I am thrilled to today reconnect with my friend and colleague, Dr. Jenn Simmons, who last joined me on Episode 432. Dr. Jenn is an integrative oncologist, breast surgeon, author, podcast host, and the founder of PerfeQTion Imaging.
In this episode, we address a range of listener questions, exploring the differences between screenings and diagnostic testing, the use of hormone replacement therapy in breast cancer patients, and more. We also dive into common concerns like fasting, what to do if you find a lump, and the role of targeted supplementation.
I know you will find this discussion with Dr. Jenn Simmons informative, engaging, and incredibly valuable.
IN THIS EPISODE YOU WILL LEARN:
Dr. Jenn explains the historical context of mammograms
How radiation exposure from multiple mammograms may be harmful for women in high-risk populations
How some categories of fibrocystic breasts are associated with breast cancer
Why metabolic health is essential for preventing breast cancer
The benefits of HRT for breast cancer survivors
Some common misconceptions about HRT
How mold causes a breast cancer risk
Why addressing the underlying causes of breast cancer is better than relying on medication
The value of fasting for disease reversal and metabolic health improvement
How creatine can improve muscle function and recovery
“When we look at population statistics, mammograms do not save lives.”
-Dr. Jenn Simmons
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Connect with Dr. Jenn Simmons
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On all social media: @drjennsimmons
Podcast: Keeping Abreast with Dr. Jenn
The Smart Woman's Guide to Breast Cancer by Dr. Jenn Simmons
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 reconnecting with friend and colleague Dr. Jenn Simmons. She last joined me on Episode 432 and she is an integrative oncologist, breast surgeon, author, podcast host, and the founder of perfeQTion Imaging. Today, we facilitated listeners questions that ran the gamut from screenings versus diagnostic testing modalities all the way up to hormone replacement therapy utilization in patients with breast cancer. You will find this to be an invaluable discussion, answering, as I stated, many of listeners questions around common themes such as fasting, what to do if we find a lump, and targeted supplementation.
[00:01:19] I will tell you that I have quite a few family members that work in the medical community and one of my cousins who's a physician called me and she was like, “So and so is convinced that you're telling people not to get mammograms.” I said, “No, that is not. I said, if you listen to the conversation, that is not the message whatsoever. I said, but you have to listen to the conversation or you have to read the transcript.” And it's like, if that's what someone heard, then they're incorrect. That was not what we said.
Dr. Jenn Simmons: [00:01:45] So, yeah, this is controversial, it's provocative. It's all of those things. it is certainly all of those things and it's a nuanced conversation. But the truth is that when we look at population statistics, mammograms do not save lives. So, then you have to consider it on a very individual basis and that's where it gets even trickier.
Cynthia Thurlow: [00:02:11] Absolutely. And you would know better than just about anyone because of your extensive experience working as a breast cancer surgeon and as a female, just being involved with oncology and all this intersection of breast cancer treatment.
Dr. Jenn Simmons: [00:02:28] Without question. But it's also the deep dive that I've taken over the last two years. And remember that mammogram is one of those urban legend things. We were told in the 1970s that it saved lives, even though the data was not there to support it. And the data was certainly not there to support it in young women, in women 40, in women 50, the data was not there. It was pretty definitive that it did not save lives in that demographic and yet it became an issue of morality. And today it remains an issue of morality. Where we think it's our moral duty to serve people with mammogram because we're told that they save lives. And we believe it, right? It's become this urban legend.
[00:03:17] And when we look at the real data, and these are huge numbers, it's undeniable when we look at these huge population statistics, when we look at the Swedish trials, when we look at the Canadian breast cancer screening studies, we find the same thing again and again and again. There is no benefit to screening the population for breast cancer. No survival benefit, you do not live longer, you do not live better, and in fact, what ends up happening when you screen the population starting at 40 or starting at 50 and you screen these women for decades, you actually end up having more cancers in the group that screens.
[00:03:59] And it's either because the additive radiation is causing some of those breast cancers and/or we are picking up things that would have never been clinically relevant in that we're picking up these microscopic cancers that would have never grown to be the size that you could feel them to be clinically meaningful. Because the truth is that breast cancer in the breast is not life threatening. Breast cancer anywhere else in the body is life threatening. So, now I started off this conversation by saying that when we look at population statistics, we know that mammograms do not save lives. So, then it becomes an individual decision. And the individual decision is mostly based on what is your risk.
[00:04:49] Because the higher your inherent risk is to get breast cancer, either because you have a strong family history or if you have BRCA mutation or that kind of thing, the higher your risk is, the more the physicians are prone to say, “Well, you need to screen because you're at high risk.” But here is part and parcel to the problem. If you're using mammogram to screen this high-risk population, the reason in general that they are high risk is because they either have some issue in processing environmental toxins so they are more susceptible to the dangers of radiation than the average person. We make them more likely to get breast cancer because we are exposing them to more radiation.
[00:05:38] So, this is the conundrum is that we're taking this population that is already at risk and essentially increasing their risk of getting breast cancer using those screening methods. So, I want to be clear. I am not telling people not to have a mammogram, but I do not recommend mammogram for screening either in the low-risk population, because I don't think it's ethical to expose healthy women to radiation for the purposes of screening. And I also don't think it's ethical to expose women at higher risk of breast cancer to radiation unless you have a reason to believe that they have the disease. And then it's not screening, then it's diagnostic. But I am not saying not to screen because we have so many amazing things available for screening now that are 100% safe. So, first of all, you can do a self-examination, right?
[00:06:33] When we looked at the Swedish trials, the difference between what mammogram was picking up and what was felt on physical examination is 5 mm, 5 mm. That is nothing. In terms of size, that is nothing. So, I think that self-breast examination is very reliable. And if you know your breasts, you're going to know when there's a change. So, that is the first thing I very much believe in self-breast examination. The second thing is there's something called the Auria test. And this is a test that's done on the fluid in your eye. You don't have to cry. You don't have to hurt yourself to do it. It's a little piece of paper that you put in the corner of your eye. You let it sit there, it collects a little bit of fluid, you mail it off to the company, and a week and a half later you get a report that says that you are either not at risk for breast cancer or you have a clinically significant report.
[00:07:28] If you have a clinically significant report, what this means is that you have the proteins the S100A8 and S100A9 proteins, and these proteins are associated with the very early stages of breast cancer. Now, to me, if you have a clinically significant result, that means you need imaging. We need to look and make sure that you do not have an identifiable lesion in your breast at this time. If you do not, this is opportunity. This is you with the power of knowing that you are at risk for breast cancer, that you have the inflammatory environment in your breast that is a precursor to breast cancer and you have the opportunity to do something about it. Like read my book, The Smart Woman's Guide to Breast Cancer. All the answers that you need to put yourself on a trajectory to prevent breast cancer. If you don't have it at that point, are there, it's there, the information is there. You just have to embrace it and welcome it.
[00:08:29] And then the third thing that I think that people should be doing for screening in terms of imaging is something that is not going to hurt you. So, mammogram is radiation. It is undeniable. And the more radiation you have over your life, the higher your risk is of getting breast cancer. So, I do not screen with mammogram for that reason. I also do not screen with thermogram because it is not a reliable tool to screen for breast cancer. So, you can either do an ultrasound, which, yes, an ultrasound will not pick up everything, I agree, but it will pick up things that are clinically relevant. And I think that that is what we should be doing. I don't believe that we should be picking up everything because I think that we are doing a terrible job in terms of over diagnosing and over treating and we are ruining women's lives when we over diagnose and over treating.
[00:09:22] So, I don't think we have to find every little bitty thing. But you should be working with someone who can put the picture together for you. So, I don't think that's something that you should have the responsibility of doing on your own. You should be working with someone who can put the picture together for you. And the imaging that I advocate for, which I understand is not everywhere. But at perfeQTion imaging, we are screening for breast cancer using a revolutionary new technique that it involves 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. There are two perfeQTion imaging open right now. By the end of 2025, there will be 10. And I'm going to put up 50 in the next five years. And I'm going to make sure that everyone who wants access to this technology gets access to this technology.
[00:10:19] I want to say one more thing before we move off this topic, and that's that I hear this narrative repeatedly. Well, the amount of radiation that you get with a mammogram is the same radiation that you get with a cross-country flight. That might be true when you're talking about absolutes, but there is a vast difference between the scattered radiation that you get on a cross-country flight and the focused cone down radiation that you get to the tissues of the breast during a mammogram. So, it's likened to this. There are very few things that have more energy than the sun. And yet when the sun shines down on us, the worst we get is a sunburn, a laser does not have nearly as much energy as the sun, but the beams are so focused that a laser cuts through glass.
[00:11:09] This is the same exact thing that is happening. Scattered radiation is not capable of that kind of damage, but focused radiation is. And this is happening, and this is happening every day. And it's mostly happening because we are not questioning the status quo. People are afraid of change. They are afraid of challenging the narrative. And we all forget because I was there too. It is this never-ending game of whisper down the lane where no one ever asks, “Wait, is this true? Where did this start? Is there data to support it?” Because when you look, there is not data to support screening with mammogram.
Cynthia Thurlow: [00:11:53] I think this information is so important. And you're right, we as a culture do not like change, it makes us uncomfortable, we use that term cognitive dissonance. It is a real thing. And when I reflect back on my personal decision to not do a mammography every year, I know that the European guidelines are different than they are here in the United States. And I think that was my decision that I discussed with my physician, who was sort of supportive of that, but felt like, okay, this is your decision. You're assuming all the risk for this.
Dr. Jenn Simmons: [00:12:33] Yeah.
Cynthia Thurlow: [00:12:33] Having said that, I think that it's important that we all question things on occasion. And not to be contrarian, not to be argumentative, but this is how science progresses when people start questioning the status quo in a way that generates vigorous discussion, debate, research, etc. And a lot of the questions that came in between our last conversation and this conversation have centered in a scattered array of different options, including questions around a history of fibrocystic breasts, concerns surrounding a history of fibrocystic breasts, and whether or not that increases your risk of developing breast cancer. Now, for many of us that have fibrocystic breasts, I was taught in my 20s because I had so many ultrasounds because of fibrocystic breasts. And I was a case study which, embarrassingly enough, I remember I had a whole med student room of young people in there with me.
[00:13:38] And I recall the surgeon saying, “This is a perfect example. We're going to encourage her to breastfeed. We're going to encourage her to report changes that she sees in her breasts.” But typically, my understanding is that fibrocystic breasts do not equate with higher risk of breast cancer. Has that been your clinical experience, your personal experience as a surgeon?
Dr. Jenn Simmons: [00:14:00] Yeah. So, I divide that into two categories, actually. So, when we talk about fibrocystic breasts, we are talking about breasts that have a lot of things going on. We call them busy breasts. [Cynthia laughs] So, there's two categories, two silos that people fall into one is the busy breast that is cystic. They have a lot of fluid filled masses. This is not a proliferative presentation. This is not a situation where you have a lot of growth, you just have a lot of cystic buildup. And this is mostly due to fluctuating hormones grow, don't grow, grow, don't grow.
[00:14:45] And your fluid response to all of that, while it is painful and annoying and often makes your checkups miserable because you get a lot of callbacks and a lot of questions and some people get a lot of aspirations and that kind of thing. So, very annoying, painful, all of that. But that is not associated with an increase in breast cancer. And in my career where I have treated 1000s and 1000s, tens of 1000s of women for breast cancer, I can remember one hand the number of women who developed breast cancer in a cystic breast, they are few and far between. On the other hand, there are people that develop proliferative lesions in the breast. And these are the women that have lots of calcifications, they have biopsies that can't come back with atypia. This is more associated with breast cancer.
[00:15:49] However, in this day, we should be recognizing that and be helping these women reverse this inflammatory proliferative condition. The problem is what our paradigm was watch and wait. And we never helped people to reverse the process or change the trajectory. And now I see that situation as opportunity. So, when I see someone with calcifications in the breast but no mass, nothing palpable, nothing seen on ultrasound, I say, great, we have an opportunity here. Your body is already telling us that what you're doing isn't working. Let's figure out what that is. Let's figure out what you're getting that you don't need. Let's figuring out what you need that you're not getting. But let's take this as opportunity to course correct, to get you back in alignment.
[00:16:53] Because all of these disease states, this is us not being in alignment somehow not being in alignment nutritionally, not being in alignment movement, not being in alignment with spirituality, not being in alignment with purpose, that's what's going on here. And when we are out of alignment, our bodies tell us and they give us signals. So, these are opportunities. But what you should not do is wait for the shoe to drop. If you have this opportunity in front of you and you know that you have something that is moving in the wrong direction, this is the time to seize it. That's why I love the Auria test because it gives you the opportunity to course correct. It gives you the knowledge that you have something going on that needs your attention.
[00:17:49] And I know that my practice is changing how we look at these lesions in the breast. And it's important that we have these discussions that we talk about it and that we don't just say we're going to cut it or burn it or medicate it, that we're going to help women to course correct instead.
Cynthia Thurlow: [00:18:15] Now, the Auria test, is this a one and done test, meaning you have it done once or is it something that's done in series? How does that work?
Dr. Jenn Simmons: [00:18:24] So it's every year if you're at low risk, and it's every six months if you're at increased risk. And so again, this is a test that's done at home on your tears, takes five minutes, totally painless, very affordable. And things change as inflammation in your body changes, things change. And so that's why it's important to do it at least once a year. But for those people who are at high risk, I do recommend that they do it twice a year. And just for the geeks out there who want the statistics, this has a 93% sensitivity, meaning that if you have breast cancer 93% of the time, this is going to detect it. It's interesting that the ones that it misses are actually the late cancers, because there must be something about these proteins that tend to go away over time.
[00:19:24] So, it's very good at detecting early cancer even before it is palpable, and not so good at the later cancers. So, and then the sensitivity is 58%. And that means that 58% of the time if you do not have breast cancer, it is in agreement it's going to be a negative test. Now, what that means is that 42% of the time, if you don't have breast cancer, you're going to get a positive result. So, there are false positives here, but those false positives, I want to be clear, are not real in that you have to have these inflammatory proteins in order for this test to be positive. And there are very few other things that could be there that could trigger this, that give off these proteins.
[00:20:22] So, if your test is positive, you have these inflammatory proteins, you have the inflammation that puts you at risk for breast cancer. So again, even if we can't demonstrate a lesion in your breast, this is very important information to know because we need to change the path that you're on. We need to pay attention to what's happening in your body. We need to pay attention to the micro environment of the breast and the macro environment of the body. What is driving this inflammatory process. So, it's great opportunity. It's great opportunity and you don't have to leave the comfort of your home to test it. So, it can go anywhere, be done anywhere except for New York.
Cynthia Thurlow: [00:21:13] Oh, New York is so frustrating.
Dr. Jenn Simmons: [00:21:14] New York is so frustrating. But I think, for instance, if you come to my clinic in Pennsylvania or go somewhere in New Jersey or some other state, you can do it that way. But New York is just incredibly, incredibly frustrating. I actually heard this story as to why. It's because they're basically raising money from all of these labs around the country. They make the labs get special certification for the privilege of working on New Yorkers. And they don't make it easy. They make them jump through a lot of hoops and a lot of people are like, “Yeah, I'll live without New York.”
Cynthia Thurlow: [00:21:52] Yeah, well, I have clients that reside in that state and when they do certain labs they have to leave the state because they are not permitted to ship from within the confines of the great state of New York.
Dr. Jenn Simmons: [00:22:05] Yeah.
Cynthia Thurlow: [00:22:06] I had also heard that it has a great deal to do with western lab for their lobbyists are so strong within the state of New York that it's made it nearly impossible to play nicely with other labs that are out there which I think is unfortunate.
Dr. Jenn Simmons: [00:22:21] It's despicable especially because Quest and LabCorp, I mean, they are the 800-pound gorillas in the room for sure, but their standards, and I don't mean they're not running a good lab or that kind of thing, but when you get your report from Quest or LabCorp, it is such a false sense of security. Because their guidelines their standard normal include 95% of the population. 95% of the population is not where I want to land. I want ideal, I want optimal. I don't want to fall in their scale of normal. And they really don't give people any opportunity to know what's truly happening or to course correct. Because you're either normal or you failed. And by the time you failed, you have disease.
here is no scale to help you to understand where you truly are and help you to optimize. And so that's what really bothers me about those labs because most people don't have a trusted healthcare person who can advise them.
Cynthia Thurlow: [00:23:38] Yeah. Normal is not optimal.
Dr. Jenn Simmons: [00:23:39]: No.
Cynthia Thurlow: [00:23:40] And that's something that a lot of people don't realize. I was having a conversation with a loved one who has diabetes, but her internist is not calling it what it is. I said, this is the 500-pound gorilla, as you were just alluding to. Your hemoglobin A1c is 8.6, your fasting blood sugar is almost 200, you are menopausal, you have diabetes. And she was so taken aback and frankly upset with me because I was just being direct. And I said, “If your physician is not having this conversation with you, we need to find you someone that will, locally on the ground so that they can deal with this proactively because that did not just happen overnight.” She kept saying, “Oh, it's this past year. And then we were talking about alcohol consumption that you and I have talked about before and how that impacts breast health.” And I said, “One statistic I want to leave you with is one drink of alcohol increases your risk of breast cancer by 7% to 10%.” Does that mean that you don't ever have a glass of alcohol? No, but it means that cumulatively, over time, if you are drinking excessively, habitually, frequently, that can negatively impact your breast health.
[00:24:50] So, that was another nail in the coffin of that conversation. And I said, “I'm just sharing this just so that you're aware,” because that was one of her concerns. I'm concerned about breast cancer. And I said, “Okay, let's talk about your metabolic health. Let's talk about your breast health.” “Oh, but I get my yearly mammograms.” And I said, “It doesn't matter” if all these other things are not where they should be or not optimized, it's going to make you greater likelihood of heading in the wrong direction health wise.
Dr. Jenn Simmons: [00:25:17] And that's another thing. So, many people say that to me. And I can't tell you over the years how many people have said to me, “Wait, I don't understand how I got breast cancer. I get my mammogram every year.” Well, maybe that's why you got breast cancer. But people have been so conditioned to think that mammogram is preventative, right? So, at the very, very best, it is early diagnosis, but in no way, shape or form does it have anything to do with prevention, nothing. In fact, it's causative, quite the opposite. We know radiation in every other scenario causes cancer. I don't know why we don't call this out for what it is. It's a breast x-ray, So, it's going to be carcinogenic, just like every other source of radiation is carcinogenic.
[00:26:05] But you brought up breast cancer being a metabolic disease, and I think that that is such a poorly understood concept, despite the fact that it's all over the literature. I don't even know how many articles have been published linking metabolic disease or not even metabolic disease. You don't even have to get that far. Metabolic dysfunction, having elevated fasting glucose, having elevated fasting insulin, having elevated triglycerides and elevated waist-to-hip ratio, elevated waist circumference. All of these things, individually and collectively make you more likely to have breast cancer. And they are predictive of worse outcomes of metastatic disease and of recurrence, all of it. So, these are directly and linearly tied to breast cancer. And yet we have people walking around with hemoglobin A1cs in the 8s, which means that your blood sugar is elevated all the time. That is a reflection of the last three months of your life. And if this is true, this is metabolic disease and this is a huge risk factor for breast cancer. And yet at the same time, it is one that can be so easily controlled if people knew and understood. And it's not just the patients that don't know. It's the doctors, it's the doctors that don't make this connection or are still practicing in that watch and wait. I'm going to wait for you to be diabetic or maybe they say you have a borderline A1c and you should move more and eat less, which we know does not work and is not helpful for anyone. But the problem goes back to physicians really don't know how to correct metabolic dysfunction. They don't know how to create the environment that drives health. They don't know.
[00:28:11] And I shouldn't pick on physicians. I think most practitioners don't know across the board. And so, we have this whole watch and wait paradigm that has been going on and it's still there. It's still there. And until you fail, until you fall off the wagon, until you get that diagnosis of diabetes, of coronary artery disease, of dementia, until you get there, no one does any. Not knowing that these things can all be reversed if you address them when the dysfunction starts to present itself.
Cynthia Thurlow: [00:28:47] I'll never forget when I was, gosh, this is before I was married. So, we're 2002 timeframe, I had a wonderful friend who was Australian who was here in the United States doing a doctorate. So, he had finished up his medical degree and was here doing a postdoc. And I remember sitting across from him and he said, “I don't understand there is two things Americans deal with terribly” and so I was like bracing myself to hear what he was going to say. He's like, “You guys do a terrible job with diabetes and you do even worse job with asthma.” And I thought to myself, “You're absolutely right.” And this is 20 plus years ago and just with the understanding that this is not new and it takes time for research to trickle into traditional clinical practice.
[00:29:34] But I feel like now we are in an age and you and I trained around the same time where there's just an over saturation of information. But I think that there are still a lot of providers, and you're rightfully so, physicians, nurse practitioners, PAs nurses, etc., that are unwilling to undo or question things that they were taught over 20 years ago. I know that you don't practice the way you did 20 years ago and I don't practice the way I did 20 years ago. And so, we invite anyone that's listening to this just to consider the opportunity that is awaiting you to look at the research and look at the information a little bit differently, to be open to the possibility that what we've been doing needs to course correct for the benefit of our patients.
[00:30:25] We can do more for them. That is really what we're saying is there are more options available than the status quo. Now, Jenn, I had a lot of questions that came in around people whether they've had breast cancer and had reconstructive surgery or people that have electively put in breast implants, asking about the additional cumulative radiation of having additional imaging every time they have mammography and helping them understand that a traditional mammogram is what, like four images? And then if they have implants, they can get eight plus images every year cumulatively over time. In your experience as a breast surgeon, how often were you seeing ruptures, leakage, obscurity, additional callbacks for more imaging because there was something that wasn't clarified, maybe there was a nipple blur. Some of the crazy things that colleagues have shared with me over time because they have implants, the additional exposure radiation cumulatively over time can be quite significant.
Dr. Jenn Simmons: [00:31:34] Yeah, so that is absolutely, positively true. And also, not for nothing, but if you go in for your screening mammogram and they rupture your implant, this is devastating to people. And this is absolutely positively happening. And the older the implant, the more likely it is to happen because of the integrity of the capsule. So, mammograms are a problem for a whole host of reasons, but you certainly don't want to expose yourself to radiation unnecessarily and that's what it's doing. So, in the population of women who have had elective augmentation, so these are just women who got implants, what happens over time is that any breast tissue that was there really does atrophy. So, physical examination is very, very reliable in this population.
[00:32:32] And then if you feel compelled to get imaging, ultrasound is very reliable in this or you can come have a QT scan at perfeQTion imaging. Now, in the women who have had mastectomy, they've had their breast tissue removed and they have implant reconstructions. There is literally no tissue there between the skin and the implant. So, physical examination, looking at your breasts every month and feeling the tissue there, is very reliable. I was not in the practice in all the years that I practiced breast surgery. I did not image my postmastectomy people. I just did physical examination on them and told them to do physical examination on them. Because if you're going to feel something, it's going to be right there. And most of the time that implant goes behind the muscle.
[00:33:34] So, you're literally have everything at access to you when you do a physical examination and feel the tissue. Now if you have someone whose implant is put in front of the muscle, most of the breast cells that remain after a mastectomy, these are mostly located underneath the skin. So, you're still going to have access to them. It is very easy to take the breast cells off of the muscle. So, we generally don't end up leaving breast cells behind in the back. The breast cells that get left behind because you can't remove every single cell but the breast cells that get left behind are the ones that are under the skin. So, I don't think no matter where your implants are sitting, I don't think there's any reason to do imaging or screening for recurrence. I think physical examination is more than adequate.
[00:34:38] But I will say this. I told every woman who had a mastectomy, I don't think you need imaging unless you have a new symptom that you can explain that's been there for more than two weeks. That was my criteria. If that was the case. If you feel something, if you have pain, if you have something that need more than two weeks that you can explain that needs to be evaluated. And that served me really well. I don't have any exceptions that rule everyone who has had a recurrence. It's been obvious, it's been obvious.
Cynthia Thurlow: [00:35:21] No, that's really helpful and kind of in that same vein. Couple questions around. Next step after finding a lump. I've never had a mammogram or other screening, so this person did not identify how old they were. They could be 30s, 40s. They could be older than that. I know for you, you're very clear in your book about the algorithm, if you will, about, if it's certain things, then we have to deal with it immediately. But if you just find a lump, what would be the next best recommendation? Again, broad generalization.
Dr. Jenn Simmons: [00:35:56] Yeah. So, ideally you then contact your provider who is either going to be your gynecologist or your primary care physician and they will either bring you in and do an examination. In my experience, they're not particularly good at discerning what that is. So, if they tell you it's nothing or tell you it's something, either way, I think that everyone with a lump in their breast should see a breast specialist. Because I have had so many, oh, I'm sure this is nothing. And they wind up in my office because it's something. So, I think anytime you feel a mass in your breast, it needs an ultrasound at the very least. And it needs to be identified as either cystic, which is fluid filled, or solid, which means that it's made up of cells. And if it's cystic, that is never anything to worry about.
[00:36:58] Cystic masses are not cancer. They don't turn into cancer. If it is a simple cyst, just a fluid-filled sac in the breast, never anything to worry about. If it is solid, that is a situation where the characteristics matter, what it looks like matters. Is it, well circumscribed or does it have fuzzy, indistinct edges? Is it mobile and moving around? Benign things grow by pushing the tissue away from them and making space for themselves. So, if I feel a mass in the breast and it's solid, but it's moving around. I know now it's not going to move from like 1 o'clock in your breast to 7 o'clock in your breast. That's not what I mean by moving around. But it's not fixed to the tissue around it.
[00:37:50] Whereas, if something is fixed to the tissue around it, I by definition know that's going to be a cancer, but only someone who was experienced in breast examinations and in interpreting the data, in interpreting the images. So, I encourage everyone who has a lump in their breast to somehow get themselves to a breast specialist. But at the same time, the thing I do not want you to do is panic. Because no matter what it is, it literally doesn't matter. No matter what it is, you have time to educate yourself, to get the imaging that you need to get, to get the opinion you need to get, with three very rare exceptions. And one of those exceptions is inflammatory breast cancer. So, inflammatory breast cancer is a condition where you have a normal breast one week, and the next week your breast is red, swollen, and filled with tumor.
[00:38:50] It's very, very dramatic. It is not subtle. No one would ever miss this. So, if you're in that situation, you need help and you need help fast. And outside of that, there are no real emergencies in the realm of breast cancer. So, take your time. If you have pain, that is probably something like a cyst, because it's very fast growing. Tumors tend to be slow growing. Now, we do have something now called turbo cancers that we did not have before 2021. But when we say turbo cancers, we don't mean that they're growing at warp speed. What we mean is the average cancer before 2021 would take 8 to 10 years to become clinically relevant. Now, we have situations where these are presenting six months, a year, two years after a certain event in your life in 2021.
[00:39:58] So, these cancers are becoming clinically relevant much quicker than they did before. And it has to do with your immune system is able to recognize and keep this process dampened in place or it was before we had this event in our lives. And now the immune system is not functioning like it used to, and it can't contain the process in the same way it can't slow down the growth. It's just not able to do its job the way that it did before. So, we are seeing these turbo cancers, and we're not just seeing it in breast, we're seeing them all over the body and in organs and at ages that we never saw them before. I never saw someone with pancreatic cancer in their 20s, in my education, never, never, ever, ever.
[00:41:01] I know three people in my community with pancreatic cancer below the age of 40. It's unheard of. And, this new phenomenon that I don't know if and when it will end. I pray it does, I pray it does, but this is exceptional. And so, I think that we need to pay more attention before. I would be dismissive before, not dismissive in a bad way. But if someone would call me on a Friday and say, “Hey, I have an 18-year-old with a lump in her breast. Can you see her?” And I would say, “You know, is she in college? Send her back, I'll see her on break.” You know that kind of thing. I am not like that anymore.
[00:41:47] Now I see them and I see them now because I want to make sure that what they have in their breast is not cancer. Because, everything is on the table now, unfortunately. But the rules still apply in that if it has benign characteristics, it's going to benign, and if it doesn't, it's not. But you need someone who is able to make that judgment for you.
Cynthia Thurlow: [00:42:10] And when someone, if they have this experience, they find a lump, maybe they have an ultrasound, they're looking for a breast cancer surgeon. Are there specific designations, ways that they can navigate finding someone in their community? Because I would imagine it's in my experience, most of the breast cancer surgeons I know are usually with big hospital systems or they're at big tertiary care centers.
Dr. Jenn Simmons: [00:42:35] Yeah.
Cynthia Thurlow: [00:42:35] How do patients go about locating? Let's just say they're in a more rural part of the country or they're not outside a big city. How do they go about finding a competent, compassionate, caring, astute surgeon?
Dr. Jenn Simmons: [00:42:51] Yeah, well, I can't guarantee that because that's hard. And I am definitely a unicorn in that. There are very few breast surgeons that think in an integrative way, but there is the American Society of Breast Surgery and they do have a directory of their members. And I know that in order to be a member of the American Society of Breast Surgeons, you do have to keep up with the latest information. You do have to be active and be doing mostly breast cancer work. So, if they meet all of those characteristics, at least they can be a trusted source. It may not be a match. You may not agree with everything that they say. They will still probably ask for a mammogram. Depending on your age, you may be able to get out of it, you may not.
[00:43:49] Remember, I never said that no one will ever have another mammogram. I said no one should have another screening mammogram. But a diagnostic mammogram, if it's to get that professional, whoever it is, a breast surgeon, or if it's to get them on your side and to get them to help you work your way through this. That may be what you need to do. And then I do have a radiation protection protocol which is right on my website at Real Health MD. And it is a combination of antioxidants and things that can help you to neutralize the free radicals that are created when you get an x-ray or a mammogram or a CAT scan or a PET scan or anything that uses ionizing radiation.
[00:44:37] And I even quite frankly tell people to do this before they go on that cross-country flight because you are being exposed to radiation. So, there are things that can neutralize the effects of radiation. And so, if you have to have a study, okay, you have to have a study. Just prepare yourself the best you can for it.
Cynthia Thurlow: [00:44:58] No, and I love that and thank you for that. You're absolutely correct that, if you go through one of the regulatory bodies and associations, you may not get the unicorn, but you may very well get an extremely competent, caring, compassionate individual that can help you navigate next steps. Thoughts in terms of environmental exposure to mold. I know it's something that you touch on in the book.
Dr. Jenn Simmons: [00:45:26] Yeah.
Cynthia Thurlow: [00:45:26] I had multiple people asking about mold exposure. When you're working with your patients, are there specific tests that you like to utilize or resources to have their homes tested, if that's a concern?
Dr. Jenn Simmons: [00:45:40] Yeah. So, I universally check people for toxins across the board. And one of the categories of toxins that I'm looking for are mold toxins. Now listen, mold is everywhere. It is ubiquitous. You literally cannot avoid mold. It's in your food, it's in the environment, it's in buildings, it's in your car. I mean, it's literally everywhere. And for 75% of people, that's okay. But for 25% of people, we, because I am included in that category, lack the enzymes that are needed to properly break down mold. We just don't have that detoxification capability in our bodies. And for people like that, we need a lot of support around mold. So, I am using a total tox panel to identify who does have mycotoxins in their body and who doesn't.
[00:46:41] If you have mycotoxins, and I have a list of 40 things that I am looking for in terms of causation for breast cancer, because I don't think it's any one thing. Yes, you can have mold, but I don't think it's the mold alone that caused your breast cancer. It didn't help. But maybe it's the mold that exhausted your immune system, and that is what really led to breast cancer or maybe you had been fighting mold for a long time and then you went through a divorce or a death in the family and you had some other trigger. Because it's never one thing. And we want to look at it in terms of, “Okay, here's the list. What's affecting me?”
[00:47:22] But if mold is one of the things that is affecting you, and we know that you have mycotoxins in your body, we're definitely looking to bind them, to get rid of them, to do things, to release them and get rid of them. But we also want to know that there's no more coming in. So, you can do your own mold testing in your home and use an ERMI test. You can go to moldpros.com and find out who in your area does mold testing, and you can pay a professional to come in. If you find mold in your home, I advise you to get a professional to remediate it. Please don't do the remediation yourself, because if you're already sick and you try to do that remediation yourself, I promise you you're going to get a lot sicker. very hard to undo that damage. So, that is one thing that is going to affect 25% of the population. How much it affects you depends on your exposure and amount of time that you've been exposed. But it can be corrected. But remember, if you've been living in mold for five years, you're not going to get better in three weeks. [crosstalk] So, it's going to take time. And you just have to have a lot of patience and understanding with yourself, because mold and the effects of mold, it affects the way you think, it affects the way you feel, it affects your emotional health, it affects your physical health, your neurological health. So, there's a lot that goes into healing from mold.
[00:49:11] So, I advise anyone who has been exposed to mold, who has any symptoms of mold illness, work with someone who is familiar with mold illness, because you can't even think your way through it. It's very, very difficult. But there is a great book by Neil Nathan called Toxic that I recommend to anyone who is struggling with mold illness.
Cynthia Thurlow: [00:49:33] Thank you for that. I think that for a lot of people, because you can't see it, you assume it's not problematic. But I can tell you, as someone that's part of that 25%. Now, when I go to hotels, as soon as I walk in a room, I can tell if I smell something moldy, musty, I automatically will ask to change my room, but I know what it can set me up for. And I live in a very humid part of the United States and the amount of extra things we did while building this house in order to mitigate mold because one thing that a lot of people perhaps don't realize is that it might be your third or fourth or fifth exposure that you suddenly get sick. It doesn't necessarily have to be your first or your second.
[00:50:17] And I think that in many instances it seems like this perimenopause to menopause transition can be a point of vulnerability. We know our immune system is impacted quite profoundly into that menopausal transition. So, is it any wonder that a lot of people that I interact with, they'll say, “Oh, I felt great until.” And it really coincides with this hormonal changes.
[00:50:43] Now, a lot of questions came in around breast tenderness, on hormone replacement therapy is this dangerous or concerning? Obviously, this podcast is very pro in determining whether or not hormone replacement therapy is the right decision for you. As a surgeon when patients came to you and they had breast tenderness on hormone replacement therapy, did you-- in the context of a good physical exam and diagnostics, was that generally something that got you concerned or was it something that you were less concerned about? Again, kind of broad strokes, not providing medical advice.
Dr. Jenn Simmons: [00:51:19] Yeah, of course. So, you know my philosophy on hormone replacement, especially in the breast cancer population, because I strongly, strongly believe in it and encourage it. I think that this is a population that is ignored. They're basically like, put out to pasture and told that they should be grateful to be alive. And they are grateful. But it's hard to feel grateful when you have brain fog and you're depressed and anxious and worried about a recurrence and you've gained weight, you feel unattractive, you've had surgery, your breasts are deformed or absent, you have palpitations, you don't have the energy you want, your gut isn't performing the way that it used to, you're bloated, you have reflux, your joints ache, your bones ache, you're told that you have osteoporosis, you have no libido, your relationship is suffering, sex is unwanted and painful, you have bladder leaks. Like, it's hard to feel grateful when all of this is going on.
[00:52:27] And yet this population has been told that they're not candidates for hormone replacement. And the truth is that there's no data to support that. It's another urban legend. It's old wives tale. It's a narrative that was created for the purposes of selling pharmaceutical drugs. Have estrogen receptors, give estrogen blockade. Well, normal breast cells have estrogen receptors. So, my reason to give hormone replacement is the same across the board. If you've had breast cancer or haven't had breast cancer, what we're trying to do is preserve your brain, preserve your heart, preserve your bones, preserve your skin, your mind, like all of it.
[00:53:10] We're trying to keep women out of nursing homes, wheelchairs and adult diapers. This is our goal. It's not too lofty. And with that in mind, you don't need much. And most women who are put on hormone replacement are taken to supratherapeutic area levels, levels that they don't need to preserve their brain health, their heart health, their bone health, their vaginal health. They don't need as much as they're getting. And often times people are not being monitored, these levels are not being measured. And so, they're walking around with symptoms like breast tenderness or this euphoria.
[00:53:55] And you can be happy, you can be comfortable, you can get rid of the anxiety, you can have a sexual appetite, you can have bone health, you can have heart health, you can have all of that without being super therapeutic. So, I prescribe hormone replacement for my women who have had breast cancer. I prescribe hormone replacement for my women who have had hormone-positive breast cancer. But I do it in a measured and monitored way. And if you're not monitoring your patient's hormone replacement and hormone levels, then you are not doing them a proper service.
Cynthia Thurlow: [00:54:39] I couldn't agree more. It's interesting because the advent of—and I don't mean there are providers out there that do a beautiful job with pellets, but more often than not, what I see is women who have super physiologic estrogen, testosterone, they feel great the first- [crosstalk]
Dr. Jenn Simmons: [00:54:57] They do [laughs]
Cynthia Thurlow: [00:54:58] -once. Second time having a pellet inserted, and then they don't. And what's interesting is because of this podcast, I get to interact with so many providers, researchers, and I pick everyone's brains. And the consistent concern that I receive is when we're talking about super physiologic dosing, we're not talking about the dosing where we would have been when we were young women, teens, 20s, 30s, we're not talking about that. We're talking about something that supersedes even those levels. And in some instances, there are providers out there that are dosing women with testosterone at such high levels. They are at levels where men would be.
Dr. Jenn Simmons: [00:55:42] I know.
Cynthia Thurlow: [00:55:44] And I was talking to Dr. Pam Smith, who is big within the integrative medicine space, very well respected, and she said, “I see so many young women, 30s, early 40s having their first heart attack because they are in super physiologic doses of testosterone in most instances.” And she said, “I find this greatly concerning.”
Dr. Jenn Simmons: [00:56:06] Completely agree with you. And I do think that a lot of the problem is that this is not being taught. It is not part of the general curriculum for practitioners. [crosstalk]
Cynthia Thurlow: [00:56:19] Weekend course.
Dr. Jenn Simmons: [00:56:20] It is not. It's a weekend course that people go back to their practices and hang a shingle out and they get a lot of positive response. People feel really good in the beginning and hormone euphoria is very real in the beginning. And it's not until they are down the road that they start to run into problems. And by the time you have a complication, for a lot of people it's bad. So, we need to do a way better job of training our practitioners. This should be part of everyone's basic curriculum so that if you're going to go out there and give hormone replacement and I am still an advocate for bioidentical hormone replacement.
[00:57:12] I know that there are people out there who believe that you can give anything and you can give the synthetics and you can use all the different delivery methods. But I am an advocate for bioidenticals. But even with that, people can get into trouble if you are giving supraphysiological doses and you simply don't need it. You don't need it. All you need is enough to maintain tissue health. And that is not nearly as much as most people are getting. And it is not nearly as much that would bring on a-- I have a friend who's like happy because she started to menstruate again. That's how much hormone replacement she's on.
[00:58:09] And I'm like, “No, no, no we do not want this.” We are not trying to recreate fertility, we're not trying to bring back menstruation, we are not trying to recreate these levels that people have in their 20s. That's not what we're after. We are after that amount that preserves health and allows us to live our lives, keep our brains working so that we don't have to walk into a room and say, “Wait, why did I come in here again?” We want to keep women out of wheelchairs, out of nursing homes, out of adult diapers. In their lives, in their heads, in their relationships. That is what we're after.
Cynthia Thurlow: [00:58:48] Yeah. I could not agree more. I couldn't said it better myself. Okay. Lots of questions around medications like tamoxifen. I don't know if you're comfortable answering some of these. There was one that came in. Is tamoxifen necessary to reduce reoccurrence? This is usually a drug that's used in menopausal women with breast cancer. We can skip over it if you prefer. It might be a little too personal and we can move on. We have so many other questions we could put on.
Dr. Jenn Simmons: [00:59:15] I'm happy to address tamoxifen. I just want to correct a little something.
Cynthia Thurlow: [00:59:19] Okay.
Dr. Jenn Simmons: [00:59:19] So, tamoxifen is a SERM. It's a selective estrogen receptor modulator, and it is used in the premenopausal population, not in the menopausal population. In the menopausal population-- [crosstalk]
Cynthia Thurlow: [00:59:31] Thank you for correcting me.
Dr. Jenn Simmons: [00:59:33] No, no problem. I just want people to be clear about it. In the postmenopausal population, people are using a drug class called the aromatase inhibitors. And what the aromatase inhibitors do is prevent the testosterone in your body from being converted into estrogen. So, the tamoxifen family of things, the estrogen receptor modulator, this is a synthetic form of estrogen. This is an altered form of estrogen. It doesn't exist in nature, it doesn't exist in our body. And what it does is it is given at such high doses that it basically crowds out the estrogen and saturates the estrogen receptors in your body and prevents estrogen from binding and doing what it's supposed to do. So, it does reduce breast cancer recurrence, incidentally, so does estrogen. [laughs]
[01:00:37] And we see that in the data again and again and again that if you would give estrogen, it would also prevent breast cancer recurrence, because estrogen neither causes breast cancer or leads to breast cancer progression. However, tamoxifen, because it is a synthetic estrogen, because it is an altered estrogen, and because it is a xenoestrogen, it is not our inherent estrogen. It is a carcinogenic drug and leads to uterine cancer because it has an opposite effect. In the breast, it has an effect of decreasing growth and stimulation, but in the uterus, it has the opposite effect and it increases growth and stimulation. So, I am not a fan of tamoxifen, but my biggest objection to tamoxifen, to the aromatase inhibitors, to this whole paradigm is that we are saying, “Okay, you got breast cancer. We don't care about why, we're not thinking about why. We're going to give you this drug afterwards and tell you to change nothing. Don't change the way you eat, don't change the way you move, don't change the way you think, don't change the things that you use, don't change the things that you put in, on and around you, just take this drug.”
[01:02:04] Some just taking the drug for most people is not helping them be healthier at all. We all have to remember breast cancer is not a drug deficiency. It's not a surgery deficiency, a chemo deficiency, a radiation deficiency, a tamoxifen deficiency, an aromatase inhibitor deficiency. Breast cancer is a normal response to an abnormal environment and it is due to that environmental shift to that metabolic shift to whatever happened to lead those cells to go into survival mode.
[01:02:38] So, what we should be talking about is how do we help women to shift that environment? I know breast cancer happens to men too. I'm sorry, I'm just conditioned to say women. How do we help people who are affected by breast cancer to shift that environment back to the chemistry of joy, from the chemistry of stress. So, whether or not people should take tamoxifen, I don't know. Are you going to change nothing? Are you going to do things exactly after your diagnosis than you did before? Then maybe tamoxifen will help lower your risk of recurrence. It will also increase your risk of getting uterine cancer. So, I don't know. That's not a coin that I would want to flip that, both ends suck. I think what we should be talking about with everyone is “What are you going to do next? What are you going to change? What are you going to do to change this path that you're on, to change this trajectory that you're on?” Because I would hope that most people would see this as a genuine and beautiful opportunity for change.
Cynthia Thurlow: [01:03:51] Course correction is important. Okay, three relatively easy to answer questions because I've been filtering them through as quickly as I can. Number one, if you were to give one important way to reduce risk for breast cancer, what would be a low-lying fruit?
Dr. Jenn Simmons: [01:04:10] Yeah. So, I think that metabolic health is probably the most important thing. And what doesn't get measured doesn't get done. So, every single person should know this about themselves. What is your fasting glucose? What is your fasting insulin? What is your waist-to-hip ratio. If your fasting glucose is above 90, if your fasting insulin is above 5, if your waist-to-hip ratio is greater than 0.8, you are at increased risk for breast cancer. Now I understand that those numbers are ideal, but that's what we should all be striving for. And it is very unusual for most people. This applies to 80% of people that get breast cancer. 20% have very complex issues and that's why they got breast cancer. But 80% of the time, breast cancer is preventable.
[01:05:15] And it's because there is either metabolic discourse or some kind of environmental impact that is affecting their overall health. And these are very easy things to measure. These are very easy things to know about yourself. If you're going to do those labs, I would probably add on a vitamin D and make sure that your vitamin D is between 60 and 100. And I would add on high sensitivity C-reactive protein to know what is your baseline level of inflammation that you're working with. And that number ideally should be less than 1. So, if you know those five characteristics about yourself and they are normal, this is going to significantly reduce the likelihood that you're going to get a breast cancer.
Cynthia Thurlow: [01:06:07] Perfect do long fasts, anywhere from 36 to 72 hours cause breast cancer to metastasize? I know you and I have the same answer to this question, but I was asked this question multiple times so it clearly needs to be stated.
Dr. Jenn Simmons: [01:06:22] I know, it is amazing to me and there must have been something that came out recently that said that fasting leads to metastasis because I've gotten this question a bunch, but I have not seen anything more dramatic or compelling than fasting for disease reversal. It is absolutely astounding to me what prolonged fasts can do in terms of disease reversal. So, that's pretty much where I tell everyone to start is while you are gathering your information, unless you already have cachexia. Cachexia, so everyone knows this is a very end-stage finding where your metabolism is so hyped up because you're really overwhelmed with tumor. And this is the rarity. Most people that get diagnosed with breast cancer get diagnosed very early. Fasting is amazing at restoring metabolic health, at reversing disease, at kicking your body's healing processes into place.
[01:07:35] Autophagy, I do not know of something more effective than fasting. So, you can do water fast, you can do the fasting mimicking diet which was made famous by Valter Longo. So, any form of fasting in my opinion is healing and I do tell people to start off on their journey with water fasts. I recommend, unless of course you have cachexia, that you do a 72 hour or three-day water fast every quarter. And we're doing them as a group at Real Health MD. So, if you're interested in doing that, you can follow along with us.
Cynthia Thurlow: [01:08:21] I love that. Okay, very last question and honest to goodness, I got asked this question multiple times too. [Dr. Simmons laughs] Is it safe to take creatine monohydrate post breast cancer? So, someone has been diagnosed, been treated, asking about a very well-studied researched supplement. There were a lot of questions about supplements, but this is the one that actually came up multiple times. That's usually my tell. It's like, “Okay, we're going to ask this question for sure.”
Dr. Jenn Simmons: [01:08:49] Yeah. So, here's the thing, and this is where this thinking came from. It's this concept that, well, tumor requires protein and if you give yourself protein, you're going to increase cancer growth. So, we need protein. We absolutely need protein. And as we age, certain things fall off and creatine is one of them and we need more as we age. I do not advocate for high-protein diets. You should never be doing that. But there is a huge difference between a high-protein diet and an adequate protein diet. So, everyone needs to get adequate protein or else your body can't heal, your body can't do what it is supposed to do. So, we need to support our body and give our body what it needs. And creatine is one of those things. So, this is not causing breast cancer. It is not causing breast cancer to grow or to metastasize or anything like that.
[01:09:55] But at the same time, you shouldn't be doing anything in excess. You should not be consuming two and three times more protein than your body is able to use. Everything needs to be done in moderation. Which is not to say that we should be doing everything in moderation, like cookies and cupcakes, that's not what I'm saying. I just don't think we should be doing large, super therapeutic amounts of anything. And you know, that goes for supplements. So, the right amount can be really helpful and the wrong amount, too little and too much can be harmful. This is true of everything.
Cynthia Thurlow: [01:10:41] Well, as always, such an honor to connect with you. Please let listeners know how to connect with you, how to work with you and your team directly, how to purchase your book and listen to your podcast as well.
Dr. Jenn Simmons: [01:10:51] Yeah, amazing. So, my practice is called Real Health MD and you can reach us at realhealthmd.com. We are working with women who are recently diagnosed, in treatment, you're beyond treatment and wondering now what, you're living with metastatic disease. We have programming for all of those people and we have programming for women who have been treated for breast cancer and are looking to get their life back. And this is certainly offering them hormone replacement-- bioidentical hormone replacement, but also giving them all the other tools that we know drive health. So, that's what we're doing at Real Health MD.
[01:11:39] And then my book for anyone who is dealing with a breast cancer diagnosis or you just love someone and you want them to have the information that can both prevent and reverse breast cancer, my book is called The Smart Woman's Guide to Breast Cancer and it's available on Amazon. If you want to hear more of what I have to say and amazing interviews like Cynthia Thurlow, you can listen to me on my podcast, Keeping Abreast with Dr. Jenn. And then you can follow me on all the social media outlets @drjennsimmons. My Jenn has two N. And if you're wondering about breast cancer screening, this is what we're doing at perfeQTion imaging, perfeqtionimaging.com.
Cynthia Thurlow: [01:12:28] Well, thank you again. Thank you for being so generous with your time. Not once, but twice in this past month for our community.
Dr. Jenn Simmons: [01:12:35] My pleasure. I'm so happy to be here.
Cynthia Thurlow: [01:12:39] If you love this podcast episode, please leave a rating and review. Subscribe and tell a friend.