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Marisa Weiss, MD - Interview

Marisa Weiss, MD - Interview

Endofound Medical Conference 2017 "Breast, Ovary and Endometriosis" October 28, 2017 - Lotte New York Palace Hotel

Marisa Weiss, MD

Chief Medical Officer and Founder Breastcancer.org

Interviewer: Dr. Marisa Weiss of BreastCancer.org. Thank you so much for being here at our conference today. When you're talking about cancer, often time you think about, gosh, maybe it's hereditary or something like that. But in your talk today, you talked a little bit about, or a lot, environmental risk factors for breast cancer and endometriosis. Talk a little bit about that.

Marisa Weiss: Well, breast cancer is the most common cancer to affect women. Only about 10% of those breast cancers are in families with one of those inherited breast cancer genes, like BLCA-1 or BLCA-2. That's to say that most breast cancers, like 90%, are largely due to growing older; how we lead our lives; what we eat; what we drink; what we breathe in; the medicines we take; and the personal products we use. Because prevention is so important, we don't want to see breast cancer, and if we had it, we never want to get recurrence.

What I tried to show were all the steps that you can take in your everyday life to be as healthy as you can be by choosing what you eat; what you drink; what you breathe in; how physically active you are; how you manage your weight; and what personal care products you use. Because no woman ever wants to see breast cancer, and if you had it you never want to have a recurrence.

If you're living with metastatic disease, you want to know what can I do in my every day to try to help make it go in remission. That's what Think Pink, Live Green is about at BreastCancer.org, where we really try to help people make those everyday choices and learn what products they should use; what they should be eating; what to avoid; how to cook; all kinds of choices like that.

Interviewer: They really aren't simple things. It's not anything that can't be done.

Marisa Weiss: Well, the list of breast cancer risk factors is really long. You can't change your family, and you can't change the past. Right? The future is just a promised to all of us. We kind of have to start today. There are very meaningful steps that you can take today. For example, if you're 50 already and you make five changes in your life, like get to and stick to a healthy weight; exercising regularly; eating mostly vegetarian-based diet, not completely but mostly; avoiding extra hormones; and limiting your alcohol. You can lower your risk of breast cancer by 50%. That's actually been shown. If we start with our daughters, our young girls, and they start as girls, our girls can keep their breast cancer risk down by 70%. Even if you were born with an inherited gene abnormality, which puts you at a really high risk of breast cancer during your lifetime, there are steps you can take to drop your risk down by up to 90%. The point is there's a lot we can do to be healthier with a goal of prevention.

We're also looking forward to new knowledge overtime that will be even help us more to reduce the risk with the goal of prevention.

Interviewer: Fantastic! Okay, so we are taking questions from our audience who's watching the live stream. The first question is: In your lecture, you spoke about birth control and the role it plays in breast cancer prevalence. Does the same apply with all forms of hormonal therapy, such as an IUD versus oral birth control pills?

Marisa Weiss: Right, so generally-speaking, we know the most about the impact of oral birth control pills on breast cancer risk. What we have found is that it can increase the risk a little bit. Now, the thing is about breast cancer risk, that breast cancer risk goes up with age. If you're a young woman down here and your risk is low, if you take something that increases the risk a little bit, it's not going to add up too much, but as you get older and you continue to take birth control pills, like into your 30s and 40s. Well, now, your risk of breast cancer is higher, so increasing a higher risk a little bit across a population will start to add up and be noticed.

My approach to this is to say that when you're young and you need something like the pill to take every day to be ready to have solid birth control, contraception. You might be taking it for your skin and managing PMS and other things, too. Okay. Five years of birth control pills will help reduce your risk of ever getting ovarian cancer, but after five years of being on the pill, it's really important to ask your doctor about other methods of contraception that don't involve hormones, like the Para Gard IUD or a diaphragm. I know it's an old-fashion type, but it actually works. You can still get it.

Now, there other IUDs that have a little bit of hormones in them. That's way lower than the amount of hormones that's present in a birth control pill. For woman in a different point of life, when they are approaching menopause or struggling with menopausal symptoms, they're already menopausal, they go to their doctor and they go like, "I can't sleep. My skin's dry. I'm having hot flashes. I have vaginal dryness. So moody. I don't even know myself anymore." The doctor's going to go like, "That's probably related to the drop in estrogen level that comes with menopause."

In that setting, women may choose to take hormonal placement therapy. We know that estrogen and progesterone combined are associated with an elevated risk of breast cancer, particularly when you take it for a few years or longer. Women just need to know that, and if there's a symptom or two that you're having that we can address in other ways, like if you're having trouble sleeping really looking at this thing called Sleep Hygiene, what can you do to improve your sleep. We have a lot of information about that at BreastCancer.org. If it's about vaginal dryness, or there a lot of other things we can do for vaginal dryness, like vaginal moisturizers together with vaginal lubricants, like a lot of them, good ones, like Uber lube or [inaudible 00:06:34]. Also, changing up your sexual intimate pattern, so if you, for example, as women get stimulated first and you actually have an orgasm first, then the vagina gets longer, wider, thicker, wetter, and more receptive, more nifty, happier, and is more receptive to intercourse. That's another way to manage some of the vaginal atrophy, or just like not less happy vagina after you're older. Those are just some examples.

But, sometimes women who are struggling with menopause may still need an estrogen to help with vaginal issues. Then, they actually can use like a vaginal estrogen only, which is sort of sucked up by the vagina and the vagina doesn't really share it with the rest of the body, so it's considered safer than taking a pill that goes everywhere.

Those are just some examples of some of the solutions that are very practical, that you kind of need to figure out through trial and error, and only through asking your doctor about this, and BreatCancer.org, of course.

Interviewer: Absolutely! The last question we're going to take from our viewers: You spoke of doing one thing to lower your risk of breast cancer, what one thing do you often recommend to your patients?

Marisa Weiss: Get to and stick to a healthy weight. It's not easy. Every woman I know, including myself, we struggle with it. I actually had been a doctor for 30 years, taking care of woman with breast cancer, and I have my own breast cancer diagnosis just over seven years ago, and I dropped 30 pounds to where I am now. It wasn't easy. I've always struggled, but there are things that can help you with that.

First of all, drop any judgment. The past is history. The future's just a promise for all of us as I was saying. 80% of weight management is what you eat. As we grow older, we don't need as much food because our metabolism goes down. You want to eat real foods, fresh foods, not packaged foods that are packed with calories. You want to be able to eat smaller portions, and minimize the amount of alcohol you drink because that has a lot of calories and you eat more after you drink alcohol.

There's a lot of attention being talked about the 12-hour fast. After you eat dinner, don't eat for another 12 hours, til the morning. Before you have your big meal, about a half an hour ahead, eat something ahead of time. It'll help your belly feel full so when you go to eat dinner, you're not going to overeat as much. Then, eat mostly vegetarian-based diet. Mostly fruits, vegetables, grains, seeds, spices, the whole range of the produce department so you get your nutrients and minimize the amount of chicken, fat, pork, other types that you eat that has a lot of calories in it.

Exercise! Even though exercise is only about 20% of what, how you manage your calories. If you're exercising, then you're staying in your, you're in the groove. You're staying in the zone. You are more much more likely to stick with your plan of healthy eating. You're going to feel better. You're going to sleep better. You're going to smile more. You're going to be ... every part of you is going to benefit from exercise. To stay on the exercise, you got to shift your thinking in your mind. You say, "It's no longer optional. It's mandatory. I have to make it my priority. I might go to a party later because I'm going to exercise first. I might wake up early to do it. I might, instead of having a long lunch with friends, I'm going to use some of it walk around the building where I work."

Make it social, so that you get to know people at the place rue going so they say, "Oh, great to see you." It's a more reason to go. Make it fun! Good live music is great, like Zumba or things that makes it you're more likely to do it. I mix it up so you don't get bored.

Interviewer: Well, thank you so much for being here and answering all those questions for us. Thank you.

Marisa Weiss: Oh, you're welcome. Thanks for having me.