ZOE Science & Nutrition - Are you at high risk of breast cancer? Follow this early detection guide | Dr. Thaïs Aliabadi
Episode Date: July 10, 2025Do you really know your breast cancer risk? Many women think they do – trusting family history, regular checkups, and mammograms to keep them safe. But what if these measures leave dangerous blind s...pots, leading to later, more aggressive diagnoses? Today's episode is a powerful wake-up call. Joining us is globally renowned OBGYN, Dr. Thaïs Aliabadi. Known simply as “Dr. A” to her global following, she's OBGYN to royals and celebrities, and a leading voice on women’s health featured on The Kardashians, The Doctors, and Dr. Phil. Dr. Aliabadi shares her own shocking story: how, despite following all the rules, she uncovered a hidden cancer risk that standard screening completely missed. Today you'll learn why your lifetime risk may be higher than you’ve been told, how diet and lifestyle could change your trajectory, and the essential steps to take today to safeguard your health. This is information every woman needs - don’t wait until it’s too late. Unwrap the truth about your food 👉 Get the ZOE app 🌱 Try our new plant based wholefood supplement - Daily 30+ *Naturally high in copper which contributes to normal energy yielding metabolism and the normal function of the immune system Follow ZOE on Instagram. Timecodes 00:00 Food's Influence on Breast Cancer Risk 00:47 Mammogram Limitations & Misconceptions 04:11 Shifting Mammogram Age Guidelines 10:02 Mammogram Limitations and Dense Breasts 11:56 How to Know if You Have Dense Breasts 13:23 Dr. Aliabadi's Personal Cancer Journey 15:37 Discovering a High Lifetime Risk 17:28 The Emotional Impact of Cancer Talk 19:11 The Day of Surgery and Unexpected News 22:32 The Importance of Being Your Own Advocate 25:10 A Second Mastectomy for Missed Tissue 27:00 Olivia Munn: A Public Story of Early Detection 31:00 Genetic Testing Beyond Family History 34:09 How to Calculate Your Lifetime Risk 37:25 High-Risk Patient Screening Strategies 40:02 Factors Increasing Breast Cancer Risk 43:03 Hormonal Birth Control and HRT Safety 46:00 When to See a Doctor for Lumps 49:10 The Power of Personalized Health 📚Books by our ZOE Scientists The Food For Life Cookbook Every Body Should Know This by Dr Federica Amati Food For Life by Prof. Tim Spector Free resources from ZOE Live Healthier: Top 10 Tips From ZOE Science & Nutrition Gut Guide - For a Healthier Microbiome in Weeks Have feedback or a topic you'd like us to cover? Let us know here. Episode transcripts are available here.
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Welcome to ZOE Science and Nutrition, where world-leading scientists explain how their research can improve your health.
Breast cancer rates are on the rise in younger women.
In 2024, some Western countries lowered the recommended routine screening age from 50 years old to 40. And while early detection saves lives,
some cancers still slip between the cracks of a routine screening.
But what if there was one simple step that every woman could take right now
to understand her risk more accurately?
Well, it turns out there is, and it's free.
And it saved the life of today's guest, Dr. Taiz Ali Abadi.
It also helped her patient, actress Olivia Munn, treat a rare form of breast cancer missed by her annual screening.
Taiz is a world-renowned gynaecologist who delivers babies for royal families and celebrities like
the Kardashians and the Biebers. She's also the host of the popular podcast SheMD.
and the Beebers. She's also the host of the popular podcast, SheMD.
Thais joins us as a breast cancer advocate
to help women before it's too late.
You'll leave today's episode with the tools
to help with early detection for you and your loved ones.
Thais, thank you for joining me today.
Thank you for having me.
So we like to kick off our shows at Zoey
with a rapid-fire Q&A with questions from our listeners.
So the rules are you can give us a yes or a no,
or if you absolutely have to, a one-sentence answer.
You want me to give that a go?
Sure.
All right.
Are cases of breast cancer rising in younger women?
Yes. Does a mammogram always catch breast cancer?
No.
Is there an accurate way to measure your lifetime risk of breast cancer?
As accurate as it can get, yes.
Could the food you eat influence your risk of breast cancer?
One thousand percent.
And you get a whole sentence now.
What's the biggest misconception about the early detection of breast cancer?
I don't have family history of breast cancer, so I'm not going to have breast cancer.
And that's not necessarily true?
It's not true at all.
Very recently, a close family friend was diagnosed with a very high genetic risk of breast cancer
and decided to opt for a double mastectomy as a result.
And that was really shocking to me because it's just not something that I had even considered that
someone might do based upon like a genetic risk from a test and definitely completely changed
my view about breast cancer and I could see that like sort of everything that I thought I'd
understood about it which was probably not very much is, is all wrong.
So I think today I hope we're going to sort of walk through everything we need to
know about early prevention based upon what's going on today and maybe not the
sort of outmoded ideas that I might've had and many of us might've had because
it's clear that the science has really moved on.
So I'd like to start maybe with what the guidance is.
And I understand that guidance is different in different countries.
So we're here in the States, so maybe US guidance about mammograms and the age at which you
should have a mammogram.
Well, the general guideline in the US right now says that a woman should start her mammogram
at age 40 or 10 years before her first degree relative with breast cancer was diagnosed with cancer.
But I'm trying to change that because that does not include the high risk patients who
fall into a category that might need to start their breast imaging as early as 25 or 30.
So not all women fall into that age 40 or above category.
Even age 40 sounds like it is earlier than the
Yes, the majority of the countries.
Yep.
So has that shifted?
Did it used to be later than 40?
Yes, it used to be 50 and in some countries
it still starts at 50.
In the US for low risk patients it's 40.
You can do it up to every two years.
I think patients need to do it once a year,
but I want every single person to know her lifetime risk
of breast cancer and based on that risk,
then we go backwards and start the imaging.
So not all women fall into that 40 and above category.
So we're definitely gonna talk a lot,
I think in this show about screening,
but this is the first time we talked about breast cancer on the podcast. So what causes breast cancer and why is it so dangerous that we sort
of focus on breast cancer versus any other type of cancer? So first of all after skin cancer,
breast cancer is the number one cancer in women. So it's very important one out of eight women
will get diagnosed with breast cancer. On average, every woman has a 12.5% chance
of getting breast cancer in their life.
And you know, I always use the airline example.
If I told you you're about to board a plane
that has a 12.5% chance of crashing,
you would think twice boarding that plane.
I mean, I wouldn't get on the plane for sure.
Right?
But when I say to patients, you have 12.5% chance of getting breast cancer, they're like, oh, so I'm fine. you would think twice boarding that plane. I mean, I wouldn't get on the plane for sure. Right?
But when I say to patients,
you have 12.5% chance of getting breast cancer,
they're like, oh, so I'm fine.
And that's a starting point.
Then we don't really know what causes breast cancer, right?
But one thing we know, there are different factors.
We talked about nutrition already,
obesity is a risk factor,
having an early period, late menopause,
having dense breasts, having family history
of it, having children after age 30, drinking alcohol, smoking, all of this will add to
that risk and it can push you up from 12.5 to as high as 80% if you have a gene mutation.
Are we seeing higher rates of breast cancer today than in the past? I am for sure.
We are seeing more cancer in younger patients in general, all cancers considered, but especially
breast cancer. But part of it is also detection, right? Earlier detection, we've gotten better at
doing mammograms, ultrasounds, MRIs, and we can diagnose these cancers a little bit earlier.
So we are finding more of them, but you're saying part of it might be we've got better technology to find them.
But I've been in women's health for 30 years, and there's definitely an epidemic of breast cancer.
I was diagnosed with breast cancer, and my risk factors were very little.
It's rare to have this combination of physician and patient and I think we'd love to talk
about that.
Do we know why there might be an increase in rates of breast cancer or this is?
I think stress, nutrition, alcohol, sedentary lifestyle, generally speaking, and I speak
for American women, the food we eat, the chemicals we're exposed to, lack of exercise, anxiety.
I think it's a combination of factors.
So we don't really know why someone gets breast cancer,
but I can tell you in my case,
it was probably diet and stress and lack of sleep.
But every patient has a different risk factor. And this is real, like the food that you eat can increase your risk of sleep. But every patient has a different risk factor.
And this is real, like the food that you eat
can increase your risk of cancer?
Yes, I believe so.
I think I was brought up with this idea
that cancer was sort of this random thing
that came from outside and there's nothing you can do,
but you're describing something where your lifestyle
has a real impact on it.
100%, in my case, I think think if for the past 30 years,
I had slept eight hours a night
and I had time to exercise regularly
and I didn't have to eat hospital food
or swallow my food in three minutes between surgeries,
I would have probably had a lower chance
of being diagnosed with my breast cancer.
I absolutely believe in that.
We've mentioned this word mammogram.
Yes. But actually, mentioned this word mammogram. Yes.
But actually what is a mammogram
and why is that typically the first step for detection?
Mammogram is an X-ray of the breast
and it's the most effective method we have right now.
It's not perfect, but it's the most reliable
we have right now.
It basically detects tumors and calcifications
in the breast years before
we can palpate it. So you want when it comes to breast cancer or any cancers, the goal
is to diagnose it as early as possible. Early detection is key. If you have an early stage
breast cancer, stage one and two, you're more likely to be cured of it than if you go to higher stages or
if you have breast cancer in the rest of your body. So the sooner we detect it, the better it is.
Sometimes patients say, well, I'll do a breast exam and I'll see if I have a lump. By the time
you feel a lump, that mass had been there probably a few years and could have been picked up by mammogram. Now the limitation of a mammogram is
a patients who have dense breast tissue, the sensitivity of a mammogram goes down. In women
ages 40 to 49, 25 percent of cancers can be missed on mammogram and after 50, 10% of breast cancers can be missed on mammogram. So mammogram alone is not
enough for patients at high risk or patients who have dense breast tissue and it's for that reason
that sometimes doctors might order a breast ultrasound in case of a dense breast or they
can order an MRI in addition to mammogram.
So if I understand this right, what you're saying is like the mammogram picks up the
cancer when it's much smaller than you would be able to find yourself and that means you're
much more likely to treat it successfully because as it gets bigger the danger of not
being able to treat it gets worse.
And you're also saying like the mammogram isn't perfect.
So I want patients to know that I don't want them to replace mammogram with any other imaging.
So as a screening tool, we use mammogram. For patients with dense breast tissue,
instead of a 2D mammogram, we prefer a 3D mammogram. Dense breast tissue. So our breast
tissue is made out of glandular tissue and fibrous tissue and fatty tissue.
The more of the glandular and connective tissue we have, the less fatty it is, the denser
it gets.
As the breast tissue gets more dense, and 50% of women have dense breast tissue, it
makes it harder for the radiologist to see or detect any cancers on mammogram.
Basically, on a 2D mammogram,
which is a 2D X-ray of your breast,
in patients with dense breast tissue,
the radiologist will see an area of white.
It's really hard to comment about whether or not there's a lesion in there.
For those patients, we recommend the 3D mammogram,
which is basically, imagine flipping
through the pages of a book. Millimeter at a time, you can flip through pages of
the breast and really look and make sure we're not missing any lesions. So 3D
imaging is more accurate and it's a better option for dense breast tissue. We
also add a breast ultrasound for patients with breast tissue that are
dense, and basically the ultrasound can detect lesions that the mammogram can We also add a breast ultrasound for patients with breast tissue that are dense.
And basically the ultrasound can detect lesions that the mammogram can miss.
Would a woman know if she had dense breast tissue?
That's a very good question. So patients touch their breasts and they're like,
I think I have dense breast tissue. It doesn't work that way.
It's an imaging diagnosis. So if you want to know whether or not you have a dense breast issue,
you wanna look at your mammogram report
or your breast MRI report,
and the radiologist will always comment
about the density of the breast.
Majority, 50% of patients have dense breasts.
So half the people who are going in for this mammogram
have a dense breast,
and you're saying that that is where
it's a lot harder for the mammogram to pick this up.
Bravo.
And also of those 50%, a percentage of those patients have extremely dense breasts.
The younger you are, the more dense your tissue. The older you get, the more fatty your breast
tissue becomes. So it gets easier and easier to detect usually as patients get older. That's why
we don't like to order mammograms
in a 25 year old,
because you're not gonna see anything.
Their tissue is so dense that an ultrasound or an MRI
would be a better method of imaging
unless they have a gene mutation
like the BRCA gene mutation.
So I think what you've told us is like a mammogram
is essential, but it doesn't necessarily tell you everything. And you've also, I think, already shared
that you have your own personal story about this.
And I wonder actually,
if having sort of provided some of that context,
you'd be willing to tell us about your own story
of diagnosis of breast cancer.
Of course.
So I was 48 and I had gone for my mammograms
every single year.
And every time I would go, they would find something.
I had a biopsy maybe when
I was 40 years old and even when I was younger and it was always benign, benign, benign. When I got to
age 48, I went for my mammogram and they picked up some calcifications. They had me go back for a
biopsy. They did a biopsy and this time my biopsy came back as atypical lobular hyperplasia.
I have no idea what that means.
Exactly. These are basically atypical cells in the breast
that can increase your lifetime risk of breast cancer, but they're not cancer.
So my doctor said, well, we're going to remove it.
She did an excisional biopsy. They take a lump out of your breast.
And she told me to go and come back in six months. Mind you, at the time I was 48,
I had been a vegetarian for five to seven years.
I've never smoked, I've never done drugs.
I rarely drink alcohol.
I had no family history of any cancers,
let alone breast cancer.
I had no gene mutations.
I was never on hormones.
So in my world, I was not going to get breast cancer.
At that point in 2017, I had started basically calculating everyone's lifetime risk of breast cancer through this tool that I used in my office that's public.
So when they told me I had this atypical tissue in my breast, I sat behind the computer and I started calculating my own lifetime risk, which I had no reason to do it before because I knew I was in that range of 12.5.
I started answering the questions and it's a tool we use basically to ask for your height,
your weight, your family history, your density of your breasts, whether you've been on hormones,
what age you had your period, what age you had your first child, and the list goes on
and on.
So I answered all the questions and I pressed you know calculate and this
number came on my screen 37.5%. I almost fell off my chair. Here I was
thinking I'm never gonna get breast cancer because I'm like the poster child
of someone who's not supposed to get cancer. I did everything right in my life
well except sleeping at night. You know I called my doctor and I'm like you know
you told me to go and come back in six months,
but 37 and a half percent is a very big number for me.
37 and a half percent is your risk of getting breast cancer
at some point in your life.
Right.
So that's like four in 10.
For sure, one in three.
And I called my doctor, I'm like,
listen, I have three little kids at home.
I love my husband.
I love my life.
I have the best job. I just have everything. I don like, listen, I have three little kids at home. I love my husband. I love my life. I have the best job.
I just have everything.
I don't want to get breast cancer.
And 37% is a very big number for me to swallow.
Is it possible to remove my breast?
And she's like, no, you're crazy.
One thing you learn in women's health is everyone always calls us crazy.
Every time we comment, and my doctors were women, and they still calls us crazy. Every time we comment and my doctors were women and they
still called me crazy because I didn't have family history and because I didn't have any gene mutation
and because I was so healthy they're like no don't worry this is crazy why would you remove it?
And she said you know what worst case scenario come back when you're 50 we'll talk about this again
but right now you're 48, you're gonna lose sensation.
I went home and I just couldn't deal with it.
It's that example, right?
Would you board the plane that has a 37.5% chance of crashing?
I wouldn't, I would run away.
And so anyways, I started asking a lot of people
and everyone called me crazy.
Finally, after a year, I found a surgeon at a different facility
from my hospital who was willing to do my surgery.
Against her advice, I remember the day before surgery,
she said, this is crazy. Are you sure you want to do this?
I'm like, well, I'm doing it for my children.
I don't have time to get breast cancer.
And you know what her reply was to me?
She said, why are you so worried?
We have really good chemo for breast cancer.
And I was like, you know what, you can't even argue with that.
I said, I really want my breasts off.
We're listening, we're not doctors.
Why was that answer not so good enough?
What were you thinking when you explained that that made you feel that didn't make you
feel comfortable?
As a physician, as a gynecologist in medicine for many, many years, until you are diagnosed with cancer,
or you have a loved one diagnosed with cancer,
you have no idea the trauma that goes with that.
It's not just this word you can throw out there
and say, oh, you have cancer, oh, we have good chemo for it.
It's a trauma that you will take with you
for the rest of your life.
It shakes you to your core. So for me to have someone tell me, well if you get
breast cancer we have really good chemo. As a mother of three children I couldn't
even listen to that. The whole point was I didn't want to get cancer to go down
the path of needing chemo and you know if you're lucky the chemo will work. It's not easy when someone tells you you have cancer. So at this point I didn't
know I had cancer. I you know begged my you know doctor to just do it and not to
argue with me anymore. So they did a double mastectomy to remove all my
breast tissue and replace it at the same time with an implant. And this was
prophylactic double mastectomy,
meaning I didn't have cancer, but I wanted to do this to reduce my risk of breast cancer
significantly. So basically you go from 37.5%, which was my lifetime risk, to less than 5%.
So I did that. I bled out during surgery because unfortunately my surgeon was not very experienced and I did my reconstructive surgery
I was really really sick when I woke up my blood pressure
I think at some point was like 70 over 30 until a friend of mine visited me who was a physician and
Basically got really upset and had them give me blood transfusion and that's when I perked up
So many people called me crazy that I hired a videographer to follow my journey.
So that videographer came to every office visit.
And I don't remember this,
but when I opened my eyes from 10 hours being under anesthesia,
the videographer was there.
And the first thing I told him,
I said, go home and tell my children
I will never come home telling them I have breast cancer.
Tell them mommy did it.
I was so proud of myself.
As I was getting blood transfusion,
my patient goes into labor
and I forced my husband to drive me to Cedars
and I delivered that baby with the help of the midwife.
But that's another story on the side.
That says something about your work-life balance perhaps.
I, yeah.
Baby Monty was born on the same day as my blood transfusion.
Anyways, a week later, I was so happy.
I felt like this heavy weight was off my shoulder.
And I get a call from my plastic surgeon, not my surgeon.
And I don't know if you know this, but doctors do not call with pathology report.
If your doctor calls you and says,
I just got off the phone with the pathologist,
I can guarantee you nine out of 10,
you're dealing with cancer.
So as soon as my plastic surgeon called and said,
you know, I just got off the phone with the pathologist.
The first thing I said was, do I have cancer?
And he said, yes, in three little areas
of your right breast.
And mind you, all this time they were biopsying my left breast and my cancer.
Three areas were in my right breast.
And for all of the people on the planet who've been diagnosed with cancer,
when someone tells you you have cancer, your brain shuts down and you stop listening.
There's so much you don't know, but the word cancer means you're going to die, right?
It doesn't matter if you're a doctor, if you're a surgeon, if you've treated cancer,
doesn't matter. When it comes inside your home, all I could think were my children,
how I fought for a year to have someone remove my breasts, and for all the times
my friends, my colleagues, my doctors, the radiologists at different centers,
they all called me paranoid and anxious and crazy. And at that moment, I was so angry at them.
Because the first thing I told myself is these people went out of their way to kill me.
And I'm just talking now as a patient, not as a doctor. I'm a doctor. I understand now
everything that happened. Things get missed on MRI. We're not gods. We all make mistakes.
The one thing that really upset me was the number of time people called me crazy for wanting to
remove my breast. It's my body. It's my breast. It's not going to affect you. I'm paying for it.
It's my breast. It's not going to affect you.
I'm paying for it.
Remove it."
And that's how women get treated in medicine.
You know, I've dedicated my life to saving women.
I've practiced for 23 years.
I have never lost a patient under my care to cancer.
You can't tell me that's luck.
But yes, I tend to be aggressive.
Call me aggressive.
I take it as a compliment. But yes, I tend to be aggressive. Call me aggressive.
I take it as a compliment, but I never call someone crazy, ever.
If someone comes to my office and says, doctor, something's wrong with me.
I don't feel well.
I never dismiss them.
And I guess the lesson learned here is you have to be your own advocate.
It doesn't matter if you're a doctor.
learned here is you have to be your own advocate. It doesn't matter if you're a doctor.
So my mission in life now is to educate, you know, the first step of becoming your
own health advocate is to educate yourself.
I always say, if you know your name, your last name, your date of birth, you also
need to know your lifetime risk of breast cancer.
It's a must.
You cannot go through life not knowing what that number is.
So firstly, Thais, thank you so much for sharing that story.
It's very powerful to hear it,
and I appreciate you sharing it with me
and with everyone who's listening.
How does the story finish?
Was everything okay because you'd had this?
Were you still at risk?
Usually when you have breast cancer surgery,
they need to sample your lymph nodes.
As part of staging for breast cancer,
you need to know if cancer is in the lymph node.
Because they didn't think I had cancer,
obviously my lymph nodes were not examined.
So I had to go to Dr. Giuliano,
who I absolutely love and adore,
one of the top breast cancer surgeons in the world.
I made an appointment with him
to go and get my lymph nodes checked. Two weeks after my surgery, at this point I had done, removed
my breast tissue and they had put implants and my breasts looked really
good. And I was looking at myself in the mirror and I called my husband, I'm like,
I don't look like I had a double mastectomy. I look like I had an
augmentation, meaning, you know, having an implant and with some breast tissue.
He's like, what are you talking about? I'm like, I feel breast tissue everywhere.
He's like, there's no way you were under for 10 hours. There's no way. I called my doctor. I'm
like, are you sure you removed all my breast tissue? She said, of course, but we leave 5%.
I'm like, I understand, but I'm a gynecologist. I can grab it. This is not 5%.
gynecologist, I can grab it.
This is not 5%.
The crazy doctor that I am, the aggressive doctor that I am, I put myself in an MRI machine two weeks after my surgery and the same doctor, MRI doctor who called me
crazy the day before my mastectomy for why I was doing it comes in and she's
like, why are you here?
I'm like, I had my double mastectomy.
I feel like there's breast tissue left.
She's like, no, I reviewed it, it's perfect.
So I looked at her, I'm like, I'm sorry, but you also missed my cancer on my MRI,
so you can understand why I'm nervous right now.
I want a second opinion.
She's like, of course.
I go get a second opinion from another center.
They said your MRI is completely negative, there's no breast tissue left.
My husband looked at me and said, don't, you're going crazy, let's just go home.
It was a Friday afternoon.
On Monday, I go to Dr. Giuliano. I'm sitting on the exam table. My husband looked at me and said, don't you're going crazy. Let's just go home. It was a Friday afternoon.
On Monday, I go to Dr. Giuliano.
I'm sitting on the exam table.
He walks in, he's like, Tais, I'm really sorry.
I'm like, why?
He's like, all that breast tissue they left behind.
At this point, and can you believe it?
And I'm just one patient.
And I'm like, what are you talking about?
Two radiologists on Friday told me
my breast tissue was completely clear.
There's no breast tissue left.
He takes me to a third radiologist
who says, you have breast tissue here, here, here, here,
here, here.
Long story short, I don't wanna give you a headache,
but I had to, I begged for a second double mastectomy
because I had a lot of atypical cells in my breast.
And now I also had breast cancer
and he was gonna do my lymph nodes anyway.
And I begged him, I'm like, Dr. Giuliana, can you do another double mastectomy on me?
It took six hours.
They did my lymph nodes.
They removed my implants, did another double mastectomy, put my implants back in.
And when I woke up, he came to me.
He's like, I'm so glad you're so stubborn.
I'm like, why?
And he said they had left 35% of your breast tissue behind.
My understanding of this lifetime risk assessment number was basically the thing that made all
of that happen, right?
Otherwise you would not have found out about this cancer until much later.
And I think you have another story that you can tell us about, which is a patient of yours
who's gone public about her story, which is actress Olivia Munn.
And I understand that for her also, this lifetime
risk assessment number was critical. Could you maybe give us a high level outline of
that? And then we'll talk through into what this can mean for people who are listening
today.
And I have so many stories like Olivia Munn, but I'm so proud of her because she used her
platform to bring awareness to it. Someone like me or my patients, we don't have a voice, but she obviously does and she made a huge difference. Basically, she just had her baby, she was
done breastfeeding. I did genetic testing, she didn't have any gene mutations. I sent
her for a mammogram and ultrasound. Her mammogram was negative, her ultrasound was negative.
I calculated her lifetime risk of breast cancer because of her family history, dense breast, age at first child, the whole list that I
just mentioned. And her risk was about 37, 38% similar to mine. So I called her to my
office and I said, you fall into the high risk category, you have to do an additional
MRI. And she said, of course, she's, you know, she's so smart. She's just an amazing woman. So she went, she did her MRI and of course they called her. They're
like, we saw something. They biopsied it. It came back cancer. Then, you know, I sent
her to Dr. Giuliano. Dr. Giuliano had the MRI reread and they found another cancer in
the other breast with the second read.
So at this point, she had multiple breast cancers,
small but very, very aggressive,
negative mammogram, negative ultrasound,
negative genetic test.
She's had a standard mammogram.
She's also had like a genetic test
for whether she's at high risk.
All of that says it's fine,
but you then run this lifetime risk assessment
and said, actually your lifetime risk assessment is really high.
So I want to go and do this other test, this MRI test.
And that has picked up this like very early cancer, but also this
like, you know, very dangerous cancer.
Right.
So everything would have been completely different had we not done the MRI.
Unlike me, she had a very aggressive cancer, but
because we caught it so early, she came to my office and she's like, what would
you do? And I said, listen, at your age, I just delivered your baby, you have a tiny
little child at home, you have bilateral breast cancer, very aggressive, you have
family history of it, take your breasts off. And she's like, I want to do what you
tell me. I'm like, if I were you, obviously I did it, take your breasts off. And she's like, I want to do what you tell me.
I'm like, if I were you, obviously I did it for myself,
but that's what I recommend.
And thank God she did it.
She had amazing results.
Dr. Giuliano did her mastectomy.
She had reconstructive surgery.
It took her a minute to recover from the trauma.
Again, you have a little baby at home.
Someone tells you, you have cancer
when your mammogram and ultrasounds are all negative.
But I think in spring of last year, she decided to share her journey, which basically, I think
honestly, she started a revolution, not only in this country, but around the world.
Basically bringing awareness to early detection, this lifetime risk assessment, genetic testing, and all things breast cancer related.
So I'm so proud of her.
Everything happens for a reason in life.
And I always say when something traumatic happens to you
in life, go down that path
and you'll see why you were placed on that path.
And I think both Olivia and myself, we found our calling.
Thank you for sharing both of those stories,
which I think are very powerful.
Before we move to talking about how you do
this lifetime risk assessment,
I just wanted to ask about the genetic risk,
because this is the experience that happened
to my family friend where there was some
of this very high genetic risk,
which was what triggered the decision
to have this mastectomy.
Because in both these stories,
the genetic test wasn't positive.
How important is genetic testing?
Very, very good question.
So less than 5% of breast cancers
are associated with a genetic mutation.
Less than five.
So majority of people who get breast cancer
do not have a genetic mutation. So please don't tell me I don't have it in my family, I'm people who get breast cancer do not have a genetic mutation. So
please don't tell me I don't have it in my family, I'm not going to get breast cancer.
That's completely false. Two, if you have any kind of cancer in your family, if it's
pancreatic cancer, if it's prostate cancer, if it's colon, uterus, ovary, breast, ask your doctor for a genetic test.
In the United States, the genetic tests are about $249.
That's it.
You know, I always compare to going to Disneyland.
You go to Disneyland, every ticket costs that much.
I'm saying one genetic test one time in your life
can save your life.
Why am I saying this?
For example, if you have
a parent with pancreatic cancer or ovarian cancer, you could have a gene mutation, most
people recognize the BRCA gene, that's associated with pancreatic, breast, and ovary and melanoma.
So some members of the family could have a melanoma, others could have the pancreatic cancer. Do the genetic test.
It doesn't always have to be breast to do a genetic test.
Are you saying that everyone should do the genetic test?
If you have family history.
If you have family history, you'd be pushing.
If someone in the family has it,
you're saying you should definitely do it.
Absolutely.
But if you don't have it in your family,
it doesn't mean you're not gonna have breast cancer.
You still need to calculate your lifetime risk of breast cancer, especially if you've had a breast biopsy that
showed atypia. And atypia means? Atypical cells in the breast that are not cancer yet.
If you're a man listening to this, is this story about genetic tests only relevant for women or
is it something that you would be saying that men should be doing as well? Absolutely, it's for men and women.
For example, if you told me I have three daughters at home
and my mom had ovarian cancer,
I would ask you to do genetic testing
because if you don't have it,
then your children are protected at least from your side.
But then we have to also ask your partners,
you know, family history.
So it's for men and women.
In that case, it sounds like the man himself
is not likely to get risked.
So today, if you're a man worried about your own cancer risk,
do these genes make a meaningful distance?
So you're saying for either side.
Absolutely.
It can cause prostate, it can be pancreatic cancer,
it can be colon cancer.
So it can be all sorts of melanoma,
it can affect all of us.
And majority of the time in the US,
believe it or not, insurance will pay for these patients
to do genetic testing.
I think in my practice, 93% of patients are covered annually.
So I'd love now to get into this lifetime risk assessment because I think you've definitely
provided a whole new perspective on taking more control over this yourself and understanding
what you can do.
So I imagine there's a lot of listeners right now who are saying, okay, how can I calculate
my lifetime risk assessment?
So the best formula to use that I use all the time, it's probably the most accurate,
easy to use, women use all the time. It's probably the most accurate, easy to use, women
can do it at home. It's the TyreQZIC risk assessment tool. I actually put a copy of it free of charge
on my SheMD podcast page. People can go there, they can calculate their lifetime risk. You basically
have to enter some personal information about yourself, height, weight,
you know, age at first period, age at first pregnancy, whether or not you're menopausal,
if you've been taking hormones, family history, density of the breast.
And once you answer all the questions, you hit calculate and it'll tell you what that
risk score is.
And I have videos explaining what each category is and what kind of imaging they need to do.
Well firstly we will put a link in the show notes both to the assessment tool
and also to your site to help to understand that. Is this something that
generally anyone listening to this can do themselves? I heard you mention
things like the breast density and you've also told me that I can't figure
that out for myself. But if they can pull their mammogram images and ask, I would say
if you are young, you
probably have dense breasts, right?
Younger patients have dense breast tissue.
I want everyone to calculate their lifetime risk of breast cancer by age 30.
30 is when we start imaging.
If you have strong family history of ovarian, pancreatic, or breast cancer, two of the 48
cancer-causing genes are BRCA1 and 2, those patients need to start
breast imaging at age 25.
So you calculate your lifetime risk of breast cancer.
And if you can't do it, ask your doctor to do it.
A lot of times, believe it or not, especially in the US, the radiologists will do that for
you.
The problem is the radiologists don't sometimes get all the information about you,
like first pregnancy or some personal history
they don't have, but they try to calculate
that tyroacusic risk score for you.
But it's something patients can absolutely do on their own.
It's pretty simple and straightforward.
Once you calculate that risk score, then,
you know, we talked about average risk being 12.5. Low risk category is anyone under a under 15%.
So if your lifetime risk of breast cancer is less than 15%, you fall into the low risk category.
In America, you can start your breast imaging at 40 or 10 years before your first degree
relative was diagnosed with breast cancer.
And if you have dense breast tissue, you have to ask your doctor for a breast ultrasound.
So that's for 15% and below.
From 15 to 20%, that's the intermediate risk category.
This is when basically in my practice, I treat every patient differently.
But knowing that they fall into that intermediate risk, I might start their mammogram a little
bit earlier, maybe get a baseline at 35.
If they have dense breasts, I do an ultrasound with it.
And if they have any family history, I start the imaging 10 years before the age of that
family member who was diagnosed with breast cancer.
And the most important group for me are patients who fall into the high risk category, which
is 20% or higher.
20% or higher patients need to start their breast imaging as early as 30.
By the way, this will never happen in your country,
in the UK.
That's the problem, right?
Early detection.
So everyone gets pushed like, you know,
much, much later, forgetting that we're missing
these high risk patients at a very young age.
And that's why sometimes people are shocked
that so-and-so at age 38 got stage 4 breast cancer.
And, you know, sometimes when I watch TV and I see these actresses at a young age
getting diagnosed or dying from breast cancer,
someone probably didn't do genetic testing on them and didn't calculate their lifetime risk.
So that's how important it is.
And so one of the things I guess I'm taking away from this is,
in a way, the progress of science and medicine today is meaning that we can be more personalized about this than
before.
You're not saying every single woman should be being screened at 30.
You're saying we can really differentiate now low risk and high risk.
And then if you're in this high risk group, you should be screened really aggressively.
And indeed, you're talking about the fact that your, you know, your own decision was my risk is so high that I'm going to take this like very serious preemptive
surgery because of your confidence in that level of the personalization and
understanding of the risks.
So this is quite a profound shift in terms of something, I guess it's very,
we're really passionate about, which is this ability to sort of take control of
your health and personalize it before you're really sick. And you're saying that actually we are now able in this area
to use this information and you know everything that we've we've learned over decades to be
able to no longer treat everybody in exactly the same way. Absolutely. And for the high risk
patients when they start as early as 30, we usually alternate mammogram and ultrasound
with an MRI a few months later.
Because in high-risk patients,
mammogram alone can miss breast cancer.
So you add MRI to make sure you basically bring
that 80% detection to a much, much higher,
especially for high-risk patients.
What are the things that tend to push somebody
into this high-risk?
Because you said that you were really high risk and now I'm hearing, you know, your number was 36%.
You're now saying even at 20%, 37, I apologize, even 20% was high risk.
But you also said, I haven't been drinking and I haven't been smoking.
So what were the things, you know, if somebody's listened to this?
The most common reason why people get pushed above 20% is family history.
That's probably obesity, early period, late menopause, patients who don't have
children are at a higher risk, pregnancy is protective, breastfeeding is protective.
Uh, if you have children after 30, that gets affected genetic mutations, dense breast tissue, patients
who have extremely dense breasts, it pushes it way high. There's so many different factors.
In my case, it was just that atypical lobular hyperplasia, which is the atypical cells,
that pushes your lifetime risk really high. Every person's risk factors are different.
The last thing I want to add is for very high risk patients,
which in my world, that's 35% and above.
Sometimes, you know, I had a patient yesterday,
her lifetime risk is 30%,
but every single woman in her family had breast cancer.
So someone like her,
I would be more prone to treat and reduce that risk.
If you have a very high lifetime risk,
let's say 30 to 35% and above,
you only have three options the way I look at it.
Number one, you alternate mammogram and ultrasound
with an MRI every six months, and you do a lot of praying.
And you pray that you don't get breast cancer.
And you pray that your doctors will diagnose it,
breast imaging. I'm really excited
about artificial intelligence reading these images
because hopefully we're gonna have more accurate reading
so someone like me where my lesion was sitting on my MRI
doesn't get dismissed.
That's number one.
Number two, patients have the option
of taking a medication like Tamoxifen.
I don't know if you've heard of it,
but once you get diagnosed
with estrogen-receptive positive cancer,
a lot of us have to take tamoxifen
to basically block the estrogen receptors.
And taking tamoxifen every day for five years
can significantly reduce your risk of breast cancer,
maybe by 50% in the next 10 years.
So that's an option.
And the third option, which is what I opted for, is a double mastectomy.
If you don't really want to do that imaging every six months,
which is pretty tough to go through.
MRIs are not easy to do.
Breast MRIs, you need a contrast.
Mammograms are not easy.
And honestly, to go through it and have to wait for
the results and be anxious twice a year about it is pretty challenging and that's why you know it's
a very very personal decision. I never tell someone do it or not do it, I just tell them what I would
do if I were them but with a strong family history or a high lifetime risk, I think double mastectomy is a good option.
The problem with double mastectomy is,
A, having access to a doctor, not everyone can afford it,
not everyone has access to a good reconstructive surgeon,
so I understand those limitations.
It's not for everyone, but at least I want them to know
that there are medications they can take for five years
to reduce that risk significantly.
Do you know a woman entering her 30s or 40s?
Or someone who might benefit from learning more
about detection of breast cancer?
Why not share this episode with her right now?
You could empower her to be proactive about early detection.
It could save her life, and I'm sure she'll thank you.
I would like to move to listener questions. So first question is,
can the food you eat influence your risk of breast cancer?
Absolutely. I think obesity is one of the underlying conditions for breast cancer. So,
you know, processed food, animal products, you know, we talked about smoking, alcohol,
all of that can affect it.
Absolutely. Does taking hormonal birth control or HRT increase your risk and how
big a concern should this be? It's not a concern. It probably can, very, very
slightly, but not significant enough. Having said that, it's individual.
Patients need to talk to their doctors, every patient has a different risk factor that needs to be dealt with. For example, if someone has a
lifetime risk of, I don't know, 50% for breast cancer. For the vast majority of
people who are listening to this, it sounds like you're saying that that's safe.
It's very safe. It's very safe. It can slightly increase their risk but not
significant enough. Having said that, for example, I don't want someone whose grandmother had breast cancer,
whose lifetime risk is 20% not to take hormone replacement during menopause and have, you know,
poor quality life with hot flashes and vaginal dryness and all these other symptoms because
they're scared of taking hormone replacement. I think that's really interesting because I know
there's a lot of debate about this.
And so it's interesting hearing you being so strong
about the risks here.
I assume you're saying that somehow you view the benefits
from these to really outweigh the risks.
Yes, especially if anyone's gone through menopause.
I mean, I'm sitting here having a hot flash.
I can't take hormone replacement.
I'm on anti-estrogen, the opposite of it.
But if you have the option, it's life-changing.
So you don't have to have a hot flash doing a podcast.
Well, firstly, thank you for sharing that.
One of the things we talk a lot about on the podcast
is how much no one is willing to talk about menopause.
So I appreciate it.
And you're performing great.
So I think you should be feeling good about it.
Final question from listeners.
Are all lumps, whether you feel them in your breast
or armpit, worrisome?
As a patient, I would say you can't decide, let your doctor decide. Some lumps are concerning,
majority are not. So you can have a swollen lymph node because you got a flu shot on that arm that
day or you got your COVID vaccine. You can have a cyst, which are very, very common. Fibrocystic changes of the breasts are very, very common.
Fibroidinomas are benign tumors of the breast
in younger women.
But generally speaking, cancer tumors don't really move.
They're stuck.
So if something is mobile, it's probably nothing,
but I would always tell my patients to call me, come in, let me examine
and let me decide if I need to order a breast ultrasound or imaging.
The one thing I will tell you, no one is too young for breast imaging.
Got it.
So even if you feel like you're just too young for this to possibly be cancer, go and see
your doctor.
I've had a 22 year old with breast cancer with no gene mutation.
Any lump needs to be evaluated by a gynecologist or a primary care doctor.
And you're saying that most of the time the doctor is going to tell you you're fine.
So don't immediately panic.
But on the other hand, don't ignore it because you can't judge for yourself.
There isn't some magic way that you can figure out at home whether this is okay or not.
No, I would say trust your doctor.
So I'd just like to finish with asking you what advice you have for women who are
struggling to advocate for themselves in the doctor's office because you're telling a story where
you found this hard and I think it's pretty clear to anyone listening to this that you're
pretty powerful and strong-willed doctor with all this advice
and knowledge and all the rest of it and you found that hard and many people listening
won't have any of that. They may indeed be in health systems where they've got less ability
to just sort of have control. What would you say to anyone listening to this who's saying,
well, how can I advocate for myself? I would say I hear you, I get you, it happened to me, it's
not easy. It starts with education, that's why I started my podcast, that's why I'm
on this podcast. Basically you have to educate yourself. In order to be your
own health advocate you have to educate. The problem is once you educate yourself
and you empower yourself and you know what you have to do and you go to your
doctor, you have to find a doctor
who actually listens, who has the time,
who takes you seriously, who doesn't call you crazy,
who doesn't dismiss your symptoms.
If you're lucky enough to find that doctor,
the problem with the healthcare system,
we're overwhelmed with patients, we don't have time, right?
So if you're lucky enough to find a doctor
who's listening to you and really taking you seriously,
then the next step is being able to afford the prescriptions that they write for.
Does your insurance cover your MRI? Does your insurance cover your ultrasound?
My MRI after I was diagnosed with breast cancer was $3,000.
Do you understand that? Being able to afford the treatment
is the next limiting factor.
So there's so many levels that we get stuck
in this healthcare system.
But I would say educate yourself.
If something doesn't feel right, get a second opinion,
get a third opinion, find a doctor who specializes in that.
If you have a breast lump and you have family history of it,
if you need genetic testing,
find someone who will take you seriously
and listen to your complaint.
Tais, thank you so much.
We'll always try and end with a quick summary.
So I'm going to try and do a summary
and I'd like you to just correct me where I got this wrong.
When I think back across the show,
I think the biggest thing I take away is
do a lifetime risk assessment for breast cancer by the time you're 30.
And if you're after 30, like do it immediately.
It's I think the biggest story because, you know, your own story is so powerful about this idea that you felt like you're doing everything right.
You're low risk. You're literally a doctor who is looking after women who can have breast cancer,
and then you suddenly did this and you're like, I'm at 37% and suddenly that transformed the way
you're thinking about it. Then the story of sort of fighting to get the treatment that you're
basically saying you feel people at this level should very seriously consider because if not,
they've got other very intrusive solutions. And then when you did it you're like thank god I did because actually it
turned out you already had cancer and thank you for telling that story which I
can tell is still you know really understandably emotional and raw and
anyone listening to that will have felt that and I can understand this also this
idea of having one's children and all the rest of it so it's really powerful.
I think the other big takeaway from this is therefore
you need to be more of your own health advocate
because probably in health systems,
or in the States or the UK or anywhere,
they're not really designed today
for this level of differentiation of risk,
like the ability to tell that somebody might be
this very low risk, right below 10% or they're above 30%.
And so sort of our screening is designed
for this average level.
And it's therefore going to probably spend too much time on people who are very
low risk and not enough on the people who are high risk.
And this is, it seems to me your big message is that we can really determine a
lot more now about who's high risk.
And it doesn't require some incredibly complicated imaging to figure out this
risk. Actually, you're saying that you can go onto a website and fill in this
information and give you this, this answer.
The other thing I took away was this story that if you have, you know, any
family history of cancer, take a genetic test, you're like, it costs the same as
going to Disney world for the day or something, and it could save your life.
And I think you talked about this this BRCA gene for example.
Which is two of the 48 cancer-causing genes. There are many cancer-causing genes.
People say oh I've been tested for BRCA that's not enough. You need the full
panel. There's check two that gives you 50% chance. PALB2 gene mutation that
gives you a 50% chance. So there are other gene mutations that can increase
your risk of breast cancer.
And then the final thing I took away was you were actually really quite chance. So there are other gene mutations that can increase your risk of breast cancer.
And then the final thing I took away was you were actually really quite strong that for
most women hormonal birth control or HRT is safe, that although there is like a statistical
increase in the risk to do with breast cancer, your view is that this is on the absolute
terms is very small.
But you know, opposite of that, I do worry about alcohol.
I do worry about smoking.
I do worry when patients are overweight.
I do worry about lack of exercise.
So those factors are so much more important.
Sleep, low stress, you know, all of that is much more important than worrying about that
birth control pill that you took for two years in your life.
And where does food fit in that list? Very important. I let you have a full podcast on
gut microbiome and our health in general, right? Our gut microbiome is linked to our insulin
resistance. As we get older, insulin resistance can cause us to gain weight. Weight gain can cause
everything is related. So it all starts with food.