Skip to main content

A Breast Oncologist, Diagnosed With The Disease

After a routine mammogram, brest cancer specialist Dr. Marisa Weiss was diagnosed with a breast tumor. The founder of discusses her diagnosis and treatment -- and how she feels about new mammography guidelines.


Other segments from the episode on December 14, 2010

Fresh Air with Terry Gross, December 14, 2010: Interview with Fred Schulte; Interview with Marisa Weiss; Obituary for Richard Holbrooke.


Fresh Air
12:00-13:00 PM
Wall Street Finds Lucrative Market In Tax Liens


This is FRESH AIR. I'm Terry Gross.

(Soundbite of advertisement)

(Soundbite of music)

Unidentified Announcer: The following is a paid advertisement for John
Beck's(ph) newly updated free and clear real estate system.

The average home in America now costs more than $219,000, but you're about to
learn how you can start buying homes like these for just a few hundred dollars
and own them free and clear, with no additional monthly payments

GROSS: So that's an infomercial promoting a system to teach you, among other
things, how to buy tax liens, the property taxes people owe and have been
unable to pay.

The idea is if a person continues to be unable to pay, and the house is
foreclosed on, you may be able to take over the home, depending on what the
local law is.

Buying tax liens has actually become a big business for some banks and hedge
funds, who can make short-term profits by adding fees and boosting interest
rates on homeowners with the possibility, in some cases, of eventually taking
over the homes.

My guest, Fred Schulte, has been investigating how financial institutions,
including some beneficiaries of bailout dollars, are creating new ways to
profit from the financial distress of homeowners.

Schulte is a reporter with the Huffington Post Investigative Fund. He formerly
worked for the Baltimore Sun and the South Florida Sun Sentinel. He's the
recipient of a George Polk Award and three Gerald Loeb Awards.

Okay, so let's get back to that infomercial and how to profit from tax liens
and tax deeds.

(Soundbite of advertisement)

(Soundbite of music)

Ms. MICHELLE BOUDREAUX: Hi, I'm Michelle Boudreaux(ph). The homes you just saw
and the many examples you'll see throughout this program were all purchased for
literally pennies on the dollar using the amazing secrets found in John Beck's
free and clear real estate system.

The secrets behind John's system are strategies that most people don't even
know exist. You need strategies that take full advantage of today's real estate
market to purchase homes all across the country for as little as a few hundred

And John's strategies don't just apply to homes. They apply to all kinds of
real estate...

GROSS: Well, Fred Schulte, welcome to FRESH AIR. So we just heard this
infomercial for John Beck "Amazing Profits." Are there a lot of people who are
offering classes or courses in how to invest in tax liens and take over
properties cheaply?

Mr. FRED SCHULTE (Reporter, Huffington Post Investigative Fund): There are.
There are many of these groups on the Internet. You can just Google them, tax
lien, and tons of them come up, and they all are selling some sort of course or
way to make a lot of money on tax liens.

GROSS: So what's the premise? How is an individual supposed to make money by
buying tax liens?

Mr. SCHULTE: Well, a tax lien is an unpaid property tax or utility bill or
something of that order. And in about 29 states, these liens are sold, usually
on an annual basis, to investors. And you can, in fact, buy the right to
collect that debt.

And in some states, that can mean that you can get 18, or even more, 18 percent
interest on that debt. You can also attach a lot of legal fees and other
charges onto the debt. So that's how you make money on it.

GROSS: So just so I understand this, so if somebody can't pay their taxes on
their property or their home and the county has given up trying to collect the
taxes from this person, they can sell the debt, they can sell the tax lien to
an individual investor or to a bank, which we'll get into later. And then the
person who's taken over the tax lien can raise the interest, add fees and start
making money. So do I have that right?

Mr. SCHULTE: That's right.

GROSS: Okay, so the ad that we just heard, for John Beck "Amazing Profits," how
to invest in tax liens, he's being sued, or his company's being sued, by the
Federal Trade Commission. What for?

Mr. SCHULTE: Well, the Federal Trade Commission is alleging that Beck's course
is misrepresenting the benefits of tax lien investing. And one of the premises
is that for pennies on the dollar, you can buy these properties. And the
position of the FTC is that you don't, in fact, buy properties for pennies on
the dollar.

And some of this gets to the whole issue of the lien, purchasing the right to
collect a debt, rather than the home. And some people don't quite understand
the difference, and this has some tax collectors a little concerned because
people think that they - may think that they're actually buying the home for
the amount of the taxes. That's not what you're buying. What you're buying is
the right to collect the debt.

Now, when you collect the debt, you can add on all these fees, and you can get
an interest rate that is set by law in the various states. So it can be a very
profitable endeavor, but it's not quite the same as buying a house for, like, a
$600 tax debt - to buy a $200,000 house for $600 isn't quite that simple.

GROSS: Now what you've been writing about isn't really the individual investor,
the kind of person that Beck is addressing himself to, as much as, like, banks
and hedge funds. That's what you've been focusing on. Why are banks and hedge
funds starting to buy up massive amounts of tax liens?

Mr. SCHULTE: Well because there's a lot of money in it. And we have been
looking more from the position of the homeowner and the person who actually has
to pay all of these fees and things, not so much at the people that are
investing, hoping to make money off of the woes of the homeowner.

But banks and hedge funds have, in fact, been in the tax lien investing
business for some years, but with the advent of the online auctions that are
being held in a number of states, most notably in Florida, there's a great
opportunity for people who have access to very cheap money, which would be a
bank, to come in and buy these debts.

And you're talking about, in Florida, hundreds of millions of dollars invested
very, very quickly. So the banks have the opportunity to - I mean, they have
the access to the money. They can buy these things quickly. Most people will
redeem the debt fairly quickly at a decent interest rate, and so that's how the
bank makes money.

GROSS: So most people, once the bank takes over the tax lien, pay back the
debt, but...

Mr. SCHULTE: They do, they do, because, you know, a lot of times, you're
talking about a debt that's $700 in property taxes or $800, and your home is
worth $60,000 or $100,000, and obviously the economics are such that if you're
the homeowner, you're going to try to come up with the money in order to keep
your home.

So the bank knows that and expects a quick redemption. That's one strategy in
buying tax liens.

There's another group of investors, and that's not so much the banks and the
hedge funds, that are actually looking to get the property. And that can be a
lengthy process, but you can, in fact, sue to obtain the property if your
demands aren't met for the payment.

GROSS: So who are those investors that are looking to take over the property?

Mr. SCHULTE: Well, some of them are people that work in urban areas, and that
are rehabbers and that sort of thing, that look for - I mean, that was one of
the original ideas behind selling these tax liens is you have a piece of
property, let's say in an inner-city, and it's not generating any taxes because
the owners have abandoned it or they've walked away from it.

But the city, then, will say, well, you know, if we could sell this to a new
investor, and they fix it up and resell it to somebody, then that property
would be added to the tax rolls. That would be a good thing for the city. So
there are people that are going out, looking for properties like this where the
taxes are delinquent.

I think where we saw some problems was if you didn't have a mortgage on the
home, let's say you'd owned the home for - and you've lived in it all your life
or, you know, it was your parents' home and the kids are living there, and the
kids are adults, and so there's no mortgage on the property, but you fall
behind in taxes, then there's no mortgage company that's going to come forward
to try to pay the taxes on your behalf in order to save the property. And in
that kind of a situation, you're really vulnerable to losing the property over

We had a situation in Baltimore where a woman didn't pay a $300 water bill. Her
family had owned the home for almost 30 years. There was no mortgage on the
property. But she didn't pay this $300 water bill.

Well, over time, as she didn't pay it and didn't pay it, it escalated, and the
legal fees kicked in, and then pretty soon, she owed thousands of dollars, and
she couldn't pay it. And so she ended up losing the house.

GROSS: Well, whose legal fees kicked in?

Mr. SCHULTE: The legal fees from the - are because you can't just force
somebody out of their house. You have to file a lawsuit against them to
foreclose - they call it to foreclose on their right to redeem the debt. It
gets a little technical and a little complicated, but essentially you sue to
take the property from them.

And as that goes through the courts, the legal fees add up, there's title
search fees, there's all these fees, and then you end up with a $300, $400 debt
morphing into $4,000 or $5,000. And that puts - that sinks some of these
property owners, and they end up losing the house.

GROSS: So in other words, those expenses are charged to the homeowner.

Mr. SCHULTE: Oh, they are absolutely, and that's...

GROSS: All the legal expenses that it takes to drive the homeowner out of their
home are charged to the homeowner.

Mr. SCHULTE: Yeah, yeah they are.

GROSS: So let's talk a little bit about how banks are investing more than ever
in tax liens. What's in it for the banks? And why are they investing more now
than before?

Mr. SCHULTE: Well, for the Bank of America, I mean, the Bank of America came
down into Florida and spent hundreds of millions of dollars buying these up.
And that was in late May and early June, when the various counties around the
state held these mostly online tax sale auctions.

They purchased the liens along with a Wall Street hedge fund, the Fortress
Investment Group, and then they later put them into a securities package and
resold them as a Wall Street bond deal.

GROSS: So if a bank invests in a tax lien, at what point are they allowed to
take over the property if a homeowner hasn't paid the tax debt?

Mr. SCHULTE: That depends on the state. In some states, as little as six months
after the sale. They can file a lawsuit six months after the purchase of the
lien and attempt to take your house from you. In other states, it's longer and
in, like, Florida, it's two years.

GROSS: So banks are now investing in these tax liens through Internet sales
because the tax liens are sold in auctions on the Internet, as opposed to the
way they used to be, which is auctions in a room where people would show up. So
how has that changed the whole nature of investing in tax liens?

Mr. SCHULTE: Well, it's put the whole process on steroids. And when you have
these banks doing this over the Internet, they're creating all kinds of
corporate alter-egos and strange names and limited liability companies that are
bidding on these things.

And, you know, like I said, they have access to a large amount of money, and
they come in, and they really rev up the system. I mean, it used to be that
there were just a few people sitting around in a room holding up paddles at
these auctions. Now you have a situation where anybody in the world can be
bidding anonymously, and millions of millions of dollars is changing hands here
in a matter of minutes. And there's very little known about who the people are
who are buying them.

But for the banks, they're able to dominate the process because they have a
ready supply of money.

GROSS: Why would the banks need to come up with alter-ego names, with names of
other companies just to invest online in these tax liens? Why can't they just
invest in their own name?

Mr. SCHULTE: Well, we've asked them that. We never really got a satisfactory
answer to that question. But, I mean, some people think that this is a business
that they would rather not talk about. I mean, they want to get the money from
it, but they really don't want to be publicly identified with a business that
some people say is, you know, benefitting from the economic misfortune of

I mean, one of the things that we looked at also was that some of the banks
doing this had been recipients of bailout money from the taxpayers. And so some
critics were telling us, critics of this whole process, were saying, well, you
know, these banks, when they were in trouble, the taxpayers bailed them out.
And now here they are running down to Florida or one of these other distressed
real estate markets and buying up liens on people that can't pay their taxes.

And, you know, it can be devastating to lose your home. I think if you're the
person taking that home, I don't think it's something necessarily that you want
everyone to know you're doing.

GROSS: So if banks are using aliases in some instances, and the counties don't
really know who they're selling the liens to, should the county care? Does it

Mr. SCHULTE: Well, they haven't really thought about it, I think traditionally.
And I think some of them, in fact, are starting to care because any time you're
selling millions and millions of dollars worth of liens and you have no idea
who you're selling them to, it's just some, you know, blankety-blank LLC, and
you have no idea who those people are, you have no idea who the funding source
is for these people, you have no idea whether they're U.S. companies or not.

We had - in the recent Florida auctions, there were some from the islands, you
know, the Cayman Islands, that sort of thing. And so some of the tax collectors
are, in fact, getting a little concerned that they don't really know who is
buying up these certificates. They call them tax lien certificates.

GROSS: My guest is Fred Schulte, a reporter with the Huffington Post
Investigative Fund. We'll talk more after a break. This is FRESH AIR.

(Soundbite of music)

GROSS: My guest is Fred Schulte. He's written a series of investigative
articles about banks and hedge funds investing in tax liens and profiting from
the distress of homeowners.

So who are the biggest players among the banks and the hedge funds investing in
the tax liens now?

Mr. SCHULTE: Well, the Bank of America, JP Morgan, the Fortress hedge fund
group. Those are three of the real big players.

GROSS: Now, the Fortress Investment Group, which is a hedge fund, is headed by
Daniel Mudd, who used to be the head of Fannie Mae.

Mr. SCHULTE: That's correct.

GROSS: So what is interesting about that?

Mr. SCHULTE: Well, I mean, he's - it's a big fund. I mean, they manage billions
of dollars, but I mean, I think that some critics have wondered why somebody
that was involved on this, the government end of these mortgages, is now on the
other end, taking advantage of people who can't pay their mortgages and
potentially taking their property.

GROSS: You've been investigating homeowners whose tax liens have been sold.
What are you learning about what homeowners are up against when their tax liens
are sold to banks or hedge funds?

Mr. SCHULTE: Well, what they tend to be up against is a lot of fees and a very
high interest rate. I think one of the things that homeowners need to
understand is that if you're having trouble financially, you've lost your job,
you must pay your property taxes because if you don't, you can be thrown into
this web of fees and uncertainty. And you can, in fact, be sued and have your
property taken from you for a debt that's only a few hundred dollars.

So I think when it's your house, you really need to pay that first and

GROSS: It's easy to see why cities and counties would want to sell the tax
liens because if the homeowner isn't paying the tax, it means that the city or
county isn't getting that money. And the more people who can't afford to pay
their taxes, which is the kind of situation we're in now, the less money the
city or the county makes. And this is especially bad at a time like we're in
now, when cities and counties are really hurting for money.

So in the short term, it makes sense that they'd want to sell these tax liens
and get the money that they're owed. But in the long term, are there questions
down the line that you think might come up that might make things not so great
for cities and counties who’ve sold a lot of tax liens?

Mr. SCHULTE: Well, there are. I mean, obviously the city or the county gets
immediate cash by doing this. In Dade County, Miami-Dade County in Florida, in
2009, over $300 million came in the day of the tax sale. So that was all money
that they would have had to go out and collect some other way. So obviously,
there's a quick infusion of cash.

Down the road, what does this mean? Well, some people think that it increases
foreclosures. In Cleveland, for example, they decided not to hold a tax sale
action this year because the previous ones had resulted in a lot of

And they figured, well, wait a minute. This is making the foreclosure rate even
worse. So that can be one of the problems that you get with the sale of these
liens. If a lien owner buys a lien on it, and let's say it's an abandoned
building, then they don't keep it up and it gets run down. And so neighborhoods
can deteriorate.

So some people are thinking, well, you know, it might have been smarter to
figure out a way to get those taxes paid on a payment basis or find some other
method to try to get the homeowner to pay, rather than just selling it off and
then not knowing who's going to buy it and what's going to happen.

GROSS: To do this story, you've probably spent a whole lot of time with public
records, going through them?

Mr. SCHULTE: Yeah, yeah. Well, and lawsuits. I mean, I think that's how you do
this kind of a story. I mean, data analysis was critical to this and also a lot
of time in the courthouse because these cases always end up in court. And in
court, people can't be anonymous, they have to be a real person.

As far as the online tax-sale auctions, all that data is available online. And
so you can download it, and you do that, and you can see the patterns and who's
buying them.

And then what we had to do was figure out who, in fact, they were. We kept
seeing these, you know, names, like you'd see, like, Benu LLC(ph) and Ecru LLC
and all these different LLCs. And so it's a whole other research job to try to
figure out who, in fact, Benu and Ecru are. And that took a long time, lots of
phone calls, lots of requests for public records.

GROSS: Who were they?

Mr. SCHULTE: The Bank of America.

GROSS: And you found that out by how?

Mr. SCHULTE: By - well, we traced it to a - or I traced it to a post office box
in Atlanta, which is the official address that they use for conduct of
business. And I called and made information requests with tax collectors all
over Florida and eventually got enough information in to see that, in fact, the
contact person for these companies was - I was able to link that person to Bank
of America.

GROSS: You've invested a lot of time into researching this story on the sale of
tax liens and how that's affecting homeowners who can't afford to pay their
city or county taxes. This is obviously a really important story to you. What
makes it that important to you?

Mr. SCHULTE: Well, I think that the issue is fairness. I mean, and everybody
would like to have a home and own a home, and some people that have owned a
home for generations want to keep it. And I think that the issue is that how do
you balance society's needs to collect taxes with the rights of the property
owner not to be just tossed out?

And the other issue is, of course, does the penalty fit the crime? I mean, I
think that's one of the big things with this, not that this is a crime, but a
debt. If you have a debt of a few hundred dollars, should that debt be able to
morph into thousands and thousands of dollars, which de facto sinks you and
causes you to be chucked out of your house, particularly a house that you've
owned free and clear for years?

And I think that's the tension in the story for us. And so it is kind of like,
well, we know that the county or the city has to collect its money, but does it
have to do it in such a way as that it imposes thousands of dollars in these
fees and really damages people? And then if that happens, who walks away with
that money? And is it right, is it fair that some bank walks away with
thousands of dollars here over your inability to pay your taxes and/or walks
away with your house?

GROSS: Fred Schulte, thank you so much for talking with us.

Mr. SCHULTE: My pleasure.

GROSS: Fred Schulte's of articles about how banks are profiting from
homeowners' distress are published by the Huffington Post Investigative Fund.

I'm Terry Gross, and this is FRESH AIR.
Fresh Air
12:00-13:00 PM
A Breast Oncologist, Diagnosed With The Disease

(Soundbite of music)


This is FRESH AIR. I’m Terry Gross.

Dr. Marisa Weiss is one of the go to doctors for women diagnosed with breast
cancer. She's the author of "Living Well Beyond Breast Cancer," and is the
founder of, a popular breast cancer resource website. She's a
breast oncologist at Lankenau Hospital in the Philadelphia area.

Last spring, after getting her annual mammogram, Dr. Weiss was diagnosed with
breast cancer. After taking time off for treatment, she returned to her
practice. We invited her to talk about what she describes as having dual
citizenship as a doctor and a patient.

Dr. Marisa Weiss, welcome to FRESH AIR. So, let me just start by asking you how
is your help now?

Dr. MARISA WEISS (Oncologist, Lankenau Hospital; Founder, I
actually feel better now than I did before I was diagnosed. You know, I've sort
of learned, had to learn how to take care of myself in the same way that I've
prescribed to my patients over the 20 years that I've been in practice, and
I've really focused on not just what the doctors have told me to do, and I've
done that, but also on what I'm doing in my everyday life, you know, what I'm
eating, what I'm drinking, what I'm breathing in, the personal products I'm
using; from, you know, the kitchen cabinet to the bathroom shelves, to the
cleaning supplies. And I've, you know, had to get my act together in a number
of different ways. And with all that work, there's been a big return on
investment and I feel a lot better.

GROSS: So you are surrounded by people who have breast cancer because you're an
oncologist who treats women with breast cancer. So did you worry before getting
it yourself that you would get it, because you see it all the time? It's so
business as usual for you.

Dr. WEISS: Right. I mean breast cancer is basically my whole life. Many people
in my family have had it.

GROSS: Your mother has it.

Dr. WEISS: My mother has had it. My aunt just passed away actually from it this
past spring.

GROSS: Sorry to hear that.

Dr. WEISS: Yeah. I have relatives I have never met who had it, who I've heard
stories about. I have taken care of thousands of women and then through Breast, there are 10 million people that come to us that I feel like I have
a relationship with over the years. And yes, I was always concerned and aware
that it could happen to me. I never thought that I would get a free pass
because I've been a good girl and, you know, and worked hard to help other
people and that that somehow would magically protect me. But when it happened
to me it was a shock because, you know, I was a very busy person and during a
very busy day like anybody else, I had to break away from my schedule to race
up to the mammography department, take the white coat off, all the clothes off,
waist up off, wait in that gown, wait to be called. And I thought it was just
going to be like any other year, where I would get the films, they would call
me back for a few extra pictures, as they always do, and then they would say,
good, everything looks great, catch up to you next year. But that didn't happen
this year. So...

GROSS: You give the news all the time to your patients. What was it like to get
the news?

Dr. WEISS: Well, the news didn't come all at one time. It started with, I see
some changes on the mammogram that are worrisome. So I said well, how worried
are you? The radiologist said I'm pretty worried. So right away I knew that
there was a change that was significant and that those words were serious
words. And then I had to come back and I was lucky to get an appointment to
come back the next day for extra pictures, so extra mammogram pictures to zero
in on the area that they were concerned about - and ultrasound. And each of
those tests showed more reason for worry and concern. Then I had to race out of
the hospital to be the keynote speaker for a luncheon of 400 women an hour
away, and then drive back for...

GROSS: About breast cancer, no doubt.

Dr. WEISS: About breast cancer, of course. That's, as I said, is my life...

GROSS: Your life.

Dr. WEISS: ...and for my MRI scan at the end of the day. And after that test I
came out and looked at the faces of the radiology technicians who operate the
machines and they wouldn’t look at me. They were just avoiding my glance. So I
knew then it was, you know, it was serious. And then I went from there to
radiology reading room and met with the radiologist who was going to, who
pulled the MRI images fresh up on the screen. And like a light bulb, there it
was, this tumor in my left breast that was clearly a cancer. And while it
hadn't yet been biopsied, I've been doing those for so long; I knew I had
breast cancer. And that was a really tough weekend because that was a Friday
night and the weekend I spent with my son and I wasn't really able to share
anything with him because I didn't want to upset him unnecessarily in case
perhaps it may not be cancer.

GROSS: So with all this evidence, the different tests that you had taken
together, what did you learn about your breast cancer that you might not have
been able to learn had you been diagnosed say, 15 years ago?

Dr. WEISS: Well, what is amazing to me is that we have had advances in many
different specialties in breast cancer treatment and diagnosis that are teamed
up with better detection. So I had the benefit of early detection with
mammography. And because it was found early, I also was able to take advantage
of a new test called the Oncotype DX test, which is like an FBI report on the
proteins and genes that turn on and turn off breast cancer cell growth and also
make the breast cancer able to invade normal tissue and spread to other parts
of the body.

So I got that test result and it showed that my risk of having distant
recurrence 10 years from now was low. And because of the result of that test, I
was able to avoid chemotherapy and instead have hormonal therapy, medicines
that block the effects of estrogen on breast cells. The medicine's called
tamoxifen. In my situation, there are many different kinds of medicines in that
category. So I feel that I benefited from early detection in more ways than
one. I had an earlier diagnosis, a better prognosis and also was able to avoid
treatments that could have had significant side effects, both immediate as well
as lingering in the future.

GROSS: So was there a part of you that was saying, even though the analysis of
my tumor says that it's not the kind of tumor that's likely to recur or spread
- do I have that right? - and therefore, you know, you don't have to do the
chemo or the radiation, surgery should be sufficient. Was there a little voice
in your head saying, but just in case, just in case, maybe I should do the
chemo or maybe I should do the radiation? Because I've certainly heard women
say that, you know, they probably don't need it but they were urged, just in
case, go through those treatments.

Dr. WEISS: Right. I mean we have this huge human nature tendency to think that
more is better. But for me, my greatest benefit was going to come from hormonal
therapy, not chemotherapy. And I know that the type of cancer I have is the
kind that can recur much later, not just within the first five years, but even
10 years or 15 years. So I need long-term protection. So I've had to get very
serious about making sure I'm as healthy as possible and that I don't expose
myself to outside hormones or chemicals that can act like hormones and address
sort of my internal environment and make that as healthy as possible.

So, for example, I got my weight down, I lost 13 pounds, and try to stick to
it. I limit the amount of alcohol I drink to five or fewer drinks per week. I
usually stick to two or three drinks or fewer per week because those two things
are closely associated with breast cancer risk and breast cancer recurrence.
I've never smoked, but I also stay even further away from people who smoke. I
make sure that I have hormone free sources of beef or dairy products. I avoid
any foods that have, that are heavily treated with pesticides, like apples,
peaches, celery, bell peppers, any kind of berries - because some of those
pesticides can act like, taste like, smell like estrogen to your breast cells
on the inside. I'm also very careful about trying to exercise three or four
hours a week, something I don't really like doing, which takes a lot of

GROSS: I know obesity might be a factor but you're quite slim. Why did you feel
you needed to lose weight?

Dr. WEISS: Well, I was overweight when I was diagnosed. Only somewhat
overweight, but obesity is connected to a higher risk of breast cancer because
the extra fat makes extra hormones. Also, a lot of the chemicals in the
environment that can act like estrogen, they dissolve in fat and your body can
harbor them. And people who are overweight tend to be less physically active
and eat less nutritious food. And it's also true that there's some interaction,
so when overweight women drink alcohol there's more of an effect than when thin
women drink alcohol. So I knew that managing my weight, something I've
struggled with my whole life, was something I had to really get real about -
get to a healthy weight and stick to it, and change my life in order to make
that happen.

GROSS: So you're talking about avoiding anything that behaves in the body like
estrogen does, because your kind of breast cancer feeds on estrogen.

Dr. WEISS: That's right.

GROSS: So we've been hearing for years that the hormonal treatments, the
estrogen treatment that were supposed to help women through menopause and help
stave off memory loss and be good for the heart, actually can feed breast
cancer cells and make you more prone to breast cancer. And there's a new study
that says, not only that, but, it can create a more aggressive form of breast
cancer - and stop me if I'm getting any of this wrong.

Dr. WEISS: No, it's exactly right.

GROSS: Yeah.

Dr. WEISS: It's like fertilizer. So basically, when you take pharmaceutical
estrogen from the outside environment into your inside environment, inside your
body, you're basically marinating your cells in a substance that's going to
promote its growth. So breast cells are very responsive to hormones, as well as
medications or chemicals that can act like hormones. And when you are
constantly being marinated in a mix that contains hormone replacement therapy,
the cells can become overactive and become cancer cells. And so that study, the
recent study, shows that women are at a higher risk for getting breast cancer,
and breast cancer that's more aggressive, that's gone to lymph nodes. So the
paper really asks doctors and patients to have a conversation about this and
say, you know what, maybe it's time to get off of hormone replacement therapy,
reevaluate what symptoms you might have, find safer effective remedies for
managing postmenopausal symptoms - like hot flashes or dryness and things like

GROSS: Did you have to decide whether or not to tell your patients that you
were diagnosed with breast cancer, the same thing you were treating them for?

Dr. WEISS: Yes. It was very difficult to figure out exactly how I disclose my
own diagnoses to my patients, because I didn't want them worrying about me when
the reason why we're meeting is to take care of them.

GROSS: And also worrying that you are not going to be their doctor...

Dr. WEISS: And...

GROSS: And maybe you'll decide to leave.

Dr. WEISS: Right.

GROSS: Maybe it'll be just too much stress, too much time.

Dr. WEISS: Right. You know, there was...

GROSS: Maybe you won't be well enough. Yeah.

Dr. WEISS: Yeah. No, I think all those concerns weighed on their minds. So in
my usual style of being open, I was upfront. I let the people know who were
under treatment at that time that I was going to have a medical procedure and I
was going to be out for the week and that I expected to be back soon and I
expected to be, you know, fully able and competent to be their doctor, and that
while I was away there would be full coverage. And then when I came back, you
know, they were asking me well, are you okay and what happened? And I said
thank you for your concern. I was diagnosed with an early stage breast cancer
and I have...

GROSS: So it was only after you came back you revealed that.

Dr. WEISS: We decided it was best to share the information in stages and not
overwhelm them with too much information at one time, particularly when I
myself needed the privacy. I needed - and didn't have all the answers.

GROSS: Right.

Dr. WEISS: So I divulged as much as I thought I could share that was reasonable
and - knowing that we would continue the conversation when new information
became available.

GROSS: How did they take it?

Dr. WEISS: I have gotten tremendous support from my patients. They've
expressed, you know, true compassion. I've gotten beautiful letters and phone
calls. It made a big difference to me and I've, you know, am very grateful to

GROSS: My guest is Dr. Marisa Weiss, a breast cancer oncologist and the founder
of She was diagnosed with breast cancer last spring.

More after a break.

This is FRESH AIR.

(Soundbite of music)

GROSS: My guest is Dr. Marisa Weiss, a breast cancer oncologist and the founder
of She was diagnosed with breast cancer last spring.

So one of the things you're concerned about is not exposing yourself to
environmental hazards and to certain, you know, products that you think can
have an estrogen like effect in your body, and you are in the process of
writing a book about environmental issues that might increase risk of breast
cancer or breast cancer recurrence. So let's run through some of your specific
concerns about that. I don't know if you want to start with food.

Dr. WEISS: Well, let me just say that breast cancer used to be pretty uncommon
about 100 years ago, and what's happened is that the breast has become the
favorite place for cancer to occur in this day and age.

GROSS: And we all know people - I think I can say this and speak for everybody
- that we all know people who have had breast cancer. So what are some of the
explanations of why the breast has become the favorite location for cancer?

Dr. WEISS: Well, most people think it is all about family history and genes you
may have inherited from your family. But actually, the breast cancer genes only
explain five to 10 percent of breast cancer cases today and those are ancient,
stable abnormalities. They haven't changed. But what has changed over the
years, that explains why the breast has become the favorite place for cancer to
occur, are changes in our outside environment and our body's inside

So in terms of the inside environment, with obesity making extra inside
hormones that can influence breast cell growth, it also triggers more insulin
growth factor. More women are drinking alcohol. More women have not stopped
smoking. They've started but they haven't stopped as quickly as men have. We
lead very stressful lives. We don't sleep enough. We're running ourselves
ragged. We're not giving our bodies a chance to heal from the wear and tear of
everyday living; from the outside environment we bring into our body's inside
environment what we're - the food, for example, the most commonly grown crops
today, corn and soy, are grown with Atrazine and Roundup. Atrazine can turn on

GROSS: What is Atrazine?

Dr. WEISS: Atrazine is an herbicide. It's a weed killer that's used to grow
corn. Roundup is a weed killer used to grow in soy. Those seeds are genetically
modified to grow in the presence of those chemicals. But we haven't been
genetically modified to withstand the side effects of Atrazine and Roundup.

Atrazine can stimulate the production of estrogen in your body by turning on
the aromatase enzyme. And Roundup is a hormone disruptor. It can kind of rock
the boat and mess up the balances of hormones in your body. But all these
chemicals, you know, they are used in agriculture or industry. They can get
into the food that we eat, the water we drink and they can have an influence -
and unhealthy influence - on our breast cells.

GROSS: Why breast cells and why not different parts of the body?

Dr. WEISS: Well, actually the breast is a very unique organ. It is the only
organ to fully – essentially, fully form after you've been born. All the other
organs and including the very beginning of the breast tissue is formed during
the first three months of pregnancy. And during that time, of course, the
breast cells are exquisitely sensitive to any kind of genetic insult as they
are building themselves. But then the breast is the only organ in the body to
actually fully form, and over a 10 year period of time - from ages eight to 18
and into your 20s - and that is when what you're eating, drinking, breathing
and using are the actual building blocks and that's when you're laying down the
foundation of your future breast health.

So, for example, exposures to DES when you're building your breast tissue in
utero produce a higher risk breast cancer, in the mothers as well as the
daughters, later in life. Bestinal A can have a permanent effect on the way the
breast is formed if you're exposed to it in utero or later on during breast
development. So that's one unique thing about the breast.

Also the estrogen receptor that runs operations in most breast cells is like a
sponge for all of these different chemicals. While it has a monogamous
relationship with estrogen it is ready to respond and it's quite promiscuous
when it comes to all these other chemicals and they can turn on breast cell
growth. And what has also happened is that girls are going through breast
development way earlier.

For African-American girls it can start as early as, you know, age eight -
seven or eight. For white girls it's around age 10. For Latino girls it's like
nine and a half. And then as soon as the breasts are made, they're ready to
respond to these chemicals and the breast cells remain quite immature and over
active until the first full-term pregnancy - which is the first time in the
life of the breast when the breast is forced to actually fully grow up, get its
act together and get a job breastfeeding. And what's happened today is that
breast development is happening earlier and earlier and many women are delaying
having their first full-term pregnancy or not having children at all or are not
breastfeeding. And during that long stretch, the breast cells are immature and
very responsive to outside chemicals it may bring into your inside environment.

Those combination of reasons explain, largely, why breast cancer has become the
most common cancer to affect women.

GROSS: So I know before you actually had your breast surgery you got
photographed so that you'd have a photo of your intact breasts.

Dr. WEISS: Mm-hmm.

GROSS: What have you done with the photograph and do you ever look at it?

Dr. WEISS: Well, a friend of mine called me before my surgery, and she said
take a picture of them. And I said why? And she goes you want to remember them,
you know, the way they are now. So I asked my husband and he said no, I don't
want to do that. So I called my sister and she said oh, there's a place called And I called them and they said we're having a special.

(Soundbite of laughter)

Dr. WEISS: So I decided that I was going to do it. I was so happy that I did
because it sort of captured the moment. It was fun. It took the edge off my
anxiety going into surgery. They put me up against a very cold exterior wall
and my breast went right up to their - the original position, just, and they
looked fabulous when the picture was taken. So I will remember them that way
and I was really pleased that I had done that. It was a lot of fun and I
haven't done anything with the photographs but I have them sort of tucked away
for a sneak peek whenever I want to, you know, remember them in their glory.

GROSS: Dr. Weiss, thank you so much for talking with us.

Dr. WEISS: Thank you for having me.

GROSS: Dr. Marisa Weiss is the founder of, and the author of
"Living Well Beyond Breast Cancer." She was diagnosed with breast cancer last

Coming up, we remember Richard Holbrooke.

This is FRESH AIR.

(Soundbite of music)
Fresh Air
12:00-13:00 PM
Holbrooke On Meeting 'Evil Incarnate' In Serbia


Richard Holbrooke had some extraordinary experiences during his career as a
U.S. diplomat. We're going to hear about one that he described in our 1998

Holbrooke died yesterday after surgery for a torn aorta. He had been serving as
President Obama's special representative for Afghanistan and Pakistan. He
worked for every Democratic president since the late 1960s. His greatest
accomplishment was as the chief architect of the Dayton Peace Accords,
negotiating an end to the war in Bosnia in 1995.

The Balkan war had shocked the world with the siege of Sarajevo and the forced
relocation and slaughter of Muslims in Bosnia in what was described as ethnic

I spoke with Richard Holbrooke in 1998 after the publication of his memoir "To
End A War."

When the times that you've dealt with Milosevic, the head of Serbia, have you
felt that you were dealing with evil incarnate, which is often the way he's
been portrayed?

Mr. RICHARD HOLBROOKE (Former U.S. Ambassador to the U.N.): I, you know, I've
dealt with so many leaders over the last 25 years who represented things alien
to the American tradition. And with Milosevic, I felt I was dealing and
continued to deal with a person whose behavior and style and activities are
just totally incompatible with those that we believe in. But the word evil is a
very powerful word and I want to depersonalize it. There is evil in the world.
It's something that we have to confront.

But the time that I felt that I was in the presence of evil, I incarnate evil,
was the extraordinary 13-hour negotiation we had to have in September of '95
outside Belgrade with Mladic and Karadzic, the two indicted war criminals who
led the Bosnian Serbs. These were hands-on murderers. It was like spending a
day with Pol Pot. And having spent my career in Asia, I was acutely aware of
the sense that this was the Pol Pot of Europe.

GROSS: Well, before you even met with them, you had to decide whether it was
morally justifiable to actually meet with them as part of the peace talks,
because after all, they were indicted war criminals. So what made you decide
that it was the appropriate thing to do to meet with them?

Mr. HOLBROOKE: We debated this on the plane flying into Belgrade. I said to my
team, look, sooner or later we're probably going to end up meeting with these
two terrible men, Radovan Karadzic, the political leader of the Bosnian Serbs,
and Ratko Mladic, the murderous general who runs the military. And each of you
has a choice here: do you want to meet with them or not? Do you want to shake
hands with them or not? We unanimously concluded, as had previous negotiators,
that's it's better to deal with these men to save the lives of people who are
still alive as the best way of honoring those who had already died, rather than
get up on one's high moral horse and refuse to meet with them.

However, because they were indicted war criminals, we made clear to them and to
Milosevic that they couldn't enter the United States or any European country -
Western European country - without facing immediate arrest under U.N.

Now, in making the decision to meet with them, I happened to be very influenced
personally buy two books that my wife, Kati Marton had written, one on
Bernadotte and one on Wallenberg. Both those men, both Swedes, had met in 1944-
45 with Eichmann and Himmler to save hundreds of thousands of Jews throughout
Central Europe by meeting with these horrendous people. And they had saved the
lives and I thought that was a valid model. So in the end we met with these
people. I chose not to shake hands with them. Some of my colleagues did. But I
think that the historical record shows that the decision to meet with them was

I might also add that everyone else had met with them routinely and not even
felt it was a moral dilemma, but I thought it was.

GROSS: Richard Holbrooke, recorded in 1998. He died yesterday. He was 69.

(Soundbite of music)

GROSS: I'm Terry Gross.

(Soundbite of music)

Transcripts are created on a rush deadline, and accuracy and availability may vary. This text may not be in its final form and may be updated or revised in the future. Please be aware that the authoritative record of Fresh Air interviews and reviews are the audio recordings of each segment.

You May Also like

Did you know you can create a shareable playlist?


Recently on Fresh Air Available to Play on NPR


Daughter of Warhol star looks back on a bohemian childhood in the Chelsea Hotel

Alexandra Auder's mother, Viva, was one of Andy Warhol's muses. Growing up in Warhol's orbit meant Auder's childhood was an unusual one. For several years, Viva, Auder and Auder's younger half-sister, Gaby Hoffmann, lived in the Chelsea Hotel in Manhattan. It was was famous for having been home to Leonard Cohen, Dylan Thomas, Virgil Thomson, and Bob Dylan, among others.


This fake 'Jury Duty' really put James Marsden's improv chops on trial

In the series Jury Duty, a solar contractor named Ronald Gladden has agreed to participate in what he believes is a documentary about the experience of being a juror--but what Ronald doesn't know is that the whole thing is fake.

There are more than 22,000 Fresh Air segments.

Let us help you find exactly what you want to hear.
Just play me something
Your Queue

Would you like to make a playlist based on your queue?

Generate & Share View/Edit Your Queue