Calculating Lifetime Risk and Screening

Hello and welcome to Zoey Recap. whereere 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. 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 Be it helps determine when and how you should be screened. and in some cases, it could save your life Today I'm join by Dr. Thas Aliabardi. 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 So I'd like to start maybe with US guidance about mammograms and the age at which you should have a mammogam Well, the general guideline in the US right now says that a woman should start her mammogram at age forty or ten years before her first degree relative with breast cancer was diagnosed with cancer. But I'm trying to change that becausecause that does not include the high risk patients who fall into a category that might need to start their breast imaging as early as twenty five or thirty. So not all women fall into that age forty or above category Even age forty sounds like it is earlier than the Yes countries. Yep. So has that shifted? Did it used to be later than forty? Yes. It used to be fifty and in some countries, it still starts at fifty. In the US, for low risk patients, it's forty. you can do it up to every two years. I think patients need to do it once a year 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 forty 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 average, every woman has a twelve point five percent chance of getting breast cancer in their life. And you know, I always used airline example, if I told you you're about to board a plane that has a twelve point five percent chance of crashing, you would think twice boarding that plane. I mean, I wouldn't get on the plane for sure. R. But when I say to patients, you have twelve point five percent chance of getting breastcer,'re like o, I' fine. 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 thirty, drinking alcohol, smoking, all of this add to that risk and it can push you up twelve point five to as high as eighty percent if you have a gene mutation. You have your own personal story about this. I wonder actually if having sort of provided some of that context, you'd be willing Tell us about your own story of diagnosis about Of course. So I was forty eight 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 forty years old and even when I was younger. And it was always benign, benign, benign. When I got to Age forty eight, 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 a typical lobular hyperplasia I have no idea what that' 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 exisional 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 forty eight, 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 point in twenty seventeen, 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 know 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 twelve point five. 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 thirty seven and a half percent 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 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 thirty seven and a fiveal percent is a very big number for me. thirty seven and a fivealf percent is your risk of getting breast. Lifetime risk of cancer at some point in your life. Right. So that's like Four and ten 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 have everything. I don't want to get breast cancer. and thirty seven percent 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, this is crazy. Why would you remove it And she said, you know what, worst case scenario, comeome back when you're fifty. We'll talk about this again. But right now you're forty eight, 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 thirty seven point a fivealf 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. Shes 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 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 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 wanted to do this to reduce my risk of breast cancer significantly. So basically you go from thirty seven and a fivealf percent, which was my lifetime risk to less than five percent. 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. If your doctor calls you and says, I just got off the phone with a pathologist, 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 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 brain shuts down and you stop listening 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, 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 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 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 Godds. 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. paying for it Remove it. That's how women get treated in medicine You know, I've dedicated my life to saving women practice for twenty three years, I have never lost a patient under my care to cancer. You can't tell me that's luck 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, Doctors, 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 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 We cannot go through life not knowing what that number is So I'd love now get into this lifetime risk assessment because I think you've definitely provide a whole new perspective on sort 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 Wen can do it at home. It's the tire Kusic risk assessment tool I actually put a copy of it free of charge on my CMD podcast page You 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, agge 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. Is this something that generally anyone listening to this can do themselves? They heard you mention things like the breast density and you've also told me that I can't figure that out for myself. So 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 thirty thirty is when we start imaging. If you have strong family history of ovarum, pancreatic, or breast cancer Two of the forty eight cancer causing genes are BRCA one and two, those patients need to start breast imaging at age twenty five. 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 entire acusic 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 um You know, we talked about average risk being twelve point five Low risk category is anyone under fifteen percent. So if your lifetime risk of breast cancer is less than fifteen percent, you fall into the low risk category In America, you can start your breast imaging get forty. or ten years before your first degree relative was diagnosed with breast cancer. If you have dense breast tissue, you have to ask your doctor for a breast ultrasound. That's for fifteen percent and below. From fifteen to twenty percent, that's the intermediate risk category. This is when basically in my practice, I treat every patient differently Knowing that they fall into that intermediate risk, I might start their mammogram a little bit earlier, maybe get a baseline at thirty five. If they have dense breast, I do an ultrasound with it. And if they have any family history, I start the imaging ten 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 twenty percent or higher percent are higher patients need to start their breast imaging as early as thirty 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 at 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 thirty eight got stage for 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. 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