Most replayed moment: Why breast cancer screening should be personalised | Dr. Thais Aliabadi

0:00Dr. Thaïs Aliabadi: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'm joined by Dr. Thayas 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 she thinks about prevention.

0:46Dr. Thaïs Aliabadi:So I'd like to start maybe with U.S. guidance about mammograms and the age at which you should have a mammogram?

0:52ZOE Science & Nutrition Host:Well, the general guideline in the U.S. 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 the breast imaging as early as 25 or 30. So not all women fall into that age 40 or above category.

1:23Dr. Thaïs Aliabadi:Even age 40 sounds like it is earlier than the greening was in the past. Yes, majority of the countries. Yep. So has that shifted? Did it used to be later than 40?

1:32ZOE Science & Nutrition Host: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.

1:59Dr. Thaïs Aliabadi: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?

2:09ZOE Science & Nutrition Host: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.

2:38Dr. Thaïs Aliabadi:I mean, I wouldn't get on the plane for sure. Right?

2:40ZOE Science & Nutrition Host: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 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.

3:17Dr. Thaïs Aliabadi: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.

3:26ZOE Science & Nutrition Host: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. These are basically atypical cells in the breast that can increase your lifetime risk of breast cancer, but they're not cancer.

4:06ZOE Science & Nutrition Host: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.

4:45ZOE Science & Nutrition Host: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 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.

5:18ZOE Science & Nutrition Host: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 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.

5:40Dr. Thaïs Aliabadi: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.

5:47ZOE Science & Nutrition Host: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'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. You know, 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 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.

6:25ZOE Science & Nutrition Host: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. 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.

7:04ZOE Science & Nutrition Host: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, 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.

7:39ZOE Science & Nutrition Host:I, you know, begged my 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%. 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 path reports, pathology report.

8:24ZOE Science & Nutrition Host: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.

9:04ZOE Science & Nutrition Host:There's so much you don't know, but the word cancer means you're gonna 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 breast. 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.

9:48ZOE Science & Nutrition Host: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 breasts. It's my body. It's my breasts. It's not gonna 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.

10:30ZOE Science & Nutrition Host: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 to educate. 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.

11:10Dr. Thaïs Aliabadi: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?

11:27ZOE Science & Nutrition Host: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 Tyrecusic 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.

12:08ZOE Science & Nutrition Host:And I have videos explaining what each category is and what kind of imaging they need to do.

12:14Dr. Thaïs Aliabadi: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.

12:22ZOE Science & Nutrition Host: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.

13:04ZOE Science & Nutrition Host: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 tyracuse 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 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.

13:52ZOE Science & Nutrition Host: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.

14:40ZOE Science & Nutrition Host: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 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.

15:21Dr. Thaïs Aliabadi:As you can imagine, hosting this podcast, running Zoe, juggling family life, it all keeps me pretty busy. So I try as best I can to stay energized and show up well in all those parts of my life by fueling my body with the right food, by exercising and by adding a scoop of Daily 30 to my meals every day. If you haven't heard of Daily 30 yet, it's the gut supplement designed by our gut health scientists here at Zoe. It's made of over 30 high-quality hand-picked plants, including seaweed, fungi, and different types of fiber. Better yet, it contains ingredients that support gut health, digestion, and energy, which is ideal for packed calendars and busy lives.

16:05Dr. Thaïs Aliabadi:Simply add one scoop a day to any meal for an extra boost of fiber and plant diversity. And because it tastes delicious on just about anything and adds a satisfying crunch, it quite quickly slots into your life, becoming a daily healthy habit you'll always have time for. By the way, whenever we talk about Daily 30 as a good source of fiber, we're required to say that it contains four grams of total fat per serving. Obviously, that's all amazing healthy fats from plants. so order yours today at zoe.com daily 30 thanks for listening and see you next time