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

**SPEAKER_1** (0:01)
Hello, and welcome to ZOE Recap, where each week, we find the best bits from one of our podcast episodes to help you improve your health. Today, we're talking about breast cancer. Here at ZOE, we know that health is deeply personal, and breast cancer risk is no different. Your likelihood of developing breast cancer is shaped by factors such as genetics, body composition, and lifestyle. Understanding your individual risk is crucial, because it helps determine when and how you should be screamed, and in some cases, it could save your life. Today, I'm joined by Dr. Thais Aliabadi to explain why breast cancer screening shouldn't follow a one-size-fits-all approach, and how our own experience with cancer has influenced the way she thinks about prevention.
I'd like to start maybe with US guidance about mammograms and the age at which you should have a mammogram.

**Dr. Thais Aliabadi** (0:52)
Well, the general guideline in the US right now says that a woman should start her mammogram at age 40 or 10 years before her first-degree relative with breast cancer was diagnosed with cancer. But I'm trying to change that because that does not include the high-risk patients who fall into a category that might need to start the breast imaging as early as 25 or 30
So not all women fall into that age 40 or above category.

**SPEAKER_1** (1:23)
Even age 40 sounds like it is earlier than the-

**Dr. Thais Aliabadi** (1:27)
Yes, the majority of the countries, yep.

**SPEAKER_1** (1:29)
So has that shifted? Did it used to be later than 40?

**Dr. Thais Aliabadi** (1:32)
Yes, it used to be 50 and in some countries, it still starts at 50
In the US, for low-risk patients, it's 40 You can do it up to every two years. I think patients need to do it once a year. But I want every single person to know her lifetime risk of breast cancer. And based on that risk, then we go backwards and start the imaging. So not all women fall into that 40 and above category.

**SPEAKER_1** (1:59)
This is the first time we talked about breast cancer on the podcast. So what causes breast cancer? And why is it so dangerous that we sort of focus on breast cancer versus any other type of cancer?

**Dr. Thais Aliabadi** (2:09)
So first of all, after skin cancer, breast cancer is the number one cancer in women. So it's very important. One out of eight women will get diagnosed with breast cancer.
On average, every woman has a 12.5% chance of getting breast cancer in their life. And you know, I always use the airline example. If I told you you're about to board a plane that has a 12.5% chance of crashing, you would think twice boarding that plane.

**SPEAKER_1** (2:38)
I mean, I wouldn't get on the plane for sure.

**Dr. Thais Aliabadi** (2:40)
Right? But when I say to patients, you have 12.5% chance of getting breast cancer, they're like, oh, so I'm fine. And that's a starting point.
Then we don't really know what causes breast cancer, right? But one thing we know, there are different factors. We talked about nutrition already. Obesity is a risk factor. Having an early period, late menopause, having dense breasts, having family history of it, having children after age 30, drinking alcohol, smoking, all of this will add to that risk. And it can push you up from 12.5 to as high as 80% if you have a gene mutation.

**SPEAKER_1** (3:17)
You have your own personal story about this. And I wonder actually if having sort of provided some of that context, you'd be willing to tell us about your own story of diagnosis of breast cancer.

**Dr. Thais Aliabadi** (3:26)
Of course. So I was 48 and I had gone from my mammograms every single year. And every time I would go, they would find something. I had a biopsy maybe when I was 40 years old and even when I was younger. And it was always benign, benign, benign. When I got to age 48, I went from my mammogram and they picked up some calcifications. They had me go back for a biopsy. They did a biopsy and this time my biopsy came back as atypical lobular hyperplasia.

**SPEAKER_1** (3:55)
I have no idea what that means.

**Dr. Thais Aliabadi** (3:57)
Exactly. These are basically atypical cells in the breast that can increase your lifetime risk of breast cancer, but they're not cancer.
So my doctor said, well, we're going to remove it. She did an excisional biopsy. They take a lump out of your breast. And she told me to go and come back in six months. Mind you, at the time I was 48, I had been a vegetarian for five to seven years. I've never smoked. I've never done drugs. I rarely drink alcohol. I had no family history of any cancers, let alone breast cancer. I had no gene mutations. I was never on hormones. So in my world, I was not going to get breast cancer. At that point in 2017, I had started basically calculating everyone's lifetime risk of breast cancer through this tool that I used in my office that's public. So when they told me I had this atypical tissue in my breast, I sat behind the computer and I started calculating my own lifetime risk, which I had no reason to do it before because I knew I was in that range of 12.5.