Today, I am honored to connect with my friend and colleague, Dr. Jenn Simmons. Dr. Simmons is an integrative oncologist, breast surgeon, author, podcast host, and the founder of Perfect Cutie Imaging.
In our discussion today, we dive into breast cancer statistics and the fact that most cases of breast cancer are preventable. We tackle the confusion caused by overdiagnosis, explain why mammograms can be problematic, and outline which breast cancer diagnoses are true emergencies. We provide clarity on the differences between various breast cancer types, the state of normal breast health, and how we have both estrogen and progesterone receptors. Dr. Simmons sheds light on DCIS (ductal carcinoma in situ) and explains why treatments like radiation may not always impact survival. We also examine the roles of trauma and alcohol in breast cancer risk, and we begin answering questions from listeners.
Don’t miss this engaging, helpful, and proactive discussion with Dr. Jenn Simmons. We were wonderfully overwhelmed with all the questions we received, and with so much still to cover, I want to reassure everyone that we are already planning a follow-up AMA episode with Dr. Jenn.
IN THIS EPISODE YOU WILL LEARN:
The shift from reactive to proactive health and the need to build health rather than just treating diseases
The role of lifestyle choices in reducing the risk of breast cancer
Why mammograms are problematic, and how the incidence of breast cancer has increased in screened populations
The carcinogenic effects of radiation
The harmful effects of unnecessary breast cancer treatments
The long-term effects of chemotherapy and radiation
The different types of breast cancer
The limitations of traditional cancer treatments and the importance of addressing the root causes of the disease
How chronic stress and trauma can increase the risk of breast cancer.
Why self-examining the breasts is essential
Dr. Jenn introduces her clinician training program to equip providers with the knowledge to use alternative imaging
“Be preventative, be proactive, look at that list of things that cause breast cancer, see what applies to you, and make the changes you need to drive health.”
-Dr. Jenn Simmons
Connect with Cynthia Thurlow
Follow on Twitter
Check out Cynthia’s website
Submit your questions to support@cynthiathurlow.com
Connect with Dr. Jenn Simmons
On her website
Keeping Abreast with Dr. Jenn (podcast)
On all social media: @Dr Jenn Simmons
Dr. Jenn’s new book, The Smart Woman's Guide to Breast Cancer, is available on Amazon.
Transcript:
Cynthia Thurlow: [00:00:02] Welcome to Everyday Wellness Podcast. I'm your host, Nurse Practitioner, Cynthia Thurlow. This podcast is designed to educate, empower and inspire you to achieve your health and wellness goals. My goal and intent is to provide you with the best content and conversations from leaders in the health and wellness industry each week and impact over a million lives.
[00:00:29] Today, I had the honor of connecting with friend and colleague Dr. Jenn Simmons. She's an integrative oncologist, breast surgeon, author, podcast host and the founder of PerfeQTion Imaging. Today, we spoke at length about breast cancer statistics and how most breast cancer is preventable and how overdiagnosis confuses women and providers, why mammograms are problematic, what types of breast cancer diagnoses are an actual emergency, descriptions of differentiators between other types of breast cancer, the state of normal breasts having both estrogen and progesterone receptors, the distinction of DCIS, which is ductal carcinoma in situ, the impact of treatment including radiation not impacting survival, the role of trauma, the impact of alcohol. And lastly, we started with listeners questions.
[00:01:25] To be reassured, we will be having Dr. Jenn back for an additional AMA episode where we will get through all of your questions. We were wonderfully overwhelmed, but impossible to get them all in one podcast episode. I know you will find this to be an invaluable, helpful and proactive conversation.
[00:01:45] Welcome back Dr. Jenn. Such a pleasure to be reconnected with you. And as I was texting you over the weekend, your book is a book that every woman needs to own because even as a clinician there is stuff in this book I did not know. And it's so important to be proactive as opposed to reactive. And so, thank you for the gift of your work and thank you for writing this book that I think is going to help millions of women.
Dr. Jenn Simmons: [00:02:13] Thank you. I have to tell you, just shortly after my book was published, I was on a podcast with three physicians and they were all interviewing me and one apologized immediately for her appearance. She had only gotten my book the day before and she stayed up all night reading it and couldn't put it down. And she was literally like bleary-eyed and crying saying, “You must feel so good because you're going to save millions of lives with this book.” And it really is something that I agree with you. You don't have to have breast cancer to have an appreciation and get tremendous value out of this book because this is how to live proactively.
Cynthia Thurlow: [00:02:56] Yeah.
Dr. Jenn Simmons: [00:02:57] That's what we all need to be doing. We need to shift that focus away from being reactive. We need to shift that focus away from only dealing with treatment. And it's not that hard, if we are able to think about health in a proactive way and building health, it actually does replace these disease states so we could all benefit from. My program isn't unique in that there are so many programs out there that are thinking about life from a health building perspective rather than reacting to illness.
Cynthia Thurlow: [00:03:35] Well. And I think people feel as if breast cancer is such a random entity, and yet I would be the first person to say that there's so much emphasis on breast cancer awareness, appropriately so and breast cancer screenings, but yet for many individuals, they don't realize the contributory portion in many instances of our lifestyle, kind of benignly. We don't even think about how day to day choices can put us at greater risk. And I wouldn't say that every single person listening per se has just had this random event, but I do think it's important for people to realize there are things they can do proactively to lessen the likelihood they will ever hear that diagnosis.
Dr. Jenn Simmons: [00:04:17] Without question and I first feel kind of obligated to say, and this is not about blame or shame, but that 80% of breast cancer diagnoses are preventable. So that is a large, large percentage of people who are suffering and almost suffering unnecessarily. So, between the diagnoses that are truly preventable and the over diagnosing, because we are over diagnosing because we're using a very inferior testing model to diagnose breast cancer. So, we're over diagnosing by somewhere between 20% to 30%, depending on the study that you look at. And we're talking about hundreds of thousands of people, maybe even millions of women who are either unnecessarily diagnosed or over diagnosed, but this is having a tremendous impact.
[00:05:21] And if treatment for breast cancer were benign, it would be one thing, but treatment for breast cancer is not benign, and in fact, it's quite harmful. And we are thrusting nearly 100% of women who are diagnosed with breast cancer into menopause, whether they were there or not. And if they were already there, we're making it worse for them. And this is a horrible state to exist in. And this is actually the topic for my next book.
[00:05:50] My next book is called the Forgotten Woman and it's the woman who has had breast cancer. And she's completed treatment and she's told afterwards that she should be grateful to be alive and she is grateful. But it's very hard to feel grateful when you can't think, when you're depressed, when you're anxious, when you can't sleep, you can't formulate a sentence, you can't do what you used to do, you don't feel like yourself, you've gained weight, and even if you haven't gained weight, your weight has redistributed around the middle, your clothes don't fit, you feel uncomfortable in your own skin, you're having palpitations, your bones ache, your joints ache, you have no libido, sex is unwanted and painful, your relationship as a result is suffering, you're having problems with continence, you're leaking urine, you can't do what you used to do, you don't have energy.
[00:06:46] It's really hard to feel grateful when all of that is happening and yet that is how we're leaving most women who have been treated for breast cancer, and they have no access to support, no access to help. And so, this is the focus of the rest of my medical practice is helping these women who have already recovered from the breast cancer diagnosis, but are left in this state of life that is just, it's not life, it's not what life should be.
Cynthia Thurlow: [00:07:19] I have several nurse practitioner friends that have been diagnosed with breast cancer. And one of them said to me, “I feel like I'm living in purgatory.” And for anyone that's listening, they're not in heaven, they're not in hell, they're in this in between. And the way that you described the way that their life is right now, they're so grateful that they got through their diagnosis. Most of them have gotten to the five-year survival mark.
Dr. Jenn Simmons: [00:07:42] Yeah.
Cynthia Thurlow: [00:07:43] But when they think about how they feel physically, they don't feel like themselves. And it's, imagine a woman going into menopause. Many of us with that transitional period, don't feel like ourselves. But this is magnified a hundredfold, every single-
Dr. Jenn Simmons: [00:07:59] That’s right.
Cynthia Thurlow: [00:08:00] -symptom because of that loss of hormones. Now one thing--
Dr. Jenn Simmons: [00:08:05] Because they don't have the access to care that everyone else has. Because if you don't have a breast cancer diagnosis, at least if you have all of those symptoms and you are talking to someone who is hormone literate, they will offer you hormone replacement. Hopefully, they will offer it to you in a responsible, bioidentical way. But if you even hint, whisper that you have had a breast abnormality in the past, God forbid, breast cancer, those options aren't available to you unless you come to my office.
Cynthia Thurlow: [00:08:40] Well, as I stated before, I'm so grateful for the work that you do and the awareness that you bring to these issues. Let's talk about mammograms. I fervently believe that this diagnostic modality was well intentioned. What are your concerns about mammography? How does it put us at greater risk of damaging breast tissue because of this ionizing radiation? Let's talk about mammograms.
Dr. Jenn Simmons: [00:09:11] Yeah, so I agree with you. I think when the mammographic screening program started in the 1970s, it was absolutely, positively well intentioned. I agree with you. And it was built on these foundational understandings, which are logical, absolutely. It was built on these foundational understandings that breast cancer growth is both linear and predictable. And without belief, if you could identify a cancer that was small and in its earliest stage, you could both save lives and save breasts because you were finding it before this kind of critical moment, at which point it was more likely to metastasize. And it is a logical theory, it just doesn't happen to be true.
[00:10:13] Breast cancer is what it is from the beginning and it is not a function of size, it's a function of biology. So even if you find a biologically aggressive tumor when it's small, it does not change the trajectory of the disease for that person. Conversely, there are some really big tumors that have no tendency to metastasize and it doesn't matter when you find that one, because those people are going to do the same. And then there's everything in between. So, we rolled out the mammographic screening program based on this understanding that growth was linear and predictable. And what we didn't do, what we never did, was impact survival. So, what happens is that no matter how many mammograms we do every year, the same number of women die of breast cancer every year. We do not impact the bottom line. No matter how many mammograms we do every year, the same exact number of women present with aggressive disease, disease that is not impacted by our treatment. These are the women that go on to die of breast cancer.
[00:11:28] So, when we look at very large population studies, we actually see what the true impact of mammography is. And this is where it gets really scary. So, when you look at large populations where everything else is controlled, the age is controlled, access to treatment is controlled, the kind of treatment is controlled. When you look at the Swedish studies, we're talking about 600,000 women. So, these are not small studies. And you look and compare at the population that screens as compared to the population that doesn't. All have access to the same care. All have equal access to care. When you look at these groups over time, the same exact number of women die of breast cancer in each group. There is no survival benefit. The difference between the two groups is that when you look at the population of women that screen with mammogram, you have a 20% to 30% increased incidence of breast cancer.
[00:12:40] Now, I am not saying that those breast cancers are caused by mammogram, but it's undeniable. And in every other situation and in every other circumstance, if you are to ask if radiation causes cancer, the answer is a resounding yes. It is a known carcinogen. Radiation is a known carcinogen. And yet when we talk about it in the context of mammogram, we are repeatedly told that mammograms are safe and mammograms do not cause breast cancer. Now, how is that possible, how?
[00:13:17] Now people often say, “Well, it's not a lot of radiation.” Actually, it's not true. The amount of radiation that is delivered during a mammogram depends on the size and the density of the breast, because the amount of radiation that is delivered is linearly related to how much tissue it has to go through and how dense that tissue is. So, the more dense your breast is and the larger your breast is, the more radiation you're getting in the course of your mammogram. So, it's not like everyone gets this dose. It's simply not true. Some people with large, dense breasts are getting ten times the amount of radiation that someone with the small, fatty breast would get.
[00:13:57] So, that's the first thing is that there really isn't-- and can't be standardization of how much radiation is delivered because the amount is contingent on what the quality of the breast is. So that's the first thing. The second thing is that, with rare exception, who's getting one mammogram? Now, sometimes on that first mammogram, someone is diagnosed with breast cancer. So, I am not saying that all cancers are caused by mammogram far from it, far from it. And there's going to be a lot of those stories of people who on their first mammogram were diagnosed with breast cancer, so obviously that is not the cause of their breast cancer. But for the women who are lifetime screeners, and they're starting screening at 40, and they're screening every year for 10, 20, 30, some even 40 or 50 years. That radiation is without question adding up, and that radiation is without question contributing to breast cancer diagnoses.
[00:15:01] And we know that the more mammograms that you have in your lifetime, the higher your risk is of being diagnosed with breast cancer. So, some of that 20% to 30% increase that we see in the screening population is caused by mammogram. And some of it is because we are picking up lesions that would have never developed into clinical disease. And again, some of that are in the form of calcifications that we're detecting that are associated with DCIS or ductal carcinoma in situ. And that is something that at least I could easily argue does not need to be picked up. And the only benefit to picking that up is that we have the opportunity to help that woman understand that she does have inflammation, that she does have pre-cancerous changes in her breast, and this is an opportunity. An opportunity to figure out why she has precancerous changes in her breast and change the trajectory of that disease. And we can intervene and we can change the trajectory of disease, but not if we treat it just like it's breast cancer. Which is what's happening in almost every hospital across this great country of ours, is that the hospitals and the physicians and the programs are using it as an opportunity to treat more people for breast cancer, even though that's not breast cancer. So that's one place that we're definitely, without question, over diagnosing.
[00:16:45] And still there are small invasive cancers that-- Everyone makes cancer cells, from the very young to the very old, everyone in between. And if you have an intact immune system, it can recognize that cancer cell in its infancy and not allow it to go on to become a cancer or a tumor or whatever name you want to give to that entity, it most will not go on to become clinically relevant disease. However, if we are going to pick up all of these 3 and 4 and 5 mm lesions and treat these women like they have breast cancer, then we're not giving the body the opportunity to do that. And this is happening a significant amount of the time. 20% to 30% of these breast cancers that we're diagnosing don't need treatment because they would never have gone on to develop anything. And we know that because we compare them to the people that don't screen. That is the control, that is the true incidence of breast cancer, but we're just inflating it by using mammography, because mammography is both detecting things that don't need to be detected and contributing to breast cancer incidence because it is radiation. And we should have long ago stopped using a test that causes cancer to screen for cancer.
Cynthia Thurlow: [00:18:16] How many women in your clinical experience, when you were working in your still kind of traditional allopathic model of care, came to you and out of an abundance of fear, were making decisions when they could have done watchful waiting? I know that in the traditional model of care, it's like cut it out, burn it, do chemo, do surgery. How many people would have benefited from having this pause to reflect on careful monitoring versus this kind of reflexive modality of addressing it immediately? And I am by no means-- I have so many friends, colleagues, etc., that have been impacted by a cancer diagnosis, I know that it's terrifying, I'm not minimizing that at all. But as a breast surgeon, was it challenging for you in instances when you knew a patient was making a decision that if she perhaps had taken a pause or had taken an opportunity to kind of process what was happening, as opposed to reflexively saying, “Just cut it out, just take it out. I don't want to deal with it.”
Dr. Jenn Simmons: [00:19:25] I would like to think that I was that intuitive when I was a breast cancer surgeon, but I wasn't. It wasn't until I got my own diagnosis that I even began to understand any of this and to look outside of what I had been trained to do and trained to think. Because as a conventional medical doctor and as a breast cancer surgeon, I was taught to diagnose and treat, that was it, like never, ever, ever were we to think about the why. And in fact, I think that's by design, because if we started to think about the why, we would think the way that I think, like, are we really doing the right thing by screening with mammogram? Are we really doing the right thing by exposing all these women to radiation year after year after year?
[00:20:18] So, I don't think that I was that intuitive. But we can look at the numbers now and just know that, in 2024, there were over 300,000 women diagnosed with invasive breast cancer and over 56,000 women diagnosed with DCIS. So just off of the top, those 56,000 women who were diagnosed with DCIS. They should all have been in a watch and wait. But not just watch and wait, be preventative, be proactive, look at that list of things that actually cause breast cancer, see what applies to you and make the necessary changes that you need to drive health, because that is ultimately what this is about. It's about being preventative and proactive.
[00:21:14] We can reverse disease too. But isn't it wonderful to not have to reverse disease, to not have the burden of all of that fear mixed in with it when you can really skip a couple of steps if you're not already dealing with a diagnosis. And of that 310,000 women who were diagnosed in 2024 with invasive breast cancer, if you look at the numbers and just say 20% to 30% of them are unnecessarily diagnosed, we're talking about 60,000 to 90,000 women. This is obscene, this is immoral, this is unethical. And we can't continue to do this because as we started off talking about, when we treat these women for breast cancer, and especially the ones with noninvasive disease who are being treated just like they have invasive disease, we're really ruining their lives. We're forever changing their lives and not in a good way.
[00:22:24] And instead, if we took this opportunity. The first thing that I talk about in my book-- The Smart Woman's Guide to Breast Cancer, the very first thing that I talk about in my book is take a breath, take a pause, you have time, you have time to think about the diagnosis, to learn about the diagnosis, to learn about treatments, to actually make an informed decision because most people are not. Most people are not given the opportunity to make an informed decision, most people are not given the information to make an informed decision. They are immediately thrust on this runaway train of sign up for surgery, sign up for chemo, sign up for radiation. And they're actually pressured. It's like a high-pitch sales.
[00:23:14] They are pressured and they are led to believe that they're going to have an adverse outcome if they don't get right in the operating room or if they don't sign up for radiation right away. They're really pressured to do these things and they're so scared. And think about how easy it is to think when you're scared, it's not. I don't have to tell you about it. You're in this total cortisol-driven state which actually shunts blood away from the thinking part of your brain, because we really only understand two states. We understand safety, we understand danger and that's it. And when you're in that danger state that fight or flight state, we don't understand that we're faced with a difficult decision and that is what is making us feel as if we're in danger. We're not that sophisticated. We are modern beings, but we're living on a very old gene code. And the dangers we understand are saber-toothed tigers on our tails. So, we're sending this wrong signaling at the time because our danger, our perceived danger is our diagnosis. It's not a saber-toothed tiger, so we're having this response where we're flooding our bodies with cortisol and we can't think because our bodies think that we just need to run away from a tiger, and yet this is the time when we need to think the most.
[00:24:44] And so that's why, with very rare exception, and I can easily talk about those exceptions, if you have inflammatory breast cancer, and you know that you have inflammatory breast cancer because you go from having a normal breast to one that is filled with tumor and red and swollen in the course of a week, at the most a month, so it's really dramatic cancer growth. So, if you have inflammatory breast cancer, if you have metastasis, breast cancer that has spread to your bones and caused fracture, not just spread to your bones, but and caused a fracture, because that is a very painful situation and it's impossible to heal if you're in pain, so that needs to be dealt with right away. And then the last thing is if you have brain mets, because if you have metastasis, if you have breast cancer that spread to your brain, the brain is in a fixed space, it's in your skull in a fixed space, so you can't afford for too much swelling, so that has to be treated right away.
[00:25:44] And all the other situations, you have time, you have the opportunity to learn, to educate yourself, to be able to understand what these treatments do and what they don't do. And part of what they do is have tremendous side effects. And what we all have to remember is that breast cancer, no cancer, but breast cancer is not a surgery deficiency, it's not a chemotherapy deficiency, it's not a radiation deficiency, and it's not a hormonal blockade deficiency. And despite the fact that these are things that are used all day, every day, they leave a wake of destruction. And it is very important to understand that before you do these things and not after. And that's the major reason why I wrote my book, so that people could understand this before they entered into treatment and actually make an educated decision as to what they wanted to do and what felt right for them, because there is no treatment out there that's going to work if you don't believe that it's going to work. And so many people dive into treatment with great trepidation and without real hope or belief. And that is my main goal, is to give people hope and allow them to understand what these things do so that they can make a decision that really feels right to them, that they believe in, that they trust in, and that they're motivated by because that's really important.
Cynthia Thurlow: [00:27:24] It really is. And I'm so glad that you touched on some of the emergent diagnoses. When I was an ER nurse in my past life, there was nothing more sad to me than a patient and I trained in the Intercity. Patient coming in that had an abrupt onset of changes to how her breasts looked. And there's something called Peau d’orange, which is a very distinctive pattern on the breast, very suggestive of inflammatory breast cancer, or patients that came in with shoulder pain. And I saw far too many of them who had breast cancer or lung cancer. And you're sitting in an emergency room, it's loud, and you're having to call oncology, you're having to call bring in-- These people think that maybe they just bumped themselves and they find out that they have metastatic breast cancer is one example.
Dr. Jenn Simmons: [00:28:11] I know.
Cynthia Thurlow: [00:28:12] Or they have a headache and they come in and we do a CAT scan and we realize they've got metastatic disease. So, I agree with you concurrently, and the types of breast cancer that allow us to have a pause to think about treatment options, getting second opinions, let's run through the more common types of breast cancer, because I think many people probably don't realize that you can have cancers just in the ducts, you can have cancer in the lobes of the breast as well as, you hear this term triple negative breast cancer or HER2-positive breast cancer. Help us understand how these are differentiated. And from your perspective as a surgeon, when you hear some of these diagnoses, which are the ones that for you give you pause to say, “Okay, we have a little bit of time to think about this,” versus “We know that this tends to be a more aggressive type of cancer.”
Dr. Jenn Simmons: [00:29:04] Yeah. So, let's get the aggressive ones out of the way first. And most of them are just descriptions of what we see under the microscope. That's how the different types go. So, an inflammatory breast cancer, however, is a breast cancer in the breast with inflammatory changes in the skin. And that is the only one that is truly a clinical diagnosis. So, if you have someone with a mass in their breast and inflammatory changes in the skin, that's inflammatory breast cancer until proven otherwise. And you do not have to prove that there's tumor in the skin. All you have to prove is that there's cancer in the breast and that they have what are visual changes, red skin, Peau d’orange, skin of an orange. It's that dimpled kind of thickened skin. That is an emergency. That needs to be treated right away and that needs systemic treatment.
[00:30:19] So, I am not someone who does not believe in conventional medical treatment anymore. Yes, I left surgery. I haven't done surgery since 2019. But I spend my time now acting as the bridge between the conventional medical world and the integrative oncology world. So, I'm not throwing the baby out with the bathwater. And I think that there's a time and a place, and I'm very clear about that for people because when people come to work with me with a preconceived notion that they're coming to work with me because they don't want to have chemotherapy or they don't want to have surgery, or they don't want to have radiation, I make no promises.
[00:31:02] So, if you come to me and you have a bone met causing a fracture, I'm going to tell you need radiation, like that's what we need to do. We need to do whatever we need to do to set the stage to start to create wellness. So, if you come to me and you have inflammatory breast cancer, I'm going to tell you that you need chemotherapy because your proverbial sink is overflowing. And yes, we certainly need to turn off the faucet. We need to figure out the why. But in the meantime, we can't work in a flood. We need to mop up the floor and surgery, chemotherapy, and radiation, these are our mops. Yes, we will get to why your sink is overflowing, but right now we need to clean up the mess. I never say no. I say, “Let's look at you, at what you need and design a program for you.”
[00:32:01] So, there is another very aggressive form of breast cancer. It's called metaplastic breast cancer. So, this is a very undifferentiated breast cancer, meaning that it's barely recognizable as breast tissue under the microscope. And again, aside from inflammatory breast cancer, all of these other diagnoses are made underneath the microscope. And how we judge breast cancer is how much of a departure it has made from normal breast tissue. So, let's take what normal breast tissue looks like under the microscope. It looks like a normal cell. And these cells are arranging themselves into ducts and lobules. And they're not crowded, they're touching each other, but they're not piling up on each other. And the nuclei are normal. So that's what a normal breast cell looks like.
[00:32:59] And a normal breast cell is going to have estrogen and progesterone receptors on them. That is normal. I'm going to say that again, a normal breast cell has estrogen and progesterone receptors on them. That's how they know what to do. They are signaled by the hormones in our body to what to do, what to do in the beginning of the month, what to do in the end of the month, what to do to transition to the next month, what to do when there's been conception, implantation, like they need these receptors for signaling.
[00:33:42] So, as we get further and further away, like a normal cell and a cancer cell looks different and we can recognize the difference. Now, sometimes those abnormal cells are just a little bit abnormal, and they're just growing up on top of each other a little bit, and we call that atypia. And I talk about all of this in my book. So, we're going to run through it right now, but it's all there in my book so that you can understand it. So, we call that atypical ductal hyperplasia. Now, if those atypical or abnormal cells then fill the duct, then we call that DCIS or ductal carcinoma in situ.
[00:34:24] Now, the thing about DCIS is that it is completely a process that is contained within the ducts. And the way that cancer spreads to the rest of the body is that it either uses the blood vessels or the lymphatic system, neither of which exist inside of the duct. So, if all these abnormal cells are contained within the duct, this has absolutely no potential to spread and therefore cannot by definition be life threatening. So, no one dies of DCIS, no one. And if you have someone that died with DCIS, it wasn't because of the DCIS. So, they either had another issue or they had invasive cancer that was not recognized. Because no one dies of DCIS alone, it's impossible, it has no ability to spread.
[00:35:19] Now, if it does grow outside of the ducts, that's when we start to call it invasive cancer. And we call it either invasive ductal carcinoma if the pattern that tumor is making, is forming ducts. Even if they're not forming normal ducts, if they start to make a ductal pattern, then we call it invasive ductal carcinoma. If they start to line up, then they're lining up in a lobular pattern, we call that invasive lobular carcinoma. Some people have features of ductal, some people have features of lobular. Some people have mixed. But it's all according to what it looks like under the microscope. Now, the other things that we look for in a breast cancer is does it have estrogen and progesterone receptors on it? Because if it does, it's still resembling normal tissue. If it's making ducts, it still is resembling normal tissue. So, these are the less aggressive cancers because they have not made such a big departure from normal.
[00:36:36] And then there's something you refer to as a triple-negative cancer. So, this is something, this cancer has lost its estrogen receptors, has lost its progesterone receptors, so it's mutated. And these tend to be more aggressive cancers because they've made a bigger departure from the normal tissue. People think it's because we have less treatment options. It's not because we have less treatment options because we can no longer target the estrogen receptor, it's because it is a different disease. It is a further departure from normal. This is a big mutation, a big change. And these tend to be more aggressive cancers. So, most of what we talk about, most of what we describe is just what we're seeing on the microscope and how far from normal have you gone. So, the Grade I cancers tend to be very unaggressive, whereas the Grade III cancers are the more aggressive of that type.
[00:37:48] And so, if you start to understand the pathology, I do think that that is important. But more importantly, we need to understand the treatments because that is what ends up having the biggest impact down the road. And people often think in this short-term window, like, “I just have to get through this, I just have to have the tumor removed, I just have to have the treatment and then I can go back to normal.” And what they don't realize is that, yes, that treatment has short-term misery for sure, but it also has a lot of long-term misery. And if we just take that 20% to 30% off of the top from the very beginning, those are people who are having any treatment for no reason.
[00:38:39] And it's hard to understand that and understand why our system would put us through all of this unnecessarily. But sadly, it's a very broken system. And it's really hard to know what to do. And again, why I wrote my book so that I could help empower people to make the right decisions for them. And our system right now operates in a very checklist kind of way where everyone who gets the diagnosis gets the same treatment, the whole treatment. So, I've had so many people come to me and say, “Listen, I had a lot of disease, but I had two cycles of chemotherapy and the disease is all gone, but they want me to finish and have 12.” So, there's no thought given to, “Have you responded? Have you completely responded? Can we do something different with you?” There's no thought given to that. It's either all or nothing in our system right now. And it puts people in a really difficult place because the ones that have had a complete response after a treatment or two and want to walk away, they are really not treated nicely by the providers at all. And they're basically abandoned by them. It's very much my way or the highway. And it's frightening to be abandoned by your physician, by your provider.
Cynthia Thurlow: [00:40:15] Well, think about how many patients get diagnosed or they get labeled rather noncompliant.
Dr. Jenn Simmons: [00:40:22] Yeah. [crosstalk]
Cynthia Thurlow: [00:40:23] And it's not that they're noncompliant. It's that they are asking questions. They are advocating for themselves. They are really looking for what I refer to as a bio individual perspective. And I know that's something that you and I both share in terms of looking at patients as individuals. What do you think is one of the biggest misconceptions about traditional cancer treatment? And by this, I mean radiation. What are the limitations of radiation because I think most people probably do not realize this?
Dr. Jenn Simmons: [00:40:52] Yeah. So, there is no survival advantage to having radiation. And I would venture to guess that nearly 0% of people who sign up for radiation realize that. I don't think they're told that. I don't think that's a discussion that they have. Now, radiation does serve a purpose and it does prevent local recurrence, meaning that if you had a lumpectomy and you have radiation afterwards, the likelihood that the cancer will come back in that breast is reduced by radiation. But what isn't happening, which most people believe is happening, is that survival is not increased by undergoing radiation. So, you do not have a greater chance of living after having undergone radiation.
[00:41:53] And in fact, depending on which side your tumor is on, there are some very serious long-term consequences of having undergone radiation beyond the cosmesis, beyond the fact that it will deform your breast, beyond the fact that it will make the texture of the breast different and hard and firm, beyond the fact that it will darken your skin and thicken your skin. I'm not talking about the cosmetic effects of radiation. I'm talking about the fact that beneath your breast are some really important structures. So, beyond what it will do to the muscles of your chest wall because it will make them fibrotic and firm and able to tear. But the ribs are there and it actually makes the ribs brittle and fragile. So from a sneeze, you can have a rib fracture. There are significant mortality and morbidity complications when you fracture your rib. People die of rib fractures all the time.
Cynthia Thurlow: [00:43:05] Mm-hmm.
Dr. Jenn Simmons: [00:43:06] So that's a problem if we are going to change the quality of the bone in the rib, but that is what's happening with radiation. Beyond that, what's behind your ribs. Well, on the left side is your heart. So, if you have radiation, you have both an increase in the incidence of coronary artery disease because it affects the vessels of the heart, but you also have an increase of cardiomyopathy because it affects the actual muscle of the heart. These are very serious consequences which, incidentally, if you are treated for breast cancer, you are two to three times more likely to develop heart disease and die of heart disease than if you are not treated for breast cancer.
[00:43:52] And what happens with those deaths? Even when they're caused by the complications of breast cancer treatment, they are not attributed to breast cancer, they're attributed to cardiovascular disease. So, we are actually decreasing survival when we use these treatment modalities like chemotherapy, like radiation. Now, for some people who have imminently life-threatening breast cancer, it is worth that trade off. But this is not true for most people. It's not true at all for most people. And I think if they knew the long-term risks and long-term ramifications of radiation, it's unlikely that they would choose it. They would take the risk of the cancer coming back in that breast and dealing with it if that happened knowing that there are so many things that we can do to prevent recurrence, things that are 100% in our control.
Cynthia Thurlow: [00:44:59] I think that for so many people, getting fully informed consent and again, it goes back to, are you making decisions from a place of fear? Are you in a position where you're able to think clearly? And trust me, I understand when we are fearful, we override our prefrontal cortex, which is our thinking brain, we are left dependent on the amygdala, which is our lizard brain, which is a survival mechanism in our bodies. We can't make good decisions when we can't think clearly. And so, I love that you touched on so many of these things.
[00:45:35] One thing that really stood out to me when I was going through your book was the issue of trauma. And not just trauma, but the risk that it puts us at in terms of a diagnosis, but also a reoccurrence. Can we speak to this? Because I think that chronic stress, whether you are cognizant of it or not, whether you are aware of it or not, because I think there are many of us that are very high functioning, that had high adverse childhood event scores, who appear from the outside, we've got everything together. But in many instances, that chronic stress pattern that we are exposing our bodies to can make us more susceptible to reoccurrence and even an initial diagnosis.
Dr. Jenn Simmons: [00:46:27] Without question. And, actually, when we look at the data, when you look at women who are diagnosed with early breast cancer, about 30% of them will have known trauma in their past. And when we look at the people diagnosed with metastatic breast cancer, 80% of them will report known trauma in their past. And then 100% of them have the trauma of a breast cancer diagnosis. So, without question, the body is keeping score. And when we don't deal properly with that trauma, and believe me, I am not judging and I am not saying that this is easy, but that if we do not deal with it properly, it will manifest as physical illness. Because when we don't listen to the whispers of the body, the body gives us screams. And this is your body's way of messaging you, of saying, “I'm not okay and I need your help here.”
[00:47:39] And it always amazes me, the people that tell me that “I'm not stressed, I have nothing to feel stressed about, everything is great.” And then you actually measure 5-point cortisol’s on them and they're off the charts. And so, they're so not in touch with how their life is affecting them. And when we are in these chronic stress states, we do have tremendous manifestations of these that end in breast cancer because of what that chronic stress means from a chemical perspective in our body. So, we talked a little bit about, we only understand safety and danger.
[00:48:28] So, if we're in this dangerous state, we were only designed to be in this dangerous state less than 5% of our day, less than 5%, because if you think about it, if you come out of the cave in the morning and there's a saber-toothed tiger there, you're either meant to run away or get eaten in seconds. You cannot run away from a saber-toothed tiger for three hours or three days or three weeks or three months or three years, you can't. And so, but unfortunately, so many of us have these perceived saber-toothed tigers that are just there constantly, every day.
[00:49:13] And the interesting thing that I talked about with my friend Tricia Pringle recently was that if you have-- I have a patient who was studying for the Bar exam. And so, every single day, that's all she did. She gave up exercising, she gave up eating healthy. All she did was sit all day and sit in the stress of studying for the Bar exam and had tremendous anxiety about the bar exam and took said Bar exam and failed and decided that she was going to just give it one more try. So, did the same thing and studied every day, all day, didn't eat well, didn't move her body, had no stress management, just plugged into that and she failed. And she decided that was it, she wasn't going to do it anymore, she wrote it off. And she told me six months later when she came to me for help, she can't lose weight. She feels fine, she feels relaxed, she feels everything, but she can't lose weight and she can't understand why, because she doesn't feel stressed about this. She's put that behind her.
[00:50:24] And then you measure her cortisol levels and they're off the charts. Because if you have a saber-toothed tiger every day at your door for two years and suddenly the saber-toothed tiger is no longer there. Well, someone needs to tell your body that, because you're on autopilot. And these people that experience their trauma year after year after year after year and suddenly think that they've forgotten it, but the body hasn't. And the body is still experiencing that day after day after day. And so, when it is not dealt with, the body is going to give you something that you understand to deal with.
[00:51:11] And then, at that point, certainly trauma is one of the causes of breast cancer. But when you have a breast cancer diagnosis, we have to think about all of the causes of breast cancer. We have to think about chronic inflammation from the diet, we have to think about processed foods, we have to think about sedentary lifestyle, but also overexercise, you can't run away from a saber-toothed tiger all the time. So, these people that are exercising for hours and hours and hours a day, we can't do it, we're not built for it.
[00:51:40] Radiation exposure, repeated mammograms, x-rays, radiation in childhood. Chronic inflammatory conditions like obesity, diabetes, thyroid disease, and celiac disease. I diagnosed several women every single year with their first diagnosis of celiac disease. They have no GI disease. 40% of people with celiac disease will have no gastrointestinal issues that they know of and their first inclination that they have celiac disease at their breast cancer diagnosis. So, chronic inflammatory diseases like inflammatory bowel disease or MS or anything like that. Chronic infections, we're surrounded by them. Think about the number of people that have parasites or viruses, fungus, mold, Lyme, yeast, bacteria.
[00:52:30] Chronic infections can lead to a breast cancer diagnosis. Heavy metals in our drinking water. Dental amalgams are a great example of heavy metals that we are repeatedly exposed to that we don't appreciate or we underappreciate. But it's also in our food, our cosmetics, chemical exposures, plastics, pesticides, herbicides, fungicides, phthalates, xenoestrogens, chronic antibiotic use, antibiotics. The more antibiotics you have in your life, the higher your risk is of getting breast cancer. Chronic dental infections. People don't realize that like root canals are a dead tooth in your mouth and they collect inflammation and infection. Frequent toxin exposures. I mean, have we normalized? Alcohol. look at alcohol use, it is directly related to breast cancer incidence. Chronic constipation, because if you're not getting rid of the toxins from your gut, then they're just being reabsorbed in your body. Nightshift work, short sleepers, insomniacs. Sleep is where the healing happens. So, if you're not sleeping, you're not healing.
[00:53:35] The electromagnetic field is another example of something that causes DNA damage. It is so invisible to most of us. Chronic stress from a difficult relationship, a bad marriage, a horrible boss, being a caregiver to a sick parent or spouse or partner or friend or God forbid, a child. And then there are other huge stressors like a divorce, a job loss, an unwanted move. And of course, as we started off, unresolved trauma. And we have to think about all of these things because they're having a tremendous impact on our bodies.
[00:54:12] And cancer is a normal response to an abnormal environment. And it's all of these things that are creating this environmental shift within us and allowing for this transformation, this cancer to start to form. And then we are living in a time where our immune systems are so challenged by everything that is in our environment and by the busyness of our lives. I mean we are just overworked and overscheduled and running ourselves ragged, and this is an immune suppressant. Our immune system simply cannot keep up with it. And this is the perfect storm. This is the recipe, this is the formula for breast cancer.
Cynthia Thurlow: [00:54:57] It's so interesting to me because there are so many contributory factors that can make us more susceptible. And certainly, you've run the gamut being so thorough. I want to make sure that we leave aside some time to address some listeners questions. And there were so many questions that I'll just have to have Dr. Jenn back because there's no way we'll get through all of them. First, thinking about thermography, someone mentioned thoughts on thermography versus mammogram, especially for dense breasts. Do you feel like there's any utility for thermography? I know we didn't touch on QT imaging. I know that is the next frontier. Do you think there's any utility to thermography?
Dr. Jenn Simmons: [00:55:39] So, I love thermography as a screening tool for inflammation, but most breast cancers, a significant number of breast cancers, are so slow growing that they're really not going to trigger very much inflammation. And so, I do not use it as a screening tool for breast cancer. And the reason why it is not gaining acceptance is because it's not a good screening tool for breast cancer. It is a great tool to screen for inflammation, but inflammation and breast cancer are not the same thing. And so, I do not use it and I do not rely on it. And when people bring me their thermography results and it says, no increased risk of breast cancer, that is not even worth the paper that it's on.
Cynthia Thurlow: [00:56:35] So, save your money.
Dr. Jenn Simmons: [00:56:36] Save your money. But if you want to use it once a year to know if you have a problem in your mouth, a problem in your thyroid, I do use it to look for inflammation. And if your CRP is elevated, if your sed rate is elevated, this can be a useful tool to look for where the issue is, but I don't use it as a screening tool for breast cancer because it's not reliable, so save your money if that's what you're using it for.
Cynthia Thurlow: [00:57:08] That's really helpful. The next couple of questions are all centered around mammography. And so, I pretty much know the answers to this, but I want to make sure we get them asked. People that are at higher risk for breast cancer, that are alternating between mammograms versus a breast MRI every six months, what are your thoughts about in terms of people that are at higher risk. What would be your suggestion for a patient that maybe has a terrible family history or is at greater risk? What do you feel like is a superior diagnostic tool?
Dr. Jenn Simmons: [00:57:44] Yeah. So, let's first talk about why they're at higher risk. So, they're either at higher risk because they have a family history, which probably means that they either have a genetic predisposition where they have bad detox genes. But there's something that's putting them at higher risk. And in general, people that are at higher risk for breast cancer have difficulty detoxifying, have difficulty with things like radiation. So, we're taking a population of people who already have proven to us that they suffer more toxicity and more damage and struggle with DNA repair, and we are exposing them to more radiation than most. So, to me, I think that it is unethical to screen high-risk people with mammogram because we are basically ensuring that they are going to develop that disease.
[00:58:50] Now, it's interesting that you asked about MRI, because most people think, “Oh, well, MRI, no radiation, so that's a good test.” And it's true, there is no radiation, but there are plenty of problems with MRI, starting with, in order for the MRI to have the sensitivity and specificity that it has, it requires gadolinium. And gadolinium is a heavy metal which is stored in the tissues of our body and has its own issues. So, I cannot get behind screening people with MRI because I can't get behind giving these same high-risk people gadolinium because they can't clear the toxins. They've already proven that they struggle with that. So how can we give them a bigger toxic load and expect to be helping them? We're not.
[00:59:50] So, and the reason that QT-- which is the technology that you brought up, the reason that QT was invented, was because the NIH knew that we needed something for high-risk screening, we needed something for dense tissue screening that wasn't harmful, that didn't put people in harm's way, which was more accessible, less expensive, affordable, but at the same time they didn't want to sacrifice the sensitivity because for people with dense breasts for young women, for high-risk women, this is a real issue. And mammogram will miss 40% of cancers in this population. So, it's not a good test anyway for those people. And so that's really why QT was invented. It was invented to help these high-risk women and give them a screening solution.
[01:00:53] So what QT is, it's sound waves transmitted through a water bath that collects 200,000 times more data points than MRI and creates a true 3D reconstruction of the breast. So, this is safe and painless. There's no compression. You just lie down on a table and your breast gets submerged in a warm water bath. So, no pain, no compression, no radiation, no gadolinium. And at the same time, we're getting an accurate image of the breast. So, this will without question, forever change how we screen for breast cancer. The main problem with it now is that it's just not that accessible because there's only six centers. But I'm working on that. I'm going to put up 50 in the next God willing, two years. I don't know that I'll sleep much, but I'm going to put up 50, God willing in the next two years and I hope to put 100 up. And by the time I do that, this will have universal adoption and forever change how we screen for breast cancer.
Cynthia Thurlow: [01:02:00] I think that's really exciting. So, a couple questions. One was when are you opening an imaging center in New Jersey or New York? That came up multiple times.
Dr. Jenn Simmons: [01:02:08] Yeah. So that's 2025.
Cynthia Thurlow: [01:02:09] Okay.
Dr. Jenn Simmons: [01:02:10] So, stay tuned.
Cynthia Thurlow: [01:02:11] Okay, so it is coming up.
Dr. Jenn Simmons: [01:02:11] It is coming up.
Cynthia Thurlow: [01:02:12] The six locations right now, I know Philadelphia. Where else are the other locations right now?
Dr. Jenn Simmons: [01:02:16] Philadelphia. I also have one in the San Francisco area, Nevada, California. So those are the PerfeQTion Imaging Centers. And then there is a center in Irvine, there's a center-- These are all in doctor's offices that also offer this service. There's a center in El Dorado Hills, California. There are two centers in Illinois, one is in Crystal Lake and I think the other one is in Chicago proper.
Cynthia Thurlow: [01:02:46] Okay, that's helpful.
Dr. Jenn Simmons: [01:02:47] But I have many many more coming this year. So, in 2025, you'll be able to go Florida, you'll be able to go to New York, you'll be able to go to LA if it ever stops burning. And hopefully we'll be also in Texas, in Colorado, in Massachusetts. I have a lot planned.
Cynthia Thurlow: [01:03:05] That's really exciting.
Dr. Jenn Simmons: [01:03:06] Yeah.
Cynthia Thurlow: [01:03:07] Several providers wrote questions centering around resources for providers to be able to recommend alternative form of imaging as providers themselves. Do you have resources or recommendations, because it sounds like the ship is starting to turn in terms of the conventionality of these alternatives. Do you have specific recommendations or do you mentor clinicians?
Dr. Jenn Simmons: [01:03:29] Well, I am introducing a clinician training program this year in 2025. I'm doing it along with the brilliant Lindsey Berkson. [crosstalk] So, stay tuned for that because--
Cynthia Thurlow: [01:03:40] Very, very popular guest.
Dr. Jenn Simmons: -we are going to both offer a patient facing program, but we're also offering clinician training. Because the truth is that I'm going to have to step away from my role as a provider in the breast cancer space. But I come along with enormous experience because I spent 20 years as a breast cancer surgeon, so I want to be able to impart my experience onto people so that they can comfortably treat people for breast cancer with all of their foundational knowledge that they have in their functional medicine practices. And I'm going to give you the oncologic piece.
Cynthia Thurlow: [01:04:23] I love it. That's fantastic.
Dr. Jenn Simmons: [01:04:25] So that will happen this year. Until then, I do have a screening paradigm. There's three things involved. The first is everyone should be doing self-breast examination. No one is ever going to know you better than yourself ever, ever, ever. So once a month, if you are premenopausal, you're doing it one week after your cycle starts. If you are postmenopausal, just do it. You can feel them on the first. Whenever you remember to do it, I want you to do it. And it is a combination of both looking at your breasts to make sure that they haven't changed in size and shape. Make sure there's no skin dimpling or anything like that, nipple retraction, that's what you're looking for. And then you're going to feel your breasts.
[01:05:06] If you are large breasted, you have to lie down and take gravity out of the picture. If you're small breasted, you can do it standing up, but you should elevate your arm over your head and use the opposite arm to examine. Always put something on your hand, be it oil or lotion or whatever to take friction out of it. And then you're just going to run your fingers from the outside towards your nipple around. Use your fingertips, they are the most sensitive part, okay, so that's step one. Everyone's doing self-breast examinations.
[01:05:39] Step two is you're going to do the Auria test. This is the tears test. There's a tiny piece of litmus paper that you put inside of the corner of your eye. And you just close your eyes, let it sit there for five minutes. That little piece of paper gets mailed off and it comes back with a result that is either normal or clinically significant. And if it's clinically significant, it means that it found these proteins, the S100A8 and S100A9 proteins. These are inflammatory proteins that are fairly specific to the very early stages of breast cancer. So, it has a 93% sensitivity, which is better than any mammogram ever. And done in the comfort of your own home. It's 100% safe and 100% painless. If you have a clinically significant result, that means that you have the inflammatory risk for breast cancer if you don't have breast cancer already. But what it is, if you don't have breast cancer already, and it means that you need to go have imaging, but if you don't have anything on imaging, you know that you have the opportunity to figure out why you have this inflammation and reverse it so that you don't have to get a diagnosis. So, I love this test because to me it's preventative. To me, it's the ability to know if you have inflammation and intervene before you have disease.
[01:07:09] And then for imaging, because I feel very strongly about not exposing normal, healthy women. That is the screening population. Because if we're screening, we're talking about the population of women who we have no reason to believe that they have disease. If you have a lump in your breast, if you have a symptom, if you have a finding, that is the diagnostic population. I am not saying women will never have another mammogram again. I'm saying that you should not use mammogram for screening, but for diagnostic, if you have something wrong, you need everything. We are not throwing the baby out with the bathwater. If you have something that we have a reason to believe that you have breast cancer, we need to do whatever we need to do to diagnose you. However, if we are talking about the pure screening population, then a QT scan, if you have access to either PerfeQTion Imaging or any of the other centers or an ultrasound, this will suffice.
[01:08:13] Ultrasound is very low-resolution technology as compared to QT, but it is way better than exposing yourself to radiation or gadolinium. I do not believe in putting normal, healthy women in harm's way. It's wrong, it's unethical. It should have been abandoned many, many years ago. There are countries around the world that have abandoned it, that have abolished it, and we should follow in their footsteps.
Cynthia Thurlow: [01:08:39] Well. Dr. Jenn, I'm hoping I can entice you to come back to do an Ask Me Anything because we had so many questions. And I think that if you're open to it, I would love for you to continue with the AMA piece because I think it'll touch on many of these issues. Thank you for the work that you're doing. Please let listeners know how to connect with you, listen to your podcast, purchase your book, or work with you or your team directly.
Dr. Jenn Simmons: [01:09:02] Yes. So, my website to work with me there, join my group, or work with me one on one. My website is called realhealtmd and you can learn all about our programs there. I too have a podcast like you and mine is called Keeping Abreast with Dr. Jenn. We put out a new episode every Monday so please tune into that. You can find me on all the social channels, I’m @drjennsimmons and then my book, The Smart Woman's Guide to Breast Cancer is available on Amazon and it truly-- You do not need to have breast cancer to get great value from this book. This book is for anyone who has breasts and wants them to be healthy because at the end of the day, as I always say, breast health is health and the same exact things that are going to give you healthy breasts are going to give you a healthy brain, a healthy heart, healthy skin, healthy bones, healthy gut, healthy everything.
Cynthia Thurlow: [01:10:02] Well, thank you again.
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