Do Mammograms Really Save Lives?

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1:00Today, we're going to talk about boobs. Because, should you get a mammogram? Well, I found videos of my next guest. She says, better to focus on cancer prevention. Because there are harms of getting mammograms that we may not consider such as false positives, such as biopsies, such as a whole list of things. So we're going to talk about it because I was due for my mammogram. I started to do some research, and I didn't go. So I'm outing myself as a bad girl. Dr. Felice Gersh is the author of PCOS, a gynecologist's lifeline to naturally restore your rhythms, hormones, and happiness. So we're going to talk about it. Thank you so much for joining me. Well, it's my pleasure. And, you know, we'll definitely talk about the nuances of mammography. It's definitely not my favorite test, but neither is breast cancer. Right. Some of the things that I want women to have to suffer from.

2:02It's a problem. You know, we're wishing for better diagnostics and better therapeutics and better everything. So let's talk about some of the things that they don't tell us, when they tell us to go for regular mammograms, such as false positives, such as some of the dangers. Because we're not saying don't ever go. We're saying in order to have truly informed consent, we must consider a laundry list of things. So can you start me off with that laundry list? Well, first I also want to mention that within the conventional medical world, this is not an established agreed upon anything. Okay. So there are like a little bit of infighting, for example, among the societies that are involved with the radiologists, cancer society, and the American College of Physicians, which not long ago, just like in the last year, came out with a very different position,

3:03which is actually much more aligned with my position today. So there's not universally agreed upon what to do about this whole issue, even in the conventional medical world and the different medical societies. And that is because breast cancer, in terms of doing data collection, is often not really easily collected, because there's so many different varieties, we'll say, of breast cancer findings, pre-breast cancer. We might say like Dr. Korsanoma in Saitu, and precursors like say atipia, and breast cancer is not like the same creature in all women. There are some very aggressive types of cancers, some very indolent, very slow-growing cancers, which leads to the whole question that we'll cover of overdiagnosis, and then leading into overtreatment. So it's complex.

4:03And so I think what is changing, especially with the American College of Physicians, happily, is not trying to treat it as one thing for all women in all circumstances. So this is one of those you really have to look at each individual woman, because there are some potential harms, and there are some potential benefits. In medicine, we always want to look at what we call the risk-benefit ratio. And some of that has to do with how often you would get a mammogram, because the amount of exposure, and we can cover that as well, to radiation, which unfortunately, you're trying to detect and prevent deaths from a cancer by putting what is in a low dose, but still is an oncogenic, a cancer-producing thing, you know, radiation. Right. So, you know, going through all the risks and benefits and helping each woman to analyze based on her own status,

5:05like what is her unique status in terms of her risk? And that's what's not happening. It's so cookie cutter right now in most scenarios, and that's where it has to stop. It shouldn't be that all women get the exact same protocols, the exact same intervals of, you know, screening, and so on. It really needs to be much more individualized, and that's is going to involve in-depth history taking for each woman of what is her actual risk situation, and then going over what every woman should have for every procedure, whether it's surgery or a diagnostic procedure, especially a screening procedure, right, is to go over what are the benefits for you, and what are the potential risks for you, you know, so we want to make sure every woman has the opportunity to have all of that taken care of, which is typically not being done. And so tell me what you mean by false positives,

6:07that there could be a type of cancer that would resolve itself, or there could be something that is not a cancer, and then you have this invasive biopsy, what exactly does that mean, and how often do you think that happens? Well, false positives are variable, but they're not uncommon. So a false positive is where it looks like it on a mammogram. It looks like it might be a cancer or a pre-cancer, but it turns out it isn't, but it does lead to a lot of callbacks. So if you callbacks meaning more imaging taken, which is more radiation exposure, and a lot of anxiety for women, and it does in a much smaller percentage, lead to biopsies for tissue issues that are not cancer. So basically it's unnecessary and unnecessary biopsy that's being performed because of a false positive.

7:08So a false positive is there is no cancer. I mean, because then there we can go into what's overdiagnosis. But so a false positive is there's suspicious findings, at least that's how it's being interpreted on a mammogram, or it could be an MRI, but we'll focus for right now on mammograms. But it isn't. I mean, that's, I just want to make clear, it isn't. Overdiagnosis is a different thing. False positive is it truly is not positive. It's false. Okay, it's not positive. And that leads to a lot of anxiety, and also a lot of additional imaging costs and some additional radiation exposure. Now, what's the incidence like you asked? Well, it's a little bit reduced now that they have 3D tomography type, you know, the tomosynthesis type of mammograms, which is more sophisticated than the 2D digital ones.

8:10That was the mainstay for many, many years. And where I am in Southern California, that's the only type of mammogram that's even offered anymore. So it's kind of replaced the older 2D digital. Mammograms, but it changed a little bit. So it was with the 2D about a 60% recall. That's a lot of recalls for additional imaging for false positives in about, um, over say 10 years. Now in my area, maybe the women have more dense press, which we can cover dense press, or maybe the radiologists are like overly aggressive. I don't know, but I would say my patient population has a higher recall in terms of being called back for more views than what is generally reported across, you know, like surveys of the country.

9:10So based on like national surveys, which is like I said, doesn't seem to apply to my area. We have higher. It should be with the 3D to almost synthesis about 50% of women will be called back. That's a very significant percentage. And this is over several years, like even over a decade, that you're going to have every woman, you know, is has at least a 50, 50 chance of being told, we're worried about your findings. We want you to come back and do more in terms of biopsies. It's a much smaller percentage, but it's still over 10% of the women that are called back. And it depends on kind of the attitude of the area. Like in my area, we have over half of women having c-section. So that tells you something, right? Maybe overtreatment is not so uncommon where I am. But so it depends on the area.

10:10And but there are a lot of women that have biopsies. And they're so happy. And I'm happy too when it comes back. It's completely benign. I mean, it's not suspicious at all, you know, but it's very common. And so almost every woman knows other women who've had callbacks like we want to take more views. Or they've had biopsies and happily it was in cancer. But in hindsight, that's actually a harm. I mean, unfortunately, it is a harm to go through a biopsy and all the anxiety and the cost. And then, well, it turns out it's nothing, hooray, but it is actually harmed from just having biopsies. Because that's actually, if you have a lot of biopsies, that's actually considered a risk factor for breast cancer. Maybe because there really is something going on, they have more dense breasts. And maybe, you know, it's sort of like the the tissue itself is not like optimal. We know that denser breasts have a higher risk of breast cancer.

11:13If they're very dense, they're denser, the more risk. But, but you know, the biopsy results are normal. But if you have many biopsies, that in itself counts as a risk factor for getting breast cancer. Maybe it's because like I said, it's the underlying tissue type itself that's causing these, you know, unnecessary or you know biopsies for normal tissue. Or maybe the biopsies are causing harm to the tissue, you know, causing inflammation and inflammation can cause DNA and stability. So, I mean, we don't know. How do we separate these things? Because no one just does random biopsies. There's always a reason. It's just said happily. In many cases, it's not, it's not a cancer. It's not a pre-cancer. It's just dense breast tissue. So, common problem. We're going to pause this interview for just a minute and tell you about our sponsors. I want to tell you about our friends at Brightcore Nutrition.

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14:18And it makes eating well on busy days so much easier. Right now, tempo is offering our listeners 60% off your first box. So go to tempoemales.com slash redacted. Again, this is something we regularly have on hand. We particularly like it Clayton and I for lunch as well because we pack the kids lunch. But then we don't pack ours and we work from home. It's especially great if you're a work from home or like us. So again, go to tempoemales.com slash redacted for 60% off your first box tempoemales.com slash redacted rules and restrictions apply. I struggle with trying to figure out if there is any, I mean, I think most healthcare providers are doing what they're taught and well intended. But you know, how many people are medicalized that don't need to be? How many people are anxieties that don't need to be cut into all of these things? And then, but then also we do see more aggressive cancers since the pandemic for various reasons. And so where do you come down on this that there that there is both things happening over medicalization and also more aggressive cancers?

15:27Well, I think that is important what you just said that there are different types of cancers. So mammography is very best at picking up what you might call the slower more indolent cancers. The ones that will be there for years before they actually do anything life threatening or maybe they never do anything life threatening. They're so slow growing or maybe they stall, you know, they just grow and then they stop growing. That's actually a feature of breast cancers are not all the same. They all have their own unique will say time timeline of how they grow and how they might metastasize and so on. That's why you can't say all breast cancers are the same, not not at all. But if you have a breast cancer that is very slow growing sort of indolent, those are the ones that are best detected by mammography. And those are the ones that are least likely to kill anyone.

16:27So that's like it just is mammography. So what does that mean? I think because I haven't studied, you know, the progress of cancer. So this is something that could you can live with your whole life and it would never hurt you or would come and go like a mole. I'm sorry for the ignorant way I'm asking that question. No, no, it wouldn't come and go. But so when you talk about breast cancers because they have both different like we'll say biological features that can be unique to each one. And then you have size. So you have like different aspects that would be considered. What's the size of the cancer? Assuming we're talking now about a cancer. And what's its biology? Like is it like the type that is just sort of slow, slow, slow growing barely, you know, like the way glaciers used to be or is it like really aggressive. So the aggressive fast growing sort of more like we'll say abnormal like if you look at the pathology, they're not they don't even look like normal breast cells at all.

17:34They look more aggressive, more poorly differentiated. They look more wild will say like wild type cancer cells. Those are the ones that mammograms find the least well. And they're the ones that have the most propensity to kill because they're more aggressive. They grow more rapidly and they metastasize more readily. And it's just the technology. It's just what it is. So those are the ones that can pop up in short order and then grow and then they get missed. So you everyone knows or most every woman knows some friend or relative who said I had mammographies every year. I mean, I was like the best like good girl. Yeah. I was like good girl. And I went and had my mammography done every single year. And then they got breast cancer and died. I mean, it's like what you know. So how is it? I didn't know this. Okay. So there's an option that you could miss. Okay.

18:40Yeah. And because and it's not the fault. I'm not saying it's the fault of anybody at all. Yeah. I mean, it could be somebody's fault that they read the mammogram poorly and they didn't see it when they should have. But that I'm not blaming anyone because often that is not the case. It's just that it actually showed up in that short window interval between mammograms. It's that aggressive and it metastasized early. It has like a loose affiliation for the other cancer cells. So it's like held together by spit and other breast cancers are held together like super glue. So what kills women from breast cancer isn't breast cancer in the breast. It's a breast cancer that has spread metastasized to other organs like the brain, the lungs, the liver, the you know, the plura, you know, the different lining cells of things. You know, of course it can go bone. So all these other sites in the body where breast cancer cells can metastasize to.

19:47That's what kills women. And that feature of when does it metastasize is a function to some degree of size and large degree of its biological qualities. Like so we call it like cohesiveness are the cells of the cancer really like together like it can keep growing growing. It's invasive cancer and it can grow and grow. But the cells are sort of super glued together. So they're less likely at an earlier size to break off and go traveling throughout the body in plant like in the liver, the lungs, the brain and then grow there and then kill the woman. Whereas a smaller but more aggressive one can put out it's like held together very poorly the cells. They're not very cohesive and they just break off and start spreading through the blood or lymphatic system to distant organs. And that can happen when they're very, very small.

20:49In some cases, even before they're at all detectable. So no one is going to say who knows anything about imaging for breast cancer that all breast cancers can be found at a pre will say mortality stage. But oh, we can if we only did mammograms on every woman every year, we could save every woman from dying a breast cancer. Unfortunately, that isn't true. So that's just a weakness of the test. It's not a weakness of the people. It's just what the test can do. And unfortunately, but it's not like a bad thing. It's just the fact that the best detected breast cancers are not those, you know, although they can not sing that the most aggressive breast cancers are never found caught in time and a woman's life is saved. Yes, that happens, but not as often as we wish. So there's no question. I want to make this clear that if every woman had regular and we should talk about intervals like how often should a woman get a breast cancer?

21:54Well, often should a woman get these these imaging tests, but every woman had regular mammographies. Breast cancer lives would be saved. Okay, breast cancer deaths would be reduced by how much overall about this is an estimate because nobody knows. By the way, this is variably determined like there is some study say, oh, it'll reduce by a third all breast cancer deaths, but in general, it's maybe 15% and you think, well, that sounds really great. And it is, I mean, it's still significant. I don't want to say it's not doesn't count. It's for the same thing. Surprisingly, for most women to hear this, breast cancer does not have as a general statement, a super high mortality rate is not interesting. I mean, over 40,000 American women died for breast cancer every year. So I would never minimize it. I have dear friends who have had breast cancer and even died from it.

23:00So I never minimize this is a killer cancer for over 40,000 American women every year, but more than 40,000 women are diagnosed with breast cancer in any year, like much, much, much more. So happily, happily breast cancer does not kill the majority of women who are diagnosed with it. And part of that is because of how they even label it, which is another confusion, because about 25% of all will call, I'm going to say what they call them, breast cancers, about 25% are actually not yet invasive. There are more like, you know, like cancers that well just inside you, they have in spread, they call them ductal carcinoma inside you. There's also lobular carcinoma inside you. So there's, you know, there's more than one tissue type in the breast and any type of tissue can develop into a cancer.

24:05But the most common breast cancers are from the ducks. They're the structures that carry milk, which is made the lobules to the nipple so the baby can get breast milk, you know, for feeding. Yeah. So the, or the most common sight for cancer development, but you also, may I just pause and ask you, is it true that breastfeeding reduces your risk of ductal cancer? It does seem to, if it's done before the age of 30, there's something about, oh, like, maybe genetic priming or something of that sort. So, and also more, the more times you breastfeed up to a certain point, but yes, there's something magical about the hormones that happen with the prolactin and the change in the hormones about breastfeeding. And maybe the way that the, the, the ducks and the lobules are sort of used, it's, you know, in, which is what they're supposed to be, right?

25:07Yeah. They're designed for creating and delivering milk. So there is something to that. I mean, I would never tell women you have to have your babies, even if you don't want them, just, you know, that not make sense. But it's a nice thing in every woman who has a baby should be encouraged to try to breastfeed for at least 12 months, if possible, that's not universal, you know, a lot of women will feed for a month, you know, but the long, you know, at least a year would be an ideal goal, two years even better, but that's a very small percentage of women that are breastfeeding for two straight years. But yeah, you brought that up pregnancy as well, the hormones and the environment of pregnancy, the way the immune system is modulated also reduces, it doesn't mean you can't get breast cancer, but it lowers the statistical risk. So that's a good thing. As we mentioned in the beginning, I, of course, one of my big goals is prevention, you know, like, how can we lower the incidence of breast cancer? Of course, there are some things we can't control, like exposures to pesticides when you were 12 years old.

26:19And then I see the woman and she's 20, I mean, that's already happened. I can't undo what's happened. It's good to, you know, know for yourself and for if you have daughters, you know, what you can do to help get them, you know, the lowest risk possible, you know, through life. Yes. So one of the things that I'm so happy about with the American College of Physicians is that they are saying so many of the things that I have been saying is that, you know, doing breast imaging with mammography on all women in their 40s every year, the American College of radiologists and the American Cancer Society. A few years ago came out and said every woman from age 40 on should have a mammogram every single year. And it turns out that and this is what the American College of Physicians is saying. And but not everything, not the other organizations, but I agree with them that it's nuanced.

27:24Why do you need to do this imaging on every woman every year? When you do that, the incidence of false positives is substantially higher. So you're calling back more women, you're doing more unnecessary biopsies, the more imaging you get. Are your guidelines every five years or just or just completely personal based, risk based analysis? Well, the American College of Physicians is recommending every other year, what they call bi-annual. Now, there was there was some research done that came out of Johns Hopkins University a few years ago. And they're saying like if you've had a few mammograms like every other year for a while and everything is good and stable, maybe you could spread them out more. Yeah. You know that every three years or more. So, but that's that's not accepted yet.

28:24Every woman has her right to make her own choices. Okay, that's really important that she know that. And my job is to give information. Right. So there's with more data that has come out that has shown that although and this is like an interesting takeaway, which I've sort of looked at in a more nuanced nuanced way myself is that no matter what they've done with breast cancer studies. They have never no no no one has come up with any data or studies that actually show that having regular mammograms done. Like in the long haul of life lowers all cause mortality. Okay, so you know like like well, like if you have mammography every year or every other year. And then you look out 30 years right that the women who are screen versus not screened.

29:27They'll be higher survival rate in one group or the other. Okay, there's no there's no proof of any of that. Okay, that like if you have mammography is every year, you are more likely to live to 100. Well, just make that up. Okay, then a woman doesn't there's for all cause mortality. There isn't that data, but there is now data, which was kind of iffy before. So that's why I've sort of modified some, you know, my position is that you will lower breast cancer deaths. Okay, so you won't you don't seem to impact all cause mortality, but you do lower breast cancer deaths. Now you'd like to think by the boat load, you know, by the truck load, but actually you don't lower breast cancer deaths hugely. It's it's in the, you know, like double, it's less than 20%.

30:29Okay, so you are lowering breast cancer deaths. And it's not insignificant, but it's not as high as I wish. Okay, I mean, I always want to, oh, well, if you get mammograms on a regular basis, your chance of dying from breast cancer has been reduced 99%. It's like, it's not that. Yeah, no, I wish it were because it gives us this false sense of security to that like I didn't have something last year. So I don't know and it's fine. I wanted to, I wonder what you think of this because when I lived in Portugal for five years and they use an ultrasound, you know, like the wand sort of it to, they start there. And then they also, just to kind of get a glimpse because I know that's not the same technology. You know, why do we not have something that's entry, that's a dumb way to put it, but entry level, so to speak, where you can just kind of take a glimpse and see if you need to look deeper. Is that useful or is that stupid because that's that's my future wish.

31:33Okay, okay, it's not stupid. Not at all. There is research looking at sort of will say very sophisticated ultrasounds, not your standard ultrasound. Ultrasound of all sorts, you know, whatever type, QT ultrasound or, you know, standard ultrasound is approved for one purpose. And that is as an adjunct to mammography. It's not considered a standalone. Now, as for this is for breast cancer screening, if a woman comes into the office and she has a lump and it feels like, and she's young, we'll say she's 25. And it feels very discreet. It feels like a mobile cyst. Okay, it feels just like a harmless annoying breast cyst. Then a 25 year old woman who has a new finding like that, she can go and just have an ultrasound.

32:33Okay, because if that lump turns out to be a simple cyst, a simple cyst, meaning it just looks like a sack of water. Okay, then that cyst can either be ignored depending on the size or it could just be drained with a little needle and a syringe. And the fluid could be analyzed, but you don't have to do a mammogram in that situation. But you have a woman who is, you know, like older and you're not sure, you know, it's what kind of lump is this, you know, it feels hard, it feels irregular. An ultrasound would not be adequate as a standalone, but that's we're talking diagnostic, not screening. Okay, if you take a screening is for people who have no symptoms, no findings. Okay, so a screening imaging test is not in response to a lump or a finding. It's totally just your fine, no complaints, but we're going to just screen you with an imaging test. Yeah, and for that ultrasound has been shown to be of no no consequence and not helping to preserve lives.

33:38It doesn't detect breast cancer. Well, it's not an early test. It's it will show a big mass or a pretty good like something that's palpable typically that you can already feel it, which means it's usually above one centimeter in size or close to that. So I wish and I hope the day will come that ultrasound can replace mammography because there's no radiation in ultrasounds or, you know, some other imaging like MRI is also out there, but MRI has to use at this time, get a lidium, which is a heavy metal and it's a toxic contrast dye and it's very costly and said to say MRIs have an even higher false positive rate and unnecessary biopsy rate than mammograms do. What? Why? Do you know why? Yeah, because it sees more stuff and a lot of that is of no consequence, but the radiologist is insure like I don't know I see something.

34:42I don't know what it is come back in three months and we'll image it again or well, I don't like it. I can't be sure what it is. Let's do a biopsy and then it's nothing, you know, so this such a thing is too much of a good thing is a bad thing. You know, the MRIs can almost see too much, you know, so it's going to find more cancers. So that could be a good thing, right? You know, assuming they're not the kind of cancers that we call overdiagnosis, the cancers that are either going to stop growing, even regress on occasion, like they just disappear or grow so slowly, you'd have to be like 250 years old for them to give you. Are those common? I think that, you know, those of us who don't study cancer think a cancer is a cancer. It's not. No, so nobody has an exact number, but something in the neighborhood of around ish 20% of all breast cancers that are diagnosed will fit into that category of the very slow growing that will not kill anyone.

35:51And that fits into the or it would kill somebody if it maybe was found in a 25 year old, but if it's in a 65 year old, no, because that one that person isn't going to live to be 140. Yeah. So, you know, if which is untrue, you know, if you have, you know, a lot more years left in your life, if you find a breast cancer that is slow growing and you're like 30, which unfortunately does happen, those could kill you because you have more years that it could keep growing. So, there's that one just to jump into this, that's one reason why as a general statement, everything is exceptions allowed, you know, the average risk woman is not recommended to keep having mammograms over the age of 75 because generally speaking, not 100% by any means, but they tend to have more slow.

36:51So, the slow growing breast cancers that are found on mammography that will never kill them, so they have more over the older you are, the more likely you'll have over diagnosis and over treatment because the more likely they'll find a breast cancer that was never destined to kill you, but then they treat you, you know, with radiation and surgery and chemo and, you know, anti hormone drugs. Yeah. So, that could be real misery. Yeah, for a woman who's 75 has something that is not going to kill her and then she's in radiation and really extreme. And so, talk more about that. That sounds a horrible way to die or to live with Peter Atia, who's in the Epstein files, calls the marginal years. We'll use to call them. Well, yeah, like why spend your marginal years like that miserable when you don't have to and women do?

37:52Well, the reality is that there is fortunately a bit of a trend, a bit of a trend in being less aggressive in that group. Like maybe if they have a small cancer, they have no lymph nodes positive, you know, not doing radiation. It's important to know, radiation is not life saving for breast cancer. Radiation reduces the risk of local breast recurrence. It has nothing to do with metastases. It's about like that's done with lumped back to me. I mean, there are other occasions when it's done like if it's invading into the chest wall, but we'll leave those out. Okay. But typically, radiation is done when a woman has a relatively small breast cancer or they shrink it with neoadjuvant chemo that shrinks it first and then they have a lumped back to me.

38:55And they do radiation to that breast to lower the risk of a new breast cancer or recurrence of the other one in case some minutia, you know, cells were not removed to prevent recurrence or new onset of breast cancer in that particular breast. But it actually has never been shown to increase longevity or reduce mortality from breast cancer. It's so, but radiation even can make you quite sick. That's what I was going to say. I was going to say, even when it's on the right side, close the lungs on the left, but even when it's a right sided breast cancer and they do radiation, the radiation spreads. Okay. So it hits the, it hits the lungs and it hits the heart and it can damage the heart muscle and make it stiffer or more prone to having rhythm problems. The conduction system like going to a fib and it can damage the coronary arteries and make them stiffer or harder.

40:04So and then you, if you're doing this in a woman who maybe doesn't have the healthiest heart and arteries to begin with, you know, like in she's 75 and maybe she's on a blood pressure drugs and you know she doesn't have great cardiovascular health. So you can do irradiate her heart. That's that can cause problems. So, yeah, fortunately, although it's not universal, there's less of aggressiveness of saying, oh, every woman should have radiation because that's sort of been the standard. You have that you have radiation. So now they say, well, maybe we can skip radiation for you, but of course radiation at any age is going to do some damage to your tissues, right. But that's where risk benefit comes in. Every woman has to decide, you know, how would I feel if I had recurrence in my breast, you know, that's why some women choose mastectomy. You choose with it's not pushed, you know, like it used to be a long time ago, because it doesn't, it doesn't reduce mortality.

41:12And that's like, well, if you think, well, if you have a mastectomy, you'll lower your risk of dying from breast cancer, but actually they haven't shown that to be the case. And only if it's like multifocal, which is not common breast cancer, so usually not in light spots, spots, spots all over the breast, what tends to be more multifocal, like it'll have different spots all over the breast is lobular or ductal carcinoma inside you. I was mentioning earlier that 25% of all so-called breast cancers, and I say so cold because ductal carcinoma can become invasive cancer and can kill, but if it stays inside you, it doesn't, it means it isn't invading, okay. So they can turn, you know, so and they have, did they grade, they grade them, you know, like is it grade one or grade two or more grade three and that can determine what to do.

42:12There's even a school of thought now, it's quite new and they do, they have some studies on it where if you have ductal carcinoma and it's a low grade, so it doesn't look really wild or poorly differentiated that they can watch it. And they found only the studies only over two years, but at the end of two years, there's statistically no difference in the outcome between having surgery or just watching it for that lower grade type of ductal carcinoma inside you, but what they found, and this is sad, but it is true that from an emotional perspective, then amount of stress that this whole process causes. With or without the surgery or with or without just observation, just close watching them and following them is all the same. Gosh, stop it. Yeah, but ETSD, that's a real thing. All women going through this kind of thing, they all have post-traumatic stress disorder.

43:15It's not if it's how much and of course that's very harmful to your quality of life and to your overall health status to have PTSD, but it's so emotionally impactful on a woman to be told that even just you need to have recall or you need to have a biopsy. Even when the biopsy comes back totally benign, they always feel like they're sitting ducks. Before we talk about hormone replacement therapy and other cancer prevention options, we're going to stop this interview for just one second and tell you about our friends at Lear Capital because it may feel like the stock market has been on an incredible run and you're thinking, can this keep going? How long will it last? Well, of course, no one knows how long it will last, but we do know one thing that markets move in cycles. They don't go up forever, they never have, and when those cycles change, they can change fast. That's why smart investors don't wait until the headlines turn negative, they make their moves while the market is strong, looking for ways to protect what they've earned.

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47:37And that makes her feel worse. And then she gets dog piled by these breast cancer communities because she's like, so her research is all around the positive movement, positive thinking movement. And it just fell like a ton of bricks on her head because of this breast cancer diagnosis. And she's like, this is really unrealistic. You're telling women who are suffering that they need to be positive, and we can't do it, and we're pissed, and we need to be pissed. And it's a beautiful representation of, now she thinks that she got breast cancer from hormone replacement therapy, and we can talk about that later. This is a very old book. I know the research is different now, and I would love your perspective. But I think that her perspective of the misery of it is worth its weight in gold. It's a fantastic book. I'm going to recommend it. Well, it is emotionally devastating to women. And when we don't have cancer and they go through callbacks and biopsies that are found to be not cancer, it's just, and you can imagine what it is when it is cancer, or the dental carcinoma inside you, which is a different, we'll say a different breed of cancer because it has spread.

48:49It's not, it's not even like locally, it's not invasive. But yeah, all of these things are really big deals. Now, if we look at, like, do we need this? Are there lives it's hard to be a woman? Do we need this extra? Well, we don't need it. We just got it, you know, and we can talk about, you know, like, well, with the one of the things that can help reduce some of the anxiety is to go along. If your average risk average risk means you're like, you don't have a lot of family history. Of course, you don't have any genetics that are prone to getting breast cancer. You have extremely dense breasts, those kinds of things. Okay. Yeah. So, but if you fit into the average risk category, what is now recommended by the American College of Physician, but not by the American College of Radiologists or the American Cancer Society, but the newer recommendation, which I like, you know, much more, is that you do not have to do breasts imaging in your forties, unless you want to.

49:55Which was never the case until a few years ago, because the, the chance of, like, if you had 10,000 women, no, not 10,000, let me get it right, 1,000 women, and you screened them with yearly mammograms from 40 to 49 every year. Okay. And you did that on a thousand women. How many breast cancers would you prevent? Like 0.27, 0.27 per person. I know it's like really, really low. Right. Really low. If you screened women for 10 years, and they're now in like every year for 10 years, and they're now in their early 70s, what, what, how many extra breast cancers would you find? Because you did all that screening for 10 consecutive years on a thousand women, it's still less than one woman. Okay.

51:01But when you do these screens on like millions of women, the numbers start adding up, but you see what I'm saying, breast cancers can be deadly, but fortunately, most aren't mammography, cans, and will save lives, but not as many as we wish, you know, and it sometimes will miss the most aggressive ones that grow really fast and wild. And, but if you do mammograms every other year, instead of every year, you will have substantially, it's amazing, substantially fewer false positives, false biopsies, you know, unnecessary biopsies. You'll also have less overdiagnosis, where remember overdiagnosis is your diagnosing women with breast cancer, and the breast cancers they have, we're never going to kill them. Okay.

52:01That is said is about an intense to increase with age, but as a general thing, and this is not an exact science, could be 20% of all breast cancers that are diagnosed would, would fit into that category. So, you know, but if you do fewer mammographies, you actually have better, you don't have, but this is really the most important takeaway, you do not have higher breast cancer mortality. So, you do not have rest, you don't, more women do not die from breast cancer when you do fewer screenings, we're talking average risk and fewer meaning in the studies, it's like every other year, that's not every five years, it's like every other year, which is lot better than every year. You're cutting down on all the bad outcomes in terms of PTSD, overdiagnosis, over treatment, false positives, false positive biopsies, by a lot, by a whole lot, and you do not increase breast cancer mortality.

53:07So, to me, this is a no brainer, but yet that's not being accepted by some of these other medical groups who happen to be, you know, like the American Cancer Society and the American College of Radiologists and other radiology organizations. So, you know, so that's really where I have sort of modified my position over the last several years to say, well, when I'm hoping, I'm hoping that we can get data to do just like we have with pap smears where you can do fewer pap smears. If you have a few years in a row, you can just do fewer that if you have a few years where every other year you did a mammogram, everything looks fine, nothing's happening and they're not, you're not high risk, your average risk, maybe we could cut down and do even viewer per, you know, like per five or 10 years and what we're recommending now, that would be nice because although radiation induced breast cancer is the most important thing to do.

54:10Very small, but not that anyone knows exactly how do you quantitate that right right, but it is, it is an oncogenic thing radiation. So it's very all risk in the picture of risks, but it's not a zero risk. It's still some you're you're using a chemical, you know, you can get some whatever you want to call it radiation will just call it what it is radiation, which is cancer inducing in high enough amounts and you're using that to detect cancer. It sort of drives me crazy. That's why I love the idea of having an alternative imaging source like whether it was MRI that doesn't give you tremendous amounts of high false positives over diagnosis and also you have to use that a lidium, which is a heavy metal that's bad for you. The best of all world would be if we had ultra sound that could be as at least as good preferably even better than mammography with no radiation that is potentially cancer causing, although I want to keep it in perspective, it's a small risk, but it's not a zero risk who wants to put radiation into you.

55:21And it's that's why if you do fewer mammographies like at least drop it down to like every other year that reduces obviously the radiation exposure by half and that is like really in the long haul if you're going to get them over decades of your life that does add up, you know, it is cumulative. Yeah, and so I haven't seen you really, you know, take the piss, I'll say out of the medical industry for trying to run up bills and make profit, but I do that all the time. So what do you think of this that perhaps if they know this, they haven't changed guidelines because it's profit driven? Well, it is sort of interesting that the radiologists are the most vehemently in favor of every year. Sure. And also the radiologists are the ones most in favor of jumping to MRIs.

56:23Yes. They very quickly faster than other medical societies to do more MRIs. So it does seem potentially profit driven or you could say it's just what they do. So it's it gives them self, I don't know, justification for all the things they do. I hate to think that doctors are doing that, but I guess it's always possible that that you know it's what they do and they want to keep doing it and doing more of it because they their income off of it. Okay, maybe they will give them the benefit of the Dalton, because we don't know. We don't like everything in this world, a mixture. Yeah. Okay, that's my pessimism speaking. So before I let you go, can you tell me what you think, what you mean when you say you would really like women to focus on cancer prevention?

57:24And what that what that means specifically? Well, and that would I hope would tie into the whole hormone issue because you know that has the scariest thing for so many women. Well, breast cancer like all cancers is really triggered by inflammation, damaged mitochondria. So what is that what am I talking about with that? Well, mitochondria are these little structures in cells that are called organelles that control the production of energy, which of course is critically important. But what they also control, which people don't think about very much when they think of mitochondria is what's called the cell cycle. Now the cell cycle tells cells that are getting old, they're getting you know inflamed, they're mitochondria are not very good. And it's time for them to die because most every cell in the body has a lifespan.

58:28And that's why we have and we want to maintain our stem cells, right? Because our stem cells are there to replace old cells that become you know decrepit and inflamed and not functional in a good way and should be eliminated by cell suicide that we call apoptosis. And it's the mitochondria that control that. And if you have inflammation from many different or any source which we can touch on, then the mitochondria become injured, harmed. And then you end up having cells that should die, but they don't. And they call senescent cells, they develop what's called mists bolded protein inside of them. And sometimes people even call them zombie cells because they should be like they're the living dead. They should be dead. But their systems for getting rid of them are not functioning well because of poor functioning mitochondria.

59:31And when you have poor functioning mitochondria and they start to disintegrate and they're not happy and healthy, they create damaged signals. And these damaged signals then create an inflammatory response. And inflammation will damage the cells even more. So it's like a spiraling downward, you know, a self-fulfilling prophecy of inflammation, begets inflammation, begets cell damage, mists folded proteins, and then DNA damage and potentially cancer. And then you have to say, okay, so why on earth are we getting these zombie cells? Why are the mitochondria becoming not healthy, whether they're not controlling the cell cycle and telling cells time to die? And it can be just from aging, no matter what we do, you know, we just age. And so things are just not working as well. It can be from environmental toxicities like chemical endocrine disruptors like plastics of all sorts, that relates, bisphenol A and bisphenol S and bisphenol F.

1:00:42And pesticides, herbicides, heavy metals like mercury, arsenic, and cadmium, all these different lead heavy metals. And then other like PFAS, you know, these persistent organic chemicals that like just don't go away, they're like they're like forever chemicals sometimes they're talked about. So there's so many chemicals in our world now that can damage cells and create inflammation. And then of course there's chronic stress, there's nutritional problems like not eating the right nutrients to get all the right micronutrients, like minerals and vitamins, and the macronutrients like adequate amounts of the good kinds of fats and proteins. And nutritional problems lack of adequate sleep because that's when cells go through a lot of cellular renewal types of things.

1:01:42So all these things and of course what you do eat, not just what you don't eat, you know, so if you're eating a lot of ultra processed foods with lots of high fruit dose, corn syrup and really toxic fats and all that sort of thing. So these are the things that we can start intervening on to lower inflammation. We can't stop aging, you know, we are going to age, but we can do things to slow the impact of aging by maintaining optimal lifestyle. And I didn't mention exercise exercises like cellular renewal. It's like fasting by the way, if people do these like multi day fast or fasting mimicking diets, where they have like the special formulated food that the body doesn't detect that called stealth food or they do a three or four day water fast on a very regular basis. One and done isn't going to do it, you have to do it regularly. That causes old bad cells, these innocent cells to die off and get rid of them, the potential breast cancer cells will die.

1:02:49Your body eliminates them. So all of these things and I just want to emphasize again, I mentioned exercise that is if you have to pick one thing pick exercise. Okay, but you don't have to pick one thing try to pick everything. But these are the things that really and truly can lower breast cancer risk. Like I said, I can't help if people were exposed to all kinds of herbicides and pesticides and weird chemicals in their food when they were kids, you know, because we know that we are like around puberty is a very sensitive time for breast exposure to like when the breasts are just developing to be exposed to toxic chemicals and bad food and all this bad stuff. But once I see a patient, usually she's not in that age group anymore, you know, she's older, but we have to take off where we are, you know, from where we are and for moms, you know, do everything you can to keep your home like cleaned of try not to when I say clean, I mean clean products. Of course, you want to keep it does free because that's where a lot of heavy metals and other toxins end up in dust.

1:03:53But you know, like as much as humanly possible get organic food and exercise exercise not too much screen time, you know, promote really quality sleep trying to go at the same time eating at the right times, not eating late at night, not of the biggest risk factor for breast cancer in menopausal women is weight gain and obesity. So not becoming obese is like the important thing to lower breast cancer risk. So all of these things are things that we have some control over. We can get air purifiers, water purifiers because if you're living in an area and there's a lot of fires, you know, that now a lot of people are facing that sort of thing. We can't control the air quality outside, but we do what we can for what's inside, you know, and and do the best we can, you know, to to live in areas that don't have the worst pollution. Right. Well, I mean, this has been just so enlightening. I really appreciate you enlightening me on the data because yeah, you know, I might have tried to be a little, you know, trying to get viewers in to say I'm not going to have a mammogram. I don't know what I'm going to do.

1:05:06I don't mean ever. I just don't think I need them every year at this point. And the data shows something quite shocking. So I really appreciate it. I am so glad to have found your YouTube channel. It's Feliz Gersh MD. So please subscribe. And again, your book is called PCOS, SOS, a gynecologist's lifeline to naturally restore your rhythms, hormones and happiness. And I just want to mention my most book. Yes, men apost 50 things you need to know. Okay, I will read it. I just turned 48 last week. So I am doing my own. Yeah, I'm on the launch pad. Yeah, right. So avoid it possible. If your average risk man, having mammograms every single year, I think that is the best takeaway. And if you don't have a real reason, don't start them until you're 50 or so. Okay, all right. That's a general statement for average risk women. Yes. All right. Well, thank you so much. It was really a pleasure to talk to you. I hope you'll come back on redacted sometime.

1:06:14I hope so. Have a great day. Thank you. You too. Bye bye.