Hormone Therapy and Breast Cancer: What Women Need to Know About Risk, Screening, and Prevention | Jenn Simmons

0:00What is the risk of starting hormone therapy when it comes to breast cancer? It is the synthetic progestogens that increase your risk. Because Dr. Jenn Simmons, a fellowship-trained breast surgeon, integrative oncologist, and founder of Perfection Imaging. After 17 years in breast oncology, she's now leading a powerful conversation on breast cancer detection, survivorship, and whole person healing. According to the American Cancer Society, there is no safe amount of alcohol for a woman. And alcohol is one huge modifiable risk factor in the prevention of breast cancer and breast cancer recurrence.

0:41What do you wish every woman knew about the birth control pill and breast cancer risk? There was a Danish study of 1.8 million women, and that showed a linear relationship between... So good, so good, so good. New summer arrivals are at Nordstrom Rack stores now. Get ready to save big with up to 60 % off brands like Rag & Bone, Levi's, Adidas, and Free People. Join the Nordic Club to unlock exclusive discounts, shop new arrivals first, and more. Plus, buy online and pick up at your favorite rack store for free. Great brands, great prices. That's why you rack. This episode is brought to you by Google Chrome.

1:24You think you know a browser, but Gemini and Chrome? That's new. It can help you with practically anything on the web, like restoring a vintage motorcycle from a 50-page restoration block, or finally break down that long article you've had open for weeks. Gemini and Chrome is here for it. Ready to make anything online make sense? There's no place like Chrome. Check responses set up required. Compatibility and availability varies 18+. There's a lot of women listening. who are afraid of starting estrogen therapy because of potential breast cancer risk. I'm sitting down with a breast cancer expert, so I have to ask, what is the risk of starting hormone therapy when it comes to breast cancer?

2:02The Women's Health Initiative was actually two trials. It was a combined synthetic progestogen trial along with conjugated equine estrogen, So non-bioidenticals, but it was also an estrogen alone arm. So just that conjugated equine estrogen arm. And the only place where we saw an increased risk of breast cancer was in that combined arm, in that conjugated equine estrogen along with medroxyprogesterone, which is not bioidentical. And it is the synthetic progestogens that increase your risk. Because in the estrogen alone arm, we actually saw a decreased incidence of breast cancer. So if you're talking about bioidenticals, though we don't have the large trials that we have in the synthetic non-bioidentical space, But we do have 20 studies in the post-breast cancer space that show that there is no increased risk if you are not using those synthetic progestogens.

3:24And it's only with the synthetic progestogens that we see an increased risk of both primary breast cancer and recurrence. Mm-hmm. So I like that you highlighted that it's not actually progesterone because most clinicians will say, well, what that study showed us is that we shouldn't use progesterone unless there's a uterus. However, progestin is not progesterone. That's right. What do you wish every woman knew about the birth control pill and breast cancer risk? Well, we have very, very clear data on that. There was a Danish study of 1.8 million women. It was released in 2018. And that showed a linear relationship between hormonal birth control and all of the hormonal birth control contained progestogens.

4:14Not all of it contained estrogen, but if you were on any hormonal birth control that contained synthetic progestogens, you had an increased risk of breast cancer. And that risk was linearly related to how many years you were taking a synthetic progesterone. And the degree to which it is unsafe is the length of time that you are on. Now, we know that if you don't develop breast cancer within five years of its use, your risk does reset. So if you get... Within five years of coming off or five years being on it. Within five years of coming off. So you're at increased risk until you hit that five-year mark of coming off, and then it resets to the general population.

5:01But there is absolutely a risk, and it's not related to age as much as it's related to the length of time they are on synthetic birth control pills. Or not even pills, any synthetic progestogen hormonal birth control. And I wish people knew that. It's not only patients. I wish providers knew that. Because even the providers prescribing are either unaware of this data or they're ignoring it. But it's been out there and available. And I just think that their hands are tied in a way because it's all they know. So if you only have a hammer, all you see are nails. And they are not trained in how to deal with hormonal abnormalities, cycle abnormalities, the symptoms of estrogen dominance.

6:06And they are not knowledgeable with regard to the various bioidentical hormones, what they do, and how to support people with hormone imbalance. They're just not trained to do anything but write for birth control pills. And so they want to help, but they don't have the skills. And this is where the removal of the black box warning really concerns me. Because now we are normalizing hormone replacement, but most providers are not trained on how to do that safely, effectively. They don't know what to prescribe, when to prescribe it, or how to monitor it. So what's going to happen is all of these women are going to go to their doctors demanding hormones.

6:57Their doctors are going to hear this universal message that the black box warning was removed. It must be safe. And they're going to prescribe them what they know to prescribe, which is birth control bills. Yeah. Right? And we're going to create a problem all over again. And though I don't think the black box warning should have ever been there, I think that is a far cry from removing it and saying to everyone, okay, just go back to doing what you were doing before, because that's not the right thing either. We need to train our professionals. We need to train our providers. They need to learn about bioidentical hormones.

7:40They need to be hormone proficient. And it's only from that that we're really going to help women. So while there have been hundreds of thousands of women who have died prematurely and millions of women who have suffered unnecessarily because of the conclusions of the Women's Health Initiative. I don't think the answer is to go back to doing it the wrong way. The answer is educate our providers and do it the right way. I want to echo what you're saying because it was one of my concerns in watching the FDA consider all of this is there was no consideration that the vast majority of first-line providers for menopausal care aren't actually trained in menopausal care.

8:27No. And aren't actually trained in hormone therapy. We even see, you know, there are many well-intentioned providers who are now getting more vocal in the online space about this. However, they've got less than five years experience actually prescribing. And I've watched many of them make the mistake of being like, well, we can just give you a progestogen. No risk. gets the same progesterone. So I think we are at a place where you and I have been in medicine long enough to watch that pendulum swing in so many arenas, and we're going to see a lot of harm. It's done if we do not get information out to women.

9:05You have a podcast, I have a podcast, we're on stages wherever we can be training providers, like trying to make that change. But for people listening right now, how can they know they're getting the right hormones from their provider because even the scientific literature will call it progesterone. I know. So what can women be looking for? What are the key things to know you are getting bioidentical progesterone? Yeah, I think you need to ask just that, right? And if your provider looks at you with, you know, 10 heads and doesn't know what bioidentical hormones are, and if you can't have an educated conversation with them, this is not the right provider.

9:46And I know that there are a lot of vocal voices out there like yours, like mine. There are some people out there with really good information. There are also some people out there with very loud voices who don't have such good information. And I think it's going to be a little treacherous for the next five, 10 years. It really is. And it's going to be hard for women. But that we're just going to have to rely on the fact that we're out there continuing to hammer this message over and over and over again, that women should be speaking to their provider and asking those honest questions. How much experience do you have in this?

10:34What are you accustomed to providing? How am I being monitored? Because if all they're doing is writing a script for you and not monitoring you, that's not the right thing either. So how are you following me? How are you keeping me safe? And if they don't have answers to these questions, you need to go find another provider. Mm-hmm. What is the appropriate monitoring that you recommend women look for in that provider's answer when they're seeking a hormone prescription? You start with an understanding between you that this is a partnership here, and I have expectations of you just like you have expectations of me.

11:15And what I expect from you is that you are going to follow my recommendations for how you eat and how you drink and how you move and how you sleep and how you detoxify and the toxins coming into your environment. And you are going to submit your samples because I'm monitoring your levels every six months. You are going to fill out the questionnaires to let me know where you are from a symptom standpoint, because I want to make sure that you're not suffering, right? I want to make sure that you don't have the symptoms that we all worry about in this menopausal space. But at the same time, I have a responsibility.

11:59I have a responsibility to you, and you have a responsibility to me. So even when all you do is monitor symptoms, when you look at those people's hormone levels and their hormone metabolites, you will only have them in optimal ranges 33 % of the time. And 33 % of the time, you're going to be overdosing them. And that's a problem. 33 % of the time, you're going to be underdosing them. And that's a problem too, right? Because the whole reason that we are giving women menopausal hormone therapy is that we're looking to help them with their longevity. Because we know that it protects the brain, it protects the heart, it protects the bones, all of these things that we are concerned about in the long run.

12:45Because lest we forget, the same number of women that die of breast cancer every year die as a result of a complication of a fracture. So bone health matters. lest we forget that the number one threat to a woman's life, even a woman with breast cancer, is cardiovascular disease. So cardiovascular disease is exponentially the number one threat to a woman's life from the time that she's 30 on. Exponentially. So we have to think about the heart. We have to protect the heart. We have to protect the great vessels. So when we are working with these women, we don't want them underdosed because we want to make sure that they are getting the benefits that we intend for them.

13:29And our goal is not to bring back fertility, to bring back menstruation. Our goal is to have women live with dignity as long as they can. From your clinical perspective, what is the number one thing women misunderstand about breast cancer? Well, I think it starts from screening. So it starts from the very start where we all think that we are saving our life or saving our breast or maybe both if we act like good girls and screen with mammogram. And the data actually from the wisdom trial was released last week, presented last week at San Antonio, and I would love to talk about that. But let's start with where this whole mammographic screening program came from, because it actually came from an invitation to screen only trial in the UK in the late 60s, early 70s.

14:26And it was done by Professor Michael Baum, who is a surgeon in the UK. And it is probably the biggest regret of his life because he took the results of that trial, which were that if you screen with mammogram, if you take a thousand women over 10 years and you screen them with mammogram, four out of that thousand will die of breast cancer. And if you don't screen with mammogram, five out of that 1 ,000 will die of breast cancer. Four is 20 % less than five. And so the headline was, mammogram reduces your risk of dying of breast cancer by 20%. And the world ran with it. And we started all of these mammographic screening programs.

15:17But what was not included in this announcement was that the same number of women died of cancer in both groups. There was absolutely no overall survival advantage. And if you screen with mammogram, you will cause 100 out of that 1 ,000, so 10 % will undergo unnecessary studies, more imaging, unnecessary biopsies, because all of those biopsies were benign, right? And so it doesn't account for the harms. And the harms are not insignificant. If you're harming 100 women in order to diagnose an extra one out of the thousand, are we really doing the right thing with that? One thing I hear from women all the time is that they're struggling with symptoms like hot flashes, sleep disruptions, and brain fog, but aren't sure where to turn to for help.

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17:08Plus, you'll get$20 off your first order today. That's M-Y-A-L-L-O-Y dot com, code Dr. Brayton. So, but the media headline was what everyone used and they started mammography screening programs all across the world based on that study. And since then, it hasn't gotten better. It's only gotten worse. And we have for decades known that there is no survival advantage to screening with mammogram. If mammograms don't save lives from breast cancer, what does? Well, we all know how to prevent breast cancer, right? Breast cancer is largely a preventable disease. And what saves lives from breast cancer is all the things, all the foundational tools that we talk about every single day, eating in a way that nourishes your body and avoiding all of that standard American diet, right?

18:12Because we know that that standard American diet is very pro-inflammatory and breast cancer is a metabolic disease. It's an environmental disease and it is the end of the line, the result of chronic inflammation over time. So if you get rid of the things that cause chronic inflammation. You reduce the incidence of breast cancer. You also reduce the deaths from breast cancer because even if you are diagnosed with breast cancer, if you then reduce your metabolic burden, if you reduce your environmental toxins, then you have better outcomes. So even if you get a breast cancer diagnosis, doing all of these things to mitigate your risk of recurrence changes that outcome.

19:01So we, of course, talk about diet. We talk about what you drink. Are you drinking clean water? You know, alcohol is a big thing. We have normalized alcohol for social reasons, and I get it. And don't shoot the messenger, but according to the American Cancer Society, there is no safe amount of alcohol for a woman. This is one area where men and women are not equal, are not equal. Our hormonal systems are far more complex than theirs. A lot of us is far more complex than theirs, right? But we just don't have the metabolic capability that they have. And alcohol is one huge modifiable risk factor in the prevention of breast cancer and the prevention of breast cancer recurrence.

19:54So that's another thing that we need to be thinking about. We need to be thinking about sleep because sleep is where the healing happens. Sleep is where all of our repair mechanisms get kicked in. So if you're not sleeping, you're not healing. And if you're not healing, then you are subjecting your body and your cells to more oxidative stress, more oxidative damage. That's what breast cancer is, right? It is that initial mutation that goes unrecognized by the immune system, and it is allowed to progress into a tumor, right? We all have individual cancer cells floating around us from the very young to the very old, everyone in between, we all have cancer cells.

20:36But an intact immune system is going to recognize those cells in their infancy and destroy them. But what kind of state is all of our immune systems in now? Our immune systems are so taxed, they're so challenged by our time management, by our lack of rest and relaxation, by our stress levels, by all the environmental toxins that we are exposed to day in and day out. So that can largely tie into how much sleep are you getting? How much rest are you getting? How much relaxation are you getting? How much are you allowing your body to rest, reset, heal itself, right? And then movement is another piece of it.

21:21We are not meant to be sedentary. We are meant to be nomadic people who have to move for their food, hunt for their food, move for safety, move for shelter. This is what our bodies are designed to do. We are modern beings living on a very old gene code, and our bodies were meant to move. Our bodies were meant to lift heavy things. We are built to be strong and nimble, and we're not doing that, right? Even for the people that are exercising, we have a lot of exercising couch potatoes. We have a lot of exercising workaholics who go to the gym and then sit at a desk for the rest of their day, right?

22:08And so when we are thinking about prevention, when we are thinking about how to both primarily prevent a breast cancer diagnosis and to reverse and prevent a recurrence, we have to think about all of these things in the context of what is our allopathic load, right? How many toxins and in what form are we asking our body to deal with? Because the breast is the canary in the coal mine. And the breast will tell you when you have exceeded that toxic burden. So all of our focus should be on containing, minimizing that toxic burden, but also working through the toxins because you can't avoid everything.

22:58Working through the toxins you're exposed to and having those detoxification practices built into your life every day. And when you do that, you can minimize your risk. You'll never eliminate it. There's no such thing as eliminating, entirely eliminating your risk, but we can mitigate it. We can reduce it. And we can live life in a very conscious way, but you need to. Because at the end of the day, breast health is health. And the same exact things that you're going to do to have healthy breasts are going to give you a healthy brain and a healthy heart and a healthy gut and healthy skin healthy libido, healthy everything.

23:40What are the early signs of breast cancer that medicine and doctors may be missing, but women should definitely be aware of? So that's part and parcel to the problem is that there are no really early signs of breast cancer in terms of clinical signs. Because most of the signs of breast cancer, things like having a lump in your breast. By the time you can feel that lump in your breast, like a one centimeter mass in the breast, that's billions of cells, right? So that is not early. That's not early detection. That's actually late detection. Now, does it mean it's not curable? No, of course not. But there are no clinical signs of early breast cancer.

24:27But the amazing part is that there are now safe ways to find those very early markers of breast cancer. So I'm not talking about circulating tumor cells tests because those two are not exactly early signs and we don't know what to do with that information. But there is something called the ARIA tears test. What it is, is it's a test that uses the fluid in your eye, your tears, in order to look for these inflammatory proteins that are highly correlated with early breast cancer. So in a five-minute, at-home, 100 % safe, comfortable, affordable way, you can screen for these precursors of breast cancer.

25:20And I think this is going to forever change how we screen for breast cancer because what I'm doing is I'm having everyone do this test. And this is a test that you would do once a year. If your test is clinically positive, then we know that you have the inflammatory precursors of breast cancer. So we have you go get imaging. And if that imaging is negative, I mean, obviously, if it's positive, you have breast cancer and you go to get treated. And when you say imaging, are you talking about mammogram with ultrasound, ultrasound only? Well, for me, I'm having everyone either do the QT scan like what we do at Perfection, which is sound waves transmitted through a warm water bath that gives a true 3D reconstruction of the breast.

26:06But if you don't have access to that, then I do ultrasound. I use either QT or ultrasound to demonstrate the presence of clinical disease now. And if that is negative, what you have is the knowledge that you have the inflammatory precursors of breast cancer, and you have the potential to prevent a diagnosis. Because we know if you do nothing in six months, if you re-image that person, another 11 % will have clinical evidence of breast cancer. So it's really an amazing golden opportunity to prevent a breast cancer diagnosis. And so that is what I am using universally to screen. It's available to everyone in the continental United States, except for the state of New York, which is such a problem.

27:00The state of New York is such a problem. Yeah, well, you know what that's about, right? So tell us. Oh, so in the state of New York, you have to pay them to have a lab test, right? So the fee is$500 ,000, which, as you all know, that is not affordable for most companies that are new companies just starting out trying to gain adoption. and there's a two-year waiting list. So, because they have to come inspect your lab, like they have any knowledge of what your lab is doing and how they're doing. I mean, it's like a ridiculous thing, but in any event, it's how New York makes a lot of money because they're charging a half a million dollars to let you do your test in their state.

27:49But anywhere else in the US, you can order this test just online and it comes to your home. And again, you do the test in five minutes, send it back, and you get the results a week and a half later. And you can actually order it from any other country in the world. The caveat is that the sample has to arrive back at the lab in 10 days from when you do the test. Because otherwise it gets dried out and they can't process it again. So if you can get it back to them in 10 days, you can do the test from anywhere, which is really amazing. So the way that New Yorkers get around that rule is that when they come to my clinic in Pennsylvania, when they come to my imaging center, Perfection Imaging, they're able to do the test while they're there.

28:37Yeah. So let me ask you, they do the test. It's showing, okay, you're heading down the road of breast cancer, but your imaging is negative. Yeah. What interventions do you employ at that point so that they don't end up with the diagnosis of breast cancer? Yeah, that's an amazing question. And we have developed a breast cancer prevention program for those women because the test has a 93 % sensitivity for breast cancer. So if you have breast cancer, it's going to pick it up 93 % of the time, which is better than any other imaging modality with the exception of MRI. But MRI comes with it a lot of false positives, a lot.

29:22And the specificity of the test is 58%. Now, some people say that that's unacceptable because what specificity means is that this is the number of times when you don't have the disease that the test agrees that you don't have the disease, right? So 42 % of the time, someone taking the test is going to have a positive result and no clinical evidence of breast cancer. But this is not a screening tool for breast cancer. This is a screening tool for inflammation for the inflammatory precursors of breast cancer. And so in that 42%, they are not false positives. These women have inflammation and what they need to do is figure out where the inflammation is coming from and mitigate that inflammation and then repeat the test.

30:18So we work with women on what they eat and what they drink and how they move and how they sleep and what toxins they're exposed to and how to detoxify. And then six months later, many of those women will take the test again and their inflammatory markers will be gone and they'll have a negative test. Mammograms aren't really recommended until you enter your 40s, when would this test be recommended? At what age should women consider screening for this inflammatory process? Yeah. So it's a great question. The clinical trials were women from 30 to 83 years old. And so that is the recommendation from the company based on the clinical trials.

31:02Now, if your mother was diagnosed with breast cancer at 36, I'm going going to tell you to start using the ARIA test 10 years before that. So at 26, I'm going to tell you that you should start using the ARIA test and do it every year. If you are in a high-risk population, like if you have a BRCA mutation or any of the other, like a PALB or any of the other high-risk breast cancer mutations, I tell those people to do the test every six months because you really want to stay on top of your inflammation if you're in that group, because that is going to be the determinant as to whether or not you get a breast cancer diagnosis.

31:45But the one thing that I know for sure is that any of those high-risk populations, the last thing you want to do is screen early and often with mammogram. because the one statistic that is inarguable is that those women have already declared by virtue of they have a mutation in their anti-cancer genes because that's what all those high-risk genes are. They're anti-cancer genes. So if you have a mutation, you're bad at fighting off those environmental insults. So the last thing you want to do in someone with a high-risk mutation is image them more. eczema is unpredictable but you can flare less with ebglyss a once monthly treatment for moderate to severe eczema after an initial four month or longer dosing phase about four in ten people taking ebglyss achieved itch relief and clear or almost clear skin at 16 weeks and most of those people maintain skin that's still more clear at one year with monthly dosing ebglyss libri kizumab lbkz a 250 milligram per two milliliter injection is a prescription medicine used to treat adults and children 12 years of age and older who weigh at least 88 pounds or 40 kilograms with moderate to severe eczema.