that if you find something on that test, it needs to be evaluated because nothing's perfect. And I think if it came back positive, you need to see a geneticist and check it. But the story I'll tell you, which will probably leave an imprint, is a young woman that's one of my favorite stories, is a young woman who she's probably about 29 and her aunt got

breast cancer. Her aunt's probably like in her mid-50s, 60s, so not somebody really young. But being empowered and who she was, she encouraged her father, the aunt's brother, to be tested because, hey, your sister's got breast cancer, and it's the only person in the family, by the way, you need to be tested. And their father's like, yeah, yeah, yeah, and ultimately he gets tested and, lo and behold, he happens to carry the gene. So she decides, well, me and my sister have to be tested, and she also ultimately has

the gene. As I said, in her 20s, she's been getting imaging like the MRI and such to keep an eye on things. And about two years later, we find something on her MRI. This little something, thank God, was a stage zero, very, very early cancer. If she had not done that, any of the things I just told you, this young woman would have presented in her 30s with an invasive cancer. It does, but it's also great, right?

Because she was empowered with the information, we started screening her. She's 20-something years old. We were not going to screen her for anything. She had one aunt with breast cancer. She was not going to be screened for anything. And I love seeing her because I say, you saved your own life. Oh, just going to drop another one of these bad boys. Right.

And so it's so I think when it comes to the genetic question, I think more information is good. I think people get scared by information because they don't want to know. But the problem I always tell them is that eventually you will know. Yeah, I not know when you can do something. Oh, that's so true. Right. That's true for everything from car repairs to retirement funds.

Car repair in particular is like, I don't know. I don't know. Please keep starting. Please keep starting. Yeah, exactly. And now what about can you tell me a little bit about really quick about imaging? What imaging methods do you recommend? I know mammograms are supposed to start. We are 40.

Like now nowadays, is it better to do MRIs? Is it better to do mammograms? Like what do you what do you suggest? So we have three modalities for imaging breasts, mammogram, ultrasound and MRI. Right now, the recommendation is mammograms, average risk person started age 40. I don't care what any other news media says. That's what you do. And I'll tell you why I believe that strongly.

One of the literature backs it up, but I'll tell you why. But mammograms is what you start with. If your breasts are dense, which is determined by the mammogram. So you can go fill yourself, people, but really it's dictated by a mammogram, not by your exam. Then we add an ultrasound. So now you're getting an ultrasound and mammogram because it's just two ways of looking at the breasts.

The mammogram kind of looks at it takes a picture of the breast, looks at the architecture, ultrasound looks for anything that's cystic or solid. And then we have what's called an MRI, which we use more cautiously. We don't use it as a screening tool unless you have a gene or strong family history or we're evaluating something. And that looks more at the activity that's in the breast itself. So the average person, average risk, it's a mammogram ultrasound starting at age 40. OK, people have said in the news that mammograms, why do we need to get a

mammogram that they always tell my breasts are dense or they're not going to see anything? The problem is a mammogram, even if it doesn't see something for every person, it's much better than me examining you. OK, by the time I feel something, the mass is now a larger mass. A mammogram can pick this up before it gets to a certain size in some cases. So even if it's 50% in the worst case scenario at picking something up, 50% is better than zero. Right. You take away a mammogram.

We're now back into 1950s and 70s before the mammogram started. Mammograms, side note, were invented in the mid 1960s. And then in 1976, machines became more widely available for routine screenings. Now, also I am neither a lawyer nor a doctor, but opinions on this topic vary. And when it comes to your own health and screening schedule, this is a free podcast that can neither diagnose nor treat diseases. So please consult your own health care provider. But yes, back to the old timey days, when doctors diagnosed things by

observing leeches and consulting oracles and looking to the sky to ask Ravens, who is in danger? Right. Oh, God, it's crazy to think that there was, I mean, I realized that there was a time before mammograms because there was a time before, like, electricity. But it's still like to think that even in the 70s. Yeah, 70s, 80s, actually, people are still questioning it. Because, again, it's technology that's far and it's uncomfortable. It's not fun. But in the same sense.

And I joke with people that I talk to in my outreach, because I say, if I we didn't have a mammogram, and if I said I have a test, I could pick up a cancer 50% of the time, people would be clamoring for it. Right. They'd be clamoring for it. If I said, you can't get it. No, no, no, I need it. I need it. Do you know what I mean? So if we have, if something else comes along, that's better, by all means, let's compare mammogram to that. But if we don't have anything else, except for my right and left hand,

I'm going with the mammogram. For sure. Even though I'm good with the right and left hand, I'm still going with the mammogram. Now, do you have any tips for making a mammogram? Just a breezy vacay of a doctor's appointment. Just so fun. Absolutely. So what I do my own is I actually schedule a dinner right afterwards and shopping.

I often will tell my patients to take and I'm little. So it's not the most comfortable thing in the world. But I often say take an Advil or Motrin to kind of preempt it, if you will. And then have planned. I always have planned with a friend of mine. She happens to be my radiologist, so it makes it easy. But a friend of mine, we're going to dinner afterwards and we're going shopping. That way you have something to look forward to afterwards, because it's uncomfortable.

It's not there's nothing I'm going to be able to do. And the reality is if the technician eases up on you, she's not compressing the tissue enough to be able to see what needs to happen. So going back, the way a mammogram works is it compresses the breast tissue and everything that's breast kind of spreads out and things that are not like a cancer won't. So they don't compress it enough. Then things are going to look like their cancers when they're not.

They need to compress it so that if something is there, they can see. So treat your boobs like a panini or a turkey burger in a George Foreman grill. It's just better squished. Now you and your family can enjoy the tender, juicy and delicious taste of grilled foods in just minutes. So I'm in the machine saying compress away now because you're not getting a second chance. And then I need to go get my wine and dinner. So that's what I do.

So you need to do something to slightly annoy your radiologist. So she has a less tender touch with you. Like just piss her off just enough just enough so she'll make sure she gets it in. And you're good. You're good. That's great advice to schedule something fun after you have to. I think you absolutely have to. I think I should do that for my tax appointment. Everything. I think it's hard to do.

I mean, if you think about it, if you remember when you were a kid, when you got a vaccinated, they gave you a lollipop or a toy. Right. Why should that change? Because I'm 40 something years old. I mean, I think that's I think I should not change at all. Oh, that's such good advice. It works for me. It works for me. And now so those are the imaging modalities.

Can you run me through a couple of the top therapies? Like let's say that you get, you know, a diagnosis, which, you know, two hundred and forty five thousand women or and men a year, because it doesn't just affect women. It doesn't just affect, you know, it affects men non-binary. So many people. What what are the plans of attack that you have? So what's good is I can tell you there's a tremendous list of the plans of attacks.

I'll put them in categories to make it easy. There's three ways we attack this. Sometimes we use one way, sometimes we use two ways, sometimes we use all three. One is surgery. So getting it out. Two is some kind of drug therapy. OK. And three is some kind of radiation therapy. And depending on basically the specifics of the tumor, the tumor tells us what it's going to do.

And we give it an answer back to make sure it doesn't do what it plans to do. This is like the worst version of call and response in country music or a rap battle involving one person who just obviously sucks. So if you have a really early cancer, let's say a noninvasive cancer that was picked up on a mammogram, very tiny. Most times you can get away with just surgery. Sometimes we might give you radiation to that area if we save the breast tissue. And sometimes we give you a pill.

If you go down the path of an invasive cancer, which means it can spread from the breast. Now we're not just protecting the breast tissue, but we're protecting the other parts of your body. So how likely it is to do that dictates what we do in terms of drug therapy because surgery and radiation can only go to the local area. Drug therapy goes through your entire body.

Oh, God. So if there are any cells anywhere in your body that we can't see today, the drug therapy presumably eliminates it. And now in your surgery, because you're a surgeon. I am proud one. Well, like you're in there. Yeah, I love it. Net on, you got a hat on, you're scrubbing up, you got a mask. Like you're like, I think if you are ever in a job

that is also a Halloween costume, like you're winning. You know what I mean? I think that's great. That's right. That's right. And so what is it like for you when you're like, OK, it's surgery day. I'm getting in there. Do you have like a routine, like a music you listen to to pump you up? Is it how often are you in surgery? Is it like every day or once a week do you do it?

Like, what is that like? So surgery, for me, is the point of it all. It's it's me doing battle with this disease that's trying to take someone's life. I often say I operate on on Mondays, Mondays and Fridays, occasionally Thursdays, but usually it's about two to three times a week, depending on what's going on and depending on what the needs are. But on Monday morning, you know, you're dredging, I'm going to work and I get to put my pajamas on.

I said, it's my favorite outfit in the world. If we're up to me, I'd be wearing scrubs and clogs all the time. It's my favorite thing. So soft. It's it's just it's it. It's it. First of all, I'm a little bit taller because I'm wearing clogs. That's even better. And I wear a scrub hat, so it's just it's just the best thing. But I think it's a privilege and an honor to be that intimate with somebody.

I think everyone can identify with the fear of going to sleep and and putting your life in people's hands. And I think take that extremely seriously. I my ritual is to pray at the sink. I asked for guidance of my hands and wisdom to do what I know that I've been given the talent to do. And thankfully today, we can see the cancers on our imaging, but we don't have these big gnarly cancers that we're taking out.

So I'm usually taking out what looks to me mostly like normal breast tissue. But I know when we take the picture of it, I'll see this cancer. And I sneer at it usually and say, you're out. And, you know, and then put this patient back to what I call an empowered state. She's kicked cancer's butt and I was there to help. My second favorite part of this whole experience is going out to the family and getting my hug. That's my favorite, especially when the spouse is, you know, six feet.

I'm four, I'm five, two, if I'm lucky. And this guy six feet, something just grabs me and just get because you get to feel in that moment, the intimacy of the human experience of what just happened for me. You know, it's what I do. I've been doing it for a number of years, but for this person, they have not. And there was something that was threatening them and we just took care of it. Wow. Yeah.

Do people ever ask to keep it? Actually, funny, not the cancers, the benign stuff I take out, they want to see. But the cancer is that I've never gotten asked that. The benign stuff, they want to see it. Can I see what it looks like? And sometimes I'll, we can't give it to them for sure, but we may take a picture of something. But rarely, you know, we can't, we can't give people body parts.

Yeah, I don't know. You're like, it was mine a minute ago. Right. Exactly. I said, yeah, but now it's mine. So. And so to you, I mean, you must get updates and stories from people all the time. I mean, I imagine that it's kind of like you have this big growing family. Yes. Right. Yeah. Did you anticipate that when you started this job?

Did you realize like, oh, I'm going to have hundreds of people in my life who I feel like really connected to and invested in? Yeah, no, not, not at all, especially because as a youngster, I was more of kind of like to myself and I had maybe one or two really close friends, but I wasn't the person who had like a horde of best friends and family. And with my patients, I do. One other one of my favorite stories is there was a young woman that I diagnosed the week of my 34th birthday and she was 34 years old.

And of course, she comes in and attractive and, you know, just full of life, etc. And she felt this mass. And there are there are many times when you examine somebody, your heart just drops into your stomach and you just know. And she was coming in with a full thought that this was going to be like a sister or something. So her mindset was different. And basically we treated her and we became actually really good friends. And one day she sent me a picture and I'm looking at the picture.

And this is like four or five years after her diagnosis. I'm looking at the picture and trying to figure it out. And you think I'd figure it out, but it just didn't make sense with her. And it was an ultrasound of twins. And so I like in tears are just kind of like, you know, I'm somewhat a part of that. I mean, she has she now has two beautiful boys are 10 years old. But just that whole process she had gone through and being a part of that process, she is family. Any time she comes near this area, we try to get together.

And I look at those boys and like, you know, just how our whole relationship started. It's just amazing. It's an incredible experience that I would do over and over again. There are a lot of patients that are older that will call me their daughter. And my staff will say, I think your mother's outside. I'm like, no, my mother's in Florida. They're like, no, that's my daughter. No, that's my daughter. So it's really, really cool. It really is.

I think that's a cool part that I just did not anticipate, but I absolutely love. I mean, just in this interview, I've already had to try not to cry like five times. Lost it. Like, have you ever like, how do you compartmentalize and not just be like, oh, God, emotions? Because I it's what you do is so touching, like it is. So so when it comes to and we've had a couple of patients that really will grab you. I'm sorry, I keep telling you stories. No, I love it. It's the way I work.

We had this one couple recently, they're traveling from abroad, but they happen to be here for work and young women actually fully pregnant, probably like a week from delivering. And unfortunately had a the breast assistant feel right to her and she was rushed to us. And sure enough, it was going to be positive. And she actually was this very strong, like, nope, it's good. I understand. But her husband started to just break down. I can do women crying. I can't do men cry because the power

of what's happening becomes real. And he just talks about how you know each other and you need to save her. I've noticed for 17 years. Oh, I'm going to cry. Exactly. And so what I do in those situations is number one, I have to remember that when somebody looks at me, they look at me as you're going to help me. So if you're on a sinking ship and the Coast Guard shows up and starts crying, you kind of get a little nervous.

So so I have to tell myself that a number of times because these things are I'm a very emotional person naturally because I think you have to be in this field. But I think it's more important that that patient needs to know that if she's not worried, I'm not going to be worried. And I try to relay that now I'm not made of stone. I will step out if it gets too much. And that was one case where I said, I'll be right back.

I'll give you a minute. And I walked into a room with my PA and the two was just kind of like, OK, let's try to keep it together because this is a human experience. You know, you have this. This should be the best time of their lives. They're having a baby in about a week or two. And I just told her that she has cancer in her breast. It's it's surreal, right?

And now what do you do to kind of decompress? Do you think about work a lot when you're off work or do you have like a very compartmentalized life where you're like, I'm off work. I'm home and with the family, with my pet parakeet. I don't know if you have a pet parakeet up, but you know what I mean? Or do you think about work and read articles a lot when you're not at work? Where is that line for you? So I've never seen this job as work.

That's number one. Oh, wow. Yeah. It's something that I really enjoy from a physical perspective and an intellectual perspective. So reading about these things is is actually very enjoyable to me. So I yeah, I will read outside of work to figure out what was going on with my patients, et cetera. I also like to write and try to write down and capture these human experiences. And as you can tell by that back wall, I love photography.

That's all mine. Oh my God, it's beautiful. Yeah. So on the wall behind me were about a dozen framed, enlarged photos that looked like professional posters of gorgeous flowers and birds and sunsets. Things you want to stare towards and breathe deeply at. And next to her pictures on a hook hung her freshly pressed lab coat, which is embroidered with her name over the breast pocket and the juxtaposition of science and art and purpose and pastime formed kind of a scene that would almost be two on the nose for an indie film, but it was real.

And I loved it. That is my go to device when it really, really hits the fan. I just grab my camera and I go somewhere. And I also have probably one of the most incredible husbands in the world who has had his own set of tragedies and has developed basically the strongest emotional quotient I can I can think of and is really good at being humorous when he needs to be and and quiet when he doesn't kind of like our German shepherd, but he really does kind of like let's go for a ride.

He really does how to read me. So having that and having, I think, a strong support family and a support system, I think it's true for any job you're in. If you're having a tough day, I'll either call my sister who will make me crack me up with something my nephews did or I'll call a friend of mine. Or, you know, having that, I think is very important for everybody. And so that's how I kind of keep it together, if you will. And how do you recommend that your patients keep together?

If someone's newly diagnosed, what is the best thing they can do for themselves to really beat it? Like, what's the best course of action they can take? What's the best mentality to have? They need to laugh. I try to make them laugh. Really? Yeah. Humor is the biggest thing.

You naturally feel really good when you laugh because, thankfully, we have a disease process that is actually, for the most part, very, very, very treatable. Knock on wood. I've ran across few cases where we really can't do anything at all. And usually it's because, unfortunately, somebody was so scared that they took a long time to be seen and diagnosed. For women who are getting their mammograms regularly,

usually it's a very good outcome. It's rare. In fact, it kind of shocks us sometimes. It's really bad. So I tell them, listen, look, this sucks for sure. No one's debating that. But you are going to be OK. I've been doing this long enough to know that and you need to find moments of pure joy and whatever that is for you, go and do, you know, and try to keep the humor if you can, but also pay the piper when you feel upset.

You need to acknowledge that this is something that's affecting your mortality and it's important to whether you want to write it down. But pick that thing that makes you happy. My sister often says, because I ask her how does she always stay happy because she seems to be happy all the time is she seeks. She craves joy, like she's craving water. So in every moment, what's the thing that's going to make me happy right now? Oh, wow. And if you do that,

little moments turn into big moments turn into a lifetime. Oh, that's such good advice. Yeah, she's good at that. She's really, really good at that. And she's got to start it. She's got to do some tests. She's got to do something. Since I've sat down to edit this episode, the last few days, I keep asking myself, where or how can I find joy? And boy, howdy is hard, but it works.

What do you recommend for partners of people who have been diagnosed? So for caregivers, I often recommend one, we have a lot of support groups. And I'm sure there's tons of online things you can go to. But the simple things are to just really be there for the person. Don't feel like you have to constantly try to help or talk about it. Sometimes you distract them. Let's go do something else. Let's try to do something that we just wanted to do or let's continue. Nothing is not that things have changed, but they're not finalized.

We're not doing a will. This is not a death sentence. Let's try to just create a new reality for ourselves and just be there for the person. And sometimes the person won't want to talk about anything. Sometimes they don't want to talk about the cancer diagnosis at all, you know? So I think being there for the person for whatever they need is the best thing that you can do and saying, look, I'm here if you need me. That's all I can do. And how do you feel about October?

I've always been curious about this because it's like October. It's breast cancer awareness month. And you're like, I can see that it's like great. Everything from like Delta Airlines to like Pepsi or whatever. It's like pink, pink, pink, pink, pink. But like, but then you're like, what about the other 11 months? Exactly. That's my thought. I'm like, OK.

Breast cancer doesn't happen, just not October. Right. You know, I I love October because I was called my rock star month. That's usually why I do a lot of talks. I love October for what it symbolizes. If you think about how breast cancer was viewed in this country prior to Betty Ford coming out and saying I had breast cancer. I just cannot stress enough how necessary it is for women to take the time out of their active lives

and take an interest in their own help and their own body. Early detection is the secret. Edith Bunker coming on television and saying it. Women were scared. They didn't say anything about breast cancer. We didn't talk about it. That's so crazy. It is. Right.

Because we're not that our generation is not like that. Right. And that fear led to death plain and simple. Straightforward led to death, because you didn't tell anybody anyone see your doctor. I think because it's in your face so much October, that's actually when we see more patients for mammograms because people start thinking a little because it's right in front of you and people start thinking about a little bit more.

So I think the advocacy and the awareness that happens with October is necessary. With that said, I often tell patients breast cancer just doesn't happen in October. We do talks outside of October and you need to be evaluated outside of October. Some of my patients are sick of October because they're tired of the pink, they're tired of the emphasis. But I have to remind them that there are a lot of women out there who have not been in your in your shoes or are yet to be in your shoes.

And that's who October is for. It's not just to celebrate the survivors. I think it's more to celebrate the ones who will become survivors. Yeah, God, that's I to think that there are a lot. It is with 250,000 people diagnosed a year. There are so many people out there that don't know that this is going to become their cause, right? Exactly. Exactly. Have you seen anything change, you know,

shifting in terms of awareness for patients who are men or who are trans or who are non-binary, like having it be less of a of a woman's issue necessarily and having it be more of a could happen to anyone. So we're we're trying to, in fact, when we do our talks, we're trying to mention that a lot more increase our awareness. And for the trans population in particular, it's actually a relatively new issue. It's funny because we were talking about this this morning at our conference because these individuals are taking estrogen.

And what we know about breast cancer is estrogen is involved. So it gets concerning when someone's actively taking estrogen for good reasons. We don't want them to now increase a risk of something that could be bad. So it's a relatively new area. But I think it applies to anyone across the board, male or female. If you feel something on your body that was not there before, evaluate it. I don't care what you are, anybody can get a cancer.

Anybody can get a cancer anywhere on their body. If it's something that's not normal for you, it doesn't hurt to just see somebody for them to say, eh, that's nothing. I'd rather do that than say, how long has this been here? Right. And plus, if you get a mammogram, you can go out to dinner afterwards. And get a toy. Don't get a toy. You have to get the toy. You can't just do the didn't.

It's the lollipop or the toy. Remember the lollipop and the toy. Don't forget the toy. The toy is important. The toy is very important. So figure out where you're going to go to the toy shopping. Dr. Manassi is a treasure. OK, getting back to hormones. And how how do hormones affect breast cancer?

Because I know a lot of people now, since the 70s, 60s, more people are on birth control. You know, more people might be taking hormonal therapies for other reasons. I'm on a hormone patch because I have overries that are like we're out before 40. So how how does hormone therapy affect that? Like, what do we need to know about that? So that's a controversial topic. But the long and short of it is we know we may not know the exact

mechanism of how estrogen directly causes a breast cancer. We know that women get it more than men and women have more estrogen than men. We know from some hormonal studies on hormone replacement therapy that some women may be at an increased risk. I have women who take hormone replacement therapy for most of their lives and never get a breast cancer. I have women who never take it and do get breast cancer. I think you have to do good nutrition, good health,

which means exercising, walking, at least 30 minutes a day, low stress if it possible. And those things build an immune system and build in an environment where things cannot develop. So you may take estrogen and alter, let's say, the cellular structure. So now it's ready to go out and conquer the world. But if the soil is not good for it, if the soil is too healthy for it, it won't thrive, right?

So I think the hormone story is going to be that for the most part, it's probably safe. I think moderation is the key to anything. If anyone is menopausal and they take hormone replacement therapy, I always say, take a break. If you can reassess, take the lowest dose possible. As human beings, we were not designed to take hormones or have hormones in our bodies forever. There's got to be a reason for that.

But with that said, you want to not bite someone's head off and you want to live comfortably and continue to have a good sex life. Then take it. And so I think it's important to look at life as a holistic approach, right? You want to be healthy. That's mental, physical, sexually and spiritually. That's what you want. And the way you do that is a multifactorial process.

It's not, OK, I'm not going to take a hormone and I'm good with breast cancer. That's not going to happen because you may have the genetics that allow that to happen. Your mom may have eaten something that allows that to happen. You may have lived near God knows what. You may be too stressed out. I have these patients who are great with nutrition and exercise all the time, but they're stressed out of their mind. What do you think that's going to do?

You know what I mean? So that's a good point. BRB, falling down a thought spiral, just evaluating my whole life. And how has your work changed in terms of breast implants? Because I know that I'm sure that in the 70s before that, that maybe wasn't around as much as a surgeon. Do you have to kind of advise patients differently if they've had them in terms of their screening and any kind of surgical answers to it? So luckily, the way our screen is done, we can screen women with breast implants easily.

It's just a different technique that we use in the past. Like when I was starting, implants were placed in the breast tissue specifically. The reason that was dangerous is because it would block some of the tissue from being seen on a mammogram. For the most part today, I think almost 100 percent, the implants are now placed behind the muscle or behind the tissue so that you can see all the tissue that you need to be that that needs to be seen on a mammogram. So for the most part, they're not put into the what we call the breast tissue specifically.

If you're wondering, how long have we as a species had boob implants? Well, then we have the same brain. So I looked it up and in the early 1900s, doctors were very creative and resourceful using all kinds of items as surgical breast implants from like ox cartilage to ground up rubber to wool to formaldehyde polymers. Strips of tape wound in a ball like yarn. They also used ivory and glass orbs as breast implants. They were like, it looked like boob, put where boob is.

No, silicone was also injected just free ballin around the breast tissue. And then in the early 1960s, Dow Chemical patented silicone breast implants and there were saline ones after that. Now, there have been all kinds of studies about the psychology of getting breast implants and I won't go into it because that's a whole other field of study. But you can always see the callology episode we already did if you're struggling with any body issues and you want to fortify perhaps your self-acceptance. Now, as a person who fills out an A cup only when I'm just bloated from a teriyaki bender,

I can tell you that pulling back the curtain to reveal cultural beauty sickness is helpful in accepting yourself. But from a medical standpoint, how does the doc feel about them? Thank for women who lose their breasts to cancer or to prevention. The some of the implants are incredible. You can't tell. I mean, I'll examine a patient. I'm like, wow, this feels really good.

Have you felt this? This is really some good stuff you got going on here. Which ones are those? Those are like the silicone ones, the silicone gel ones. I mean, I don't have a pair in my office, but if you ever get a chance, you have a girlfriend to say, hey, look, don't mean to be weird. But I've been instructed by Dr. Manassi because I think, again, knowledge is power and people have a fear of

if I remove my breast, what is that going to look like? Right. So I often will send them to my plastic surgeons who are incredible, incredible people and they'll let them feel the implants and say, this is what it feels like, right? So I think it's I think it's important. I like implants. And it's funny because it's funny because the A's want to be B's and C's

and the C's and D's want to go back to B's and A's. And I'm like, it's incredible. You know, I had a gynecologist on for the gynecology episode, Dr. Philippa Rubinck, and she said, no one likes their own boobs. Yeah. It's like, really? It seems like very few people really find that their breasts are they're either too big, they're too small.

There's no better lesson. You could teach your daughter and then love your body. Everyone hates her boobs. I was like, really? She's like, everyone hates her boobs. I think it's an image thing. I think in Europe, I think they love their boobs. And here we don't as much.

I don't we just I don't know. It's a thing. Yeah. I don't know what we think everyone else has. And that's what I'm saying. I think you need to, you know, pull your friend aside and say, look. Yeah, you know, let me see your boobs and I say, OK, mine are much better. I'm happier now.

That's the thing is maybe we just don't see enough boobs. I don't think I think that's what it is. We got to show more boobs. I think you have to see more boobs on TV. All right. And then you can make an assessment and you say mine are actually great. I always tell my patients, you know, if they're happy and they're healthy, then they're fine. They're great boobs.

They're great. They're healthy boobs. So then that's the best. Can we do a rapid fire round with some? Oh, sure. Sure. Sure. But before we take questions from you, our beloved listeners, we're going to take a quick break for sponsors of the show. Sponsors. Why sponsors? You know what they do?

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And this ad break allows us to give a ton of money to them. So thanks for listening and thanks sponsors. OK, your questions. So a couple more questions. Listeners who donate to Patreon get to ask you questions. OK. OK. Anna Thompson wants to know, does the makeup or shape of your breast factor into your risk of getting breast cancer?

No, absolutely not. The only thing that makeup and shape does is it affects maybe how the mammogram may look. So if your breasts are more dense, you need a mammogram and ultrasound. We still can pick things up on a mammogram, but not as easily as if your breasts were fattier. OK. Mm hmm.

Oh, it's so weird that some could be fattier and some could be denser. Yeah. And that's and that's somewhat familiar. That's somewhat genetic. All the women in your family have similar breast tissue. Good to know. It's good. It's important. OK, here's my pitch. Set all of your family reunions on European beaches

like happy, unashamed, nude lizards. You know the drill. Send me a postcard. Here is Karl wants to know, I've heard aluminum in deodorant contributes to breast cancer. No, God, no, people wear your deodorant. Please wear your deodorant. We get that question all the time, like, please wear deodorant. It does not.

There's no evidence to suggest that it does increase your risk of breast cancer. If it really drives your nuts, use something that does not have aluminum. Tom's of Maine, for example. But you have to apply it many times. I've tried and you just need to apply it many times. But please wear deodorant.

Right. And I know that those crystal rocks work for like one day. And then the next day, they just don't. They just don't. So it's just please wear deodorant, people. It's it. It's some as a New Yorker. Yeah, please wear your deodorant. Side note, I did fact check this. And according to cancer dot org, quote, there are no strong epidemiological studies

in the medical literature that link breast cancer risk and antiperspirant use and very little scientific evidence to support this claim. So there you have it. Also, can I tell you the weirdest story? You know what? I'm going to save it. I'm going to save it for my secret at the end of this episode. Also, if you've never listened to the very end of the episodes

after the credits, I tell you a secret. So if you turn off the show during the credits every week, whoo, oh, boy, OK, back to rapid fire. Becca wants to know as the unhappy owner of a set of lumpy boobs. I get mammograms and ultrasounds on these jerks twice a year. Is there anything else I could do to stay healthy? Is the six months between squeezes too much time? So yeah, anything she can do to keep them healthy in between.

First, don't call them jerks. They're happy and healthy. They're they're your friends, the girls. They don't mean to be disruptive. Lumpy is is not a bad thing. It's just a type of breast tissue. In fact, the lumpier, the more they sit up nicely for you, fatty breasts tend to go down.

So let's yeah, that's why when a 20 year old they're up here when as you age, they become fattier and they go look at your toes for a minute. So that's that's the difference. So be happy that they are the way they are. No, six months is not is doing it every day or shorter than that is not is not necessary. It hasn't been proven to find anything earlier.

I think the things we talked about exercise, nutrition, providing a safe environment for yourselves so that nothing grows a good soil is the best thing you can do in terms of prevention. I really do. That's good to know. I hadn't even thought about that, you know. Let's see.

Jane Ennis wants to know, how have we not developed a better way to screen for cancer than putting our boobs into a honka honka machine? Yeah, we just haven't. It's a good thought. I think in the future, we will probably be better at that. There's been a number of attempts at looking at your blood to see if there's anything that we can pick up

like a marker to say, hey, this person needs to be screened specifically. Technology is not there. However, I would encourage everyone to donate to the Comans of the world to the Breast Cancer Research Foundation so that people have enough funding to do research to find those things.

To make better honka honka machines. That's what you want, better honka honka machines. Charlotte Milling wants to know, is there a link between gynecological abnormalities people might experience earlier in life like endometriosis or PCOS and the propensity to develop breast cancer? So there are a lot of disruptions that can occur.

We know things like ovarian cancer are associated with an increased risk of breast cancer. Things that increase our hormonal state can also increase your risk of breast cancer. And so these are things that we potentially monitor for. But anything more specific than that, we don't really highlight as a specific problem. Okay.

Natasha Biharj wants to know, I've seen so many sexist, objectifying breast cancer awareness campaigns. What is the professional opinion on this? Is any awareness good or could there be negative downstream effects of bad campaigns? So awareness I think is always good.

I think people can get overwhelmed by the pink. Pinkwashing is what we call it. Pinkwashing? Yeah, pinkwashing. My partner often shows a slide where you show a bunch of, you know, there's pink tennis balls. He came across a slide that,

I guess it was the Gun Club of America where you can get a gun with a pink handle. Oh boy. And his favorite was Kentucky Fried Chicken's pink bucket. You can get cancer while you're preventing cancer. So don't eat fried chicken. It's not, I mean, it's great tasting, trust me, but it's unfortunately one of those foods

you try to avoid. So that term, pinkwashing, especially refers to companies whose products do not help prevent cancer in the first place, but they make a big show about donations and awareness after they cause cancer. Sometimes spending more money on marketing their pink products than is actually donated to the cause.

So you may have to read the fine print, like literally. A few years ago, Dick's Sporting Goods was caught just with the teeny tiny disclaimer on their site saying that some of the companies selling the pink items they're hawking don't even donate to a charity. It's like having a cool party and then some friend of a friend invites capitalism

who like spills hot sauce on the carpet and then insults the host and clogs the toilet before it leaves. But you can get overwhelmed by it. And I think if you remember the spirit of what it is, and it's good that we're overwhelmed by it because there was a time where nobody spoke about it at all. And I think in October is a celebration of those times

and that we will never go back to that, that we are here and we're proud and that knowing about breast cancer and there's still some women out there who fear it and don't say anything. They still come into my office. That's what that month is for, yeah. Marissa Brewer wants to know,

how do you feel about marijuana as a substitute for chemo? And I'm wondering if she means a substitute or something that helps you through chemo. I don't know. I hope she means it helps you through chemo. Okay. Meaning the side effects. I believe that, especially with side effects

from chemotherapy, you need to do whatever it takes to be able to get through chemotherapy. Marijuana has many positive effects with respect to nausea, control, appetite. And if that's the thing that works for you, then please, by all means, because the most important thing is, as I said, is to be healthy and to be able to continue eating.

And if you're nauseous and not eating, even though we're treating you, the soil, once again, is not being fed well. Oh, got it. And so, bad things can take an opportunity. So, if the weed makes you crave chicken fingers, maybe hold back and just try to eat more broccoli. Try, try.

Also, my patients say they have the C-card, so they technically are allowed to do whatever they want right now. I said, no, because you have the C-card, you are not to do it. But yeah, I mean, yeah, just try to make smart food choices. I think today, especially,

we have a lot more healthy options that taste good. I think people just jump for something because it's convenient. But if you clear your pantry of the bad stuff and put something in that's really, really good, I think you'll choose that. And are there any movies where breast cancer or breast cancer patient is depicted

that you feel like get it right or get it really wrong? Well, not a movie, but there was a famous scene in Sex and the City that I love. Oh, what is it? It's the one where one of the characters, and I have that on her names right now, but... P.S. looked it up, and it was... Samantha, you look so pretty today.

Thanks, I have cancer. Basically, she had had chemotherapy and breast cancer, a very, very sexy woman who obviously you're seeing the effects of the treatment, and she was giving me a speech. If you want to see the face of breast cancer, look around you with this wig on. And her younger boyfriend, very handsome guy,

was in the audience, and she starts talking, and there's a lot of women in the audience, and she starts sweating because of the lights and the hot flashes from the therapy she was getting. And finally she said, oh, eff it, and pulls the wig off. And this woman who was very nervous about the way she looked and everything, the whole crowd just cheered.

And stood up and started pulling their wings off. And I think that's what I always believed about breast cancer. It's very empowering. If you have the right support and the right people around you to help show you that this can be a very empowering disease, you kicked cancer's butt.

Or if you're in the fight, you're fighting cancer's butt. You're getting up every day and doing it, no matter whether you're somebody who's stage four with disease that's gonna be there, or somebody that we've treated and disease is no longer there, you're still getting up every day to fight this thing. And you need to be empowered by that

because not everybody can do that, right? And so that probably is a scene that still sticks in my mind as portraying a very empowered person because this woman had a very difficult time. Her sexuality was being affected, the way she looked was being affected. And finally in that one moment she basically said, screw it, I'm gonna be who I am

and screw you cancer, which I think is a good thing. That is a good thing. That is a very good thing. Do you have any patients that are like, I know that it's a battle, I know I'm fighting, but some days I'm just like, oh, I'm not a warrior. All my patients, I think you're not human if you don't do that.

And I think that's why I say you have to pay the pipe or sometimes. Those moments are gonna come and to pretend that 24 seven, you're fine, I think you're kidding yourself. And it will come in a moment where you're not expected. In the middle of a shopping mall, for example, you need to recognize that you just almost fell off

of a cliff and in that moment realize that someone gave you a parachute too. But I think you need to do both. I really do. I think you'd be kidding yourself if you're not. I think one of the things that's trickiest for my patients is they go through treatment, they get through everything, and then we say, fine,

things are great, I'll see you in three months or six months. And they're like, well, wait a minute, where are you going? Because now we've put them on a survivorship track and they're not ready mentally and emotionally because now no one's, okay, now what do I do? Am I waiting for the next bomb to go off? It's human. But that's where we're working on trying to empower

these patients through survivorship planning. Now you're a survivor. This is one of the things we need to pay attention to. These are some of the side effects that can happen, but you're still ours, you know, you're still our family member, and we want to make sure you're okay. And I always do a segment about debunking flim flam.

Is there any myths, any major myths or misconceptions that you're like, if I could tell the world, like megaphone, this is not true, do this instead, anything else that comes to your mind that you're just like a myth about breast cancer that you're like, nope, got it wrong? That mammograms cause breast cancer. Oh no.

Yeah, they think the radiation in mammograms will give you breast cancer. The radiation in mammograms are equivalent to the radiation of flying back and forth to California three times. It's not gonna cause cancer. I think that that is, the reason that's one of the myths that I hate, and you'll hear me give an hour lecture on, is because it's the one tool we have

that actually can pick this up as early as possible. When we come up with something via blood test, via X-ray vision, glasses, whatever you want, then fine, we can debunk mammograms. But right now, it is the one thing that made a difference between the 1980s, 70s, and 80s, and the women that are so empowered today to yell and scream about why we don't need mammograms.

So that would be the one. And two more questions I always ask. What about your job sucks the most? What is the hardest part of your job, the most tedious part, the part that you don't look forward to, the part that you're like, oh, fine. The most tedious part of my job, aside from my charts that I have to do,

the electronic medical record, even aside from that, I just wish I could just dictate it and it just comes out and it's like, okay, it's done. Aside from that, I think, I don't know, it's a stupid thing to say, but I actually like most parts of my job, for sure. Because remember, I'm seeing people who are at their worst moment in time.

And the little things that may annoy me, the things that I don't like that I'm very upset about if a patient doesn't get treated properly, and I mean from my custodian all the way up. This patient walks into our doors, they are a family member, and they have to be treated as such, and I am lucky to be an institution where that happens, but in case you get somebody

who just is not thinking about why this person's here, that will send me through the roof. Really? Because this is a very vulnerable time for a person. It really is. Even if I tell you you're gonna be fine and we make jokes, et cetera, I just told you you have cancer.

That's never, as a human, never gonna cause shutters down your back. It's never not gonna happen. It's always gonna be something that creates that feeling. And for anyone here to either brush somebody off or not recognize the importance of that, really does bug me. You have to have some humanity.

This person is sitting here with a life-threatening diagnosis. Even though, thankfully, we can take care of it. You just never know, you know? Your staff was very nice to me in the waiting room. Yes, good, so I don't have to fire anybody today. Okay, good. And what is, last question,

what is the thing that you love the most about your top? What do you love about your work? What is, I know that that's gonna be hard to pick for you. I love, I love, it's a hard one. I love the hug. I love the hug for my patients, especially after I've done surgery. And I see them for that first time, post-operatively,

and say, welcome to being cancer-free. And they just grab me. Oh no, you're making me grab you. I know, but they do. And that's what I'm just like. They just grab me. And it's funny because I think I give off a good vibe that I'm a hugger, cause I am a very big hugger.

But they kinda like lean in a little, and then they just grab me and whisper in my ear, thank you. I think that is worth everything that I've ever done is in that moment. Oh. Everything. So after holding it together and trying not to cry

this entire time, most of the time out of just pure inspiration and hope, I finally just broke and my mascara was not where it started. I'm sorry. You're making me cry, that's so wonderful though. That is actually, that is my favorite moment, for sure. I mean, are you kinda glad you didn't become a mechanic?

I do tinker once in a while, but I am. I mean, you know, when you get pretty emotional, your car's not working. So if I tell you, you know what, I can fix it for $5. I think people would hug me too, but yes. I think my mom was right, for sure. This is much better than being a mechanic.

I think you picked the right job. Thank you. I think I did too. Thank you so much for doing this. My pleasure. Anytime, I love doing this. You're my favorite surgical oncologist. Well, you're only surgical oncologist.

Well, yes. That's my favorite. Thank you, my pleasure. So remember to ask smart people stupid questions because it just might save your life or somebody else's. Dr. Manasi is at the Mermanides Medical Center in Brooklyn, New York. And for more resources, cancer.org, breastcancer.org

are all there, so many sites for resources to reach out to. Susan G. Coman is the largest nonprofit that deals with breast cancer awareness and research, and they deal with community health, global outreach, public policy. Again, that's Coman.org. But you may have your preferred charities. Also, the third week of October is specifically

Male Breast Cancer Awareness Week. So now you're aware of that too. Consult your own health care advisors and providers if you have questions about screening and treatment and share your stories. This episode is dedicated to everyone of all genders who has had or has been affected by breast cancer and the amazing folks who are out there working toward a cure

and helping patients. My Aunt Norma, pretty much my second mom, Kathy, and Stephen Ray Morris' grandma are all survivors. And my cousin, just this last week, was diagnosed. She personally echoes Dr. Manasi. She says, get a baseline mammogram at 40. And she added that if you have dense breasts, ask about 3D mammograms.

She undergoes surgery this week. So please keep my cousin in your thoughts if you can. She's a tough cookie, and we love her very, very much. Thank you to Bonnie Dutch and Shannon Feltis. Thanks to everyone at Patreon. Part of your support this month goes toward a donation to Breast Cancer Research. Thank you, Stephen Ray Morris, for editing this all together.

And also for the amazing Allergy's Allergy bonus episode you hosted this past week. You killed it. Thank you, Erin Talbert. Love to your mom, Kathy, and to Hannah Lippo for admining the Allergy's Facebook group. Thank you to Nick Thorburn, who wrote and performed a theme song.

And is it a band called Islands? Oh, also Stephen Ray Morris hosts The Percast and See Jurassic Right. I figured everyone who listens to this podcast listens to his already, but if you don't, you got to check that out. Really quick before we get to the secret, I wanted to plug two friends' things.

These aren't ads. They don't even know I'm doing it, but I just think they're cool. And I feel like Allergy's listeners would be so up in this. But on October 20th in New York at Caveat NYC in the afternoon, they're doing a deep dive with a deep ocean expert. And they're Skyping to people on the research vessel

Falcor for a live Q&A. It's Going to Be Bananas. And it's hosted by Science Friday and also by a toothologist, our favorite squid scientist, Sarah McNulty. So Caveat NYC has tickets. They're like $15 or something. And it's October 20th. And then also, if you want to do SCICOM for a living,

do science communication. You want to start a podcast or do videos or write books about science, and you're not quite sure where to start or if this is your deal. If you can get yourself to the West Coast November 2nd through 4th, I have friends Cara Santa Maria, Sarah Curtis, and Jason Goldman. They're awesome.

And they run this camp called SCICOM Camp. It's scicomcamp.com. And they have lectures, s'mores, horseback riding, seminars, workshops. It's all about science communication with some of the best people in the world who do it, who all gather there. So I just wanted to tell you guys about it

so that it didn't pass. And you guys didn't say, Ali, why didn't you tell me about it? I always go, and I love it. And it's been so helpful for me too. So those are two things that my friends are doing. I just wanted to tell you about. OK, so oh, I promised you a secret at the very end. All right.

OK, so we're talking about crystals, deodorant. I was talking to someone about this a while ago about how, but don't those crystals just stop working spontaneously? Also, what's with these magic crystals? They're just a big hunk of mineral salts. And when you get them wet or you rub them on your damp armpits, it gives you a layer of salt on your skin. And the bacteria that would normally

cause you to smell like pepperoni in a hot car can't grow on your armpits. So that's why you don't smell. You still sweat, but you won't smell, I guess, because the bacteria flora can't survive in a salty environment like that. So there you go. But I've heard of people using them,

and they just kind of stop working for them. Maybe their bacteria flora changes, or maybe they're not getting it wet enough, whatever. And I was talking to this woman about it, and I said, yeah, like, what if you're dancing with a governor, and then all of a sudden it stops working and you smell terrible? And she was like, that's so weird, because that happened to me.

I was using crystals deodorant. It stopped working. She was at the governor's ball dancing, and she realized she smelled bad. And I was like, that's really weird. I don't know where I got. What if you were dancing with a governor? But it happened to you with a governor's ball.

Anyway, thanks for listening. Please take care of yourself. I'll love you, kiddo. All right, bye-bye. Hackadermin College, homeology, cryptozoology, lithology, and technology. Meteorology, low-peptology, pathology, seriology, phenomenology.

And so I think it's important to look at life as a holistic approach, right? You want to be healthy. That's mental, physical, sexually, and spiritually. That's what you want.