The Silent Signs of Breast Cancer & How to Know Your Cancer Risk With World-Renowned OB-GYN

Mel, if I told you [music] you were about to  board a plane that had a 37% chance of crashing, would you board that plane? Today on [music]  the Mel Robbins podcast, worldrenowned OBG, Dr. Thaïs Aliabadi [music] reveals what every  woman needs to know about cancer. 85% of women. who get breast cancer don't have a family history  of it. the screenings that could save your life. and what your doctor may be missing during  your annual exam. You better be scared. I'm.

here to scare you because unless I scare you,  you won't be your own health advocate. If you. listen to this podcast, I will promise you  at the end of it, you may save your own life, the life of a loved one, and together we can save  millions and millions of lives around this world. Dr. A, I've been dying to get you on this podcast.  So, I want to start by saying thank you for taking.

time from your extraordinarily busy clinical  practice, from all the speaking that you're doing. and teaching that you're doing to be here with us.  You say this conversation could save the person. who's listening life or the life of their sister  or their mother or their daughter. But I want them. to hear it from you. Why did you want to be here  today? And what are we going to learn from you? To your listener, I will say that I am here for  you. I'm doing this for you. And by listening to.

this podcast, I will promise you it will change  your life. I want you to know that majority of. women get dismissed in the current health care  system. Their pain is minimized. They're told. it's in their head. They're anxious. They're  stressed. They're not sleeping well. They come. up with a million reasons without truly diagnosing  the underlying condition. And I'm here to tell you. that you need to become your own health advocate.  By the end of this episode, I will teach you.

the most important things you need to know about  women's health. I will teach you how to calculate. your lifetime risk of breast cancer before you get  cancer. I will talk about how to diagnose yourself. early on if you're at risk for dementia, for  heart disease, for stroke, and how to prevent it. I'm going to teach you about genetic testing. I'm  going to tell you how to lower your risk of female. cancers. Let me tell you, under my care for the  past 25 years, I've never lost a patient who did.

exactly everything I told her to do. And if you  listen to this podcast, I will promise you at the. end of it, you may save your own life, the life of  a loved one, and together we can save millions and. millions of lives around this world. Well, Dr. A,  I believe you. I believe this conversation could. save the person who's listening's life. And one  of the reasons why I believe that when you say it.

is because you're not only a physician in clinical  practice, you're also a breast cancer survivor and. you have not lost a patient in your practice  in 25 years. What do you attribute that to? I am hyper vigilant when it comes to prevention  and I probably order a lot more tests than most. doctors do, but I do that and it has worked  and I want every woman to have access to this.

level of care. So, as far as my own story with  breast cancer, uh when I was 48, I had no family. history of any cancers. I didn't have any genetic  mutations. I've never smoked. I've never done. drugs. I've had maybe 20 alcoholic drinks all my  life. I've never been overweight. I was never on. hormones. So, I was the poster child for someone  healthy who was not supposed to get breast cancer. Right. At 48, I had an atypical biopsy. I had  a, you know, abnormality on my mamogram. They. biopsied it. They're like, "Oh, it's just atypical  cells. Let's remove that area. You're good to go.".

So, what does atypical cells mean? These are  cells that have the potential to become cancerous, right? They removed the tissue and  told me go come back in 6 months. So that day I went back to my office and because I  had this atypical biopsy I'm like you know what my. risk was always less than 10% but let me check it  now with this atypical biopsy. So I recalculated. my lifetime risk of breast cancer and this number  popped up on my screen 37%. I almost fell off my.

chair and I'm like what wait what me? 37% chance  of getting breast cancer. I called my doctor. I'm. like, "You told me to come back in six months,  but the 37% back then I had uh three daughters. and I had not adopted my little daughter yet."  And I called her and I'm like, "I have these. little kids running around. I don't want to get  breast cancer." She's like, "Don't worry. You. have no family history. You're so healthy. You  have no genetic mutation. Don't worry about it.".

Mel, if I told you you were about to board a plane  that had a 37% chance of crashing, would you board. that plane? Absolutely. With your family? No. No.  So, I said, "Remove my breasts." And they're like, "No, you're crazy. Why are you so paranoid? Why  are you so anxious? You don't have any family. history? It's a mutilation. I could care less  about my breasts. I loved my family. I love my. husband. I love my children. I love my job. I love  my patients. I didn't want to get breast cancer.

Finally, I found a doctor. She was willing to do  my double masectomy because I'm like, "Take these. off. I can't come every six months and go into  these machines and then wait for a few days to get. the results. It's too much for me. I couldn't  handle it." And the day before my surgery, she's like, "I just want you to know I'm still not  agreeing with your decision." And I'm like, "Why? Why is it so hard for you guys? It's my body.  It's my breast. I don't care about it. Why do. you care so much?" You know what she said?  We have really good chemo for breast cancer.

To a mother of three children, to a busy doctor,  I don't want chemo. Take these breasts off. So, finally, she did it. A week goes by. I get  a call from my plastic surgeon, not my surgeon. And my plastic surgeon said, "I just got off  the phone with a pathologist." Anytime a doctor. calls you and says, "I got off the phone with a  pathologist," it's cancer until proven otherwise. because unfortunately that's the only time the  pathologists call us. As soon as he said this,

my brain shut down. I asked him, I'm  like, "Do I have cancer?" He said, "Yes.". So all this time they were digging in my left  breast. They found invasive breast cancer in. my right breast when they removed the tissue.  You're kidding. I was devastated. I was devastated. because so many of my doctors, of my friends, of  my colleagues called me crazy, paranoid, anxious. You name it, I heard it. Thank God I didn't  listen. I didn't care what people said and I.

pushed for what I wanted. Otherwise, I don't  know if I would have been here today. I was. devastated. But more than devastation, I was so  angry. I was so angry. And my first breast cancer. surgeon who did the initial excisional biopsy,  she called me. She said, "Tais, you're so lucky. You're so lucky you caught your cancer  early." I'm like, "I'm not lucky.

I've been asking for this." And everyone called  me crazy. Long story short, it didn't end there. After 2 weeks, I realized that I had a lot of  breast tissue. And I put myself through another. MRI cuz I kept saying, "I don't think you removed  all my breast tissue." And my doctor kept saying, "No, I removed all of it." I'm a gynecologist.  I do breast exam. I know breast tissue. So the first two radiologists who reviewed my  imaging said, "No, there's no tissue left." And. it got to a point my husband was like, "Just  let it be. You're fine. There's no tissue left.".

I follow up with another surgeon friend of mine  at Cedars and he walks in and he said, "Tais, I'm. so sorry about this MRI postmastctomy." I'm like,  "Why?" He's like, "There's so much breast tissue. left." Oh my god. I started balling my eyes out  in his office. And I'm like, "What are you talking. about? Two doctors told me there's nothing left."  He's like, "Let me take you to a radiologist.". This third radiologist tells me I have all this  breast tissue in my breast. So I forced him to. do a second double mastctomy. He didn't want  to do it because I had just done one and I had.

blood transfusion and I didn't do well with the  recovery. So he finally did another one 6 weeks. later. I got more blood transfusion and after I  woke up he said, "I'm so glad you had me do it. They had left 35% of your breast tissue behind."  And listen, Mel, you know what I always say. as a gynecologist? I consider myself one of the  biggest women's health advocates on this planet.

My mission, my passion is to change the world of  women and to lift the standard of care for women. So if someone like me, a gynecologist in  this business, a women's health advocate, goes through our health care system, gets  dismissed, people tell her she's crazy, I mean, and goes through all of this. Do you think  other women have a chance? No. In fact, hearing this story, it makes me scared. You  better be scared. I'm here to scare you because.

I want you. Unless I scare you, you won't be  your own health advocate. You're going to say, "I'm fine. I don't have a family history." I  didn't have a family history. No genetic mutation. So now I'm fine. I'm cancerree. I was stage one.  I got lucky because I pushed for this, right? But this lifetime risk calculator saved my life  because 37%. You need to know what that number is. An average American has a 12.5% chance of  getting breast cancer. An average American.

If you have dense breast, that goes up. If you  have family history of breast cancer, that goes. up. If you have a genetic mutation, it goes up.  If you're overweight, it goes up. If you have. any history of any atypical biopsy like I did, it  shoots it up. If you get older, it goes up. So, you need to know what this number is. You need  to know your lifetime risk of breast cancer. It's mandatory. It's non-negotiable. So, how  do you calculate your life? I use the tire.

A tire is a tool. It's a formula. Okay. The  tool we use to calculate a woman's lifetime. risk of breast cancer. You have to enter your  height, your weight, your density of your breast, which you can only get it from your breast  imaging. Look at your mamogram. And they. have to report on the density of your breast. It  asks about when you got your period, if you've. gone through menopause, if you're on hormones, if  you've had a biopsy, what your family history is, all of it. You enter everything and then you  press enter. It takes two minutes. Two minutes.

to calculate your lifetime risk of breast cancer.  But this number can make a huge difference. Why? If your lifetime risk of breast cancer is 20% or  more, you fall into the category of high risk. For high-risisk patients with lifetime risk of  breast cancer, 20% or more, these women need to. start their breast imaging as early as 30. So  don't come to my office and tell me that you.

have no family history of breast cancer and you're  not 40 yet. The age 40 for mamogram is completely. misleading. You need to know your own lifetime  risk of breast cancer and based on that number. then we give you directions on when to start your  breast imaging. So for women 20% or above you. start at 30 in addition to a 3D mamogram which  we use for women with dense breast tissue and.

50% of women have dense breast tissue. We also  add ultrasound and we also add a breast MRI. So mamogram and ultrasound alone are not enough  for women at high risk for breast cancer. For women in intermediate risk 15 to 20 I do the  mamogram and ultrasound. Usually I get a baseline. in my practice at 35 because I think 40 is too  late and I also might do an MRI every 3 years on.

these patients. For women who are low risk, they  start mamogram. They can start at 40. I still in. my practice get a baseline at 35. And if they have  dense breast issue, I order a breast ultrasound. And usually we can go back 10 years. So if you  have an aunt who was diagnosed at age 43, then. you have to start your breast imaging 10 years  earlier than that. But if there's one message. I want everyone to understand is the importance of  this lifetime risk number that will determine when.

and what type of imaging you get. So, I know  that I'm going to leave this conversation and go. calculate my lifetime risk. And I'm also thinking,  okay, I got to log into my patient records and get. my breast density. No, but you should know your  breast. I have no idea what it is. I'm 58 years. old. I have no idea what it is. 50% of women have  dense breast tissue, right? Dense breast tissue a.

makes it difficult for a radiologist to basically  look and find cancer because dense breast tissue. on mamogram looks white and cancer looks white. So  it all blends and it's hard for the radiologist. That's why you need a 3D mamogram instead of 2D so  the radiologist can see better. But dense breast. tissue itself increases your risk of breast  cancer. I had extremely dense breast tissue. You need to know what you have because if you  have dense breast tissue, mamogram alone is not.

enough. Not only you need a 3D mamogram but you  also need an ultrasound. How do you know if you. have dense breast? Look at your mamogram report.  But what if you're 30 and you've never had one? So if you you just skip that, okay? And by skip  that, you mean do the test anyway and don't put. in the dance. Yeah, you can just skip it. But I'm  telling you, 50% of us have it. If you've ever had. a mamogram, go look at it. They report it. Well, I  know the person listening because I feel this way.

is now wanting to go calculate it. We're going to  link to this in the show notes because these tests. are free. But I want to add one thing before we  leave. Breast cancer. For years, I couldn't figure. out why I had breast cancer, right? My genetic  tests were negative. I had no family history and. I had no real risk factors until about 4 months  ago. I did a full genome sequencing of my DNA. I used um Simplified Genomics, which is a genetic  one of the companies that runs uh whole genome.

sequencing. They look at maybe 6.4 4 billion DNA  pairs, millions of variants, and 2100 diseases. And they give you literally a 30, 40 page report.  What do you think the first thing flagged on my. report? Breast cancer. At high risk for breast  cancer. Why? Because some of us walk around with. major genetic mutations. Remember, Angelina Jolie  came out and said, "I have Brocka, the BRCA gene. mutation." But less than 5 to 10% of women who get  breast cancer have a major genetic mutation. The.

rest of us fall into this category. We don't know  why we got it, but we have some family history. I didn't even have a family history. But  these full genome sequencings now look at your. polygenic risk score. Have you heard of that?  Nope. Polygienic risk score means you don't have. a major genetic mutation in your DNA, but you have  a ton of these tiny little markers, these variants. that individually don't have power. But some  of us, like me, walk around with tons of those.

that can increase your risk, sometimes as high  as a genetic mutation. Wow. So, I was one of. those people. So, that's why my genetic test was  always negative. But this full genome sequencing. showed my polygenic risk score at three times more  likely to get breast cancer than another person. So if I had this information 10 years ago, no one  would call me crazy anymore. That's true, right?

That's true. And my family, what are you going  to look into my family history? My dad had no. siblings. So maybe if he had a sister, that sister  would have had breast cancer. So that's why don't. come to my office and tell me I don't have family  history of breast cancer so I'm not going to get. breast cancer. It's not true. 85% of women who get  breast cancer don't have a family history of it. That's that's that's unbelievable. 85% of women  with breast cancer don't have family history.

No, but you don't know what's in your DNA and you  don't know what you've done in the environment, right? Alcohol, being obese increases  your risk. having atypical biopsies, having had radiation to your chest, having dense  breast tissue. The other thing I want to address. is the genetic testing. If you have family  history of breast cancer, ovarian cancer, pancreatic cancer, you need to do your genetic  test. Remember those major gene mutations. that you still need to get tested for those.  There are 11 gene mutations, if I'm not mistaken,

that are directly linked to breast cancer. You  have to take that test. And I want you to take. that test by 25. So usually at 25, I do that  test because if someone has a genetic mutation, let's say someone like Angelina Jolie, she  would have started her breast imaging at 25. If she had had the genetic test done, and is this  something that you can just do at your doctor's. office? And is it just like a blood draw? How do  you do it? It it could be a sputum test. It could.

like you spit. Oh, well that's easy. Or you can do  a blood test. So just go to your doctor and say, "I want to do a gen I have a family history. I  just heard this podcast with Mel Robbins and Dr. A. and I would like to get just a full spectrum  genetic test done." Yes. And if they can also, you know, the whole genome sequencing is the  way to the future. It's more personalized care, right? Like it basically gives me your  information not based on your mom. Your.

family history and your tyusic is still very  important. How is breast cancer diagnosed? Well, biopsy and that's the only way, right? That's the  only way. That's the only way. I don't want you. to mix up. Listen, you can have a breast imaging,  right? You can have a mamogram, ultrasound, MR and. the radiologist can say this lesion is suspicious  or highly suspicious. But at the end of the day, you need to have a biopsy and that's the only way  to diagnose breast cancer. That biopsy will tell.

you what type it is, what grade it is, what are  the biomarkers, is it estrogen receptor positive, progesterone positive, um is it her two positive  or negative? So, it's like the driver's license to. that tumor because not all breast cancers have  the same treatment. And then you need surgery. They need to address your lymph nodes to stage it,  but ultimately it's biopsy. But in order to get to.

the biopsy, you need to know, you need to do the  screening test. You need to have your mamogram. If you have dense breast, you need an ultrasound.  If you're high risk, you also need an MRI. If you're high risk, you start at 30, not  at 40. And by the way, for your listeners, I want every single woman between 25 and 30 to  calculate her lifetime risk of breast cancer. That's number one. So, you have to do all  this. I never ever have a patient under my care. show up to my office at 35 with stage four breast  cancer. That has never happened to me. You can't.

tell me this is luck. I don't believe it is. I  think you are giving the patients under your care. the preventative screening that we all deserve.  Mrs. Meyer's plug-in scented oil diffuser is here. to fill your home with long lasting fragrance  for up to 60 days, creating a little space that. invites you to slow down and savor the moment. One  of my rituals, one of my habits is to have a clean.

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breathe it in, and let your favorite scent  do the rest. Because finding your outlet. doesn't have to be complicated. You can find it  right at home. Pick up a Mrs. Meyers premium oil. diffuser kit complete with a warmer and one of  their garden inspired scents to find your outlet. Dr. A, I would love to have you give us the list  of the tests that we should be walking into our. doctor and asking for. You walk in and you say,  "I have family history of X breast cancer, ovarian.

cancer, pancreatic cancer, aggressive prostate  cancer, colon cancer. I need a genetic test. Do. you offer that genetic test in your office?" Yes.  Great. Can I have that test? No. Can you refer me. to someone who can do that genetic test for me?  By 30, know your lifetime risk of breast cancer. If that number is 20% or more, start your breast  imaging as early as 30. Find out if you have dense.

breast tissue. For women with dense breast  tissue, ask your doctor for an ultrasound. If your lifetime risk is 20% or more, go back to  your doctor, say, "I calculated my lifetime risk. uh and it's 20% or 25% or 30% or 37% and you  didn't order an MRI for me." A lot of times, insurance companies will not approve an MRI. I had  to pay $3,000 for my MRI even though my lifetime. risk was high. But if your doctor writes on the  prescription that you have a high lifetime risk,

a lot of times it will get approved. So just so  I'm tracking, if your life if you're 30 years or. older, your lifetime risk is above 20%. You can  calculate that risk for free by just going to the. show notes and clicking on the link. And you also  coach your doctor into saying, "Please, when you. order the MRI, write on the order that I have a  high lifetime risk," which is anything over 20%.

That will increase the chance that your insurance  will pay for it. That's the test that you want. And sometimes I send patients, let's say, at 34  and she has a 30% lifetime risk of breast cancer. She calls my office. She's like, "I went to this  center and they're telling me, why are you here? You're not even 40. Why are you doing a breast  MRI? I fight for my patients every single day. Every single day. Because I feel like I have  to advocate for them so they can advocate for.

themselves, you know, and they still get push  back. Is there anything else after you get the. MRI? That's a good question. So for women who  have a very high risk for breast cancer, and I. consider that 35% or above, they have two options.  They can take temoxifen which is a hormone blocker. for 5 years and by taking that they can reduce  that risk by 50%. Which is huge or choose what.

I did which a lot of people still think I'm crazy  but a double masectomy was the best decision I've. made for myself. Okay. Now, not everyone has  access to the plastic surgeon that I went to, um, you know, or could afford this surgery, but  a lot of times it's covered by insurance. Um, the outcomes are different depending  on who the reconstructive surgeon is, but it's the best decision I've  ever done in my life. Dr. A, what do you wish every woman understood about  breast, ovarian, cervical, and uterine cancers?

So, all of the these cancers are completely  different. I want to move to ovarian cancer. Ovarian cancer is very tricky. Okay. And one  thing I want your listeners to understand is. that when it comes to ovarian cancer, know your  family history. Make sure you don't have a genetic. mutation. The broa gene mutation can increase  your risk of ovarian cancer. Lynch syndrome. can increase your ovarian cancer. So if you have  family history, ask for the genetic test, right?

And make sure you know your family history.  If there is one other thing I would change in. this country and make it mandatory, I would have  every single woman on the planet get an annual. pelvic ultrasound. Do you think women get that?  No. I don't even know the last time I got one. You're looking at me. But can I tell you  something? Yes. That's why my patients don't die. Do you know I diagnose? And when I say this, I had  an oncologist who used to work with me. He's like,

he called me one day. He's like, "You know, you're  the only person," and he was so well known in Los. Angeles. He's like, "You're the only person I know  who sends me ovarian cancer stage one and two.". Why? Because I do pelvic ultrasounds on  every single patient. And if you have. family history of ovarian cancer, guess  what I do? Either at menopause, again, I'm very aggressive. This is not standard of care,  but I this is aliabody standard of care. Okay?

I remove those ovaries once they're completely  dead. But for people who want to keep their. ovaries and they're at high risk, did you know  that if you remove someone's fallopian tubes, you can significantly reduce their risk of ovarian  cancer because they did a study 65 some people. say 85% of ovarian cancers start in the tube. I  had a patient three weeks ago. I met this woman.

in July. She came to me. She had long history  of endometriosis. Endometriosis bumps up your. risk of ovarian cancer. And I was talking to her  and I said, "You know what? Also, there's a slight. increase in your risk of ovarian cancer." She's  like, "I don't want cancer. Uh, can you remove. everything?" I'm not saying everyone run and  remove your ovaries, but I pick and choose my. patients. this one. I said yes, I will because she  had long history of inflammation in her pelvis and. I already knew she was a little at risk. I  did her surgery and the pathologist called me.

again. You don't want the pathologist to call you  and uh she told she's like, "How did you diagnose. this patient? Why did you do her surgery?" I'm  like, "You know, she was at risk." So, I removed. her tubes, tubes and ovaries because she was  like 60 years old. And she said she has highgrade. cirrus fallopian tube cancer. 7 millm. You know  how little 7 millimeter is. Wow. I saved her life.

How invasive is the surgery to remove your  fallopian tubes? For me it takes me 10. minutes but 10 minutes maybe 15 minutes. It's  very fast. I do it laparoscopically. You know. the recovery is couple of days. Um, no core  exercises for four weeks, but I don't care. if you if you're at high risk. I'm removing your  tubes. Well, I'm glad you're talking about this. because I have a very good friend who's the chief  operating officer of Breakthrough Cancer, which. is this foundation that's funding collaborative  research. And one of the breakthroughs is the.

research they've funded around the fact that the  majority of ovarian cancer begins in the tubes. and the fallopian tubes can be removed and it's  life-saving. Yeah, for some people it can take. longer, but you don't need to be cut open for a  tube removal. It has to be done laparoscopically. It's outpatient. If you are at risk, remove your  tubes. The only uh group of patients, let's say.

a broa patient who has a very high uh lifetime  risk of ovarian cancer. In those patients at 40, you also want to remove their ovaries, not just  their tubes. But for the rest of us, like if. someone showed up to me and said, I'm done having  kids. um 42 years old. Uh my mom and aunt died of. ovarian cancer. I would remove her tubes and after  menopause, I would go probably remove her ovaries. But while she's done having kids, I would  remove her tubes. So is removing ovaries a. much more invasive procedure? Not really. No. 20  minutes. What happens when you remove somebody's.

like do you like spin into menopause? Like  so if you remove someone's ovaries absolutely. because you put them in surgical menopause. You  don't want to do that. You want your ovaries. you want to keep them. The exception are women  with a positive genetic test, let's say broa. Those women need their ovaries out by 40. And yes,  we do put them in surgical menopause because they. have a high uh lifetime risk of ovarian cancer.  For the rest of them, if you remove the tube, the ovaries are still functioning. You're still  ovulating. You profoundly reduced your risk of.

cancer. Significantly reduce your risk of uh  ovarian cancer. But don't forget your pelvic. ultrasound. How do you get a pelvic ultrasound?  Ask your doctor. Beg if you have to. You need a. pelvic ultrasound. I don't have a single patient  who doesn't have a pelvic ultrasound. And let's. go to uterine cancer. Next, I'll tell you why  um ultrasound is so important. After menopause, when I do an ultrasound, the inner lining  of your uterus. Can I show you my model?

I would love to see your model. Okay. So, here's  the model I brought for you guys. Where's my pen? So, this is the vagina. This is the uterus where  the baby grows. These are your fallopian tubes. and these are the ovaries. Right? So the hormones  are secreted from the ovaries and the fallopian. tube. The job of the fallopian tube is it grabs  the egg as the sperm comes up from the vagina into. the uterus and into the tube they meet and then  the embryo implants into the uterus. So removing.

the fallopian tubes will significantly reduce  your risk of ovarian cancer. But when it comes. to uterine cancer after menopause, the lining  we call it endometrial echo complex. It's the. lining inside the uterus. And that's what we're  shedding when we menrate. Right. Correct. Okay. After menopause, you want that lining less than  4 millime. So if you're my patient and you come. to my office, every single year I'm doing your  ultrasound and I measure your lining and let's say.

it's 3 mm, right? Yeah. And then one year you show  up and it's suddenly 7 mm. You have no symptoms. You have no bleeding. Guess what I'm going to  do? I'm going to do a biopsy of your uterus. I'm going to investigate why this lining that's  always been 3 mm is suddenly 7 mm. Do you know how. many uterine cancers I've caught over the years?  Stage one, because of my transvaginal ultrasound,

because I'm checking this lining. And what is  the width that triggers you to do a anything. past 4 millimeters? Now, let's say, you know, if a  patient comes to me, she's a new patient and says, "Oh, I've had a ultrasound or I did they did a  biopsy of this lining two years ago. I always my. lining is a little too thick." I'll document I get  her ultrasound. I uh and her path report. I put it. in the chart. But if she doesn't know and she's  post-menopausal and her lining is thick, again,

I don't watch anything. It takes me 10 seconds  to biopsy the uterus. Why would I not do it? Why. would I hesitate to biopsy someone when it takes  10 seconds, right? Yes. So, what's the last one? Cervical cancer. Listen, no one should die of  cervical cancer. Almost all cervical cancers. start with HPV. Human papilloma virus is  sexually transmitted virus. Get your papsmears.

and get screened for HPV. There is no reason why  anyone should ever die of cervical cancer. It's. almost 100% preventable. Since I've let  left county USC, that's where I trained. and we would see cervical cancer every call.  Women would come, oh my last pastors was 10. years ago on bleeding. It was like a common thing  on call every time. Every week we would have a.

bunch of women with cervical cancer. That has  ended. We have the HPV vaccine. We screen for. it. So that is 100% 100% preventable. Talk to me  about the vaccine. Every woman should get it. Yes. Uh 9 to 46. Now it's part of childhood vaccination  9 to 11. It works. There are 100 different strains. of HPV. About 30 of them affect the genital area.  Of the 30, 15 of them are high risk, meaning they. can cause cervical cancer. Of the 15, two of  them, number 16 and number 18, HPV, are highly.

associated with cervical cancer. Those are the  patients you need to watch very closely. Those are. patients who come in with a negative papsmear. If  your HPV16 or 18 is positive and your papsmear is. negative, guess what? you still need a coposcopy  so we can look at the cervix and take a biopsy of. areas that are suspicious just to make sure we're  not missing cervical cancer. If you didn't get an. HPV vaccine as a child, should you do it as an as  a woman, as an adult? Yeah. Up to age uh 46? Yeah.

Dr. A, what should women do every day just to stay  aware of changes that might be happening in their. body? So, I don't want to put this fear in you  that you have to do something every single day, but as a woman, you need to know your body. You  need to know what your breasts feel like. You need. to know what the skin looks like on your breasts.  You need to know what symptoms you experience. You need to know if your periods are regular.  You need to know if you have acne. You have to.

notice hair loss. You have to notice if you're  bloated all the time. So, you just need to be. aware of yourself. Don't ignore your symptoms.  Our health care system has taught us to dismiss. symptoms to ignore pain and it has normalized uh  everything we feel bloating it doesn't matter what. we feel they say it's normal and the the other  thing I want to talk about is if your doctor. tells you if you feel like something's wrong  and the doctor looks at your labs and says.

no your labs are normal you're good to go. That's  not true. doesn't work that way. You can have a. completely normal lab and have breast cancer.  So, don't tell me that your labs were normal. I want to thank our new sponsor, ADT, because  they know that you can't control everything that. happens in a day. And trying to, well, that'll  get you nowhere. But the one thing you can do, get yourself an ADT home security system to  give you more peace of mind and make sure you,

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up to an EPA estimated 619 miles of range. View  US News best cars at cars. usnews.com and call. 562314-4603 for complete details. So, what  should I be advocating for? I love this. It depends on your age. Let's start at a  young age, right? First of all, for teenagers, I want, if you're listening to this podcast and  you have a teenage daughter, I want you to look.

for signs of endometriosis. Make sure your  daughter doesn't have painful periods. You don't. have to go pick her up from school because she's  in pain. she and you know make sure she's not. going to the doctor complaining of painful periods  or pelvic pain in general. Make sure she doesn't. have constant struggles with bloating. That's  endometriosis. Make sure you also look for signs. and symptoms of PMOS. Does she have irregular  period? Is her acne out of control? Is she.

gaining weight? No matter what she does, she can't  lose it. Is she having signs of disordered eating. or is she struggling with an eating disorder? Does  she have any hair loss? So, those are symptoms I. would look for to make sure you're not missing  PMOS. Uh, in a teenager, make sure their HPV. vaccine is up to date, right? If they're sexually  active, you want to talk about STDs with them. You. want to talk about birth control. And for patients  who by 18 to 20, I get an egg count, baseline egg.

count on every single patient of mine. EC count  uh is AMH, antimmalarian hormone is a simple blood. test that you can do at your doctor's office. You  can do it with your primary. You can do it with. your gynecologist. You can do it with your family  practice doctor. And basically, it tells me about. your ovarian reserve. Having a high AMH doesn't  mean you're going to get pregnant and have all the.

babies you want. And having a low AMH doesn't mean  you're infertile. But it tells me where you're. sitting with your ovarian reserve. Right? So it's  very important information. And then by age 25, I ask every single woman. I talk about family  history and if they have any family history. of any cancers, I will do a genetic test on them.  But at this age, I've also done a baseline hormone. panel on the patients. I check testosterone free  and total. I check prolactin levels. I check DH.

EAS. It's a hormone secreted by the adrenal  gland that can have symptoms similar to PMOS, but it's mostly stress related. And I do a full  thyroid panel. For patients who are overweight, I check their hemoglobin A1C at this point.  So once I do I have a baseline hormone panel, the papsmear, you know, it starts at age 21 and  I usually combine a papsmear with the HPV test.

For women who uh are sexually active before that,  we usually start your pap either at 21 or 3 years. after the first intercourse, whichever one comes  first. By age 30, I calculate everyone's lifetime. risk of breast cancer. If that lifetime risk of  breast cancer is um 20% or more, I start your. their breast imaging, mamogram, ultrasound, and  MRI as early as 30. Um by age 28, if my patients. are not in a relationship and they don't have  any plans or they're not dating, um I usually.

start talking about egg freezing uh unless their  egg count was uh low and I had done it earlier. But between 28 and 32, I push my patients to  freeze eggs. How come? Uh because as we get older, the count goes down and the quality of the  egg goes down. And because in my practice, I see a lot of PMOS and endometriosis patients and  egg quality becomes an issue. I always recommend.

um egg freezing in these patients, in  my patients. The problem is, Mel, when. women are young and they have great eggs, they  can't afford it. they can't afford egg freezing. When they're older and their egg count and quality  is gone, then they can afford it. And what is it? What does it typically cost? I realize it  varies, but what is the procedure? So, basically, it costs anywhere from$10,000 up to $35,000 per  cycle. Wow. And in your late30s, then I talk also.

I get my patients ready for pregnancy. That's the  age mostly women get pregnant, but that's a whole. podcast by itself. But usually by by 35 even for  low-risk patients in my practice I do a mamogram. baseline mamogram and ultrasound and then um this  is when a lot of women believe it or not can start. pmenopause. Average age of menopause is 51 and  a half. The range is 45 to 55 but 7 to 10 years.

before menopause women go through pmenopause. So  if your body is programmed to go through menopause. at 45, at 35 you can start having permenopausal  symptoms. So I watch my patients very closely. These are patients who suddenly show up and say,  "I don't feel good. Something's wrong. Something's. changing in my body. I'm not sleeping well. I'm  angry. I'm yelling at my kids. I want to kill my. husband. I'm irritable. I have hot flashes. I have  night sweats. I'm gaining weight. I don't know. Whatever I used to do to control my weight is not  working anymore. I'm losing hair. My joints hurt.

Sex suddenly hurts. I don't know why I'm peeing  so much. Those are all permenopausal symptoms. And you can see those between the ages of 35  or your late 40s. Yes. Absolutely. Got it. So, you need to, you know, it's less common in your  late 30s, but it's it can absolutely happen. So when you start to experience the permenopause  symptoms, whether you're in your late 30s or. mid30s or your, you know, mid to late 40s, you  can start HRT based on symptoms. Absolutely.

As long as you don't have breast cancer and you  don't have any contraindications for hormone use, the best form progesterone, which we prescribe  uh micronized progesterone for parmenopausal and. postmenopausal women. Progesterone has a calming  effect on the brain. For patients with brain fog, which is a very common symptom, they  forget things. They have hot flashes, night sweats, uh they're more irritable, they feel  depressed. Um they can start estrogen patches. It's the best. Obviously, you can do topical  estrogen. You can take oral estrogen. Um but at.

45, you want to have a ba a baseline colonoscopy,  right? If you have family history of colon cancer, you start 10 years prior to that. So, if you  had an uncle who had colon cancer at age 48, then you start your colonoscopies at 38. You don't  wait for 45. I always I love getting bone density. on my patients in their 40s. I want to know what  the baseline is. I don't wait until you're 60. to get a bone density. So, I get a baseline bone  density on my patients in their 40s. And if it's.

low, I watch them. I, you know, if I have to treat  it, I treat it. If I have to recommend exercise, weight bearing it, whatever it is. Uh, but  I don't want to suddenly wait for menopause. The biggest loss in menopause happens the  first uh five years of menopause with bones. So you don't you want to build up the bone  so when you lose it you don't drop into the. osteoporotic range. But one of the things  that um I do on every single patient as. soon as uh they're sexually active is a pelvic  ultrasound on my annual exams every single year.

So as soon as you're active I'm doing a  pelvic ultrasound. It takes me one minute. to look at your ovaries, tubes, and uterus. If  you tell me that you don't want an ultrasound, it's like covering my eyes and asking me to  drive. I literally have no idea how gynecologists. uh treat patients on their wellwoman exam without  doing an ultrasound. So, let's say you are now.

past having kids. You're past perry menopause. You  are in menopause and you have not had your period. So, you're kind of 50 and over. What should you be  asking for at your wellwoman exam? Uh, one thing. I'm very passionate about is longevity, right?  And a lot of women do not see another doctor. They don't have a primary care who takes care of  them. They only go to their gynecologist once a. year. What do they get? A papsmear, a breast exam,  a bmanual pelvic exam, and maybe an SEDD check.

and off they go. Maybe a prescription for birth  control. That's not wellwoman, right? a wellwoman. exam, you need to rule out everything I talked  about, but you also have to address longevity. What is longevity? Is my patient at risk for  stroke? Is my patient at risk for heart attack? These are simple tests. Is my patient at risk  for dementia? There's a simple blood test, APOE4. 20 to 25% of women carry the APOE E4 variant.  Okay? If you have the ApoE4, so 20 to 25%, I'm.

one of them. 20 to 25% carry one copy, 2% carry  two copies. People who have the APOE4 variant are. at a higher risk for having Alzheimer's disease.  So these are the patients you have to intervene. One information is exercise. Exercise makes a  huge difference in these patients. It doesn't. mean you're going to get dementia. It means you're  at a higher risk than the general population.

Two is sleep. These patients need to get at  least 7 hours of restful sleep at night, right? Three, omega-3s are very important. Four, avoiding  alcohol, avoiding smoking, avoiding processed. food, and keeping these patients homocyine down,  which is another blood test I check on every. single patient. If your homocyine is high, it  means that you're not methylating well. So these. patients I usually prescribe methylated B to them.  The other data we recently have is that if you.

put patients with APOE E4 on hormone replacement  within the first seven years of menopause you can. reduce their risk of Alzheimer's in life which is  huge right so you don't want to miss that window. so that's your APOE4 ask your doctor to check your  APOE4 level um the other test is your APOB we used. to look at cholesterol and LDL and it's great  we triglycerides we still look at all of that. but One new value we look at is your apo. And I  think every single woman listening to this podcast.

needs to know her apo. Imagine a bucket y of  four particles in your blood that can make plaque. and increase your risk of heart attack.  Heart attack is the number one killer. Right? So don't you want to know what that bucket is? In  this bucket of apo B, there are four particles. Lipoprotein little A, which is genetic. 20% of us  have it. You either have it or you don't have it.

Uh LDL, IDL, and VLDLDL. In this bucket of apo,  the 20% of women who have this lipoprotein little. A, it pushes their APOB to go high. And these  are women who tend to have earlier heart attacks. Like you look at these some families, they're  like everyone in our family has a heart attack. at age 50. Well, their APOB was not checked. In my  practice for longevity, I always tell my patients, it's not a magical number, but I want to keep that  number below 60. There's a longevity cardiologist.

that I work with. He says, "Bring it down to below  40 if you want to live to be 100." Do you know. how many women they look healthy, right? They  look they exercise, they do everything right, they eat healthy, they don't drink, they don't  smoke, but their Apoes are in the hundreds. Whoa. So, you need to know if you haven't heard of your  APOB, go ask your doctor. It needs to be fasting. There are two centers that run a correct APOB.  One is Cleveland Clinic and the other one is.

Boston Heart. Um, so a lot of random labs can  run APOBS. It could not be as accurate. Again, go see a cardiologist. Ask about these values. Um,  take a note and add these to your to-do list. So, when you go for your fasting blood test, you're  asking for all these uh uh tests every year. I'm laughing because I'm I it  makes me uncomfortable knowing. how little I've asked for. And that  brings me to a very realistic question.

Knowing that every woman typically gets about 15  minutes with their doctor after listening to this. conversation with you. What specifically  should we walk into our annual visit. and ask for and say and do? I hope that everything  I covered, you know, I covered the most important.

topics. I didn't cover all of it, but I want you  to take a piece of paper, make a long list of. everything you want. Educate yourself. If you want  to advocate for yourself, educate for yourself. Go into that meeting empowered, educated. I don't  expect you to be a doctor. But I do expect you. to advocate for yourself because no one  on this planet cares about your body.

or your health as much as you do. So you need to  advocate for yourself. Get that piece of paper. ready. If you have family history, you know what  to do. If you now you know how to calculate your. lifetime risk. You don't need your doctor to do  it. Make sure if you need mamogram, ultrasound, MRI, you have it on your to-do list. If you think  you have PMOS, ask your doctor. If you think you. have endometriosis, ask about endometriosis.  If you're doing your fasting blood test, add everything I told you to the list. Say,  "Doctor, are you also checking my APOB? I'm.

permenopausal. Are you checking my hormones? Are  you checking my ApoE4? Am I at risk for dementia? Are you ordering a bone density for me? Am I due  for my colonoscopy? Do I need genetic testing?". Write it on a piece of paper because that 15  minutes, you don't want to waste a minute of it. Go in with a mission in mind. Well, that's why I'm  grateful that you are here today because you just.

educated us. It will save millions of lives. Mel,  if you drop everything and just take the breast. cancer lifetime calculator, imagine if every woman  calculated her lifetime risk of breast cancer. Do you know how many millions of lives you will  save with your podcast today? Millions. Dr. A, what are your parting words? My parting  words is when it comes to women's health, don't let them dismiss you. Don't let them  tell you it's in your head. Don't let them.

tell you it's normal. Don't let them tell you your  labs are normal so you don't have the condition. If you get dismissed, go get a second opinion. If  you still get dismissed, go get a third opinion. No one said you need to be stuck. I didn't stay  with my first doctor's opinion who told me I was. okay and I didn't need a double mastctomy. I  kept pushing and pushing the boundaries until. I get the care that I deserve. And you deserve  the best care on this planet. There's no reason.

why you should ever be dismissed. Don't  let anyone tell you that you're anxious, that you're stressed, that it's in your head.  fight for it, educate yourself, empower yourself, and become your own health advocate. That's the  only way to survive this health care system. As you said, Dr. A, no one cares about your  health as much as you do, and you deserve. the best care on the planet. And I want to thank  you on behalf of the tens of millions of women.

who will listen to this, who will share this with  the women in their life. I want to thank you on. behalf of the men who love the women in their life  who have educated themselves by listening to this. And I know there's no doubt in my mind that based  on the information that you shared with us today. and the way in which you shared it, there will  be people whose lives are saved. And I believe.

it will be in the millions because every time  someone listens and they take all this information. and they empower themselves to take responsibility  for demanding the care that they deserve, you are saving a life and you're improving it.  And so thank you for the extraordinary work. that you do. Thank you for sharing this beautiful  mic. Thank you for everything you do. Thank you, Dr. A. And thank you. Thank you for listening to  something. I know you don't have a lot of time,

so thank you for making the time to listen to  something that will educate you. And thank you. for being extraordinarily generous with this  episode. I am going to ask you personally. to take a minute and copy the link and text  it, email it, send it to every woman you know. We covered information that is critical for  every teenage girl all the way up to every woman.

that you know through the end of her life. And  this is a free resource with a world-renowned. expert who wants you to have the best care on the  planet. And having the best care on the planet. means educating yourself and advocating  for that. And so together we can support. women all over the world. And we can support  them in not only advocating for themselves, but also in advocating for the women in their  lives and the girls in their lives that they know.

All righty. In case someone else tells you as  your friend, I'm also going to remind you that. I love you and I believe in you and I believe in  your ability to create a better life. [music] All. righty. I'll see you in the next episode.  I'll welcome you in the moment you hit play. And thank you for watching all the way to the  end here on YouTube. Thank you for spending time. with me. I loved being with you. And thank you  for sharing this with people in your life that. you care about. All righty. I know you want to  watch another episode of the Mel Robbins podcast. [music] You're going to love this one next. And  I'll welcome you in the moment you hit play.