Interview with Beth DuPree, MD, Breast Cancer Surgeon and Author

Beth DuPree, a breast cancer expert and author, finds a balance between new medical technology like digital mammograms, and alternative therapies that can help beat breast cancer.

By Bari Nan Cohen

Beth DuPree, MD, FACS, is a partner in Comprehensive Breast Care Associates in Langhorne, Pennsylvania. She is also the author of The Healing Consciousness: A Doctor’s Journey to Healing (Woven Word Press).MORE: If you had unlimited funds and unlimited time, what is the one area of breast cancer research that you would want to pursue?Dr. Beth DuPree: One area? I can’t have two?MORE: Let’s start with one, and we’ll see.DuPree: Mammography saves lives, and women don’t get them annually. The number of women that get them annually is so much lower than the number of women that need to get them. I see women sometimes who have gotten mammograms annually, and then they don’t get them for three years. And that’s when they show up with cancer. When women get screened every year for mammography, the death rate from breast cancer drops 45 to 50 percent. It is astronomical the difference that it makes. The problem that occurs is that a lot of women get very complacent in their lives, and they stop making themselves a priority. So they forget to go, or they just put it off, or out of fear of finding a cancer, they don’t go. The bottom line is that they should be afraid about not finding a cancer soon enough. So, all the research in the world at this point can’t replace what we already have in place, which is early detection and women who don’t get their mammograms. It’s like going to the dentist. You have to do it once a year no matter what. I pulled up some numbers because I did a TV show this week, and they did research in this very affluent area in New Hampshire. Apparently four-fifths of the women said that they did get their mammograms. But when they actually checked, less than two-thirds had gone. And in that two-thirds, some of them only [went] every two years. So what they found was even in an affluent area where women have health insurance, where they have access to it, they don’t go. So think about the fact that we have a screening tool, and that it is not taken advantage of. Even before we look at the research for the future, that’s a huge, huge thing. What are we missing here? In our society, why are women not caring for themselves? If we can’t make a difference in our own lives, how do you make a difference in the world?MORE: There was, maybe in the last two years, some discussion that Breast Self-Examinations (BSE) don’t make a difference. DuPree: There was a very prominent breast surgeon who poo-pooed breast self-exam. But [with] screening and early detection, the death rate from cancer drops. A friend of mine, Lazlo Tabar, a radiologist in Sweden, has been one of the most phenomenal mammography education gurus in the world. He trains mammographers and breast surgeons all over the world to do breast care. Over a 20-year period, [when] they show the number of cancers diagnosed from early detection — the death rate drops off hugely. Look at the difference between what chemotherapy does for breast cancer versus what early detection does. Early detection by far kicks everybody else’s butt. The earlier you find [breast cancer], the less likely it is [to show up] someplace else. With breast self-exam, what came out publicly is that it didn’t change the death rate from breast cancer. But for the 20 percent of women whose cancers are not found mammographically, breast self-exam is still important. I am a firm believer in this, because I see a large number of young women, meaning under the age of 35. Had they not done their self-exam, they would not have found their cancer early, and they wouldn’t be alive 10 years later to tell about it. So, you know what, it may not statistically change the death rate of cancer, but in women whose cancers are not found by other means, it is incredibly important. This is the deal. You own [your breasts], they’re yours. Know them, examine them, feel them. If you’re more in touch with yourself, you are more likely to take better care of yourself, and you are more likely to get your mammograms and do the other things that you need in your life. It is so easy to put ourselves second to everybody else. That’s my first deal.MORE: That’s a great deal. I love it.DuPree: It comes before all research because it is something that we already have and don’t do. And if I tell you the number of women that I see with cancer in my office who haven’t been going every year and will skip two or three years and then they get the cancer.MORE: Right.DuPree: The way that I look at it, if they’re not getting their mammograms, are they more stressed in their life? Do they have other things that are pushing their buttons? If you’re too busy in your life, and you’re too stressed to take the time to take care of you, what kind of havoc [are you] wrecking on your body? To me, they are very related. It’s one of those things, you have a birthday, get a mammogram. It is the easiest thing to remember. None of us over 40 forget our birthdays. For God’s sake, we celebrate every year, so why not get your mammogram for your birthday? MORE: Right.DuPree: That’s easy because getting an annual mammogram doesn’t require research. It just requires women to be empowered to take care of themselves and to use what we already have out there. The other thing that’s really been in the news is digital mammography. Digital mammography enhances our ability to find cancers in young women. Meaning women under 50, women with very dense breasts. So it really should be the screening tool for that particular population of dense-breasted women and the women who are still menstruating.MORE: How widespread, availability-wise, is digital mammography?DuPree: It’s not. It is in probably less than 10 percent of the mammography units in the country. And this is the big thing that has kind of kept it a secret. No matter what your insurance is, they can’t tell you where to go for your screening mammogram. And what primary-care doctors, gynecologists, and other physicians usually do is to send patients to places where their insurance will pay for the screening and the diagnostic and for the ultrasound and all the other stuff. But what the problem is, if you’re not getting the best screening tools, could they be missing something. That’s where I think if women are ever going to spend healthcare dollars outside their insurance plans, that’s [an area] that makes a difference. So women can get a screening digital mammography. They may be required to go elsewhere for ultrasound, additional views, or for an MRI. But if something is picked up on the screening digital mammogram that isn’t on the analog or conventional mammogram, their insurance company is going to have to send them back for additional digital imaging. You know, they can’t deny them that service. Digital is a very expensive proposition; most of the digital places are equipped with what we call CAD, which is computer-aided diagnostic, which is like having a second set of eyes look at the mammogram. Like in addition to having human eyes look at it, the computer looks at it as well. MORE: Would you go so far as to say if you have unlimited funds you would use them toward getting more digital mammogram machines in more places?DuPree: I think that would be very important. If we’ve got the technology to make it better, let everybody have access to the technology. Yeah, and if I had unlimited funds for research, what I would really like to prove — which I already have kind of proven it to myself in my own practice — is that holistic therapies such as reiki, massage, reflexology, and guided imagery complement your conventional therapies. If I had unlimited funds, I would like to prove that those therapies make a difference in every aspect from survival to overall wellness. I use them in my practice. I speak at a lot of national conferences about this because I have become one of the few breast cancer surgeons who has integrated that type of a concept into my practice.I do state-of-the-art Western medicine. Don’t get me wrong, I mean most patients are on clinical trials. We do the latest and greatest of all there is to have, but in addition to that we make sure our patients get what they need. Everybody needs something different. A 65-year-old woman who has never done yoga is probably not going to be into a vigorous kind of yoga session. But that is someone who might benefit from guided imagery, or she may benefit from massage or from reiki or from some modality that helps to center her spiritually. You don’t have to prove to me that the mind/body/spirit connection is so incredibly powerful, but in Western medicine we have spent so much money on research of the physical body. We have done a little bit of research on the mental. How stress and positive attitudes make a difference on outcome. We have done so little to look at the absolute overall benefit from our spiritual practices. I would love to do a breast cancer prevention trial looking at a group of high-risk women and get them into decreased stress, decreased risk type behaviors. Meaning following them to make sure they are exercising at least three hours a week because we know that decreases the risk of breast cancer by 20 percent.MORE: Wow.DuPree: I give talks to women, and they are afraid of breast cancer. And I’m looking around the room and thinking, there is not a woman in this room who can’t shed 50 pounds. And yet they’re worried about breast cancer. Yeah, they’re at higher risk to get it because they’ve got the extra fat; they’ve got extra circulating estrogen. When you talk about where research needs to go, prevention is a huge part of all of it. I think we need to look at ourselves as a society, as a group of women, and empower each other to get breast cancer to go away. I mean to get it to go back to where it was before where it wasn’t affecting one in eight women. Let’s go back to when it was one in 25 or one in 50. I would love to put me out of business. I’ve got plenty of things I can do with my days. One of the reasons why I love the book I wrote, and one of the reasons why I do the speaking that I do, is that I think empowering women to find their voice and take charge of their lives again is one of the best things we can do to prevent cancer. Don’t make the excuses of no-time-to-exercise or de-stress. My stress reducer? I dig in the dirt. I go to my garden, I plant my vegetables, I pull my weeds. In summer I don’t have to work out in the gym because my body is so sore from doing squats and pulling weeds. MORE: So would you advise women to experiment a little and find the de-stressing thing for them as a preventive measure?DuPree: We each need to do something that reduces our stress level. Someone sent me a great e-mail the other day that said if you pick up a glass of water, and you hold it in your hand for an hour, [your hand is] okay. If you hold it for four hours, it starts to get sore. You hold it for a day, you’re really in spasm. If you hold on to it for a week, you’re gonna end up in the hospital because you are going to be frozen, and you’re not going to be able to move. If that glass of water is the stress that you have in your life, if you hold on to it so tightly, it [can] paralyze the rest of your life because you can’t let it go. And don’t put it off.My sister, she has always loved art but she goes, ‘I’ll paint when I retire.’ Why would you wait until the end of your life to do something that really fuels your passion? We lack passion anymore. We lack passion in our relationships; we lack passion in our jobs. I love what I do. I love going to work. I was just in a business meeting with a bunch of guys who are investing in a hospital we’re building. So I am sitting with these guys at the table and they’re saying, ‘You know you’re so spiritual, and you’re so passionate.’ And I’m thinking, do you go to work just to get a paycheck? Is that what your life is about? Is that what our lives have become about? Are we so caught up in getting the stuff in life that we forget to love what we do? So whether your passion is found in yoga, in gardening, in cooking — some women find passion in cooking and providing for their families. Hello, that’s my mother. She is 81 years old. There is nothing that makes her happier and more passionate than preparing a meal for her family. She is in heaven when she is preparing a meal for her family. Women can be passionate about being homemakers, and we’ve kind of made that a dirty word. It doesn’t matter what it is. But we’ve stopped really promoting and embracing passion, and it’s sad. If you could prove with a clinical study that going back to a lifestyle that is less stressful and more fulfilling would decrease your risk of breast cancer, then we could save a whole lot of money on very toxic drugs. Among my patients, the ones that are the best at changing their lifestyles are the ones that are diagnosed with precancerous changes because they know that they dodged a bullet. That’s the group of patients that will lose weight. They exercise, they eat well, they quit the bad jobs, they leave bad marriages, they don’t tolerate abusive relationships. That is the group of women that really make a change in their lives and do really, really well. MORE: That’s amazing. DuPree: That’s why I wrote my book, The Healing Consciousness: A Doctor’s Journey to Healing. It is about awakening to the fact that we are all interconnected, and that what we see in front of us is way greater than the human being beside you. We are all spiritual beings connected, and the sooner you realize that the better you treat the earth and mankind. The people who you may not think are friendly to you, or they may be your enemies, you need to look at them in terms of, ‘Okay what am I learning about that? What am I learning through that process?’ They seem bad to begin with, but I am learning something through that process. I am developing as a spiritual being. Even though I may hurt as a human being, I am evolving as a spiritual being. So as I teach other doctors about the latest and greatest technology in Western medicine, I also get the opportunity to get them to open up a little bit to the big picture.Being a breast cancer surgeon allows me to help patients to heal. I can operate on them, I can remove their cancer. Yeah, we can cure patients of cancer, but I can’t make them heal if they don’t have the tools. If they don’t understand what healing is. And if someone is cured of breast cancer but they sit in their house afraid to live, waiting for the cancer to come back, what have I done for that person? Not a lot. But if I have a patient that I can’t cure of cancer, but I can help them get to a safe place so that when they pass over out of this body they feel complete, and they feel as though their life has not been useless. They really feel as though they are in a safe place and that they can transition and move on, then I have helped them to heal. And educating other doctors about that is a big deal. When someone’s dying and they’re transitioning, that is when the family needs the doctor the most because they are scared, and they don’t know what to do. They’re looking for guidance. Being there or being present for them is another huge thing that we physicians have stopped doing. We have stopped helping patients become comfortable with death. It’s one of the guaranteed things in life. You know, birth, death, and taxes. I mean hello! You know, there is nothing else that is guaranteed in life. So I’m at a great place in my life, but you know what, I had to create it myself. I didn’t just go to my kitchen cupboard and open up the door and find time and find balance. They weren’t sitting there on my shelf waiting for me to pick them off. I have had to carve out time for me and carve out time for my family. I had to carve out time to write a book, but do you know what? It happened. Now I’m getting ready to open a hospital. A first of its kind, state-of-the-art hospital, which will do everything from digital mammos to diagnosis, ultrasound, MRI, etc., plus a 4,000-square-foot holistic spa. I’m a reiki master myself, so I do reiki with meditations in the OR. I work with acupuncturists, I work with healers of all varieties.Learn more about Comprehensive Breast Care Associates Purchase The Healing Consciousness Originally published on MORE.com, October 2006.

First Published Mon, 2009-04-06 17:22

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