ZOE Science & Nutrition - Most replayed moment: Why breast cancer screening should be personalised | Dr. Thais Aliabadi

Starting point is 00:00:00 Hello and welcome to Zoe Recap, where each week we find the best bits from one of our podcast episodes to help you improve your health. Today we're talking about breast cancer. Here at Zoe, we know that health is deeply personal, and breast cancer risk is no different. Your likelihood of developing breast cancer is shaped by factors such as genetics, body composition and lifestyle. Understanding your individual risk is crucial because it helps determine when and how you should be screened, and in some cases it could save your life. Today, I've joined by Dr. Tias Ali Abadi to explain why breast cancer screening shouldn't follow a one-size-fits-all approach and how her own experience with cancer has influenced the way

Starting point is 00:00:42 she thinks about prevention. So I'd like to start maybe with 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 to. 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.

Starting point is 00:01:23 Even age 40 sounds like it is earlier than the greeny was in the past? 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 U.S., 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. 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.

Starting point is 00:02:27 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, 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 breast, 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%

Starting point is 00:03:15 if you have a gene mutation. 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 from my mammoth 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

Starting point is 00:03:59 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

Starting point is 00:04:47 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, it asks for your height, your weight, your family history, your density of your breast, 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 and a half percent. I almost fell off my chair. Here I was thinking, I'm never going to get breast cancer because I'm like the poster child of someone who's not supposed to get cancer. I did everything

Starting point is 00:05:28 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 37.5% is a very big number for me. 37.5% is your risk of getting breast cancer at some point in your life. Right. So that's like four in 10. For sure, one and 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, I have everything. I 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 called me crazy

Starting point is 00:06:18 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 going to lose sensation. I went home and I just couldn't deal with it. It's that example, right? Would you board a plane that has a 37 and a half percent chance of crashing? I wouldn't.

Starting point is 00:06:44 I would run away. And, you know, 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's like, 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. As a mother of three children,

Starting point is 00:07:23 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 have cancer. So at this point, I didn't know I had cancer. I, you know, beg 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 was. But, you but I wanted to do this to reduce my risk of breast cancer significantly. So basically you go from 37 and a half percent, which was my lifetime risk, to less than 5

Starting point is 00:08:07 percent. Anyways, a week later, I was so happy. I felt like this heavy weight was off my shoulder. And I get a call for my plastic surgeon, not my surgeon. And I don't know if you know this, but doctors do not call with path reports, pathology report. If your doctor calls you and says, I just got off the phone with the pathology. I can guarantee you nine out of ten, 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

Starting point is 00:08:36 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, you have cancer, 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, it 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 breast, and for all the times,

Starting point is 00:09:25 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, you know, 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 times 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. 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

Starting point is 00:10:20 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 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. So my mission in life now is, 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

Starting point is 00:11:08 what that number is. So I'd love now to get into this lifetime risk assessment because I think you've definitely provided a whole new perspective on sort of 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 can do it at home. It's the Tyrochusik Risk Assessment Tool. I actually put a copy of it free of charge on my GMD podcast page. People can go there. They can calculate their. lifetime risk, you basically have to enter some personal information about yourself, height,

Starting point is 00:11:54 weight, you know, age at first period, age at first pregnancy, whether or not your 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. Is this something that generally anyone listening to this can do themselves? So they 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 breast, right? Younger patients have dense breast tissue. I want everyone to

Starting point is 00:12:33 calculate their lifetime risk of breast cancer by age 30. 30 is when we start imaging. If you have strong family history of ovarium, pancreatic or breast cancer, two of the 48 cancer-ca-ca-1 and two, 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 U.S., the radiologists will do that for you. The problem is the radiologists don't sometimes get all the information about you, like, you know, first pregnancy or, you know, some personal history they don't have, but they try to calculate that tire care. Qyzic risk score for you. But it's something patients can absolutely do on their own. It's pretty

Starting point is 00:13:23 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 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 get 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

Starting point is 00:14:18 35. If they have dense breast, 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.

Starting point is 00:14:54 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 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. I'll end this episode with something I think you'll like, a free Zoe gut health guide. If you're a regular listener, you know just how important it is to take care of your gut.

Starting point is 00:15:32 Your gut microbiome is the gateway to better health, better sleep, energy and mood. The list just goes on. But many of us aren't sure how to best support our gut. I wasn't sure before doing Zoe, which is why we've developed an easy-to-follow gut health guide. It's completely free and offers five simple steps to improve your gut health. You'll get tips from Professor Tim Specter, Zoe's scientific co-founder and one of the world's most cited scientists, plus recipes and shopping lists straight to your inbox. We'll also send you ongoing gut health and nutrition insights, including how Zoe can help.

Starting point is 00:16:08 To get your free Zoe gut health guide, head on over to Zohy's health guide. head on over to zoey.com slash gut guide. Thanks for tuning in and see you next time.

ZOE Science & Nutrition - Most replayed moment: Why breast cancer screening should be personalised | Dr. Thais Aliabadi

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