Hormone Therapy and Breast Cancer: What Women Need to Know About Risk, Screening, and Prevention | Jenn Simmons

Dr. Brighten: [00:00:00] What is the risk of starting hormone therapy when it comes to breast cancer? It is the synthetic progestogens that increase your risk because 

Dr. Jenn Simmons: Dr. Jen Simmons 

Narrator: A fellowship-trained breast surgeon, integrative oncologist, and founder of Perfection Imaging. 

Dr. Jenn Simmons: After 17 years in breast oncology, 

Narrator: she's now leading a powerful conversation on breast cancer detection, survivorship, and whole-person healing.

Dr. Jenn Simmons: According to the American Cancer Society, there is no safe amount of alcohol for a woman, and alcohol is one huge modifiable risk factor in the prevention of breast cancer and breast cancer recurrence. 

Dr. Brighten: What do you wish every woman knew about the birth control pill and breast cancer risk? 

Dr. Jenn Simmons: There was a Danish study of 1.8 million women, and that showed a linear relationship between 

Dr. Brighten: There's a lot of women listening who are afraid of starting estrogen therapy because of potential breast [00:01:00] cancer risk.

Mm-hmm. I'm sitting down with a breast cancer expert. Mm-hmm. So I have to ask, what is the risk of starting hormone therapy when it comes to breast cancer? 

Dr. Jenn Simmons: The Women's Health Initiative was actually two trials. It was a combined synthetic progestogen trial along with conjugated equine estrogen, so non-bioidenticals, but it was also an estrogen alone arm, so just that conjugated ex- equine estrogen arm.

And the only place where we saw an increased risk of breast cancer was in that combined arm. Mm. In that conjugated equine estrogen, along with a m- along with medroxyprogesterone, which is not bioidentical, and it is the, it is the synthetic progestogens that increase your risk. Because in the estrogen alone arm, we actually [00:02:00] saw a decreased incidence of breast cancer.

So if you're talking about bioidenticals, though we don't have the large trials that, that we have in the, in the synthetic, um, non-bioidentical space, but we do have 20 studies in, in the post breast cancer space that show that there is no increased risk if you are not using those synthetic progestogens.

Mm. And it's only with the synthetic progestogens that we see an increased risk of both primary breast cancer and recurrence. 

Dr. Brighten: Mm-hmm. So I like that you highlighted that it's not actually progesterone, because most clinicians will say, "Well, what that study showed us is that we shouldn't use progesterone unless there's a uterus."

However, progestin is not progesterone. That's right. What do you wish every woman knew about the birth control pill and breast [00:03:00] cancer risk? 

Dr. Jenn Simmons: Well, we have very, very clear data on that. There was a Danish study of 1.8 million women, it was released in 2018, and that showed a linear relationship between Hormonal birth control and all of the hormonal br- birth control contained progestogens.

Not all of it contained estrogen, but if you were on any hormonal birth control that contained synthetic progestogens- 

Dr. Brighten: Mm-hmm ... 

Dr. Jenn Simmons: you had an increased risk of breast cancer, and that risk was linearly related to how many years you were taking a synthetic progestogen. And the degree to which it is unsafe is the length of time that you are on.

Now, we know that if you don't develop breast cancer within five years of its use, your risk does reset. So if you get- 

Dr. Brighten: Within five years of coming off? Mm-hmm. Or five years being on it? 

Dr. Jenn Simmons: Within five years of [00:04:00] coming off. 

Dr. Brighten: Mm-hmm. 

Dr. Jenn Simmons: So you're at increased risk until you hit that five-year mark of coming off, and then it resets to the general population.

But there is absolutely a, a, a risk, and it's not related to age as much as it's related to the length of time they are on synthetic birth control pills. Or not even, not even pills, any synthetic progestogen hormonal birth control. And I wish people knew that. I- it's not only patients. I wish providers knew that.

Dr. Brighten: Mm-hmm. 

Dr. Jenn Simmons: Because even the providers prescribing are either unaware of this data or they're ignoring it. But it's been out there and available, and I just think that there- Their hands are tied in a way because it's all they know. 

Dr. Brighten: Mm-hmm. 

Dr. Jenn Simmons: So if you only have a hammer, all you see are [00:05:00] nails. And they are not trained in how to deal with hormonal abnormalities, cycle abnormalities, um, estro- the symptoms of estrogen dominance, and they, they are not knowledgeable with regard to the various bioidentical hormones, what they do, and how to support people with hormone imbalance.

They're just not trained to do anything but write for birth control pills. 

Dr. Brighten: Mm-hmm. 

Dr. Jenn Simmons: And so they want to help, but they don't have the skills, and this is where the removal of the black box warning really concerns me. 

Dr. Brighten: Mm-hmm. 

Dr. Jenn Simmons: Because now we are normalizing hormone replacement, but most providers are not trained on how to do that safely, effectively.

They don't know how, what to prescribe, when to prescribe it, or how to monitor it. So what's gonna [00:06:00] happen is all of these women are gonna go to their doctors demanding hormones. Their doctors are going to hear this universal message that the black box warning was removed, it must be safe, and they're gonna prescribe them what they know to prescribe.

Hmm. Which is birth control pills. 

Dr. Brighten: Yeah. 

Dr. Jenn Simmons: Right? And we're gonna create a problem all over again, and- Though I don't think the black box warning should have ever been there, I think that is a far cry from removing it and saying to everyone, "Okay, just go back to doing what you were doing before," because that's not the right thing either.

We need to train our professionals. We need to train our providers. They need to learn about bioidentical hormones. They need to n- be hormone proficient, and it's only from that that we're really gonna help women. 

Dr. Brighten: Mm-hmm. 

Dr. Jenn Simmons: So while there have been hundreds of thousands [00:07:00] of women who have died prematurely, and millions of women who have suffered unnecessarily because of the conclusions of the Women's Health Initiative, I don't think the answer is to go back to doing it the wrong way.

The answer is educate our providers and do it the right way. 

Dr. Brighten: I want to echo what you're saying, because it, it was one of my concerns in watching the FDA consider all of this, is there was no consideration that the vast majority of first-line providers for menopausal care aren't actually trained in menopausal care- 

Dr. Jenn Simmons: No

Dr. Brighten: and aren't actually trained in hormone therapy. Mm. We even see, you know, there are many well-intentioned providers who are now getting more vocal in the online space about this. However, they've got less than five years experience actually prescribing, and I've watched many of them make the mistake of being like, "Well, we can just give you a progestogen.

No risk. It's the same progesterone." So I [00:08:00] think we are at a place where you and I have been in medicine long enough to watch that pendulum swing in so many arenas, and we're going to see a lot of harm is done if we do not get information out to women. You have a podcast, I have a podcast. We're on stages, wherever we can be, training providers, like, trying to make that change.

But for people listening right now, how can they know they're getting the right hormones from their provider? Because even the scientific literature will call it progesterone. 

Dr. Jenn Simmons: I know. 

Dr. Brighten: So what can women be looking for? What are the key things to know you are getting bioidentical progesterone? 

Dr. Jenn Simmons: Yeah, I think you need to ask just that, right?

And if your provider looks at you with, you know, 10 heads and s- and doesn't know what bioidentical hormones are, and y- if you can't have an educated conversation with them, this is not the right provider. 

Dr. Brighten: Mm-hmm. 

Dr. Jenn Simmons: And I know that there are a lot of vocal voices out there like yours, like mine, like, i- the [00:09:00] there are some people out there with really good information.

There are also some people out there with very loud voices who don't have such good information. 

Dr. Brighten: Mm-hmm. 

Dr. Jenn Simmons: And I think it's gonna be a little treacherous for the next five, 10 years. It really is, and it's gonna be hard for women. But- That we're just going to have to rely on the fact that we're out there Continuing to hammer this message over and over and over again, that women should be speaking to their provider, and if they're, and, and asking those honest questions.

You know, how much experience do you have in this? What are you accustomed to providing? 

Dr. Brighten: Mm-hmm. 

Dr. Jenn Simmons: How am I being monitored? Because if all they're doing is writing a script for you and not monitoring you, that's not the right thing either. So, how are you following me? How are you keeping me safe? And if they don't have answers to these [00:10:00] questions, you need to go find another provider.

Dr. Brighten: Mm-hmm. What is the appropriate monitoring that you recommend women look for and that providers answer when they're seeking a hormone prescription? 

Dr. Jenn Simmons: You start with an understanding between you that this is a partnership here, and I have expectations of you, just like you have expectations of me. And what I expect from you is that you are going to follow my recommendations for how you eat and how you drink and how you move and how you sleep and o- and how you detoxify and the toxins coming into your environment, and you are going to submit your samples because I'm monitoring your levels every six months.

You are going to fill out the questionnaires to let me know where you are from a symptom standpoint because I wanna make sure that you're not suffering, right? I wanna make sure that you don't have the symptoms that we all worry about [00:11:00] in this menopausal space. But at the same time, I have a responsibility.

I have a responsibility to you, and you have a responsibility to me. 

Narrator: Mm. 

Dr. Jenn Simmons: So, even when all you do is monitor symptoms, when you look at those people's hormone levels and their hormone metabolites, you will only have them in optimal ranges 33% of the time, and 33% of the time you're gonna be overdosing them, and that's a problem.

Mm-hmm. 33% of the time you're gonna be underdosing them, and that's a problem, too, right? Because the whole reason that we are giving women menopausal hormone therapy is that we're looking to help them with their longevity because we know that it protects the brain, it protects the heart, it protects the bones, all of these things that we are concerned about in the long run.

Because lest we forget, the same number of women that die of breast cancer every year die as a result of a complication of a fracture. 

Dr. Brighten: [00:12:00] Mm-hmm. 

Dr. Jenn Simmons: So, bone health matters. Lest we forget that the number one threat to a woman's life, even a woman with breast cancer, is cardiovascular disease. So, cardiovascular disease is exponentially the number one threat to a woman's life from the time that she's 30 on.

Dr. Brighten: Mm-hmm. 

Dr. Jenn Simmons: Exponentially. So, we have to think about the heart. We have to protect the heart. We have to protect the great vessels. So when we are working with these women, we don't want them underdosed because we wanna make sure that they are getting the benefits that we intend for them. And our goal is not to bring back fertility, to bring back menstruation.

Our goal is to have women live with dignity as long as they can. 

Dr. Brighten: From your clinical perspective, what is the number one thing women misunderstand about breast cancer? 

Dr. Jenn Simmons: Well, I think it starts from screening. So it starts from the very start, where we all think [00:13:00] that we are saving our life or saving our breast, or maybe both, if we act like good girls and screen with mammogram.

And the data actually from the wisdom trial was released last week, presented last week at San Antonio, and I would love to talk about that. But let's, let's start with where this whole mammographic screening program came from, because it actually came from an invitation to screen only trial in the UK in the late '60s, early '70s, and it was done by Professor Michael Baum, who is a surgeon in the UK.

And it is probably the biggest regret of his life because he took the results of that trial, which were that if you screen with mammogram, if you take 1,000 women over 10 years and you screen them with mammogram, 4 out of that 1,000 will die of breast cancer. And if you [00:14:00] don't screen with mammogram, 5 out of that 1,000 will die of breast cancer.

Four is 20% less than five, and so the headline was, "Mammogram reduces your risk of dying of breast cancer by 20%." 

Dr. Brighten: Mm-hmm. 

Dr. Jenn Simmons: And the world ran with it, and we started all of these mammographic screening programs. But what was not included in this announcement was that the same number of women died of cancer in both groups.

There was absolutely no overall survival advantage. And if you screen with mammogram, you will cause 100 out of that 1,000, so 10%, will undergo unnecessary studies, more imaging, unnecessary biopsies, because all of those biopsies were benign. 

Dr. Brighten: Mm-hmm. 

Dr. Jenn Simmons: Right? And so it doesn't [00:15:00] account for the harms, and the harms are not insignificant.

If you're harming 100 women in order to diagnose an extra one out of the 1,000, are we really doing the right thing with that? So But the, the media headline was what everyone used, and they started mammography screening programs all across the world based on that study And since then, it hasn't gotten better.

It's only gotten worse. And we have, for decades, known that there is no survival advantage to screening with mammogram. 

Dr. Brighten: If mammograms don't save lives from breast cancer, what does? 

Dr. Jenn Simmons: Well, we all know how to prevent breast cancer, right? Breast cancer is largely a preventable disease, and what saves lives from breast cancer is all the things, all the foundational tools that we talk [00:16:00] about every single day.

Eating in a way that nourishes your body and avoiding all of those f- that, that standard American diet, right? Because we know that that standard American diet is very pro-inflammatory, and breast cancer is a metabolic disease, it's an environmental disease, and it is the end li- end of the line, the result of chronic inflammation over time.

So if you get rid of the things that cause chronic inflammation, you reduce the incidence of breast cancer. You also reduce the deaths from breast cancer, because even if you are diagnosed with breast cancer, if you then reduce your metabolic burden, if you reduce your environmental toxins, then you have better outcomes.

So even if you get a breast cancer diagnosis, doing all of these things to mitigate your risk of recurrence changes that outcome. So we, of [00:17:00] course, talk about diet. We talk about what you drink. Are you drinking clean water? You know, alcohol is a big thing. 

Dr. Brighten: Mm-hmm. 

Dr. Jenn Simmons: We have normalized alcohol for social reasons, and I get it, and don't shoot the messenger, but according to the American Cancer Society, there is no safe amount of alcohol for a woman.

This is one area where men and women are not equal. 

Dr. Brighten: Mm-hmm. 

Dr. Jenn Simmons: Are not equal. Our hormonal systems are far more complex than theirs. A lot of us is far more complex than theirs, right? But we just don't have the metabolic capability that they have, and alcohol is one huge modifiable risk factor in the prevention of breast cancer and the prevention of breast cancer recurrence.

So that's another thing that we need to be thinking about. We need to be thinking about sleep, because sleep is where the healing happens. Sleep is where all of our repair [00:18:00] mechanisms get kicked in. So if you're not sleeping, you're not healing, and if you're not healing, then you are subjecting your body and your cells to more oxidative stress, more oxidative damage.

That's what breast cancer is, right? It is that initial mutation that is n- goes unrecognized by the immune system, and it is allowed to progress into a tumor, right? We all have individual Cancer cells floating around us from the very young to the very old, everyone in between, we all have cancer cells.

But an intact immune system is going to recognize those cells in their infancy and destroy them. But what kind of state is all of our immune systems in now? Our immune systems are so taxed. They're so challenged by our time management, by our last lack of rest and relaxation, by our stress levels, by all the environmental toxins that we are exposed to day in and day out.

So that [00:19:00] can largely tie into how much sleep are you getting, how much rest are you getting, how much relaxation are you getting, how much are you allowing your body to rest, reset, heal itself. 

Dr. Brighten: Mm-hmm. 

Dr. Jenn Simmons: Right? And then movement is another piece of it. We are not meant to be sedentary. We are meant to be nomadic people who have to move for their food, hunt for their food, move for safety, move sh- for shelter.

This is what we are... our bodies are designed to do. We are modern beings living on a very old gene code. Mm-hmm. And our bodies were meant to move. Our bodies were meant to lift heavy things. We are built to be strong and nimble, and we're not doing that, right? Even for the people that are exercising, we have a lot of exercising couch potatoes.

We have a lot of exercising workaholics [00:20:00] who go to the gym and then sit at a desk for the rest of their day. 

Dr. Brighten: Mm-hmm. 

Dr. Jenn Simmons: Right? And so when we are thinking about prevention, when we are thinking about how to both primarily prevent a breast cancer diagnosis and to reverse and prevent a recurrence, we have to think about all of these things in the context of what is our allopathic load, right?

How many toxins and in what form are we asking our body to deal with? Because the breast is the canary in the coal mine. 

Dr. Brighten: Mm-hmm. 

Dr. Jenn Simmons: And the breast will tell you when you have exceeded that toxic burden. So all of our focus should be on containing, minimizing that toxic burden, but also working through the toxins because you can't avoid everything.

Working through the toxins you're exposed to and having those [00:21:00] detoxification practices built into your life every day. And when you do that, you can minimize your risk. You'll never eliminate it. There's no such thing as eliminating, entirely eliminating your risk. But we can mitigate it. We can reduce it.

And we, we can live life in a very conscious way, but you need to. Because at the end of the day, breast health is health, and the same exact things that you're gonna do to have healthy breasts are going to give you a healthy brain and a healthy heart and healthy gut, healthy skin, healthy libido, healthy everything.

Dr. Brighten: Mm-hmm. What are the early signs of breast cancer that medicine and doctors may be missing, but women should definitely be aware of? 

Dr. Jenn Simmons: So that's part and parcel to the problem- 

Dr. Brighten: Mm-hmm ... 

Dr. Jenn Simmons: is that there are no really early signs of breast cancer in terms of clinical signs. Because most of the signs of breast cancer, things like having a lump in your breast, [00:22:00] by the time you can feel that lump in your breast, like a one centimeter mass in the breast, is, that's- That's billions of cells.

Dr. Brighten: Mm-hmm. 

Dr. Jenn Simmons: Right? So that is not early. That's not early detection. That's actually late detection. Now, does it mean it's not curable? No, of course not. But there are no clinical signs of early breast cancer, but the amazing part is that there are now safe ways to find those very early markers- Mm-hmm ... of breast cancer.

So I'm not talking about circulating tumor cells tests, because those two are not exactly early signs, and we don't know what to do with that infor- information. But there is something called the Aria Tears test. What it is is it's a test that uses the fluid in your eye, your tears, in order to look for these inflammatory proteins [00:23:00] that are highly correlated with early breast cancer.

So in a five-minute, at home, 100% safe, comfortable, affordable way, you can screen for these precursors of breast cancer. And I think this is going to forever change how we screen for breast cancer, because what I'm doing is I'm having everyone do this test, and this is a test that you would do once a year.

If your test is clinically positive, then we know that you have the inflammatory precursors of breast cancer, so we have you go get imaging. And if that imaging is negative, I mean, obviously, if it's positive, you have breast cancer and you go to get treated. Mm-hmm. 

Dr. Brighten: And when you say imaging, are you talking about mammogram with ultrasound, ultrasound only, or?

Well, for 

Dr. Jenn Simmons: me, I'm having everyone either do the QT scan, like what we do at Perfection, which is sound waves transmitted through a warm [00:24:00] water bath that gives a true 3D reconstruction of the breast. 

Dr. Brighten: Mm-hmm. 

Dr. Jenn Simmons: But if you don't have access to that, then I, I do ultrasound. I use either QT or ultrasound to demonstrate the presence of clinical disease now.

Dr. Brighten: Mm-hmm. 

Dr. Jenn Simmons: And if that is negative, what you have is the knowledge that you have the inflammatory precursors of breast cancer, and you have the potential to prevent a diagnosis. Because we know if you do nothing, in six months, if you re-image that person, another, uh, uh, 11% will have clinical evidence of breast cancer.

So it's really an amazing golden opportunity to prevent a breast cancer diagnosis. 

Dr. Brighten: Mm-hmm. 

Dr. Jenn Simmons: And so that is what I am using universally to screen. It's available to everyone in the continental United States except for the state of New York, which is such a problem. They really are about testing. The state of New York is such a problem.[00:25:00] 

Yeah, well, you know what that's about, right? 

Dr. Brighten: So tell us 

Dr. Jenn Simmons: Oh, so in the state of New York You have to pay them to have a, a, a lab test. Mm-hmm. Right? So the fee is $500,000, which, as you well know, that is not affordable for most companies that are new companies just starting out, trying to gain adoption. 

Dr. Brighten: Yeah.

Dr. Jenn Simmons: And there's a two-year waiting list. So, because they have to come inspect your lab. Like they have any knowledge of what your lab is doing and how they're do- I mean, it's, like, a ridiculous thing. But in any event, it's how New York makes a lot of money. 

Dr. Brighten: Mm-hmm. '

Dr. Jenn Simmons: Cause they're charging a half a million dollars to let you do your test in their state.

But anywhere else in the US, you can order this test just online, and it comes to your home. And again, you do the test in five minutes, send it back, and you get the results a week and a half later, and you can actually order [00:26:00] it from any other country in the world. The caveat is that the sample has to arrive back at the lab in 10 days- 

Dr. Brighten: Mm-hmm

Dr. Jenn Simmons: from when you do the test, so, 'cause otherwise it gets dried out and they can't process it. Yeah. So if you can get it back to them in 10 days, you can do the test from anywhere- 

Dr. Brighten: Mm-hmm ... 

Dr. Jenn Simmons: which is really amazing. So the way that New Yorkers get around that rule is that when they come to my clinic in Pennsylvania, when they come to my imaging center, Perfection Imaging, they're able to do the test while they're there.

Dr. Brighten: Yeah. So let me ask you, they do the test. It's showing, okay, you're heading down the road of breast cancer- 

Dr. Jenn Simmons: Mm-hmm ... 

Dr. Brighten: but your imaging is negative. 

Dr. Jenn Simmons: Yeah. 

Dr. Brighten: What interventions do you employ at that point so that they don't end up with a diagnosis of breast cancer? Yeah. 

Dr. Jenn Simmons: That's an amazing question, and we have developed a breast cancer prevention program for those women.

Because the test has a [00:27:00] 93% sensitivity for breast cancer. 

Dr. Brighten: Mm-hmm. 

Dr. Jenn Simmons: So if you have breast cancer, it's gonna pick it up 93% of the time, which is better than any other imaging modality, with the exception of MRI, but MRI comes with it a lot of false positives. Mm. A lot. And the specificity of the test is 58%. Now, some people say that that's unacceptable, because what specificity means is that this is the, the number of times when you don't have the disease that the test agrees that you don't have the disease, right?

So 42% of the time, someone taking the test is going to have a positive result and no clinical evidence of breast cancer, but this is not a screening tool for breast cancer. This is a screening tool for inflammation, for the inflammatory precursors of breast cancer. Mm-hmm. And so in that [00:28:00] 42%, they are not false positives.

These women have inflammation. And that what they need to do is figure out where the inflammation is coming from and mitigate that inflammation, and then repeat the test. So we work with women on what they eat and what they drink and how they move and how they sleep and what toxins they're exposed to and how to detoxify.

And then six months later, many of those women will take the test again, and their inflammatory markers will be gone. 

Dr. Brighten: Mm-hmm. 

Dr. Jenn Simmons: And they'll have a negative test. 

Dr. Brighten: Mammograms aren't really recommended until you enter your 40s. When would this test be recommended? At what age should women consider screening for this inflammatory process?

Dr. Jenn Simmons: Yeah. So it's a great question. The clinical trials were women from 30- Mm-hmm ... to 83 years old. And so that is the recommendation from the company based on the clinical trials. Now, if [00:29:00] you're 30 s- if your mother was diagnosed with breast cancer at 36, I'm gonna tell you to start using the Aria test 10 years before that.

Narrator: Mm-hmm. 

Dr. Jenn Simmons: So at 26, I'm gonna tell you that you should start using the Aria test and do it every year. If you are in a high-risk population, like if you have a BRCA mutation or any of the other, like a PALB or the, any of the other high-risk breast cancer mutations, I tell those people to do the test every six months because you really wanna stay on top of your inflammation- Mm-hmm

if you're in that group, because that is going to be the determinant as to whether or not you get a breast cancer diagnosis. But the one thing that I know for sure is that any of those high-risk populations, the last thing you want to do is screen early and often with mammogram. 

Dr. Brighten: Mm-hmm. 

Dr. Jenn Simmons: Because the one statistic that is inarguable is that those women [00:30:00] have already declared by virtue of they have a mutation in their anti-cancer genes, because that's what all those high-risk genes are.

They're anti-cancer genes. So if you have a mutation, you're bad at fighting off those environmental insults. So the last thing you wanna do in someone with a high-risk mutation is image them more, right? You're just exposing them to more environmental insults. Mm-hmm. And we know that over your lifetime, the more mammograms you get, and this is all comers, the more mammograms you get, the higher your risk is of being diagnosed with breast cancer.

Dr. Brighten: Mm-hmm. 

Dr. Jenn Simmons: Right? So that is exactly what you don't wanna do. So I don't have a minimum starting age, but I think that it should be based on risk stratification. 

Dr. Brighten: Do your screening recommendations change if a woman starts estrogen therapy? 

Dr. Jenn Simmons: No. No When I evaluate [00:31:00] someone for hormonal replacement, I'm, I'm kind of doing the same evaluation on everyone.

Mm. I am looking at, do you have breast cancer right now? So I'm doing the ARIA test to, to see where their inflammation is from that standpoint. I am imaging them using 100% safe imaging, so I'm either doing a QT scan, like what we do at Perfection, or having them get an ultrasound. And I am running what I consider to be a baseline laboratory assessment.

Narrator: Mm-hmm. 

Dr. Jenn Simmons: And then from there, their follow-up is they're getting a yearly ARIA test, they're getting yearly imaging, and they're getting twice yearly lab panels. 

Dr. Brighten: Mm-hmm. You spoke early on in this episode about a new study that came [00:32:00] out. 

Dr. Jenn Simmons: Yeah. 

Dr. Brighten: Can you talk more to that? 

Dr. Jenn Simmons: WISDOM trial. 

Dr. Brighten: Mm-hmm. 

Dr. Jenn Simmons: So what the WISDOM trial looked at is, are we doing the right thing by using mammography and screening everyone from 40 years old on every year with mammogram?

And is that really equal or better to taking women and stratifying them to, are you low risk, are you average risk, or are you high risk for breast cancer? And if you're low risk for breast cancer, we should not be exposing you to radiation before the age of 50- Mm-hmm ... unless something makes your risk increase.

So the low risk got stratified to having less mammograms, nothing until the age of 50, and then 50 on every other year. Unless for some reason they became high risk. And if you're at average risk, you're just getting yearly mammograms. And if you are at above average risk, you're getting yearly [00:33:00] mammograms plus yearly MRIs, and you're spacing them six months a- apart from one another, so you're getting imaged every six months.

And what they found is that if you risk stratify women, there's no increase in advanced cancers. So you can do far less mammograms and still have the-- afford them the same benefit. Now, was there an overall benefit to doing it one way or another? No. Like, they diagnosed the same number of cancers in both groups.

Uh, there were more biopsies in the stratified group, but the stratified group, um, had more high-risk people, or at least they had the knowledge that they were high risk. And so-- and they also had MR thrown in. So MR is gonna have so many false [00:34:00] positives- Mm-hmm ... that that's what, that's what reflects that, is that there were more biopsies probably because there were more MRs.

The study wasn't powered to say that, but that's what I'm taking out of this study. But we can safely say, based on this wisdom trial, that we do not need to screen everyone every year with mammogram. Now, I wish there was an arm where there wasn't mammogram at all. 

Dr. Brighten: Mm-hmm. 

Dr. Jenn Simmons: Because that would allow us to say, "Hey, there's no benefit at all to screening with mammogram."

We know from this trial that there is no harm coming from less mammograms. I think that Uh, if nothing else, the Wisdom Trial will give women permission to say that we should be risk stratifying everyone. Now, from my perspective, what I'm using for that risk stratification is not [00:35:00] necessarily what they used.

They used a questionnaire and genetic information, so they looked for, uh, genetic mutations, which occur in, I mean, less than 1% of the population. But when you use the ARIA test, you can see who does and who does not need imaging. So that's your real-time risk assessment of whether or not this person is at increased risk for breast cancer or has breast cancer right now.

Dr. Brighten: So outside of genetics, what were the other things they were looking for that put someone in that high-risk category? 

Dr. Jenn Simmons: Yeah. So not everyone with a family history has a family history because there's a genetic mutation, right? Mm-hmm. Or there are genetic mutations that we just haven't recognized yet. So strong family history, or if you've had a history of a lot of biopsies, there are other things that would put people in that high-risk category outside of just [00:36:00] having a genetic mutation.

A genetic mutation is definitely the strongest thing that's gonna put you in that high-risk category, but it wasn't exclusive to that. 

Dr. Brighten: Mm-hmm. Do you see a correlation between women with a past history of trauma or emotional suppression and risk of breast cancer? 

Dr. Jenn Simmons: Absolutely. There was that book, Your Body is Keeping the Score or something.

Yeah, 

Dr. Brighten: Your Body Keeps Score. 

Dr. Jenn Simmons: Yeah, yeah. And that's absolutely true. And again, breast, canary in the coal mine. 

Dr. Brighten: Mm-hmm. 

Dr. Jenn Simmons: So if you are reliving that trauma over and over and over again, it's going to change your chemistry. It's going to change what is happening on a cellular level. And what's happening on a cellular level in terms of the development of breast cancer is these cells are being harmed.

They're getting mutated. Um, and the reason that the breast is the canary in the coal mine is when you think about the makeup of breast tissue, it's made up of [00:37:00] glandular tissue, milk-producing tissue, it's made of connective tissue, it's made of fat, and it's all inside this skin envelope. And where do we store our toxins?

We store them in fat. So when, when the, the fat cells in the breast are used for toxin storage, which they quite frankly are- And that those toxins are being stored right next to the glandular tissue, there is going to be some crosstalk and some direct damage to the breast cells. And when you combine that with a stressful situation, what you are doing is you are actually shifting your physiology from the chemistry of joy to the chemistry of stress.

Trauma is actually putting you into stress chemistry. Stress chemistry is allowing those toxins in the breast to amplify, [00:38:00] and eventually what's going to happen is you're gonna have the formation of a tumor, and your immune system is essentially going to be turned off, because we only understand really primitive dangers.

So if we're experiencing that trauma over and over again, all our body is saying is, "Run, run, run, run, run." We don't understand the difference between the fact that we're not in imminent danger right now and that the trauma was a year ago, five years ago, 10 years ago, 20 years ago, 30 years ago. If you're still living it, your body is, is still interpreting it as happening right now.

Dr. Brighten: Mm-hmm. I wanna go back to the toxin conversation, 'cause you brought up toxins multiple times as you were talking about the effect of stress. When it comes to toxins, which ones specifically are the biggest offenders for breast cancer? [00:39:00] 

Dr. Jenn Simmons: Well, I don't know if it's the biggest offender, but I know that this is one that is so seldomly recognized and so impactual, and that's what is happening in your mouth.

Mm. So few providers connect this, but the fact is that much of the chronic inflammation that, that we have is because of dysfunction in the mouth. So for many years, the source of their chronic inflammation, the thing that's driving their disease, is what's happening in their mouth, and it's going totally unrecognized.

And you can do all of the right things for people after a diagnosis. That infection is still going in their mouth. They still have the reason that they got breast cancer intact. 

Dr. Brighten: Mm-hmm. 

Dr. Jenn Simmons: So I think the first thing that we all need to do is be talking about this more because what's happening in your mouth matters.

It matters for your breast health, it matters for your cardiovascular health, it matters for your gut health. And Nathan Bryan did an [00:40:00] amazing talk yesterday. I don't know, do you know him? 

Dr. Brighten: Mm-mm. 

Dr. Jenn Simmons: Oh, he's, he's the nitric oxide guy, and he did an amazing talk yesterday about dysbiosis in the mouth and the connection to every chronic disease- Yeah

that we think about and talk about. So I don't know why we decided that dentistry was somehow separate from medicine. 

Dr. Brighten: Thanks insurance. 

Dr. Jenn Simmons: Yeah, yeah. We need to put it back together again. 

Dr. Brighten: Mm-hmm. 

Dr. Jenn Simmons: Because you cannot have a healthy body without having a healthy mouth, and you can't have a healthy mouth and not have a healthy body.

Like, w- w- it's all one system. We're all connected, and I know the medical system would like us to think that everything is separate, but we're all one system. And so if one system is unhealthy, the rest of it is going to be suffering So we have to start to think systemically. All of us have to start to think systemically.

Yes, I'm a breast doctor, but [00:41:00] I'm thinking about all of you when I have you in my care. 

Dr. Brighten: Is there a type of dentist that you recommend people look for? 

Dr. Jenn Simmons: Yeah, so I tell people to find a biologic dentist, a holistic dentist, and I do cover all of this in my book, The Smart Woman's Guide to Breast Cancer. There is going to be a school of biologic dentistry that is running alongside the Institute for Functional Medicine, and I think that they're enrolling for their first class now.

So I do think that the training is going to be offered and standardized, and I think that that's gonna be a huge benefit to everyone across the board. But ultimately, I would hope to see dentistry as a subspecialty of medicine. 

Dr. Brighten: Mm-hmm. 

Dr. Jenn Simmons: Because in fact, that's exactly what it is. 

Dr. Brighten: Mm-hmm. We had Dr. Stacy Wittman on the podcast, 

Dr. Jenn Simmons: who's actually- Yeah, she's ama- she's involved in that.

[00:42:00] Yeah, she's- She's 

Dr. Brighten: spearheading that. I want to ask you, when it comes to being a breast cancer survivor, what do you wish that women who are survivors of breast cancer were told early on their journey? 

Dr. Jenn Simmons: Unfortunately, if you went the conventional route, you were kind of convinced that you didn't have any power in this journey, that you didn't have any role, that there's nothing that you could do, that you didn't cause your breast cancer.

And that's true in that it's not about blame or shame, but that there was also nothing that you could have done to prevent it. There's nothing that you can do to prevent a recurrence, and that's simply not true. 

Dr. Brighten: Mm-hmm. 

Dr. Jenn Simmons: We have so much more power than we think, so much more power than we are led to believe.

I think Kelly Turner did a great job of elucidating this point in her, in her books. She wrote Radical Remission and then Radical Hope. And the one glaring point that was seen threaded [00:43:00] throughout this is that just by virtue of calling it a radical remission, like it somehow happened by accident, like all of these people did radically changed their health, did things to radically change their health, to own their health.

And the medical oncologist kind of poo-pooed all of this. And when she went back to the medical oncologist and said, "You know, why aren't you talking to these people who were given stage four cancer diagnoses and told to go get their affairs in order, and five, 10, 15, 20 years later, they're still here without disease," to talk about it.

And what the response across the board was, "Well, we don't wanna give people false hope." 

Dr. Brighten: Mm-hmm. 

Dr. Jenn Simmons: And that's because they literally don't understand it. 

Dr. Brighten: Mm-hmm. 

Dr. Jenn Simmons: But the bottom line is that [00:44:00] no one is gonna save you but you. You are the only person that can make you healthy. Health is happening at home with what you do every day.

But doctors should be all trained to be longevity doctors. That's what we should all be trained to do, how to create long-term health. And are there going to be people that fail? Yes, but they can't do that in a vacuum. We also have to get all of the garbage food out of there, and if someone is eating garbage food, you know, that should be a hard thing to do.

It should be easy to get fruits and vegetables and whole foods- Mm-hmm ... and really hard to get the processed garbage, right? So right now, we're setting, we're set up for failure all along the way, and the value is in sickness. If I could change something tomorrow, it would be redo education, [00:45:00] put the value on health.

And when you do that, I think a lot of things would change. 

Dr. Brighten: Mm-hmm. 

Dr. Jenn Simmons: But we need to change our value system. 

Dr. Brighten: For women listening right now, if you could give them three things to implement, like come Monday, to really set the course right to prevent breast cancer, to prevent metabolic disease, to have the longevity you've been speaking to, what would you challenge them to do?

Dr. Jenn Simmons: Yeah. So what I want everyone to do is control what you can control, right? Mm-hmm. We can control the kind of food we eat. We can control what we're drinking. We can control our alcohol consumption. We can control how much we're moving our body. We can control how much we are prioritizing sleep. So control what you can control.

And Beyond that, screen in a way that doesn't put you in any [00:46:00] danger. So again, I would tell everyone to be using that Aria Tears test to screen and know what your inflammatory burden is, and always work to minimize the inflammatory things that you come into contact with every day. And then lastly, I think the power of joy is tremendous.

Narrator: Mm. 

Dr. Jenn Simmons: And you should make sure that you are having, incorporating joy into your life every single day. Every single day. I mean, I have the advantage of having a beautiful marriage to a man that is hysterical, and we laugh every single day. And I'll tell you that it has gotten us through some really, really hard times in our relationship, because marriage is hard.

Dr. Brighten: Mm-hmm. 

Dr. Jenn Simmons: Marriage is hard. I mean, we're only [00:47:00] married for 23 years. Marriage is hard. 

Dr. Brighten: Only . Well- Only 23 years ... well, 

Dr. Jenn Simmons: but I mean, you think about it. I mean, my parents, before my father died, my parents were, were going on s- like 60 years of marriage, right? It's really, really hard, and the only way that those things work is if you find joy in one another.

And joy is so important, because it literally changes your chemistry. I know that there's that study that says even if you fake the laughter, it changes your chemistry. 

Dr. Brighten: Mm-hmm. 

Dr. Jenn Simmons: So it doesn't matter if you're really laughing or fake la- laughing, it changes your chemistry, and that's what we all need. We all need to shift from that chemistry of stress to that chemistry of joy.

So if you feel that stress coming on, because quite frankly, we're not gonna eliminate the stressors. We can sharpen our tools to deal with the stressors, but we'll never [00:48:00] eliminate the stressors. But if laughter is in your toolbox, if joy is in your toolbox, if you have those tools in your toolbox to help you get through each day, your, your life and your health is going to show it.

Dr. Brighten: Mm-hmm. What a beautiful message. Well, thank you so much for sitting down and taking the time to chat with us today. 

Dr. Jenn Simmons: It's my pleasure. I was so happy to be here, and I so enjoyed getting to sit across from your sparkly self. You just- 

Dr. Brighten: When in Vegas. Thank you so much for joining the conversation. If you could like, subscribe, or leave a review, it helps me so much in getting this information out to everyone who needs it.

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