Why Younger Women Are Getting Breast Cancer at Record Rates (And How to Reduce Your Risk)

Episode Overview

• Host Dr. Mark Hyman (affiliated with Function Health, board member of the Environmental Working Group, and author of the upcoming book 100: What to Do Today to Live 100 Healthy Years) interviews Dr. Thais Aliabadi, an OBGYN with 25 to 30 years in private practice, co-host of the She MD Podcast, and founder of the PMOS supplement and health platform Ovii.
• The discussion investigates why breast cancer rates are rising among younger women with worse mortality outcomes, why standard medical screenings miss up to 25% of breast cancers, and how systemic medical dismissal leaves women's pain and symptoms ignored.
• Through Dr. Aliabadi's personal story of discovering hidden Stage 1 breast cancer despite negative imaging and no family history, the episode explains how women can calculate their true lifetime cancer risk using the Tyrer-Cuzick assessment and polygenic risk scores.
• Beyond oncology, the conversation reframes common female hormonal conditions—including the renaming of PCOS to PMOS (Polyendocrine Metabolic Ovarian Syndrome), endometriosis, PMDD, and perimenopause—around root-cause metabolic health, environmental toxin reduction, and advanced diagnostic testing.

Key Concepts

• Systemic Access Gaps and Medical Dismissal in Women's Healthcare: Currently, 50% of U.S. counties do not have an OBGYN. When women do access primary care or gynecology, standard visits often last only 10 minutes (compared to Dr. Aliabadi's 45-minute comprehensive exams), where patients frequently have their pain minimized and symptoms ignored. Furthermore, standard bimanual pelvic exams and metal speculums are archaic compared to a 1-minute transvaginal ultrasound, which provides clear 3D visualization of pelvic organs.
• The Blind Spots of Standard Mammography and Dense Breast Tissue: While standard screening protocols begin at age 40 every 2 years, mammograms only detect 75% to 85% of breast cancers, missing 15% to 25% of cases. More than 50% of women over age 40 have dense breast tissue (and only 10% have purely fatty breasts). Because both dense tissue and cancerous lesions appear white on a 2D mammogram, tumors easily get lost in the background noise.
• The Family History Myth and True Risk Calculation: An average American woman has a 12.5% (1 in 8) lifetime risk of developing breast cancer, and 85% of women diagnosed have no family history of the disease. Rather than relying solely on family history, risk should be evaluated using the Tyrer-Cuzick Risk Assessment Tool, which incorporates age, height, weight, breast density, family history, age at menarche, age at menopause, and abnormal biopsy results (such as atypical lobular hyperplasia).
• Dr. Aliabadi's Diagnostic Case Study: Demonstrating the limits of standard criteria, Dr. Aliabadi had no family history, no genetic mutations, a thin build, heavy exercise habits, no smoking or drug use, and only about 20 alcoholic drinks in her life. At age 48, a left-breast biopsy showing atypical lobular hyperplasia elevated her Tyrer-Cuzick lifetime risk score to 37%. Despite a negative mammogram, a negative ultrasound, and an MRI read as benign—and despite her surgeon resisting a prophylactic double mastectomy by stating they had good chemotherapy—Dr. Aliabadi insisted on the 10-hour surgery (during which she bled out, dropping to a hemoglobin of 5 and blood pressure of 60/20, requiring 2 days of transfusions). One week later, pathology revealed invasive Stage 1 breast cancer in her right breast.
• Single-Gene Mutations vs. Polygenic Risk Scores (PRS): Less than 10% of women with breast cancer carry one of the roughly 11 single-gene pathogenic breast cancer mutations (such as BRCA, PALB2, CHEK2, or ATM, which sit on broader 48- to 90-gene panels and raise lifetime risk to 25%, 35%, 50%, or 80%). Many women instead have an elevated Polygenic Risk Score, which evaluates roughly 86 to 305 genetic variants (as Dr. Aliabadi notes with slight hedging on the exact marker count); scoring above the 90th percentile places a patient at high risk.
• Environmental and Lifestyle Multipliers of Genetic Risk: Genetics interact heavily with the environment; Dr. Hyman notes that in the 1930s and 1940s, carrying a BRCA gene did not confer as high a cancer risk as today's roughly 75% risk. Modern estrogen exposure is driven by earlier puberty (some girls starting as young as age 8), alcohol consumption (Dr. Hyman cites a JAMA study showing 1 glass of wine per day increases breast cancer risk by 40%), gut microbiome disruption affecting the estrobolome, heavy metals, and petrochemical xenoestrogens (PCBs, phthalates, BPA, and parabens in plastics, cosmetics, and sunblocks). While Dr. Aliabadi clarifies there is no blood test that predicts or diagnoses breast cancer—unless cell-free DNA is detected, such as via the Galleri multi-cancer test, which Dr. Hyman hedges is not perfect—addressing metabolic health and inflammation significantly lowers risk, though Dr. Aliabadi notes lifestyle changes cannot reduce risk to zero.
• The Shift from PCOS to PMOS: Polycystic Ovary Syndrome (which affects 10% to 13% of women and is a leading cause of infertility) has been renamed PMOS: Polyendocrine Metabolic Ovarian Syndrome, reflecting its true nature as a metabolic and insulin disorder rather than an ovarian cyst condition. Diagnosis requires 2 of 3 criteria: irregular periods, PCO-appearing ovaries on ultrasound or elevated AMH, and high-testosterone symptoms (acne, facial/body hair, hair thinning). Because 75% of PMOS patients struggle with weight gain, anxiety, depression, and eating disorders, many go undiagnosed in eating disorder clinics while being prescribed psychiatric medications instead of metabolic interventions.
• Endometriosis Overlap and Emerging Diagnostics: According to Dr. Aliabadi's own studies, 61% of PMOS patients also have endometriosis, a condition that takes an average of 9 to 11 years to diagnose. While Dr. Aliabadi states her clinical history-taking is 99% accurate, new non-invasive diagnostics are emerging, including HerResolve—an AI-assisted blood test measuring circulating microRNAs (miRNA) with 80% accuracy (though she cautions a negative result does not rule out the disease)—and an upcoming saliva test reporting 97% accuracy.
• Perimenopause, PMDD, and Nuanced Hormone Replacement Therapy (HRT): While 75% of women experience PMS, 3% to 5% suffer from PMDD (Premenstrual Dysphoric Disorder), causing severe emotional disruption, anxiety, depression, and increased suicide risk during the 10 to 14 days prior to menstruation. Later in life, menopause occurs at an average age of 51.5 (normal range 45 to 55), preceded by 7 to 10 years of perimenopause—meaning women can experience upwards of 30 perimenopausal symptoms starting in their late 30s and benefit from HRT. Furthermore, 2% of women carry two copies of the ApoE4 gene (raising Alzheimer's and stroke risk), and Dr. Aliabadi cites new data suggesting that treating ApoE4-positive women early in perimenopause/menopause with HRT for 7 years can probably reduce dementia risk, though she hedges that dementia is multifactorial. Conversely, she will not prescribe HRT to patients with a history of estrogen-receptor-positive breast cancer (even 7 years cancer-free) due to the risk of recurrence 20 years later; for high-risk patients (e.g., 50% lifetime risk), taking the hormone blocker Tamoxifen daily for 5 years cuts breast cancer risk by 50% over the subsequent 10 years, despite menopausal side effects.

Quotes

• At 0:00:01 - "You know, mammograms pick up 75% to 85% of breast cancers. More than half of women above age 40 who had mammogram had dense breast tissue. The more dense the breast tissue is, the harder it is to catch that cancer on breast imaging." - Dr. Aliabadi explaining why standard 2D mammography misses 15% to 25% of breast cancers.
• At 0:02:23 - "50% of counties in this country don't have an OBGYN. Five-zero, 50%. So that's the first problem. Patients, they find lumps, they don't even—they can't even go see an OBGYN, that's number one. When women get to that medical office, whether it's their primary care or gynecologist, they're more likely to be dismissed. Their pain is minimized, their symptoms are completely ignored, and that's a fact." - Dr. Aliabadi highlighting the structural and cultural barriers women face when seeking medical care.
• At 0:03:56 - "85% of women who get breast cancer don't have it in their family. I had no family history of any cancers. I didn't have a genetic mutation. I was very healthy. I never smoked, I have never done drugs, I had maybe—I've had 20 alcoholic drinks all my life. I've always been thin. I used to exercise a ton when I was diagnosed with breast cancer. You can't really say, you know, I don't have it in my family so I'm not at risk." - Dr. Aliabadi debunking the misconception that a lack of family history or a healthy lifestyle guarantees protection against breast cancer.
• At 0:06:06 - "If that number is 20% or more, you do not start your imaging at age 40. You actually start it as early as age 30, and you get a mammogram, if you have dense breast tissue you do an ultrasound, and for high-risk patients that fall above this 20, 25%, we also add a breast MRI annually." - Dr. Aliabadi detailing the early screening protocol required when a woman's Tyrer-Cuzick lifetime risk score reaches or exceeds 20%.
• At 0:09:00 - "And the day before surgery she's like, 'You know I'm doing this, but it's against my wish.' And I'm like, 'Why? Why so much resistance? It's my body, why do you care so much?' You know what she said? 'We have really good chemo for breast cancer.'" - Dr. Aliabadi recounting her surgeon's pushback against performing a preventative double mastectomy despite a 37% lifetime risk score.
• At 0:10:12 - "And all this time they were digging in my left breast, my cancer was actually invasive stage 1 in my right breast." - Dr. Aliabadi revealing what her post-mastectomy pathology report uncovered after her mammogram, ultrasound, and MRI had all failed to detect malignancy.
• At 0:19:02 - "At the latest, by 25, every single woman with family history of not just breast cancer and ovarian cancer—pancreatic cancer, prostate cancer—ask your doctor for genetic cancer testing." - Dr. Aliabadi establishing the timeline and expanded family cancer criteria for seeking genetic screening.
• At 0:26:20 - "I was shocked when I remember reading in JAMA that was like if women had one glass of wine a day, their risk of breast cancer was increased by 40%. That's just one glass a day." - Dr. Hyman illustrating the potent impact of modifiable lifestyle factors on breast cancer risk.
• At 0:37:00 - "You know, it took us years to bring awareness to PCOS and then they changed the name to PMOS, which is better, because Polycystic Ovary Syndrome does not describe the condition. It's actually Polyendocrine Metabolic Ovarian Syndrome." - Dr. Aliabadi explaining the medical reclassification of PCOS to reflect its underlying metabolic and endocrine drivers.
• At 1:01:51 - "You know what patients get? A Pap smear, a bimanual exam, maybe a prescription for birth control if the patient's sexually active, maybe an STD check, and maybe a breast exam, and if they're 40 they get a mammogram and off they go. That's not well-woman. That's dismissal." - Dr. Aliabadi critiquing the superficial nature of standard annual gynecological visits.

Takeaways

• Calculate Your Lifetime Breast Cancer Risk and Upgrade Your Imaging: Do not wait until age 40 to assess your risk. Use the Tyrer-Cuzick Risk Assessment Calculator in your 20s. If your lifetime risk score is 20% or higher, begin annual screening at age 30 with a mammogram, a bilateral breast ultrasound (if you have dense breasts), and an annual breast MRI (for scores above 20% to 25%). Whenever getting a mammogram with dense breast tissue, specifically request a 3D mammogram plus a bilateral breast ultrasound rather than a standard 2D X-ray.
• Request Genetic and Polygenic Testing Early: By age 20 to 25 at the latest, women with any family history of breast, ovarian, pancreatic, or prostate cancer should request a comprehensive genetic cancer panel (covering 48 to 90 genes, including BRCA, PALB2, CHEK2, and ATM) as well as a Polygenic Risk Score (PRS) test to identify if they fall above the high-risk 90th percentile.
• Advocate for Annual Transvaginal Ultrasounds and Advanced Whole-Body Screening: Starting as soon as you become sexually active, request a 1-minute transvaginal pelvic ultrasound every year rather than relying on a manual pelvic exam. Additionally, Dr. Aliabadi's preventative cancer protocol includes liquid biopsy testing and recommending a total body MRI after age 45.
• Order a Comprehensive Metabolic, Hormonal, and Genetic Lab Panel: Move beyond standard 20-marker checkups and evaluate biomarkers against age-specific optimal targets rather than broad lab reference ranges (such as Quest's standard cutoffs of <90 for ApoB or ≥1 for AMH). Request AMH (egg count), free and total testosterone, DHEA-S, prolactin, Hemoglobin A1c, fasting insulin, lipid panels, ApoB, Lipoprotein(a) [Lp(a), which is genetically elevated in 20% of women], hs-CRP, homocysteine, Vitamin B12, Vitamin D, iron, ferritin (Dr. Hyman notes a target of 45 rather than anemic levels like 3), and ApoE4 genetic testing for perimenopausal planning.
• Treat PMOS (PCOS) through Metabolic Lifestyle Protocols: To reverse the insulin resistance driving PMOS and hormonal dysfunction, prioritize walking after every meal, getting 7 hours of sleep per night, exercising daily, and optimizing nutrition. Consider targeted supplementation such as Vitamin D, an inositol blend, and wild mulberry (the ingredients used in Dr. Aliabadi's Ovii formulation).
• Minimize Estrogenic and Environmental Toxic Load: Reduce lifetime exposure to endogenous and foreign estrogens by eliminating or strictly limiting alcohol (given the 40% increased breast cancer risk associated with 1 glass of wine daily) and auditing personal care products, sunblocks, face creams, and plastics to remove petrochemical xenoestrogens like BPA, phthalates, parabens, and PCBs.