Navigating Breast Cancer Screenings: Risks, Benefits, and New Technologies with Dr. Jenn Simmons

Hi there, it's Dr. Jen. And welcome back to another episode of the Keeping a Breast Podcast. I want to talk today about what all the buzz is about. Breast Health Awareness Month. Now, as important as it is to have a time when we specifically recognize breast health, I also think that this is something that is so important to be carried through throughout the year. So I just wanted to create something that. That kept this in perpetuity, because, as I always say, breast health is health. And the same things that you're going to do to have healthy breasts lead to a healthy brain, a healthy heart, healthy bones, healthy skin, healthy joints, all of it. And we need all of this. We need all of this so that we can have optimal function, so we can live as long as possible and die young. So in Breast Health Awareness Month, there is a lot of focus on screening, on screening for breast cancer. So I want to do a deep dive about screening, about our current screening programs, about what it does, about what it doesn't do, because there is a lot that it doesn't do. And I want to talk about what I believe the future of screening is, and then we can get to more things about prevention and we can talk about reversal of breast cancer, because all. All of these are really relevant topics that we need to be talking about, and we need to be talking about a lot, and we need to be talking about them openly and honestly, because there is a lot of veiled truths, if you will, in this arena. So first, let me start by saying what I think is a requirement, an absolute requirement of a screening program. So if you are going to have a screening program for a disease that affects a large part of the population, and I think that arguably breast cancer fits into that category. I think that, you know, those statistics that we see 1 in 7, 1 in 8 over a lifetime, this is certainly a disease that affects a large percentage of women and therefore does deserve some. Some screening does deserve some attention. But we have to be very careful and specific about what that means right now. Well, what screening should mean. Screening should be affordable, screening should be available, screening should be safe, and screening should be reliable, meaning that you can't use a test to screen for a disease that actually puts someone in danger. So the. The test has to be extremely safe if you're going to expose a large percentage of the population to it. And the test ought to be very reliable in that if that test is negative, you should be able to confidently know that you do not have that disease. So let's talk specifically about mammogram, because I think that that is the most relevant thing to discuss when we talk about breast cancer screening. It is certainly the standard of care. It is widely recommended and I think only fractionally understood. So the slogan everyone's heard is, is that mammograms save lives. And it's been said so many times that I think people stop questioning whether or not it's true. So I want to dive deep into the data. I want to talk about mammogram, talk about its benefits, talk about its drawbacks, because there are plenty of them that we're not discussing, and talk about whether or not it is really even appropriate to be using mammogram to screen for breast cancer. And if it's not appropriate, what should we be doing? So, first, let's talk about the mammographic screening program, because at its inception about 50 years ago, it was built on some foundational understandings that actually don't turn out to be true. So mammogram was built on the understanding that breast cancer growth was both linear and predictable, that breast cancer growth was something that started small and grew to some critical size, at which point it was more likely to metastasize. The belief was that if you found that lesion before it reached that critical mass, you could both see save lives and save breasts and spare people the harms of treatment. And these are all lovely, lovely theories. They just don't happen to be true because breast cancer growth is neither linear nor predictable. Now, there are some cancers, I want to be clear, There are some cancers that that's true for. So colon cancer growth is absolutely linear and predictable. And if you catch it as a polyp, it's not going to go on to become an invasive carcinoma. But that is not true in the breast, in that if you have atypical ductal hyperplasia, there is no requirement that that's going to go on to become DCIs. And DCIs, there's no requirement that it goes on to become invasive cancer. It just doesn't work that way. And there are invasive cancers that are de novo in that it didn't pass through atypical ductal hyperplasia and DC to get to be invasive. It just de novo on its own, turned out to be an invasive cancer, grew an invasive cancer. And there are very small cancers that have already metastasized, spread throughout the body. There are very large cancers that will never metastasize, that will never spread throughout the body. And. And then there's everything in between. So when we talk about breast cancer and Breast cancer growth. And we have this whole screening program that is based on these understandings, and they turn out to not be true. This is a huge problem. And this questions that entire platform. So let's go over each one individually. So I already told you that breast cancer growth is neither linear nor predictable. So you can't say, based on the size of something, what it's going to eventually be. And because of that, we cannot predict who does and who does not need to be treated by identifying things just by their size, by doing a screening mammogram and finding a small tumor does not guarantee that that person is going to have a good outcome and does not predict in any way what treatment that person should have. Because if you have an aggressive cancer, you kind of need all the treatments, and you get fooled by the fact that your tumor was small. You get fooled by the fact that it seems to be an early stage. So that's not really what matters. And in addition, when we look at the data, we know that no matter how many screening mammograms we do every year, the same exact number of women will die of breast cancer. So mammogram is not impacting survival. It's not impacting that bottom line. Now, when you talk about it in terms of percentages, of course it looks good for mammogr. There's also something called lead time bias, where someone who's going to present with a palpable lesion, something that you can feel as compared to something that was picked up on mammogram, if they both go on to die of their disease, but one dies in eight years because it was picked up on mammogram, and one dies in four years because it was picked up by being able to feel it, the death at four years will statistically be counted towards breast cancer. But if you use five years as your survival criteria, and the person died at eight years, you're going to say that mammogram saved that woman's life. But ultimately, if she dies of breast cancer just four years after, did mammogram really save her life, or did mammogram just commit her to treatment earlier? So there is this whole element of lead time bias that is built into mammogram that actually does not reflect true survival. And this is a problem. And the other issue with mammogram is that no matter how many mammograms we do every year, again, the same number of women die from breast cancer, and no matter how many mammograms we do every year, the same number of women will present with aggressive disease. These are interval cancers. These are cancers that develop in between mammograms, and they just have aggressive biology. Screening with mammogram doesn't save women, certainly doesn't save women with aggressive biology. It has no impact on those women with aggressive biology. But that we have to ask, if we're not saving women, are we doing the right thing? Well, I would argue that maybe we're not saving lives, but if we're saving breasts, if we're preventing women from going on and having mastectomy, I think that is a worthwhile endeavor. I think that's a tremendous contribution. So, again, let's go back to the data. Let's look at the data. Does screening with mammogram lead to less mastectomies? As it turns out, that answer is a resounding no. When we look at the population that screens with mammogram, they are 20% more likely, more likely to have a mastectomy. And this is for several reasons. First, there is no better way of frightening the hell out of a woman than giving her a breast cancer diagnosis. And when a woman gets a breast cancer diagnosis, her instinct is to just remove the breast because something in her intuitively believes that she is less likely to die of breast cancer if she has her breast removed. And quite frankly, it is the responsibility of their doctor to explain to them that there is no survival advantage to mastectomy. And if there were, we should be doing them all the time. Right? But there is no survival advantage. You do not have a greater chance of surviving breast cancer if you have your breasts removed. So why is it being done? Well, it's being done out of fear. Because. Because lots of physicians don't take the time to convince people otherwise. And it's done out of the fact that we are. And this is gonna sound harsh, but we are looking too hard for breast cancer. We're looking too hard. We're finding these little things. Sometimes they're meaningful, sometimes they're not. But a lot of the time, women are told, well, we know you have a cancer here, and you have a little finding over here, and you have a little finding here, and you can biopsy it. But I'm going to recommend that you just have a mastectomy or you have an mri, and that MRI shows multifocal disease. And I can't tell you how many times as a surgeon, when I have gotten MRIs on women that I knew had a breast cancer in their breast, and there were findings all over the breast multifocal findings. And those women went on to have mastectomy on my recommendation because I believed the mri. And then the pathology comes back and then there's no disease other than the known disease that they had in the breast and they had a mastectomy for nothing. And I'll tell you that I have had many a sleepless night since I learned this information. I have had many a sleepless night in horrible regret, horrible regret that I advise women to have their breasts removed when they did not need their breasts removed. And I'll tell you that those mastectomy scars, they run deep. And I don't believe that there is any way that you can fully prepare a woman for a mastectomy. I don't think that there are any words, I don't think that there's any therapy, I don't think that there's any preparation for how a woman is going to feel after she loses her breast because it affects you on so many levels. You're afraid for your life, you're afraid for your relationship, you're afraid for your sexuality, you're afraid for your self image, you. And on and on and on it goes. And I'll tell you that a woman who has a mastectomy, has her breast removed, there will never come another day for the rest of her life that she will not remember that she had breast cancer, because that mastectomy will be a constant and ever present reminder that she had breast cancer. However, if you have a lumpectomy and you have a well done lumpectomy, there will come a day where you will no longer be defined by breast cancer. And so towards the end of my surgical career, I really encouraged people who wanted to and were willing to keep their breast, to keep their breast. So I guess ultimately it comes down to if mammograms don't save lives and mammograms don't save breasts, do they lead to lesser treatment? And certainly they don't lead to lesser treatment. Surgically, do they lead to less medical treatment? And the answer to that question again is no, because we tend to treat everyone the same way. If you have breast cancer, then you get this. And there, there is some variation according to do you have hormone positive breast cancer? Do you have hormone negative breast cancer? Do you have her two positive breast cancer? Do you have her two negative breast cancer? These are considerations that are taken into account when these treatment paradigms are developed. However, suffice to say, most people grouped in a group get the same thing. So this is a problem and ultimately, I want to talk about two studies and what it comes down to for me. I first want to talk about the Canadian breast cancer screening study, because that was a study primarily on young women. Because arguably, if. If mammograms saved lives, if it led to young women becoming old women without disease, I do think that that's a worthwhile endeavor. And please know I'm not even talking about mammograms being painful or uncomfortable or anything like that, because, I mean, they are. They are certainly painful and uncomfortable. And for all of you that tell me that you don't have pain with your mammogram, God bless you. But I want you to know it's still hurting you. Beyond that, the only thing that matters in the end is is it reliable and are they saving lives? So the Canadian breast cancer screening study looked at women 40 to 59 years old, and it specifically was. It was 90,000 women, and it was designed to look at whether or not mammograms saved lives in young women. 45,000 underwent mammogram and 45,000 did not. Now, the interesting thing is the same exact number of women in each group died of breast cancer. The same exact number. Screening with mammogram, therefore, does not save lives, because even though it detected these cancers, they ended up doing the same. They did the same. But what this trial demonstrated, which was so exceedingly clear to the people that actually thought about it, was that if you are in the breast cancer screening with mammogram group that 45,000 women underwent screening mammogram, you were 20 to 30 times. No, there was a 20 to 30% increase in the number of women diagnosed with breast cancer. So the same number of women die of breast cancer in each group, but in the group that screens with mammogram, they treat 20 to 30% more women with breast cancer. This means that 20 to 30% of women who are diagnosed with breast cancer by mammogram alone and get treated for breast cancer did not need to be treated for breast cancer. Those women would have never developed clinical disease. This is a huge problem. This problem means that we are treating 20 to 30% of the people diagnosed with breast cancer every year unnecessarily. This is the concept of over diagnosis and over treatment. If all you do is use mammogram to determine who does and who does not get treated for breast cancer, you are going to over diagnose and and over treat 20 to 30% of the breast cancer population. Let me give that to you in numbers that mean something in the United States? In the United States, in 2024, we will diagnose in and around 300,000 women with breast cancer, 300,000 with invasive breast cancer. I'm not talking about DCIS. I do not consider DCIS a cancer. And that's a topic for another day, but we can definitely talk about that. So if you have 300,000 women diagnosed with invasive breast cancer and 20 to 30% of those women are being treated unnecessarily for breast cancer, we are talking about 60 to 90 thousand women every year. 60 to 90 thousand women every year treated unnecessarily for breast cancer. This is not a negligible amount. This is a huge number of women who are treated unnecessarily. Now, if this study were some like, fly by night, you know, I don't know why they got those results, but it's not consistent. That would be one thing. But then we can talk about the Nordic trials. And this is a trial of 600,000 women that had the exact same outcome. The exact same outcome. And what came out of the Nordic trials is that for every 2,000 women that you screen over 10 years with mammogram, you can potentially save one woman's life. And you will cause 10 women to be unnecessarily treated, to be over diagnosed and over treated for breast cancer. The balances are not there. They're just not there. And telling women that mammograms save lives is simply not true. Now, there may be some advantage in, in the older population, but I can argue that, you know, why are we even doing that? When for the most part, if you just waited for clinical disease or you had a test that could tell you what's meaningful and what's not, then it just doesn't make sense to screen with mammogram. So let's talk about the benefits of mammogram, because I think that that's an important, that's an important statistic to have. So mammograms are inexpensive. That's definitely true. Mammograms are readily available. Mammograms are easy to read and there are plenty of people to read them and they are the accepted gold standards. However, they are painful, they are highly inaccurate and lead to a lot of false positives. And statistically speaking, when you look at women with dense breasts, which is at least 40% of the population, women who get mammograms over a 10 year period, the callback rate for them over 10 years will be at least 50%. At least 50% of women who screen with mammogram over 10 years will be called back and the vast majority of them will be false positives. So mammograms are painful, they are inaccurate. And I think we have to address the 800 pound gorilla in the room in that. I'm not sure that they meet the safe criteria. I am not sure that they are not causing a percentage of the breast cancers that we see every year. Because mammograms, despite their lovely name, they are radiation. They're radiation. They are delivering low energy radiation to the tissues of the breast. And we know in every other arena that radiation is carcinogenic, it is cancer causing, it does damage DNA without question. Now there are lots of proponents of mammogram that say that the radiation that you get with mammogram is equal to that of background radiation over seven weeks or a plane ride across country. And that might be true, but we are not comparing apples to apples because we are now talking about the difference between scattered radiation or radiation that is just generalized and focused radiation. Radiation that is focused down coned down onto the tissues of the breast that is going to have dramatically different effects than scattered radiation. So that focused radiation, though the numbers may be the same, there is a vast difference between scattered radiation and focusing that radiation down on the tissue of the breast. And what ultimately happens, because radiation is additive, is that the more mammograms that you have in your life, statistically speaking, the more likely you are to, to get diagnosed with breast cancer. And that is twofold. It is because A, you are radiating yourself every year and so that radiation is going to build and going to cause damage. And B, the harder you look, the more you're going to find. And in my opinion, we are looking too hard for breast cancer and we're finding it. And as a result, we're treating more and more people every year. You know, six years ago we were talking about treating 240,000 women a year for invasive breast cancer. Now we're close to 300,000. And this is a complicated thing because there is something that happens between that time that I think is contributing to more breast cancer diagnoses. And yes, our environment is more toxic. I won't argue with that. However, we're also looking too hard and we're finding too much and we're doing it unnecessarily. We are without question over diagnosing and over treating breast cancer. And I, I harp on this for a really good reason and that's that once you diagnose a woman with breast cancer, she literally will never be the same again. Never, never. You can't unring that bell for her. And beside the psychological impact, which is not negligible, right, which is a monster. But besides the psychological impact, there are tremendous physical implications to being treated for breast cancer. Are you ready for a breast cancer screening revolution? Well, I'm thrilled to introduce to you a breast cancer screening tool that I have only recently learned about, but I have universally adopted. This is the ARIA test. This groundbreaking at home breast cancer screening test is one that I believe will completely change the game. So imagine a screening test that's as simple as shedding a tear, because that's aria. It's a non invasive, convenient and perfect for all bodies and all breasts. Dense breasts, implants, no problem. ARIA makes it clear for everyone, even women as young as 30. Aria is backed by over a decade of clinical trials, thousands of samples, and it's developed alongside top breast health experts. Here's how it works. You collect a tear sample at home and then ARIA then analyzes it for protein biomarkers that can signal early breast cancer. And the best part, you get a consultation with a breast health specialist to review your results. Now, ARIA isn't replacing breast imaging. I am using it alongside qt. It's complementing it and giving you a fuller picture of your breast health. Knowledge is power and ARIA is putting that power back in your hands. It's time to take control of your breast health. And ARIA is another way of doing it. Go to aria care a u r I a care and use my code drgen20 in capitals d r j e n n 20 to get 20% off. Back to our show, Let's start with Almost all the treatments for breast cancer are deforming, right? The surgery is deforming. Even if you have a lumpectomy, it's deforming and it's traumatic. Surgery is traumatic without question. Now, some of this is for the good, right? And so we tolerate that. But let's talk about the some 70% of women who have hormone positive tumors and get put on hormonal blockade, either with an aromatase inhibitor if you are postmenopausal, or tamoxifen if you are premenopausal. And there are serious consequences to getting rid of your estrogen. I mean, we have estrogen receptors all throughout our body and for good reason. Because estrogen is what helps our brain to function, it helps our skin to be healthy, it helps our heart to function, our blood vessels to function, our Gut to function. It helps our muscles, our joint, our sexual health system, our urinary tract system, it's doing all of that. And so when you take that away, women start to complain of neurodegenerative disease. They have brain fog, they're forgetting, they're dizzy, they, their vision changes, they have anxiety, they have depression, they have difficulty sleeping, they're having palpitations, Cardiovascular disease gets accelerated, their lipids go up, they gain weight, especially, especially around the middle, which is the most dangerous place to gain weight. Their joints ache, their bones ache, they have dry skin, they have dry hair, they have dry everything. They have no libido, their relationship is suffering, Sex is painful, they're leaking urine and on and on and on. And we get to the point of really diminished return. So especially when we're talking about that 20 to 30%, that 60 to 90,000 women a year are getting treated for breast cancer unnecessarily. And now they have all this. And people say, oh, you should be grateful to be alive. Well, it's hard to be grateful when you can't think and you can't speak and you can't sleep and you have palpitations and you're gaining weight and you're feeling awful about yourself and your bones ache and your joints ache and you're wearing adult diapers and you have no libido and sex is painful and your relationship is suffering or your spouse left you and on and on and on. It's hard to be grateful when all of that is happening. And for 20 to 30% of women, for 60 to 90,000 women every year, that's happening unnecessarily, all because we're using a very unsophisticated, unreliable, and in my opinion, unsafe test to screen for breast cancer. And ultimately, I don't think we should be using a test that causes cancer to screen for cancer. Now, there are some populations where I don't necessarily feel this way. So if we're talking about the lung cancer population and people who have smoked for 20 or 30 years, they are at very high risk of developing lung cancer. And finding their lung cancer small is very meaningful. So for these people, because they're at such high risk and because lung cancers are very hard to cure, and because it's important to find a lung cancer when it's small, because it really is going to change the ultimate outcome for that person, I think that screening with low dose CAT scan is the right thing to do. But that's not what we're talking about in our general screening. Population. So in our general screening population, we are talking about healthy women who, we have no reason to believe they have the disease. Now, I want to be very clear now. I am not talking about a diagnostic scan. I am not talking about the woman who has a lump in her breast. I'm not talking about the woman who has nipple discharge. I'm not talking about someone who has a big red swollen breast who has new symptoms. I'm not talking about the person with skin retraction or change in size or shape or the appearance of the breast or has a lump under her arm. I'm not talking about her. That woman who has symptoms should go have a traditional workup, should go have whatever workup that she can have in order to get a diagnosis, because a diagnosis in that woman is very important. And I want to make sure that that woman has a diagnostic scan. But that's not what we're talking about here. We are talking about the screening population, the population of normal healthy women who, who have no reason to believe that they have breast cancer. And in this population, I believe that it is unethical to use mammogram to screen for breast cancer. We are looking too hard. We are finding things that are not meaningful. Women are undergoing additional studies unnecessarily, they are undergoing biopsies unnecessarily. And some of them are, or even getting unnecessary diagnoses. And nowhere is that better demonstrated than in the DCIS population. So DCIS stands for ductal carcinoma in situ. And most of the time, not all of the time, most of the time. The reason that they get that DCIS diagnosis is because they have calcifications seen on their mammogram. And when calcifications are seen on a mammogram and they have a certain appearance. So what the radiologists are looking for is a pleomorphic appearance where they don't all look alike. Some are big, some are small, some are granular, some are spiculated. Some, you know, they have different appearances and they tend, and the shapes are different and, and they tend to be found in a linear distribution, which ultimately to us means that they are lining a duct. And so when calcifications present that way, and biopsy is suggested, sometimes that pathology will show ductal carcinoma in situ. And then these women are treated for breast cancer. Now, ductal carcinoma in situ is a non invasive condition, meaning that it is only a disease that lines the ducts. These cells do not go outside of the duct, and it's only Outside of the duct where the blood vessels and lymphatics are. That is the way that breast cancer spreads from the breast to the rest of the body through the lymphatics, through the bloodstream. And DCIS has no ability to, to get into the bloodstream or into the lymphatic system. So by definition, DCIS is 100% survivable because it has no way of ultimately affecting any other organ other than the breast. So why do we treat it? Well, unfortunately, we treat it because we can. But the question is, should we, should we be treating dcis? So in my practice, I do not treat dcis. I instead choose to use DCIS as an opportunity, an opportunity to take stock in what you're doing, look at what's working, look at what's not. This is an opportunity to get healthier. This is an opportunity to reverse disease. This is an opportunity to create a better environment both inside and out. And this is in fact, reversible. So if you can get to the point where you develop disease, you can also get to the point where disease goes away. So I think it's very important to know all of this. And I'm just going to pause for a moment and say that if any of this is resonating with you and you want to know more, this is why I wrote the Smart Woman's Guide to Breast Cancer. I wrote it because I knew that people were getting these diagnoses, being handed a piece of paper, a pathology report, and being urged to quickly undergo treatment of some kind, whether it be surgery or chemotherapy. People are rushed into treatment. And with very rare exception, that is not the right thing to do. And if we are going to treat people for breast cancer, certainly with these conventional medical treatments that have long term implications that are significant for people, I think that they ought to be given the opportunity to make an informed decision. And you can't make an informed decision unless you're given the time and space to do so. So I wrote the Smart Woman's Guide to Breast Cancer so that you could understand your pathology report, understand the conventional medical treatments, surgery, chemotherapy, radiation, anti hormonal treatment. I wrote the book so that you knew the questions to ask Your surgeon, your radiation oncologist, your medical oncologist, your reconstructive surgeon, your integrative oncologist, your functional medicine doc, your nutrit nutritionist. I gave you all the questions and then I gave you what I believe is the most important thing, and that's a health plan. Because no matter what you do in the course of treating Your breast cancer, the most important thing is that you build your health. And every single person who gets a breast cancer diagnosis gets a treatment plan. But the thing that absolutely everyone needs is a health plan. And I want to make sure that you have a health plan. So pick up your copy of the Smart Woman's Guide to Breast Cancer on Amazon and we'll link to that in the notes. And please know that if you have a breast cancer diagnosis, great, you need this. If you had a breast cancer diagnosis, great, you need this. If you are currently going through treatment, great, you need this. But if you know someone with a breast cancer diagnosis, they need this. And your mother needs this, and your friend needs this, and your neighbor needs this, and maybe even maybe your doctor needs this. So think about the person in your life that would benefit from having this at their fingertips and get that for them. That is the gift that truly goes on giving. So I've talked a lot about what not to do, right? I haven't talked so much about MRI yet. So I want to briefly speak about mri and I want to briefly speak about the high risk population because I think it's really important. Even though they are a fraction of the breast cancer population, I think it's important to give them an action plan as well. So what makes you high risk for breast cancer? Because I hear all the time, oh, I can't do this because I'm high risk for breast cancer. Oh, I need a mammogram. Because I'm high risk for breast cancer. So I want people to understand what that means and the implications of that statement. I need a mammogram. So the people that are high risk for breast cancer are. If you've already had breast cancer, you're at increased risk as compared to the general population. If you have first degree relatives with breast cancer, if you have a known mutation, genetic mutation in your family that is associated with breast cancer and you carry that gene, you're certainly at increased risk. Incidentally, if you come from a family that has a, a genetic mutation and you don't, you're not at increased risk. So just be aware of that. It doesn't mean you're not going to get breast cancer because people with genetic mutations get breast cancer and people without genetic mutations get breast cancer. Just like people who take hormone replacement get breast cancer and people who don't take hormone replacement get breast cancer because it's not one thing. And even in the population of women who have genes that make them more likely to get breast cancer, breast cancer, there's still a percentage of those people that don't get breast cancer, because the number one most important thing is the environment. But let me say something about the people that are high risk for breast cancer, either because you have a strong family history or because you have a genetic mutation, or because you have a personal history of breast cancer. These are people who have already proven that their cellular repair mechanisms do not work properly, do not work efficiently, do not work as if they should or like they should. And we know that because when people develop breast cancer, it is a multifactorial, multi step process. So yes, you have that, that one end of it where your cell undergoes cellular damage and goes into survival mode, where the cell is just reproducing, reproducing, reproducing without any the normal checks and balances. And that in and of itself is not enough because we all have these built in mechanisms. Her immune system, our, our DNA repair system that's supposed to recognize these rogue cells in their infancy and destroy them. However, so many of us are walking around immunocompromised or we have bad detoxification systems or whatever it is, and it allows these cells to reproduce and to reach critical mass and actually become a tumor. So in this population of vulnerable people, just about the worst thing you can do is give them a mammogram every year. And I'll tell you why. People who do not repair their cells, well, people who are especially vulnerable to toxins, don't do well when you radiate them every year. And you are essentially, if you're screening that population with mammogram, you are essentially guaranteeing that they develop the disease. This is a huge problem because we're recommending screening early and often in this population of very vulnerable people. And we're hurting them, we're hurting them and we are causing a certain percentage of that disease. And then if they get the breast cancer, then we screen them even more afterwards and we're causing them to have a second incidence of disease. So the other side of it is that people who are at high risk or people who have implants, or people who have proven that mammogram doesn't work for them, they are often getting a suggestion to use MRI for screening. So that is the gold standard in the dense breast, high risk population is screening mri. But screening MRI has a whole host of problems. Screening MRI is expensive, it's cumbersome, there are availability issues because there are not MRIs everywhere. But the biggest problem that I have with MRI is that it requires gadolinium now, gadolinium is a heavy metal and whenever we take in a heavy metal, it is stored in our body and it's stored at the expense of something else. It's stored at the expense of something that you need, that you need. And when we store gadolinium in our cells and in our organs, it has long term consequences. This will damage our organs over time. This is a problem. So I do not use MRI for screening. Again, I want to emphasize, I'm talking about the screening population. I'm talking about women who are healthy. I don't believe in putting women, healthy women in harm's way. I don't believe in giving them mammograms and radiating them. And I don't believe in using MRI to screen. So what do I believe in? What do I think the right thing to do for screening is? Well, I think that the Canadian breast cancer screening study, I think that the Nordic trials told us that self breast examination is an adequate screening tool in most people. And though it is not going to find tiny, tiny tumors, with rare exception, it is going to find the tumors that are meaningful and the tumors that need to be treated. And remember I said before, that is a criteria that we need to pay attention to, to because we do not want to over diagnose people and we do not want to over treat people. We do not want to treat those cancers that don't need to be treated. Those screen detected cancers that would have never reached critical mass, that would have never become life threatening. We don't want to treat them. So I believe that we should all be doing self breast examination. What that looks like is if you're premenopausal, you're going to do it one week after your cycle starts. If you're postmenopausal, you're going to do it on the first of the month. And you want to look at your breasts, both with your arms down by your side and up over your head and look for any skin changes, look for any dimpling. And then you're going to take your fingertips and you are going to go around the breast radially from outside to in, so from the outside towards your nipple. And you're going to run your fingertips over your breast tissue because these are the most sensitive parts of your hands, is your fingertips. And you're going to work your way around the breasts. You do not need to check your nipple for discharge. If you're going to have nipple discharge, that's meaningful. It's going to come out on its own. You do not need to check. And if you go around your breasts and you feel little lumpy things, that's probably your normal. Get to know your lumps so that you can know when there's been a change. And if you feel something that's abnormal, if you feel something that feels very firm and it's kind of tethered to your skin, it's not really mobile, it's kind of stuck in the tissue around it. This is something that's consistent with breast cancer and needs to be investigated. So if you feel feel something in your breast, you don't necessarily need to decide what it is. If you feel something in your breast, that is the criteria to go and get work done. So if you feel something in your breast or you have nipple discharge or some kind of change, I am encouraging you, go see a breast surgeon, go see your gynecologist, get an exam, listen to what they say. If they send you for a mammogram and an ultrasound and even an mri. Fine, fine. Because you need to know what's happening there. You need to know what that lump is. You need to make a plan. But if you do not have a new symptom in your breast, it's hard for me to argue for any of those things that I know will ultimately hurt you or can ultimately hurt you. Now, this is not satisfying to a lot of people because a lot of people really want to do more for screening. So I'm going to tell you about the two things that I use. One of them is available everywhere in the United States. The other one is not yet available everywhere in the United States. But I am working on it. Please believe me that I am working night and day and weekends to make sure that this becomes available to everyone who wants it. So I'm going to talk about the QT scan Perfection imaging, where we offer this scan that is absolutely positively going to revolutionize how we image the body. So the breast scanner specifically is a vat of water that has ultrasound arrays around the outside of it. Your breast gets submerged in the water and the ultrasound goes around your breast, sending out 3D circumferential 360 degree sound waves that we collect 200,000 times more data points than an MRI. And it ultimately creates a 3D reproduction of your breast that has 40 times the resolution of MRI. So we're able to see things that are really small. And yes, we're able to see calcifications, and yes, we're able to see small masses, and yes, we're able to see architectural distortion and changes in the tissue. And yes, we can see through dense breast. It was actually designed to see through dense breast tissue. But that is not the most important part to me, because like we spoke about before, finding things isn't so much the problem, it's finding meaningful things that is the problem. Because we do not want, I do not want to over diagnose and over treat breast cancer. I do not want to create unnecessary suffering. This is very important to me. This is my mission, that I want to save women from over biopsy, over diagnosis, and over treatment. This is my life's mission. So the fascinating thing about this technology is that, and this is what it got FDA approval for, it is volumetric measuring, meaning that if we see a lesion in the breast, we can measure the volume, we can count the cells, and then we can bring someone back for a short interval study, 60 days, 2 months, and we can reimage them, recount the cells, remeasure the volume, and measure a doubling time. So cancers or things that are meaningful have a doubling time of less than 100 days. And things that aren't meaningful or aren't cancer have a greater doubling time. So by using this technology to measure a doubling time, we are able to avoid unnecessary biopsies over diagnosis and over treatment because we are only treating the things that matter. We are only treating the things that are active, we are only treating the things that are progressing. And I think that this is going to have a huge impact. Now. Lots of people are not satisfied with that, in that they want to know, they want to know, and that's okay, that's okay, go the traditional way. I am not trying to convert everyone. I am mostly addressing that 40% of people who are eligible to screen for breast cancer but are not screening for breast cancer because they don't want to undergo mammogram, they don't want to subject themselves to unnecessary radiation, they don't want to be compressed, they don't want to be in pain, they don't want to be traumatized. And they don't believe the hype. They don't believe that mammograms are safe. That is who I'm talking to. I know that my take on this, my perspective on this, is not universally shared. I know that there are plenty of people that believe that mammograms save their lives. And believe me, I am delighted that their lives are saved. But the statistics say otherwise. And even Otis Brawley, who is the former head of the American Cancer Society, says that the benefits of mammograms have been exaggerated, and many women who think they were helped by mammogram were actually harmed. That might not be the exact quote, but that's. It's pretty close. It's pretty close that many women. Many women who think that they were actually helped by mammogram were actually harmed. This is a huge, huge issue. Again, we're talking about 60 to 90,000 women this year will unnecessarily be treated for breast cancer. And now we have a test that can prevent that. So it's not about its ability to image the breast without pain or compression. That's great. It's not about the ability to image the breast without radiation. Well, maybe it is. Maybe it is. Because I think that when we have those criteria that we have to meet for a screening study, it needs to be affordable, it needs to be safe, and it needs to be reliable. And QT without question, meets all of those criteria. A screening examination is in and around $500, which I know sounds like a lot of money, but in the scope of what an MRI costs, in the scope of what a screening ultrasound costs, this is not a lot of money. It's a lot less money. It is 100% safe. There is no radiation, there's no trauma, there's no compression, and it is reliable. We are not missing things when we look with qt, but what we're doing is we are separating out the things that are meaningful and the things that are not. So it's never my goal to call everything, because I don't want to. I don't want to create unnecessary worry. I don't want to create unnecessary concern. And I'm not trying to be paternalistic in that. You know, let me worry about it. Don't you worry about it. What I'm trying to do and what I'm trying to be is intellectually honest. And I don't want you worried about something that will never hurt you. Let's worry about things that matter. Let's worry about the things that need intervention. Let's worry about the things that we need to acknowledge and do something about and the things that aren't going to hurt us. Let's use them as opportunity. Opportunity to do better, opportunity to be better. And with this test, we can do that. So there are currently five centers open in the United States. One of them is mine. It's Perfection Imaging. Outside of Philadelphia, there is another one in Nevada, California. There's one in Irvine in the center for New Medicine, there's one in El Dorado Hills, California. And there's one in Scottsdale in the Vincere Cancer Center. And I am making it my life's work to make sure that I put up 50 in the next five years so that it everyone who wants access to this test can get access to this test. So that's the qt. Now, I want to tell you about another test that I am very excited about because it's something that you can do at home. It's 100% safe, and it is fairly sensitive. So it has a 91% sensitivity and a 57% specificity, meaning that it's very good at picking up breast cancers. And what it's actually measuring, it's called the Aurea test Auria. And what it's measuring are two proteins that are secreted early on in the process of breast cancer. So These are the S100A8 and S100A9 proteins. And the way that we identify these proteins is we take a sample of your tears. So you take a small piece of paper and you put it in the corner of your eye, and it sits there for a few minutes. And then you take that paper and you send it off to the company. And about a week and a half later, you get the results. And it either says that you're at low, intermediate, or high risk of having breast cancer according to that level that is in your tears. So if you're at high risk, this is someone that needs to be screening every year and be vigilant about their examinations, be vigilant, more so even about their health, about doing the things that build health, about doing the things that lower inflammation and drive wellness. And if you're at low risk, you can comfortably know that you don't have disease and that maybe you're someone who can screen with a QT scan every other year because you're at low risk. And this is a test that I recommend that people use every year because it's so simple, because it's so affordable. I think the test is around $150. And because it's so easy to do and gives you such valuable information. So if you would like the ARIA Test, it is Aria Auria Care. And if you use my code, DoctorJen20, all caps D R J E N N20, you'll get 20% off of that test. And that is pretty good for peace of mind. So again, my ideas for screening, my beliefs for screening, my programs and recommendations for screening are that everyone should be doing a breast examination. Everyone should know what their breasts feel like when they're normal so that they can recognize a change. And then if you are in a position to have a QT scan, I believe that QT scan is the safest, most accurate, most reliable way to know what does and doesn't need attention. And then have the ARIA test every year, Auria care so that you can know what your true risks are of developing breast cancer. And with that, I am going to wish you goodbye. I am going to plan another one of these again real soon. But I think that we covered screening adequately today so that you can go forward and make an informed decision about what you want to do for screening. Because the information is important and people should know. And just because you hear something a whole bunch of times doesn't make it true. And we need to trust our instinct. And 40% of the screening population is trusting their instinct. 40% of the screening population is choosing to not screen with mammogram because of the dangers and because of their concerns with mammogram. And now you know that you have other options. So I'm wishing you health, I'm wishing you safety, and, and I'm wishing you all the information that you need to make good decisions. If you have any questions, please leave us a comment, send it to us here. Or you can send it to my my Instagram @Doctor Jennsimmons D R J E N N S I M M O N S And make sure that you pick up a copy of my book, the Smart Woman's Guide to Breast Cancer. It's available on Amazon and, and this will most certainly answer the questions that you have. I will be back next week, same time, same place. It's Dr. Jen Bye for now.