May 14, 2024 • 29 mins
On this episode, we will hear from naturopathic physician, Dr. Erin Rurak. Dr. Rurak will share some talk about why breast screening is so important, who should be screened, when and how often they should be screened, and the role of screening in breast cancer prevention.
Five To Thrive Live is broadcast live Tuesdays at 7PM ET and Music on W4CS Radio – The Cancer Support Network (www.w4cy.com) part of Talk 4 Radio (www.talk4radio.com) on the Talk 4 Media Network (www.talk4media.com).
Five To Thrive Live Podcast is also available on Talk 4 Media (www.talk4media.com), Talk 4 Podcasting (www.talk4podcasting.com), iHeartRadio, Amazon Music, Pandora, Spotify, Audible, and over 100 other podcast outlets.
Five To Thrive Live is broadcast live Tuesdays at 7PM ET and Music on W4CS Radio – The Cancer Support Network (www.w4cy.com) part of Talk 4 Radio (www.talk4radio.com) on the Talk 4 Media Network (www.talk4media.com).
Five To Thrive Live Podcast is also available on Talk 4 Media (www.talk4media.com), Talk 4 Podcasting (www.talk4podcasting.com), iHeartRadio, Amazon Music, Pandora, Spotify, Audible, and over 100 other podcast outlets.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
Any health related information on the followingshow provides general information only. Content presented
on any show by any host orguest should not be substituted for a doctor's
advice. Always consult your physician beforebeginning any new diet, exercise, or
treatment program. Welcome to five toThrive Live, a podcast about thriving for
(00:44):
those who have been affected by cancerand chronic disease. I'm doctor Lisau Schuler.
I co host this show with mygood friend Carolyn Gazella, and you
can find all of our past podcastson any major podcast outlet. So tonight
I'm going to be talking to doctorAaron Rorek about breast cancer screening, a
(01:04):
particularly timely topic actually in light ofthe new breast cancer screening recommendations that were
released by the US Preventative Services TaskForce. They released those guidelines early in
May twenty twenty four. So we'regoing to talk about these guidelines, We're
going to talk about some other considerationsregarding breast screening and helping us to do
(01:25):
that is my guest, doctor AaronRourek, who is a licensed nachropathic physician.
She graduated in twenty fourteen from theBouchet Institute of Natropathic Medicine. She
received her Bachelor of Science at theUniversity of British Columbia with a degree in
microbiology and immunology. Doctor Rourek isalso a certified clinician throughout the SORRY through
(01:46):
the North American Menopause Society, andshe has a keen interest in cancer,
particularly its prevention, as well ashormonal changes related to menopause. So before
we introduce her and get started,I do want to thank our sponsors.
We first thank American Biosciences which arethe makers of metatrol fermented wheat term extract
(02:07):
for enhanced mitochondrial function and Empower AHCCto supercharge your immune system and you can
get some free samples, some researchand you can do that with an exclusive
discount if you go to the HarmonyCompany dot com forward slash Thrive. We
also think Emmuse, a unique patentedpost biotic that gives your immune system a
(02:31):
key advantage. Ammuse is an ingredientin many immune supporting dietary supplements. To
look for Immuse on the label orgo to immusehealth dot com. Also cognizance
toticoline, which keeps your brains energyfiring on all cylinders. If you're looking
for a way to get your brainfunction going, improve your memory, focus
(02:53):
and attention, look for Cognizant onthe label, or you can go to
Cognizant dot com for more information.And finally, doctor Hira's Probiotics a best
selling probiotic for over thirty years whichcontains twelve probiotic strains which are shelf stable
without refrigeration due to their unique threeyear fermentation process, and you can learn
(03:15):
more at doctor Hira Probiotics dot com. And with that, welcome to the
show, Doctor Urek. Hello,thank you so much for having me.
It's a real pleasure to be here. Absolutely well, the pleasure is mine.
I'm very interested in your thoughts onthis topic. And but before we
do that, you know it helpsour listeners, I think to just get
(03:35):
to know you a little bit,So maybe tell us a little bit why
you particularly are interested in breast screening, what you know, how did this
become a focus area of yours.Well, with my work, I see
a lot of women who have been, you know, diagnosed with breast cancer,
who may have a high risk ofbreast cancer, who may be breast
(03:58):
cancer survivors, or who may beliving with breast cancer as more of a
chronic condition, and it just strikesme how this can inflict women to such
a great degree. And I justhave found over the last i would say
seven years, more and more womencoming to see me regarding their breast cancer,
(04:19):
and not only that, more andmore younger women being diagnosed with breast
cancer. And that to me reallygot my interest in what is going on
here. I know that not allbreast cancer can be prevented, but I
do think that we should be ableto catch breast cancer extremely early so that
(04:40):
less women would need to be diagnosedwith a stage two or greater, which
would then affect their treatments and potentiallypose them with more toxic treatments. M
M, yep. I would agreewith you on this. So I think
early detection is key for sure.So let's start with definitions. When you
say breast screening, are you areyou talking about mammograms or are you talking
(05:01):
about more than that? Well itreally I think we have to take a
step back here and know that Iam talking about mammograms, but screening really
does depend on, in my opinion, a woman's risk of developing breast cancer.
So we know that on average onein every eight so twelve percent risk
(05:23):
of developing breast cancer in women.But that's a population based statistic, so
we have to take a step backand think, well, what does that
mean for the person sitting in ouroffice. It does not mean that their
particular risk is twelve percent. Itmay be much greater than that. It
may be lower than that. SoI would say for the vast majority of
(05:45):
women when I mentioned screening, I'mtalking about mammograms, but that may not
be enough for women who may beat a higher risk because of their density
or because of perhaps hereditary gene mutations. Right, So, yeah, I
think that's a really important point youjust made that breast screening is sort of
(06:05):
universally applied to some extent because ofthe sort of a population wide incidence rate,
which is what you'd refer to,but that each person has their own
individual set of circumstances which would makethem higher lower risk. So we'll get
into that in the moment. Iwant to bring us to the US Preventive
(06:26):
Services Task Force, which is amajor organization that sets guidelines which in turn
determine insurance reimbursement in the United States, and really influence physician practice throughout North
America. So in early May twentytwenty four, they updated their screening guidelines
for breast cancer and the major changewas that they lowered the recommended h to
(06:50):
start regular screening from fifty years oldfor females to forty years old, and
they recommend regular screening up to theage seventy four. And they did that
because their evidence reviews suggests that byreducing the screening age that will we can
save twenty percent more lives because ofearly detection. They also, as another
(07:15):
part of their recommendations, recommended thatwomen get screened every two years instead of
every year. So let's dissect thisa bit because both of these recommendations are
new and they're creating some controversy.So let's start with the age. Do
you agree with lowering the age ofscreening from fifty to forty one hundred percent?
Yes. Just this week I hada woman come into my office she
(07:40):
got her screening. I'm in Canada, so the guidelines are different. So
many of our provinces start screening atthe age of forty, So in British
Columbia that's what's recommended. She gother screening mambogram done and lo and behold,
she was diagnosed with an invasive doctorcarcinoma with no family history. If
(08:00):
she waited until the age of fifty, this would not be have caught at
such an early stage and she wouldhave been a completely different situation. So
one hundred percent. And there's moreand more women being diagnosed with breast cancer
in their twenties and thirties and forties. So if there was not this reduction
in age of screening, we wouldnot be doing the best that we could
(08:24):
do to ensure that if women aredeveloping breast cancer, we wouldn't be catching
them at an early stage. Right, And you know, you're bringing up
a really important point, which isthese cancers are showing up in people at
younger ages. We used to thinkof cancer as an age of the older,
the elders, and it's actually nottrue anymore. There was We had
(08:45):
a really great show with doctor TinaKayzer on April thirtieth about early onset cancers,
and Tina and I had a reallyinteresting discussion about why these cancers might
be showing up in earlier ages.And so if you're interested than that,
you can check that show out,But you know, I think it's true.
Right, So breast cancer is showingup younger and it tends to be
(09:07):
more aggressive also when it's manifesting ayounger woman. So screening, you know,
really can in fact save less.What about this every other year instead
of annually? You know, thisis interesting, particularly in light of the
fact that these younger women tend tohave more aggressive which generally means more fast
growing tumors. So if they're gettingscreened earlier, yay, but every other
(09:30):
year, what do you think,well, would I would not recommend.
I don't think that's ideal. Ithink it would be every year annual screening
mammograms. But again, if wewere to think back and what we started
with, well, what is thatwoman's individual risk of breast cancer? So
perhaps if her individual risk was let'ssay eight percent, maybe that would be
(09:54):
okay. But if we have apatient in whose risk is much higher than
twelve percent, I would in noway feel comfortable having her go every other
year for a screening mammogram. Okay, So I want to pick that up
and can you give us some ideas, some considerations that would cause you to
(10:16):
pause and suggest to somebody I thinkyou're at higher risk, Let's make sure
you get screened to annually. Whatwould make somebody at higher risk? Well,
in order to know your individual riskof breast cancer, you need to
know what the risk factors are.So that would require you asking questions with
(10:37):
in a history in an exam,and so I would be asking about family
history of breast cancers, or uterinecancers, or colon cancers. I would
ask a when they had their firstmenstrual cycle, if they are menopausal,
when did they enter menopause? Ifthey have had children, how old were
(10:58):
they when they had their first child. Those are reproductive factors, family factors
that influence a person's risk of developingbreast cancer. And then I would do
a deeper investigation as to understand whatthat patient is eating, so I have
a sense as too if they're eatingmore of a whole foods diet. I
(11:20):
would be asking about alcohol intake,just because there is very good evidence that
alcohol is a risk for breast canceras well as a number of other cancers.
And then we would discuss, well, what have your previous mammograms look
like if you've had one, whatis the breast density? Have you had
a previous biopsy what's your hormonal use, be it oral contraceptives or menopausal hormone
(11:46):
therapy. Those are all factors thatneed to be taken into consideration when understanding
a person's risk. And if geneticshave been run on that individual, have
there been any high risk mutations thatwere picked up? Right? So I
think one takeaway from your answer isthat it's not simple. That it's multitude
of factors which have to be consideredcollectively to really understand somebody's individual risk and
(12:13):
therefore the most optimal screening program.So it may not be simple, but
it is completely possible. So there'ssome very good models that can be used
in office. Women can do thison their whole own at home. There's
the Gale model that is an easyfive question you know is it questionnaire just
(12:37):
to get your sense of a roughrisk of your individual breast cancer. I
typically use the tire Cusic scoring method, which goes into a bit more depth
about these factors that I just mentioned. But you know, if clinicians are
used to doing this, you cando a tire Cusic in ten minutes.
Okay, it's not impossible. Goodyeah, right, good point. This
(13:01):
is complex, but not impossible.And in fact, it would be something,
Yeah, women should. I wasjust gonna say women should advocate for
this. So maybe when they're goingto see their primary care physician, you
know, ask them, have youcan you put my information into one of
these models to determine my risk forbreast cancer so that I can make a
(13:24):
decision with you about how often Ishould get screening. I think that's a
way in which people can be veryproactive about their own health. So I
want to go back to the guidelinesfor a second too. There's another interesting
thing about this, which is thatyou know, we're yes seeing breast cancer
show up in younger people, butwe are also as a population living older,
so therefore still the majority of cancers. Breast cancers are found in menopausal
(13:46):
women, and menopausal women are livinglong now generally, so the guidelines suggest
that screening be stopped at the ageof seventy four, many women are living
well beyond that. What do youthink should they continue screening beyond seventy four
or if not, are there alternativescreening methods that you think would be effective
(14:09):
in older women women? Well,I think a screening mammogram would probably be
very effective. Of course, inolder women because older women, on average
have less dense breadths, which iswhere mammograms work the best. I would
say that I would also be mindfulof we have to understand how old,
(14:33):
not just how old that patient iswhen they come to see you, but
how long you would expect them tolive for. So you may see a
patient who is seventy four, whohas a number of other chronic illnesses and
so may not make it to theage of seventy seven. So I likely
wouldn't at that time recommend a screeningmammogram. But if I have a healthy
eighty year old female in my practicewho I feel for sure she's going to
(14:56):
be living greater than ten years,I would say, we've got to keep
up with your breast screening. Mmhmm, right, yep, fair enough.
I think that's really a smart answer. And so again it brings it
down to the level of the individual. So what about you know. Another
criticism of the guidelines is that racialdisparities and breast cancer are not addressed.
(15:18):
To some extent. They are inthat the you know, black women are
forty percent more likely to die ofbreast cancer than white women. Unfortunately,
they tend to have more aggressive cancersdiagnosed at younger ages, yes, and
more triple negative. So in someways, the guidelines kind of address this
universally by lowering the starting age ofscreening to forty. But I'm wondering if
(15:43):
you have any other thoughts on thisdisparity from a screening perspective. Well,
I think I would agree that loweringthis to forty will be helpful in catching
women at a younger age, regardlessof their race. I think that it's
really important. We would have todissect, well, why are black women
(16:03):
more prone to pass away from breastcancer? And there could be disparacy disparities
within their access to healthcare. Soperhaps they're not actually able to get their
screening mammograms, or perhaps they havenot been had an opportunity to sit down
(16:23):
with a healthcare practitioner and let themknow that they may be at higher risk.
Therefore, we need to look intoyour risk factors in a deeper level
just to make sure that we're doingeverything that we can to be proactive for
not only breast cancer prevention but earlyscreening. So it's a lot of education
involved there and making sure that allwomen have equal access to the same level
(16:47):
of health care Yep, that's areally important comment, and I think that
the access issues are really critical.You know, there's a lot of issues
around educ community education, and awarenessthat need to be addressed as well.
So switching you's a little bit.You know, one of the criticisms that's
(17:10):
going to come from the public aboutlowering the age of screening is a concern
on the part of women about theadditional ten years of exposure to the radiation
from MRA from mammograms to their breasttissue. So what are your thoughts about
that. You know, Well,mammogram, although it's considered at this point
(17:32):
the gold standard in breast cancer screening, I mean, it's not perfect.
Just like any screening modality, itwill always have its downfalls, and this
is you know that radiation exposure potentiallyevery year is going to be potentially a
concern for a lot of women.But you've got to also measure that with
the importance of the screening. Thatif you're not getting your mammograms, the
(17:56):
risk of that is that you maybe diagnosed with a later stage breast cancer.
So you just have to weigh thepros of the cons I feel that
the annual screening outweighs the risk ofthe very low dose radiation exposure, and
do you feel like if a patientcomes to you, let's say, and
(18:18):
says, look, I'm interested inscreening. Are there any alternatives to mammogram
that you trust? Yes, Sothis happens to it all the time.
And so if I have a patientin my office who is concerned about having
annual mammograms for whatever reason it couldbe, there could be many different concerns
(18:41):
there, I would I would say, okay, well let's think about this
for you. Well, could weperhaps do as screening mammogram one year and
then the next one do a breastultrasound of bilateral breast ultrasound, So we
go back and forth, back andforth. If I have a really high
risk patient in my office, becausefor example, they have extremely dense breasts,
(19:04):
I would know right there that it'sa bit like you know, when
you're doing screening mammograms and you havevery dense breast, it's a bit like
trying to find a white ball ina snow storm. It's so hard to
pick up on mammograms. So Imay say, well, perhaps we could
consider doing a mammogram one year andthen a bilateral MRI the next year,
(19:25):
which doesn't have any exposure to radiationor X rays, right, And I
think that that's a good distinction youmade. So one of the opportunities with
these guidelines is that for women whoare concerned about the radiation exposure to the
breast issue, there is the opportunityon the off year to do, like
you said, an ultrasound exam,which can be useful. It's not as
(19:48):
sensitive, of course, but actuallyfor women with dense breasts sometimes is very
helpful. And then of course breastMRI unfortunately very expensive, so not generally
recommended as a general screening, butfor high risk women certainly could be used.
I think those are really creative andgood thoughts around how to sort of
maximize the sort of the benefits,if you will, of this every other
(20:12):
year screening. And you know,I think that really the point of screening
is to detect cancer early when it'sas you said, earlier, more treatable
with less toxic therapies potentially. Ofcourse, stepping back from that, primary
prevention is really about how can Ilower my risk for cancer in the first
(20:33):
space. So this is a verybig question, and I you know,
we don't have time to go intoevery single opportunity, but just in sort
of a broad sweep, what wouldyou say some of the most actionable ways
are there to reduce a risk ofbreast cancer, so that women get screened,
(20:56):
they don't find anything. Well,so then we're talking more about the
modifiable risk factors. So I wouldfirst bring up diet. I would be
really trying to recommend a whole foodsdiet, limiting process and package foods,
educating women that you know, althoughvery convenient, these types of processed foods
(21:21):
are likely inflaming us from the insideout. I would be trying to recommend,
not that I think patients need tobe vegetarian, but a higher plant
based diet where they're getting quite afew of their proteins from plants, be
it lentils and beans and nuts andseeds at amami and tofu. We have
to have a very good discussion onalcohol in terms of if that person is
(21:45):
drinking more than three units of alcoholin a week. I see that as
a potential way to reduce the riskof breast cancer. And then certainly trying
to help women achieve optimal weight aswell, especially for women who are menopausal
That could be a really challenging thingfor women because weight becomes harder and harder
(22:07):
to maintain after menopause. But it'sactually increased weight after menopause that increases the
risk of breast cancer. It's notas much of a factor for premenopausal women
when it comes to breast cancer risk, but postmenopausal women. And I think
you know, as we're talking aboutthese modifiable risk factors, it bears mentioning
(22:27):
that these are not going to takesomebody's risk down to zero. You know,
these are things that will lower therisk, but there's still the opportunity
for breast cancer to grow because thereare a lot of other factors that contribute
to cancer growth, some of whichare beyond our control, like environmental factors.
The breast tissue concentrates environmental toxics,and we are are all exposed to
(22:51):
those from the minute we're created.There's even epigenetic factors, so things that
our grandmother was exposed to a theegg that our mother developed, which then
becomes us. So actually those pectors, you know, there's a lot out
of our control. But you know, the things you're mentioning, even if
they don't prevent the cancer from occurring. They do have the potential to keep
(23:15):
the cancer from being aggressive or maybeit reduces the risk. And so that's
where it's really important for women tounderstand what their risk of breast cancer may
be through the Gale model or thetire cusic. So then if the purpose
of doing these assessments is not toscare women or make them happy, the
(23:37):
purpose of doing this is to letwomen know what their risk is so that
if it does happen to be higherthan what we would like to see,
that is to give them understanding,well, let's work with what we can
to lower your risk. Let's workwith that nutrition. You know, can
we lower your alcohol, What canwe do here to help optimize your weight.
Those are the things to give womenthe empowerment that they need to make
(24:00):
these healthy changes in life, becauseit's going to reduce the risk of breast
cancer. But it's going to dofar more than that. It's going to
reduce the risk of cardiovascular disease anda number of other type two diabetes.
So it's super important. M Yeah, very good point. So what about
genetics. You know, let's saysomebody finds out that they have they carry
(24:21):
the braca mutation, which is somethingthat they're born with. And for some
of these BRACA mutations there are differentkinds, but for some of these mutations,
that woman may have up to aneighty seven percent lifetime risk of having
breast cancer. So, first ofall, I those women obviously need to
be screened. How often should theybe screened? And should you know there
(24:45):
be any additional do you treat thosewomen differently in your practice if they have
not had a diagnosis of breast canceryet? So women with these high risk
mutations are always screened different then womenwho are average risks. So if a
women's individual risk of breast cancer isgreater than twenty percent, that should trigger
(25:10):
it so that that individual can haveaccess to bilateral breast MRIs. And so
that would be the same for womenwho carry these high risk gene mutations such
as BRAKA. They're not going tobe getting screening mammograms. But if we
take a step back here, it'sreally important that people are aware that only
about ten percent of individuals who carrythese high risk genes are aware of it,
(25:34):
So that means there's ninety percent ofpeople with these high risk genes that
are mutated that are walking around haveno idea that they have them, and
we as healthcare practitioners, how dowe best help them when ultimately we don't
even know who they are, right, and we were not at a place
where we screen the general population forthese mutations. So you're right, it's
(25:56):
a conundrum. It's a conundrum.But there's been such an explosion in genetics
and testing that it has significantly reducedthe price down to these multi gene panels
for cancer. So I will often, you know, if my patients can
do it, if we're women whocan do this, and men too,
(26:17):
because know that men can have mutationin these genes and pass this on to
their offspring. You know, spendingtwo hundred and fifty dollars one time in
your life to do a multi genepanel related to cancer, I think is
well worth it. Okay, well, that's a very good pearl there.
(26:37):
So, Aaron, what final thoughtswould you like to leave with our listeners
on this topic. Well, Ithink I just want to really hone in
on the fact that we cannot preventall breast cancers, but we should be
able at this day and age tomake sure that if women are being diagnosed
with breast cancer we are catching itat an early stage, which is essentially
(27:00):
means it's securable cancer. We haveto educate women on the importance of screening
and the importance of understanding their individualrisk and you know, if their risk
is higher, let them know that. This is to help us understand well,
do we need to change your screening? Do you have a risk higher
than twenty percent which would then allowyou access to bilateral breast MRIs. What
(27:23):
can we change in your environment,in your lifestyle to help lower your risk?
Is to help empower women to makethese changes and in hopes really reduce
the risk of being ever diagnosed witha later stage breast cancer. Yeah,
okay, good, good final thoughts, Well, gosh, this has been
really a good show. I appreciateyour time, appreciate your thoughts, your
(27:45):
wisdom, your research on this topic. So if our listeners would like to
find you, where can they findyou? Well, you can always look
me up online. If you putin my name Aaron Rarak, you'll see
that I'm working four days a weekin the lower mainland of a British Columbia
seeing patients, so I'm actively seeingpatients all the time. I do have
(28:06):
an Instagram account at Dr Aaron Muraqthat you could visit at any time.
I'm not that active on it.People always ask me, well, why
am I not active on social media? And I'm too busy seeing my patients.
Maybe yeah, all right, well, thank you again, Doctor Murac.
Really appreciate your time. And thatwraps up this episode of five to
(28:30):
Thrive Live. We thank our sponsorsCognizanceticolon to help enhance memory, focus and
attention, immuse a post biotic forimmune support doctor or hero Is Probiotics Award
winning pre and probiotic formulas and AmericanBiosciences makers of Metatral and Empower the perfect
combination for mitochondrial health, immune systemsupport and maximized energy. Again for free
(28:53):
samples you can go with a discountyou can go to the Harmony coompany dot
com forward slash Thrive and with that, I thank you listener for joining us.
May you experience joy, laughter andlove. It's time to thrive everyone.
Scott Castinea, Jesus the City lost
Any health related information on the followingshow provides general information only. Content presented
on any show by any host orguest should not be substituted for a doctor's
advice. Always consult your physician beforebeginning any new diet, exercise, or
treatment program. Welcome to five toThrive Live, a podcast about thriving for
(00:44):
those who have been affected by cancerand chronic disease. I'm doctor Lisau Schuler.
I co host this show with mygood friend Carolyn Gazella, and you
can find all of our past podcastson any major podcast outlet. So tonight
I'm going to be talking to doctorAaron Rorek about breast cancer screening, a
(01:04):
particularly timely topic actually in light ofthe new breast cancer screening recommendations that were
released by the US Preventative Services TaskForce. They released those guidelines early in
May twenty twenty four. So we'regoing to talk about these guidelines, We're
going to talk about some other considerationsregarding breast screening and helping us to do
(01:25):
that is my guest, doctor AaronRourek, who is a licensed nachropathic physician.
She graduated in twenty fourteen from theBouchet Institute of Natropathic Medicine. She
received her Bachelor of Science at theUniversity of British Columbia with a degree in
microbiology and immunology. Doctor Rourek isalso a certified clinician throughout the SORRY through
(01:46):
the North American Menopause Society, andshe has a keen interest in cancer,
particularly its prevention, as well ashormonal changes related to menopause. So before
we introduce her and get started,I do want to thank our sponsors.
We first thank American Biosciences which arethe makers of metatrol fermented wheat term extract
(02:07):
for enhanced mitochondrial function and Empower AHCCto supercharge your immune system and you can
get some free samples, some researchand you can do that with an exclusive
discount if you go to the HarmonyCompany dot com forward slash Thrive. We
also think Emmuse, a unique patentedpost biotic that gives your immune system a
(02:31):
key advantage. Ammuse is an ingredientin many immune supporting dietary supplements. To
look for Immuse on the label orgo to immusehealth dot com. Also cognizance
toticoline, which keeps your brains energyfiring on all cylinders. If you're looking
for a way to get your brainfunction going, improve your memory, focus
(02:53):
and attention, look for Cognizant onthe label, or you can go to
Cognizant dot com for more information.And finally, doctor Hira's Probiotics a best
selling probiotic for over thirty years whichcontains twelve probiotic strains which are shelf stable
without refrigeration due to their unique threeyear fermentation process, and you can learn
(03:15):
more at doctor Hira Probiotics dot com. And with that, welcome to the
show, Doctor Urek. Hello,thank you so much for having me.
It's a real pleasure to be here. Absolutely well, the pleasure is mine.
I'm very interested in your thoughts onthis topic. And but before we
do that, you know it helpsour listeners, I think to just get
(03:35):
to know you a little bit,So maybe tell us a little bit why
you particularly are interested in breast screening, what you know, how did this
become a focus area of yours.Well, with my work, I see
a lot of women who have been, you know, diagnosed with breast cancer,
who may have a high risk ofbreast cancer, who may be breast
(03:58):
cancer survivors, or who may beliving with breast cancer as more of a
chronic condition, and it just strikesme how this can inflict women to such
a great degree. And I justhave found over the last i would say
seven years, more and more womencoming to see me regarding their breast cancer,
(04:19):
and not only that, more andmore younger women being diagnosed with breast
cancer. And that to me reallygot my interest in what is going on
here. I know that not allbreast cancer can be prevented, but I
do think that we should be ableto catch breast cancer extremely early so that
(04:40):
less women would need to be diagnosedwith a stage two or greater, which
would then affect their treatments and potentiallypose them with more toxic treatments. M
M, yep. I would agreewith you on this. So I think
early detection is key for sure.So let's start with definitions. When you
say breast screening, are you areyou talking about mammograms or are you talking
(05:01):
about more than that? Well itreally I think we have to take a
step back here and know that Iam talking about mammograms, but screening really
does depend on, in my opinion, a woman's risk of developing breast cancer.
So we know that on average onein every eight so twelve percent risk
(05:23):
of developing breast cancer in women.But that's a population based statistic, so
we have to take a step backand think, well, what does that
mean for the person sitting in ouroffice. It does not mean that their
particular risk is twelve percent. Itmay be much greater than that. It
may be lower than that. SoI would say for the vast majority of
(05:45):
women when I mentioned screening, I'mtalking about mammograms, but that may not
be enough for women who may beat a higher risk because of their density
or because of perhaps hereditary gene mutations. Right, So, yeah, I
think that's a really important point youjust made that breast screening is sort of
(06:05):
universally applied to some extent because ofthe sort of a population wide incidence rate,
which is what you'd refer to,but that each person has their own
individual set of circumstances which would makethem higher lower risk. So we'll get
into that in the moment. Iwant to bring us to the US Preventive
(06:26):
Services Task Force, which is amajor organization that sets guidelines which in turn
determine insurance reimbursement in the United States, and really influence physician practice throughout North
America. So in early May twentytwenty four, they updated their screening guidelines
for breast cancer and the major changewas that they lowered the recommended h to
(06:50):
start regular screening from fifty years oldfor females to forty years old, and
they recommend regular screening up to theage seventy four. And they did that
because their evidence reviews suggests that byreducing the screening age that will we can
save twenty percent more lives because ofearly detection. They also, as another
(07:15):
part of their recommendations, recommended thatwomen get screened every two years instead of
every year. So let's dissect thisa bit because both of these recommendations are
new and they're creating some controversy.So let's start with the age. Do
you agree with lowering the age ofscreening from fifty to forty one hundred percent?
Yes. Just this week I hada woman come into my office she
(07:40):
got her screening. I'm in Canada, so the guidelines are different. So
many of our provinces start screening atthe age of forty, So in British
Columbia that's what's recommended. She gother screening mambogram done and lo and behold,
she was diagnosed with an invasive doctorcarcinoma with no family history. If
(08:00):
she waited until the age of fifty, this would not be have caught at
such an early stage and she wouldhave been a completely different situation. So
one hundred percent. And there's moreand more women being diagnosed with breast cancer
in their twenties and thirties and forties. So if there was not this reduction
in age of screening, we wouldnot be doing the best that we could
(08:24):
do to ensure that if women aredeveloping breast cancer, we wouldn't be catching
them at an early stage. Right, And you know, you're bringing up
a really important point, which isthese cancers are showing up in people at
younger ages. We used to thinkof cancer as an age of the older,
the elders, and it's actually nottrue anymore. There was We had
(08:45):
a really great show with doctor TinaKayzer on April thirtieth about early onset cancers,
and Tina and I had a reallyinteresting discussion about why these cancers might
be showing up in earlier ages.And so if you're interested than that,
you can check that show out,But you know, I think it's true.
Right, So breast cancer is showingup younger and it tends to be
(09:07):
more aggressive also when it's manifesting ayounger woman. So screening, you know,
really can in fact save less.What about this every other year instead
of annually? You know, thisis interesting, particularly in light of the
fact that these younger women tend tohave more aggressive which generally means more fast
growing tumors. So if they're gettingscreened earlier, yay, but every other
(09:30):
year, what do you think,well, would I would not recommend.
I don't think that's ideal. Ithink it would be every year annual screening
mammograms. But again, if wewere to think back and what we started
with, well, what is thatwoman's individual risk of breast cancer? So
perhaps if her individual risk was let'ssay eight percent, maybe that would be
(09:54):
okay. But if we have apatient in whose risk is much higher than
twelve percent, I would in noway feel comfortable having her go every other
year for a screening mammogram. Okay, So I want to pick that up
and can you give us some ideas, some considerations that would cause you to
(10:16):
pause and suggest to somebody I thinkyou're at higher risk, Let's make sure
you get screened to annually. Whatwould make somebody at higher risk? Well,
in order to know your individual riskof breast cancer, you need to
know what the risk factors are.So that would require you asking questions with
(10:37):
in a history in an exam,and so I would be asking about family
history of breast cancers, or uterinecancers, or colon cancers. I would
ask a when they had their firstmenstrual cycle, if they are menopausal,
when did they enter menopause? Ifthey have had children, how old were
(10:58):
they when they had their first child. Those are reproductive factors, family factors
that influence a person's risk of developingbreast cancer. And then I would do
a deeper investigation as to understand whatthat patient is eating, so I have
a sense as too if they're eatingmore of a whole foods diet. I
(11:20):
would be asking about alcohol intake,just because there is very good evidence that
alcohol is a risk for breast canceras well as a number of other cancers.
And then we would discuss, well, what have your previous mammograms look
like if you've had one, whatis the breast density? Have you had
a previous biopsy what's your hormonal use, be it oral contraceptives or menopausal hormone
(11:46):
therapy. Those are all factors thatneed to be taken into consideration when understanding
a person's risk. And if geneticshave been run on that individual, have
there been any high risk mutations thatwere picked up? Right? So I
think one takeaway from your answer isthat it's not simple. That it's multitude
of factors which have to be consideredcollectively to really understand somebody's individual risk and
(12:13):
therefore the most optimal screening program.So it may not be simple, but
it is completely possible. So there'ssome very good models that can be used
in office. Women can do thison their whole own at home. There's
the Gale model that is an easyfive question you know is it questionnaire just
(12:37):
to get your sense of a roughrisk of your individual breast cancer. I
typically use the tire Cusic scoring method, which goes into a bit more depth
about these factors that I just mentioned. But you know, if clinicians are
used to doing this, you cando a tire Cusic in ten minutes.
Okay, it's not impossible. Goodyeah, right, good point. This
(13:01):
is complex, but not impossible.And in fact, it would be something,
Yeah, women should. I wasjust gonna say women should advocate for
this. So maybe when they're goingto see their primary care physician, you
know, ask them, have youcan you put my information into one of
these models to determine my risk forbreast cancer so that I can make a
(13:24):
decision with you about how often Ishould get screening. I think that's a
way in which people can be veryproactive about their own health. So I
want to go back to the guidelinesfor a second too. There's another interesting
thing about this, which is thatyou know, we're yes seeing breast cancer
show up in younger people, butwe are also as a population living older,
so therefore still the majority of cancers. Breast cancers are found in menopausal
(13:46):
women, and menopausal women are livinglong now generally, so the guidelines suggest
that screening be stopped at the ageof seventy four, many women are living
well beyond that. What do youthink should they continue screening beyond seventy four
or if not, are there alternativescreening methods that you think would be effective
(14:09):
in older women women? Well,I think a screening mammogram would probably be
very effective. Of course, inolder women because older women, on average
have less dense breadths, which iswhere mammograms work the best. I would
say that I would also be mindfulof we have to understand how old,
(14:33):
not just how old that patient iswhen they come to see you, but
how long you would expect them tolive for. So you may see a
patient who is seventy four, whohas a number of other chronic illnesses and
so may not make it to theage of seventy seven. So I likely
wouldn't at that time recommend a screeningmammogram. But if I have a healthy
eighty year old female in my practicewho I feel for sure she's going to
(14:56):
be living greater than ten years,I would say, we've got to keep
up with your breast screening. Mmhmm, right, yep, fair enough.
I think that's really a smart answer. And so again it brings it
down to the level of the individual. So what about you know. Another
criticism of the guidelines is that racialdisparities and breast cancer are not addressed.
(15:18):
To some extent. They are inthat the you know, black women are
forty percent more likely to die ofbreast cancer than white women. Unfortunately,
they tend to have more aggressive cancersdiagnosed at younger ages, yes, and
more triple negative. So in someways, the guidelines kind of address this
universally by lowering the starting age ofscreening to forty. But I'm wondering if
(15:43):
you have any other thoughts on thisdisparity from a screening perspective. Well,
I think I would agree that loweringthis to forty will be helpful in catching
women at a younger age, regardlessof their race. I think that it's
really important. We would have todissect, well, why are black women
(16:03):
more prone to pass away from breastcancer? And there could be disparacy disparities
within their access to healthcare. Soperhaps they're not actually able to get their
screening mammograms, or perhaps they havenot been had an opportunity to sit down
(16:23):
with a healthcare practitioner and let themknow that they may be at higher risk.
Therefore, we need to look intoyour risk factors in a deeper level
just to make sure that we're doingeverything that we can to be proactive for
not only breast cancer prevention but earlyscreening. So it's a lot of education
involved there and making sure that allwomen have equal access to the same level
(16:47):
of health care Yep, that's areally important comment, and I think that
the access issues are really critical.You know, there's a lot of issues
around educ community education, and awarenessthat need to be addressed as well.
So switching you's a little bit.You know, one of the criticisms that's
(17:10):
going to come from the public aboutlowering the age of screening is a concern
on the part of women about theadditional ten years of exposure to the radiation
from MRA from mammograms to their breasttissue. So what are your thoughts about
that. You know, Well,mammogram, although it's considered at this point
(17:32):
the gold standard in breast cancer screening, I mean, it's not perfect.
Just like any screening modality, itwill always have its downfalls, and this
is you know that radiation exposure potentiallyevery year is going to be potentially a
concern for a lot of women.But you've got to also measure that with
the importance of the screening. Thatif you're not getting your mammograms, the
(17:56):
risk of that is that you maybe diagnosed with a later stage breast cancer.
So you just have to weigh thepros of the cons I feel that
the annual screening outweighs the risk ofthe very low dose radiation exposure, and
do you feel like if a patientcomes to you, let's say, and
(18:18):
says, look, I'm interested inscreening. Are there any alternatives to mammogram
that you trust? Yes, Sothis happens to it all the time.
And so if I have a patientin my office who is concerned about having
annual mammograms for whatever reason it couldbe, there could be many different concerns
(18:41):
there, I would I would say, okay, well let's think about this
for you. Well, could weperhaps do as screening mammogram one year and
then the next one do a breastultrasound of bilateral breast ultrasound, So we
go back and forth, back andforth. If I have a really high
risk patient in my office, becausefor example, they have extremely dense breasts,
(19:04):
I would know right there that it'sa bit like you know, when
you're doing screening mammograms and you havevery dense breast, it's a bit like
trying to find a white ball ina snow storm. It's so hard to
pick up on mammograms. So Imay say, well, perhaps we could
consider doing a mammogram one year andthen a bilateral MRI the next year,
(19:25):
which doesn't have any exposure to radiationor X rays, right, And I
think that that's a good distinction youmade. So one of the opportunities with
these guidelines is that for women whoare concerned about the radiation exposure to the
breast issue, there is the opportunityon the off year to do, like
you said, an ultrasound exam,which can be useful. It's not as
(19:48):
sensitive, of course, but actuallyfor women with dense breasts sometimes is very
helpful. And then of course breastMRI unfortunately very expensive, so not generally
recommended as a general screening, butfor high risk women certainly could be used.
I think those are really creative andgood thoughts around how to sort of
maximize the sort of the benefits,if you will, of this every other
(20:12):
year screening. And you know,I think that really the point of screening
is to detect cancer early when it'sas you said, earlier, more treatable
with less toxic therapies potentially. Ofcourse, stepping back from that, primary
prevention is really about how can Ilower my risk for cancer in the first
(20:33):
space. So this is a verybig question, and I you know,
we don't have time to go intoevery single opportunity, but just in sort
of a broad sweep, what wouldyou say some of the most actionable ways
are there to reduce a risk ofbreast cancer, so that women get screened,
(20:56):
they don't find anything. Well,so then we're talking more about the
modifiable risk factors. So I wouldfirst bring up diet. I would be
really trying to recommend a whole foodsdiet, limiting process and package foods,
educating women that you know, althoughvery convenient, these types of processed foods
(21:21):
are likely inflaming us from the insideout. I would be trying to recommend,
not that I think patients need tobe vegetarian, but a higher plant
based diet where they're getting quite afew of their proteins from plants, be
it lentils and beans and nuts andseeds at amami and tofu. We have
to have a very good discussion onalcohol in terms of if that person is
(21:45):
drinking more than three units of alcoholin a week. I see that as
a potential way to reduce the riskof breast cancer. And then certainly trying
to help women achieve optimal weight aswell, especially for women who are menopausal
That could be a really challenging thingfor women because weight becomes harder and harder
(22:07):
to maintain after menopause. But it'sactually increased weight after menopause that increases the
risk of breast cancer. It's notas much of a factor for premenopausal women
when it comes to breast cancer risk, but postmenopausal women. And I think
you know, as we're talking aboutthese modifiable risk factors, it bears mentioning
(22:27):
that these are not going to takesomebody's risk down to zero. You know,
these are things that will lower therisk, but there's still the opportunity
for breast cancer to grow because thereare a lot of other factors that contribute
to cancer growth, some of whichare beyond our control, like environmental factors.
The breast tissue concentrates environmental toxics,and we are are all exposed to
(22:51):
those from the minute we're created.There's even epigenetic factors, so things that
our grandmother was exposed to a theegg that our mother developed, which then
becomes us. So actually those pectors, you know, there's a lot out
of our control. But you know, the things you're mentioning, even if
they don't prevent the cancer from occurring. They do have the potential to keep
(23:15):
the cancer from being aggressive or maybeit reduces the risk. And so that's
where it's really important for women tounderstand what their risk of breast cancer may
be through the Gale model or thetire cusic. So then if the purpose
of doing these assessments is not toscare women or make them happy, the
(23:37):
purpose of doing this is to letwomen know what their risk is so that
if it does happen to be higherthan what we would like to see,
that is to give them understanding,well, let's work with what we can
to lower your risk. Let's workwith that nutrition. You know, can
we lower your alcohol, What canwe do here to help optimize your weight.
Those are the things to give womenthe empowerment that they need to make
(24:00):
these healthy changes in life, becauseit's going to reduce the risk of breast
cancer. But it's going to dofar more than that. It's going to
reduce the risk of cardiovascular disease anda number of other type two diabetes.
So it's super important. M Yeah, very good point. So what about
genetics. You know, let's saysomebody finds out that they have they carry
(24:21):
the braca mutation, which is somethingthat they're born with. And for some
of these BRACA mutations there are differentkinds, but for some of these mutations,
that woman may have up to aneighty seven percent lifetime risk of having
breast cancer. So, first ofall, I those women obviously need to
be screened. How often should theybe screened? And should you know there
(24:45):
be any additional do you treat thosewomen differently in your practice if they have
not had a diagnosis of breast canceryet? So women with these high risk
mutations are always screened different then womenwho are average risks. So if a
women's individual risk of breast cancer isgreater than twenty percent, that should trigger
(25:10):
it so that that individual can haveaccess to bilateral breast MRIs. And so
that would be the same for womenwho carry these high risk gene mutations such
as BRAKA. They're not going tobe getting screening mammograms. But if we
take a step back here, it'sreally important that people are aware that only
about ten percent of individuals who carrythese high risk genes are aware of it,
(25:34):
So that means there's ninety percent ofpeople with these high risk genes that
are mutated that are walking around haveno idea that they have them, and
we as healthcare practitioners, how dowe best help them when ultimately we don't
even know who they are, right, and we were not at a place
where we screen the general population forthese mutations. So you're right, it's
(25:56):
a conundrum. It's a conundrum.But there's been such an explosion in genetics
and testing that it has significantly reducedthe price down to these multi gene panels
for cancer. So I will often, you know, if my patients can
do it, if we're women whocan do this, and men too,
(26:17):
because know that men can have mutationin these genes and pass this on to
their offspring. You know, spendingtwo hundred and fifty dollars one time in
your life to do a multi genepanel related to cancer, I think is
well worth it. Okay, well, that's a very good pearl there.
(26:37):
So, Aaron, what final thoughtswould you like to leave with our listeners
on this topic. Well, Ithink I just want to really hone in
on the fact that we cannot preventall breast cancers, but we should be
able at this day and age tomake sure that if women are being diagnosed
with breast cancer we are catching itat an early stage, which is essentially
(27:00):
means it's securable cancer. We haveto educate women on the importance of screening
and the importance of understanding their individualrisk and you know, if their risk
is higher, let them know that. This is to help us understand well,
do we need to change your screening? Do you have a risk higher
than twenty percent which would then allowyou access to bilateral breast MRIs. What
(27:23):
can we change in your environment,in your lifestyle to help lower your risk?
Is to help empower women to makethese changes and in hopes really reduce
the risk of being ever diagnosed witha later stage breast cancer. Yeah,
okay, good, good final thoughts, Well, gosh, this has been
really a good show. I appreciateyour time, appreciate your thoughts, your
(27:45):
wisdom, your research on this topic. So if our listeners would like to
find you, where can they findyou? Well, you can always look
me up online. If you putin my name Aaron Rarak, you'll see
that I'm working four days a weekin the lower mainland of a British Columbia
seeing patients, so I'm actively seeingpatients all the time. I do have
(28:06):
an Instagram account at Dr Aaron Muraqthat you could visit at any time.
I'm not that active on it.People always ask me, well, why
am I not active on social media? And I'm too busy seeing my patients.
Maybe yeah, all right, well, thank you again, Doctor Murac.
Really appreciate your time. And thatwraps up this episode of five to
(28:30):
Thrive Live. We thank our sponsorsCognizanceticolon to help enhance memory, focus and
attention, immuse a post biotic forimmune support doctor or hero Is Probiotics Award
winning pre and probiotic formulas and AmericanBiosciences makers of Metatral and Empower the perfect
combination for mitochondrial health, immune systemsupport and maximized energy. Again for free
(28:53):
samples you can go with a discountyou can go to the Harmony coompany dot
com forward slash Thrive and with that, I thank you listener for joining us.
May you experience joy, laughter andlove. It's time to thrive everyone.
Scott Castinea, Jesus the City lost
Popular Podcasts
On Purpose with Jay Shetty
I’m Jay Shetty host of On Purpose the worlds #1 Mental Health podcast and I’m so grateful you found us. I started this podcast 5 years ago to invite you into conversations and workshops that are designed to help make you happier, healthier and more healed. I believe that when you (yes you) feel seen, heard and understood you’re able to deal with relationship struggles, work challenges and life’s ups and downs with more ease and grace. I interview experts, celebrities, thought leaders and athletes so that we can grow our mindset, build better habits and uncover a side of them we’ve never seen before. New episodes every Monday and Friday. Your support means the world to me and I don’t take it for granted — click the follow button and leave a review to help us spread the love with On Purpose. I can’t wait for you to listen to your first or 500th episode!
The Joe Rogan Experience
The official podcast of comedian Joe Rogan.
Stuff You Should Know
If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.