21. Breast Cancer Awareness in Midlife: What Women Need to Know

In this episode of 'Midlife and Glowing,' hosts Alicia and Nicole discuss the importance of breast health, especially during Breast Cancer Awareness Month. They delve into the risks and limitations of mammography, explore alternative screening tools like Thermography, QT ultrasound, and the Auria test, and emphasize the importance of prevention through lifestyle choices. They also provide resources and advice on advocating for personalized breast health screening. Tune in to gain a comprehensive understanding of how to support your breast health with the latest information and tools available.

00:00 Introduction to Breast Health Awareness
00:57 Understanding Breast Cancer Statistics
01:40 Mammograms: The Gold Standard and Its Limitations
04:17 Exploring Alternative Screening Tools
05:27 QT Ultrasound: A Promising New Technology
10:30 The Auria Test: Liquid Screening with Tears
14:54 Lifestyle and Prevention Tips
20:48 Empowerment and Advocacy
21:23 Conclusion and Resources

📌 Resources:
💧 The Auria Home Breast Health Assessment → https://auria.care/
🔊 QT Imaging Locations → https://www.qtimaging.com/locations/
📚 The Smart Woman's Guide to Breast Cancer by Dr. Jenn Simmons → https://amzn.to/4myIPTm
💗 Dr. Jenn Simmons Breast Health Programs → https://www.realhealthmd.com/work-with-us/
♻️ Our Episode on Microplastics (to avoid the endocrine disrupting chemicals that increase risk for breast cancer) → https://youtu.be/rYmHqciUvRE

Transcript

Alicia: 0:00

Hey there. Welcome back to Midlife and Glowing. I'm Alicia,

Nicole: 0:03

And I'm Nicole. October is breast Cancer Awareness Month, and we wanted to dedicate an episode to a topic that's on so many women's minds in midlife breast health.

Alicia: 0:13

and we're not just talking pink ribbons and awareness campaigns. We're going deeper into screening, prevention and the tools we actually have available.

Nicole: 0:22

Because the truth is there's growing concern about the risks and limitations of mammography. Some countries are even moving away from routine mammogram programs, and women are left wondering why and what are my options?

Alicia: 0:34

So today we're covering mammography, alternate screening tools like Thermography and QT ultrasound, new tests like the Auria test, and also what you can do day to day to support your breast health.

Nicole: 0:47

This isn't about fear, it's about being armed with the knowledge to support you, giving you facts, context, and options so you can make the right choices for your body.

Alicia: 0:56

Okay. Let's start with the big picture. Breast cancer is the most common cancer in women worldwide. According to the World Health Organization, about 2.3 million women were diagnosed with breast cancer in 2020.

Nicole: 1:10

That is a lot. Also in the US your lifetime risk is about one in eight women. Most of us either know someone personally affected, or have personally struggled with it, and the risk increases with age, especially in midlife and beyond.

Alicia: 1:25

But here's the encouraging part. Survival rates have improved dramatically because of early detection and better treatments. Awareness matters, but it also matters that we're asking which tools we use for detection and whether they're the best options.

Nicole: 1:40

So let's talk about mammograms. They've been the gold standard for decades. Basically, a low dose x-ray that can detect abnormal tissue or calcifications.

Alicia: 1:49

And there's no doubt mammograms have saved lives. Studies show they reduce breast cancer mortality by about 20% among women that undergo screening according to the US Preventative service task force. With the benefit being higher in older women.

Nicole: 2:04

But there are downsides. First, radiation exposure. It's small, but cumulative if you're screening every year for decades. Plus breast tissue is radiation sensitive tissue, which means that the cells in breasts are more easily damaged by radiation compared to many other tissues in the body. Radiation can cause small breaks or changes in DNA. Because breast cells are particularly sensitive, repeated or high doses of radiation can increase the risk of DNA mutations that can later contribute to breast cancer.

Alicia: 2:36

Then there's the issue of false positives. About 15% of women who get a mammogram will be called back for more testing, and over 80% of callback biopsies are benign. But the stress, the extra cost, and sometimes unnecessary procedures are real.

Nicole: 2:52

Yeah, there's definitely an issue with over-diagnosis, once they're found, they're treated aggressively. Based on a 2017 study published in the British Medical Journal, 20 to 30% of breast cancers detected through screening may be over-Diagnosed. Over-diagnosis means detecting and treating cancers that would never have become life-threatening or caused symptoms in a person's lifetime.

Alicia: 3:15

And the experience itself, let's be honest, uncomfortable, and a little awkward.

Nicole: 3:21

Now, to be fair, mammography does work best in women over 50, where breast tissue is less dense. But in younger women or women with dense breasts, it's less reliable.

Alicia: 3:31

Okay, so here's something that's interesting. Not every country screens the same way we do in the us.

Nicole: 3:37

Right. For example, in Switzerland, a 2013 Independent medical Review actually recommended phasing out routine mammography screening, citing concerns about overdiagnosis, false positives, and the overall balance of risks and benefits.

Alicia: 3:52

In many European countries, screening starts later and is done every two years instead of annually. The US Preventative Services Task Force recently updated its recommendation to start at age 40 instead of 50, but still every two years.

Nicole: 4:07

The bottom line is there's no one size fits all approach. Different countries are reassessing based on the evidence, and that tells us the conversation is far from settled.

Alicia: 4:17

Okay, so if mammograms aren't perfect, what else is out there? Let's start with thermography.

Nicole: 4:22

Yes, thermography uses infrared cameras to detect heat patterns and blood flow in breast tissue. The idea is that cancers can create more blood vessel activity, which shows up as heat, but here's the problem. It is just not accurate enough to stand alone. It can miss early cancers that aren't large enough to show heat changes. And there's also high false positive rates because it can pick up heat from issues that aren't cancer, like infection, inflammation, or injury. So this can create unnecessary fear and lead to follow up imaging anyway. And because of the lack of clinical validation, most insurance companies don't cover thermography, so that makes it an out-of-pocket cost for patients without providing reliable reassurance.

Alicia: 5:07

Okay, so the pros, no radiation, no compression, and it's completely non-invasive.

Nicole: 5:13

Right. The cons are that it's not as widely accepted, and large studies show that it's not as sensitive as mammography for catching early cancers. Right now, most experts view it as a possible adjunct tool, not a replacement. Another option that's more promising is QT ultrasound. So it's a newer technology that uses sound waves, not radiation to produce 3D images of the breast. I learned about this imaging through Dr. Jen Simmons podcast. Now, Dr. Jen Simmons spent 17 years as a fellowship trained breast surgeon and after her own cancer diagnosis she shifted to a functional medicine and integrative oncology model. So she did an interview with Dr. John Klock on her podcast, and he's an oncologist and one of the creators of this technology, and I just found it extremely fascinating and also encouraging to hear about this imaging technology. He said that the imaging quality of QT imaging, which again uses ultrasound technology is 40 times that of the best MRI in the world. It's 20 times better than x-ray or mammography, and it gathers 200,000 times more data than a mammogram or MRI. It's 99.8% accurate and does hundreds of thousands of times more calculations from more angles than other types of imaging can. So it provides the ability to see things that are 50 to a hundred microns, which is the size of a human hair, and you just can't get that with other types of imaging technology. So said that because of its accuracy, they can tell if a lump or a mass is stable within eight to nine weeks, which means that if you have a scan and it shows a mass, doing another scan in eight to nine weeks, you'll be able to see how much that mass has grown and whether or not it's a problem. Because of how accurate this imaging is, you'll be able to see whether or not the growth rate is problematic. Dr. Klock also mentioned a study out of the University of California that showed that imaging caused 5% of all cancers in the United States. So that's referring to imaging that uses radiation things like mammography. But the real bonus with this type of imaging, this QT imaging, is that it's 100% safe. He said the technology uses sound technology that's just above the spoken word to do the imaging, so there's no radiation or other toxic exposures. The other upside of this technology is that it's relatively inexpensive. So I'll admit after I turned 40, I really wasn't too keen on getting a mammogram because of the radiation issue, but at the same time, I wasn't aware of any better options. So I did get one because obviously breast cancer is a real and growing issue, so I didn't wanna just stand by and do nothing. But after learning more about this type of imaging, I've definitely decided that this is gonna be my personal choice for future screening. So I've been looking into, you know, where can I get this done? Where is this offered? And after looking at three different clinics, I've seen prices anywhere from$550 to$725 for a screening. So, you know, it's not necessarily pocket change, but at least we're not talking thousands of dollars. And again, when it comes to peace of mind, you know that you're doing something that's safe. You are getting the screening that you need, and you're not just sitting by and doing nothing. But yet at the same time, you're not getting a screening that could potentially be exposing radiation sensitive tissue to radiation. So I think that's really encouraging and hopefully growing use of this technology will lead to insurance coverage in the future. But because of how accurate this is and how much data it collects, you don't need one of these scans every single year.

Alicia: 8:59

Well, you know, I think personally after hearing that screenings make up 5% of cancer cases. I mean, that's wild.

Nicole: 9:07

Yeah,

Alicia: 9:08

wild.

Nicole: 9:09

is

Alicia: 9:09

It definitely seems well worth it to spend that cash and go for a completely safe option in my personal opinion.

Nicole: 9:17

Yeah, I couldn't agree more.

Alicia: 9:19

Okay, so the FDA cleared it in 2017 as a supplemental tool. It's especially useful in women with dense breasts where mammograms struggle.

Nicole: 9:28

Right, which is 50% of women, by the way, half of all women have dense breasts for which mammography isn't as effective. One study reports that mammography misses 35.6 to 52.2% of breast cancers in dense breast tissue. Early studies are showing QT imaging can detect cancers, mammography might miss. And by the way, women with dense breasts have an increased risk of developing breast cancer. And I just wanna say, you don't need to have large breasts to have dense breasts. Uh, you know, I'm an A cup on a good day and I have dense breasts, so the risk isn't necessarily associated with breast size. So I just wanna make sure that that's super clear too. I will say the limitation with this type of imaging is that it's not widely available yet, but this is improving. So we'll make sure to put a link in the resources for this episode with sites that offer QT Breast Imaging, which show that there's eight clinics in the US that offer it.

Alicia: 10:27

Okay, so now let's talk about something that's a little bit newer. It's the Auria test, which is a type of liquid screening.

Nicole: 10:34

It's a test that actually uses your tears to look for small cancer markers circulating in your body. It's still emerging, but the idea is that a simple tear test could one day screen for cancers earlier than imaging can.

Alicia: 10:47

Wow, this sounds kind of crazy. Like, that's wild.

Nicole: 10:51

Yeah, it is.

Alicia: 10:52

work on your acting skills or, uh, you know, to gather up those tears. Um, maybe read something sad or.

Nicole: 11:01

Watch the notebook,

Alicia: 11:02

Yes.

Nicole: 11:03

What?

Alicia: 11:03

exactly. Or lately, I don't know. I, I must be going through it because it seems like anything makes me teary eyed. Animals, babies, all the things.

Nicole: 11:14

All the things.

Alicia: 11:15

myself getting a little choked up, but, so I would be totally good to get this screening right now, these

Nicole: 11:20

That's right. Order the kit.

Alicia: 11:22

so anyhow, right now it's not meant to replace mammograms, but it's definitely a fascinating direction for the future.

Nicole: 11:29

Yeah, exactly. It's another completely non-invasive, simple option for early detection. Auria has a sensitivity of 92%, which is pretty amazing for a screening tool that just uses your tears and that you can do right at home with a home test kit for under$200. So it can be another really great option for that early screening, early detection as a good, way to protect yourself. Also, there's MRI, which is very sensitive, but typically used only for high risk women due to cost and potential for false positives. In the interview that I mentioned that Dr. Simmons did with Dr. Klock, he mentioned that the false positives rates for MRI are over 50%. That's a lot. Yeah, that's a lot. The other issue with MRI screening of the breast is that you need contrast, which requires the use of gadolinium, which is a heavy metal, so also not ideal, Automated breast ultrasound. This is another type of imaging that is based on ultrasound imaging. It's a whole breast ultrasound that uses a larger transducer. To take hundreds of cross-section images across the breast, which are then reconstructed into a 3D view. Like QT imaging, this type of ultrasound doesn't involve radiation, but it's also usually used as a supplemental screening tool alongside mammograms, not a replacement. Basically this type of ultrasound is high frequency sound waves reflected off tissue to create images, whereas QT ultrasound is transmission ultrasound, so it's sound waves that actually pass through the breast instead of just reflecting back. As the waves travel, the system measures how they slow down or bend through different tissues, and that produces the true 3D map of tissue density and stiffness that you get from the QT imaging. So ultimately you get a lot more data and a much better image from the QT technology.

Alicia: 13:17

So the landscape is evolving. Mammograms are still the standard, but we're clearly moving towards more personalized screening.

Nicole: 13:25

Yes, and I also wanna share a resource you might find helpful, Dr. Jen Simmons book. It's called The Smart Woman's Guide to Breast Cancer. So she's a leader in this field. Friends, she was a breast surgeon for 17 years. Like I said, she had her own experience with breast cancer and now she's an integrative oncologist and functional medicine specialist in breast health. So she knows this landscape well. And in addition to her book, she offers breast health programs for women interested in prevention for breast cancer, as well as women who have been diagnosed and are on the path to healing. So we'll make sure to link to her site in our resources for this episode as well. And let's not forget as well the importance of self breast exams. That is also incredibly important and should be something that we're doing on a very regular basis to add to this picture of prevention.

Alicia: 14:16

Right. So if something feels a little different definitely that is a good time to get further screenings.

Nicole: 14:23

Absolutely yes. Don't let something go that doesn't feel right. Call your doctor. Get an appointment. Make sure that you're taken care to think about these things. And if you do notice something different that you know, some of these non-invasive simple options, that we've just mentioned, talk to your doctor about them. Ask your doctor if the Auria test or some of these options would be a good fit for you. But ultimately, if you feel something that doesn't feel right, you wanna get in with your doctor and make sure that you are being taken care of. Screening is incredibly important, but it's not the whole story. Breast health is also about prevention.

Alicia: 14:56

And lifestyle plays a huge role in this. So for example, the American Institute for Cancer Research estimates that maintaining a healthy weight, being active, limiting alcohol and eating a plant rich diet, could prevent up to one third of breast cancers.

Nicole: 15:13

That's a lot. That is a lot. And you know, another thing that Dr. Simmons mentioned is the incredible direct correlation between metabolic health and breast health. Metabolic health is incredibly important. Obesity actually increases your risk for at least 13 different types of cancer, including breast cancer. So paying attention to your metabolic health and opting for doing whatever you can to adhere to a healthy lifestyle is one of the best forms of prevention. Ultimately, just by implementing small habits, you can reduce your risk pretty dramatically. Specific habits that help: limit alcohol. Even one drink per day raises breast cancer risk. In fact it's estimated that just one to two drinks per day increase breast cancer risk by 30 to 50%. Yeah, I know it's data from the Annals of Epidemiology and the Journal of the American Medical Association. That's an incredibly high risk, just doing one to two drinks per day. So, you know, we've talked a lot about alcohol and the impact it can have on various aspects of our health, especially in perimenopause. And this is just another indicator of how it can impact us. Eating more fiber and cruciferous vegetables. Things like broccoli, Brussels sprouts, cauliflower, kale, and cabbage.

Alicia: 16:36

You know, it's,

Nicole: 16:37

it's funny

Alicia: 16:37

that you mentioned Brussels sprouts, uh, over the weekend we spent some time with grandma at her place in, in the assisted living. We played cards and whatever, and we were talking about food and we brought, somebody brought up Brussels sprouts and she said they get served Brussels sprouts all the time. And for me, I'm like, oh, I do not like Brussels sprouts. So sadly I won't be eating the Brussels sprouts, for fiber. I'll stick to broccoli and the other things.

Nicole: 17:03

That's fine. Yep.

Alicia: 17:05

yeah,

Nicole: 17:05

That is funny.

Alicia: 17:06

Brussels sprouts quite a bit, so

Nicole: 17:10

Oh my gosh.

Alicia: 17:11

over there.

Nicole: 17:12

Was she like happy about that or was she like not too excited about it?

Alicia: 17:17

that, uh, she said sometimes they're fro, they're half frozen still,

Nicole: 17:22

no.

Alicia: 17:23

I

Nicole: 17:23

So not,

Alicia: 17:24

they're okay. Sometimes they

Nicole: 17:27

not so great.

Alicia: 17:27

up the, uh, cooking.

Nicole: 17:29

Yeah. Okay. Well you know, I traditionally, I also am not a huge fan of Brussels sprouts, but I really do think if you cook them in the right way, at least for me, I found cooking them in the right way. I really, really, really can enjoy them.

Alicia: 17:45

Yeah.

Nicole: 17:45

people

Alicia: 17:46

say

Nicole: 17:46

that

Alicia: 17:47

and I have tried said, cooking them in the right way. I haven't cooked them in the right way, but other people have, and I've tried them.

Nicole: 17:54

okay,

Alicia: 17:55

still a no for me, it's

Nicole: 17:57

Sometime. Okay. just to see if maybe you might be open to liking them. We'll have to go downtown sometime when you're here and get them from, I think it's like the Dearborn or something like that. There's a restaurant on Dearborn and Chris and I got the Brussels sprouts from there one day. They were like out of this world. Amazing.

Alicia: 18:18

the, I think I'll have the brussel sprouts.

Nicole: 18:21

I don't know. We, we actually like accidentally ordered them thinking that we were getting an order to split and they brought both of us out. There's huge, these huge orders of Brussels bruss. So we, um, got our share of,

Alicia: 18:35

You got

Nicole: 18:35

fiber and, you know. Cancer, preventing substances, right? but so these aren't just nutritious, they're powerful support for estrogen metabolism. And now you might be wondering, why does estrogen metabolism matter? And it's because many breast cancers are what's called estrogen receptor positive, meaning that they grow in response to estrogen. About 70% of all breast cancers fall into this category, so supporting healthy estrogen balance and detoxification in the body is a really important piece of prevention. Cruciferous vegetables contain compounds like indole 3 carbanol and its metabolite di indole methane, that helps shift estrogen towards producing more of the protective metabolites, while reducing the more harmful estrogen metabolites that are linked with cancer risk. In fact, research has shown that women who eat more cruciferous vegetables have more favorable estrogen profiles, and according to the International Journal of Cancer from 2013, large population studies show that diets rich in cruciferous vegetables are linked with about a 15 to 20% lower risk of breast cancer. So, broccoli, cauliflower, or other cruciferous vegetables are great breast cancer prevention foods. So that's great to hear that Grandma's getting lots of breast cancer preventing veggies in her diet. Exercise regularly. Right? We talked about metabolic health having a major impact on breast cancer risk and just cancer risk in general. So physical activity lowers risk by 10 to 20% in studies.

Alicia: 20:05

You know, and that's something that we talk about a lot around here is exercise and you know,

Nicole: 20:11

Yeah.

Alicia: 20:12

another facet of why it's so important and the benefit of getting that regular exercise.

Nicole: 20:20

Absolutely. You're lowering your risk for breast cancer, which is amazing,

Alicia: 20:24

to the benefits list.

Nicole: 20:26

right? Yeah. Reduce toxin exposure. Avoid parabens, phalates, and endocrine disruptors in your food, beauty, and home products. And if you need more on this, make sure to go back and listen to our microplastics episode.

Alicia: 20:41

And self-awareness, knowing your own breasts, noticing changes, and not being afraid to bring up concerns with your provider.

Nicole: 20:48

So what do you do with all this information? The key is advocate for yourself.

Alicia: 20:54

Ask your provider about individual risk factors, family history, breast density, genetics, screening should be tailored to you.

Nicole: 21:02

And if you're interested in alternatives like QT ultrasound, ask what's available in your area. Sometimes you have to seek out specialty clinics, but women are pushing demand for these tools. And again, we'll share the link with locations of the QT ultrasound in the resources for this episode.

Alicia: 21:18

Remember, you deserve options, so don't be afraid to get a second opinion if your concerns are dismissed.

Nicole: 21:23

So here's the takeaway. Mammograms save lives, but they're not perfect. Alternatives like QT ultrasound and emerging tools like Auria testing are screening tools that look promising in the future of breast health.

Alicia: 21:36

And lifestyle, what you eat, how you move, how you manage stress. This all plays a huge role in prevention.

Nicole: 21:42

The most important thing is that you feel informed and empowered. This is your body and your health we're talking about it's your future.

Alicia: 21:50

Right. we'll link resources and studies in the show notes. And if this episode helped share it with a friend because these conversations save lives Thanks for hanging out with us on Midlife and Glowing.

Nicole: 22:01

If you love this episode, it would mean the world to us. If you'd follow the show, leave us a review or share it with a friend who's glowing through midlife right alongside you.

Alicia: 22:09

Let's make it our best era yet. We'll see you next time.