A Noted Breast Surgeon’s Book of Solid Advice

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If your surgeon or facility does not meet the standards that I have outlined, then a second opinion is probably an excellent idea.

—Elisa Port, MD


Title: The New Generation Breast Cancer Book: How to Navigate Your Diagnosis and Treatment Options—and Remain Optimistic—in an Age of Information Overload

Author: Elisa Port, MD

Publisher: Ballantine Books

Publication date: September 2015

Price: $20.00; paperback, 320 pages

When a new book on breast cancer is published, the first question that comes to mind is: Why should this book be added to the already crowded shelves of breast cancer books? A new book on breast cancer by Elisa Port, MD, deserves a prominent place among recently published books in this genre because it lives up to its subtitle: How to Navigate Your Diagnosis and Treatment Options—and Remain Optimistic—in an Age of Information Overload.

Moreover, the author is eminently qualified to speak directly to women with breast cancer and those at risk. Dr. Port is Chief of Breast Surgery at Mount Sinai Medical Center and Director of the Dubin Breast Center, a state-of-the-art facility opened in Manhattan in 2011. She is also a frequent contributor to print, radio, and television media.

Screening and Early Detection

The book is organized into 20 chapters, ending with two highly informative appendices. To her credit, Dr. Port leads off with a chapter about screening and early detection. As with prostate-specific antigen screening, mammography has been scrutinized for its worth vs the downsides of overdiagnosis and false-positive results. Organizations as diverse as the Affordable Care Act and the U.S. Preventive Services Task Force (USPSTF) have altered their screening recommendations over the years, adding confusion to an issue that is vital for breast health.

Dr. Port is a true advocate for breast health, traveling the country leading seminars and general public education workshops, during which she has to field questions from concerned women. For example, “My sister was diagnosed with breast cancer when she felt a lump one month after a normal mammogram. Why should I get one if it didn’t work for her?” 

This is a tough question for a clinician/advocate, but given the level of understandable anxiety produced by the continuing debate over the value of mammography, Dr. Port is firm. And that’s a good thing for women. “Mammograms are not flawless—no test is…but even when all the variables are taken into account, mammograms are still the best tool currently available for identifying breast cancer in the majority of women.”

Another reason this book deserves a prominent position in the crowded world of breast cancer books is its unparalleled readability and structure. In the opening chapter on breast cancer screening, Dr. Port breaks down the various screening methods along with risk factors.

Smartly, she uses callout boxes to illustrate her points. For example, in one callout titled “Need to Know: What is the appropriate screening regimen for the average woman, she gives her recommendations, backed by the best available data, without overloading the reader with statistics.

 Dr. Port follows this with a Myths and Facts callout. “Myth: If you don’t have a family history of breast cancer…the reality is that 80% to 90% of women diagnosed with breast caner have no special risk factors.” This simple and straightforward delivery style is one of the many strong points of this book.

Diagnosis and Treatment

The chapters dealing with diagnosis and treatment are handled with care and clarity. Again, Dr. Port takes difficult clinical issues and drills down to their core messages. A surgeon herself, Dr. Port advises women with breast cancer to spend some time thinking carefully about their surgeon. “A surgeon isn’t just the person you are going to trust with your operation. A good breast surgeon will provide you with critical information that you need to make the right decisions,” she writes.

In her section on needle biopsy, along with her step-by-step clinical explanation of the procedure, the author also tackles common myths that cause needless confusion for patients with breast cancer, such as needle biopsy can spread cancer. “Somehow, at some point, someone came up with the misinformation that needle biopsies can spread cancer—and if a needle biopsy is done and shows cancer, surgery needs to be done quickly to contain the cancer and reduce the risk of spread caused by the needle,” writes Dr. Port, as she debunks this misinformation that vulnerable patients with breast cancer can find on irresponsible cancer-information Internet websites.

Seeking a Second Opinion

One of the most difficult choices newly diagnosed patients with breast cancer face is the choice between lumpectomy and mastectomy. In this section, Dr. Port uses strategically placed Word to the Wise callout boxes that give patients invaluable advice on how to put a surgical team together and make tough clinical decisions.

Perhaps the best part of this section is one that is often overlooked in books for the lay public: when a second opinion is needed. Throughout the book, Dr. Port has indicated when a second opinion is needed. Here, Dr. Port takes on the understandable mindset that prior to breast cancer surgery, the patient must have a second opinion, which is often guided by well-meaning family and friends.

And, as Dr. Port points out, this approach can be misguided. She illustrates her point with an actual case history in which one of her patients was persuaded by a friend to see the surgeon who had performed her double mastectomy. Dr. Port’s patient was being pressured by her friend to have a double mastectomy, “as that’s what worked for her.”

However, no two cancers are alike, and Dr. Port suggests that even if a patient seeks a second opinion, it is important to make the choice based on the criteria she has outlined in the preceding chapter. “If your surgeon or facility does not meet the standards that I have outlined, then a second opinion is probably an excellent idea,” writes Dr. Port.

Clinical Trial Participation

Yet another issue that many cancer books fail to address in depth is clinical trial participation. Dr. Port again uses a case history to illustrate her messages. After surgery, her 59-year-old patient saw a medical oncologist who strongly recommended that she go on a clinical trial. “I explained to her that every standard treatment for breast cancer was once an experiment and part of a clinical trial. I am extremely supportive of clinical trials, but only when they are appropriate for a particular patient, and in this case it was,” writes the author.

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She then elucidates a complicated issue that is largely misunderstood by the lay public, using the excellent callout boxes and shaded subheads that have made this book a cut above most others. Advantages and disadvantages, questions to ask, red flags, and a note on financial compensation are explained in this section.

Dr. Port also discusses genetic and life-style factors that increase the risk of breast cancer. She also devotes a full chapter to male breast cancer, followed by a description of standard chemotherapies and a look into the future. This is the only section where the layperson might have difficulty.

The end of the book deals with recurrence and end-of-life care, replete with online resources. Appendices on Myth and Truth and Frequently Asked Questions are so good they could be published as stand-alone pamphlets.

The New Generation Breast Cancer Book may not dazzle The ASCO Post readers with new information, but it will give aspiring authors a level of excellence to strive for. ■