ATHE_Transcript_Ep 573_Dr. Felice Gersh
JJ Virgin: [00:00:00] I'm JJ Virgin, PhD dropout, sorry mom, turned four time New York Times bestselling author. Yes, I'm a certified nutrition specialist, fitness hall of famer, and I speak at health conferences and trainings around the globe, but I'm driven by my insatiable curiosity and love of science to keep asking questions, digging for answers, and sharing the information I uncover with as many people as I can.
And that's why I created the Well Beyond 40 podcast. To synthesize and simplify the science of health into actionable strategies to help you thrive. In each episode, we'll talk about what's working in the world of wellness from personalized nutrition and healing your metabolism to healthy aging and prescriptive fitness.
Join me on the journey to better health so you can love how you look and feel right now and have the energy to play full out at 100.
This. Episode is [00:01:00] fire. So I have an event called the MindShare Leadership Summit for what we call the Trusted Authorities in Health. Just amazing thought leaders in health care. And we always do a future of health competition where people share, you know, the thing that's going to make a big difference in health.
And Dr. Felice Gersh, who I've known for years, gosh, I think I've known her for maybe 20 years. Anyway, she's a phenomenal physician. In fact, she's a multi award winning physician with a dual board certification in both OBGYN and integrative medicine. Anyway, she came up and did a talk on mammography and I was like, Oh my gosh, you have to come speak.
So let me tell you a little bit more about her. And then I'm going to tell you what is in store for you here. So Felice is the Founder and Director of the Integrative Medical Group of Irvine and it is a practice that provides comprehensive health care for women combining the best evidence based therapies from conventional naturopathic and holistic medicine.
She taught obstetrics [00:02:00] and gynecology at Keck USC School of Medicine for 12 years, where she received the highly coveted Outstanding Volunteer Clinical Faculty Award, and she now serves As the affiliate faculty member at the fellowship in integrative medicine through the university school of medicine, where she lectures and regularly grades the case presentations written by the fellowship students for their final exams.
So she is also the best selling author of PCOS SOS, PCOS SOS fertility fast track and menopause 50 things you need to know. By the way, we're going to have an ebook for you for free. I'm putting it at jjvirgin.com/mammo, M A M M O cause we're talking mammograms here. She has had numerous scientific articles published in peer reviewed medical journals.
She's a sought out lecturer. She's been featured in a bunch of different films and documentaries, including The Real Skinny on Fat with Montel Williams, fasting with Valter Longo, the business of birth control. And again, I've just, I've known her for years, hung out with her a bunch. Lots of stuff I love about Felice, but one of the cool [00:03:00] things is she has this whole traditional training, has taught a bunch and just looks critically at everything.
So now you have someone that you can listen to. When she said this at MindShare, she explained why she isn't getting mammograms anymore. And it was like all of us were sitting in the room. It was a bunch of MDs kind of going, Yep, I get it. Yep, I'm going to do that. It was pretty fantastic. So, the real purpose of this interview is to help you look at your risk, really know the information out there, and so you can make the right decision for you as to what you should be doing with screening, and more importantly, you'll know the direction you should be focusing on so that you can be living and playing full out, right?
So that is what we're up to. I look forward to sharing this interview with you and I will be right back with Dr. Felice Gersh. Stay with me.
So I will tell you [00:04:00] that when you did your talk at the future of health talk at the MindShare Leadership Summit, I think everybody's kind of like, I suspected this, but to hear it from you, Dr. Felice Gersh, holy smoke. So I'm so excited to have you on the show. To really get into mammograms and breast cancer and what we really need to know.
It's kind of like the truth about mammograms, right?
Dr. Felice Gersh: It is. And I wish we had more data, but I'll deliver everything we've got. Sometimes though,
JJ Virgin: if you look at it, you got to look at the mechanisms of action, the pathways and what data you do have. Because if you wait till all the data comes in, it's like how many people have to be hurt, die, et cetera, to get the data in.
Dr. Felice Gersh: Well, that's how I feel about almost everything. We just act on what we have and make the best choices based on our best judgments. Right.
JJ Virgin: And I mean, shouldn't people be able to, especially now be able to get all of the data and make the decision for themselves?
Dr. Felice Gersh: Well, I am a firm [00:05:00] believer in everyone making their own choices.
Hopefully based on real factual information, the best that we have available, right? I'm totally supporting individual choice in basically every health care issue.
JJ Virgin: Well, I know we're going to unpack a lot of the science and evidence here and then make some decisions, but let's start with just breast cancer in general.
Like how big of a problem is it in the United
Dr. Felice Gersh: States? Well, it's a very significant issue over 40, 000 women die in the United States every year from breast cancer, so you can't belittle the significance and of course, the majority of women, not of course, but it is a fact that fortunately, the majority of women were diagnosed with breast cancer do not die, but they suffer emotional trauma and go through a great deal of treatments, many of which have significant side effects.
And really changes their view of themselves and they're really the course of their lives in most cases. So [00:06:00] it's a huge issue. And everyone that deals with breast cancer is doing their best. So I always like to say, you know, some of the problems that have evolved, which we'll touch on is not due to intent.
Sometimes there is the unintentional fallout from things that are implemented with all the best of intentions. And I think that mammography does fall into that because knowing how many women die from breast cancer, the healthcare industry wants to do whatever it can to avoid those deaths. And, you know, the whole history and interesting facts surrounding the evolution of mammography and breast cancer screening is interesting, but it was all definitely done for the right reasons.
JJ Virgin: It was interesting when I got to the age where I got to have the mammogram and, you know, every woman hears about it and you see all the cartoons about what it's really like, you don't really realize that those are actually not that far from the truth when you go in to do it. But at the time… I remember hearing pros and cons on both [00:07:00] sides and then you should do thermography and it was so confusing for me to try to sort through it, which is why I'm excited that you're going to give this information, but the talk that you did at mind share was like, basically, your decision is not to get mammograms anymore.
So I'd love to just talk about like, where did mammograms come from? Let's just unpack all about them. What are they? I know there's different technologies.
Dr. Felice Gersh: Sure. Well, the first mammogram is attributed to research that was done in Europe, and that was back in the mid 1960s. It evolved pretty rapidly, and the American Cancer Society, and it became mainstream recommended as an annual kind of a test back in 1976.
So it really entered mainstream American medicine in the mid 1970s. And it really grew from there. So initially it was what we call film screen mammography, where it ended up on an x ray that you would [00:08:00] see where somebody would poke it up on a screen and you could see it, you know, like a piece of cellophane type of a thing.
And then in the year 2000, it became digitalized. So then you had digital mammograms. And then about a decade later in 2011, that's when they developed the so called 3D mammograms, the tomosynthesis. And that is the typical standard that is being utilized today, but we even have a newer version, which is a CT mammogram, which would then be potentially more capable of finding cancers.
The issue is. Of course, is finding cancer going to save a life and how much radiation is delivered. So, with each new iteration of a mammogram, it did deliver more radiation. So, for example, when they went to the so called 3 D. It's really hard to get the data, but it's somewhere in the neighborhood of two to three times the radiation dose.
So, [00:09:00] if you figure that the average woman is told to get a mammogram every year, in the space of ten years, she'll get somewhere between two to three hundred times the radiation dose. That she would have gotten back when it was the digital mammogram. And now I can tell you in my area and everywhere that I talk about this Tomo type, the 3D, has become the standard of care.
And it was implemented before there was even any data, and there still isn't, to show that it actually prevents cancers at a greater frequency. Or, you know, statistical significance compared to the digital .
JJ Virgin: So prevents cancers, meaning early detection, right?
Dr. Felice Gersh: Let me clarify that prevents cancer death, that it detects cancer more readily.
So there was actually one interesting study with the 3D. And the ultimate conclusion was that it was not inferior to the digital, you know, which means it's the same.
Well, that's B. [00:10:00] S.
That's the kind of word they use, you know, that it's not inferior. So what did they find, though? They found that the 3D actually isolated more findings.
So it created more positives. The problem is that when they actually did testing on those positives, they turned out to be not anything. They were just incidental lomas. They were just benign things. So you ended up having more biopsies and more follow ups for these findings. That's a real problem.
Finding more things on a mammogram doesn't mean that they're cancer or that you're actually saving a life. Finding cancer doesn't mean that you'll save the life because you don't know what that cancer is going to do, which, you know, is a big topic that we want to cover. So, mammographies have definitely evolved over time, and with more radiation dosing, and more findings in terms of how [00:11:00] they can pick up, because They pick up little things that sometimes, or in the majority of cases, turn out not to be cancer, but then involve tremendous amounts of emotional trauma to the woman, and invasive procedures, and additional follow ups, which involves even more radiation
JJ Virgin: exposure.
And there's no way to know when you're finding a thing. What that thing is once you found it until you biopsy it, correct?
Dr. Felice Gersh: Typically, it is difficult. Sometimes they could say, well, it looks pretty benign. So we'll just do another view or we'll get more mammography, you know, repeat studies in a few months, like three months or six months.
So the women get onto this like endless merry go round where they're always getting more images. What's interesting, even when they get a biopsy and the biopsy comes back benign. They're often left thinking, well, you know what, the next one is going to be cancer, and then they're often put into a more frequent screening protocol.
[00:12:00] It seems like the dark hole where you can't get out once you fall into it.
JJ Virgin: Right, and then you just wonder, you know, kind of looking at the Dr. Joe Dispenza world and the world of thoughts create. So now you get into the stressful thing of thinking that you have something that could become cancer. And you focus on it and what you focus on expands besides the radiation risks and sort of backpedal.
We've now gone from 2D to 3D supposedly because it would be better. However, the research shows that it's not necessarily better. It's just not worse yet. It's worse because it has. Two, three times the, like, am I hearing this correctly? Cause this sounds ridiculous.
Dr. Felice Gersh: That is true, right? They didn't actually show when they did studies that it saved lives, that it found more cancers that would have led to death had they not been found.
It was clear that they found more things that were irrelevant, essentially, that led down the path to more biopsies or to more frequent [00:13:00] re scans. And like you said, much more radiation over the long haul. And of course, radiation is a well acknowledged carcinogen. Right. So that is always sort of like this weird thing about using radiation as a screening tool.
For a general population, So, you know, I always want to emphasize when we're talking about screening mammograms, we're not talking about diagnostic. We're not talking about someone who has an actual finding. We're not talking about people with genetic high risk situations. We're just talking about taking random women who have average risk and then putting them through the screening protocol like mass population screening.
And that's where the problems really come in because there's no discrimination, you're just taking every single woman and putting her through this screening protocol. And as they keep developing more sophisticated mammography, which [00:14:00] it involves as in more radiation, what we could really label as false positives.
And false positives are a huge problem. Now, what they talk about with the 3D and they like tout it's like, Well, you actually have more callbacks or potential false positives from the digital because some of the images are not clear. And a lot of women have heard this, like the tissue looks like it might be folded over or it's not really a clear view.
So they call women back for additional views. So they're not really false positives like that would lead to a biopsy. They're just saying, you know, the image is unclear. So let's get more views to see if we can clarify what's really going on. And those are the callbacks. So when you talk about callbacks, the digital mammography leads to a very high rate, about 60%.
So if you take women who are screened, about 60% of them will end up with callbacks at some point. And that's, you know, additional views and a lot of [00:15:00] anxiety when they do the 3D. It's dropped from the 60% to 50% and they tout this as such a big improvement, you know, and then, of course, you talk in percentages, but in actual numbers, it's not much of anything, but when you look at the fact that you're already putting in 2 to 3 times the radiation dose.
You're not really saving radiation, you know, and maybe you're saving some anxiety, but for the number of callbacks, you're actually creating a great deal more radiation exposure to the average woman. It's a real challenging situation when you look at the global situation of callbacks to get better views and all the false positives and false positives are a very significant problem because if you had say a thousand women who are age 50 screened for 10 years of that group you could have hundreds and hundreds of callbacks and false positives.[00:16:00]
When you think about that over 10 years That even with the so called, you know, the 3D that 50% of them are going to get callbacks for additional views. And you'll end up out of a thousand women about 200 unnecessary biopsies for benign conditions. So there's a lot of this going on. I mean, it's just, it's a huge industry.
Now, I don't want people to think that no lives are ever saved by screening mammography. And it's really hard to get data. I mean, that's part of the problem is that when they look at observational studies, they're looking at different populations, different age groups, different modalities of screening, different frequencies, intervals of screening.
It's really difficult. It's like always comparing apples to oranges. And there's not really a lot of good control group planned double blinded studies. It's just hard to do that. They had one from Canada. Where they [00:17:00] looked at women, but once again, it's like a retrospective kind of a thing where they offered women screening mammographies or not to have screening mammographies, and then they followed them for 30 years.
And what did they find at the end of 30 years? They found that there was no statistical difference. In the overall death rate from any cause, what we call all cause mortality between the two
JJ Virgin: groups. What about breast cancer specifically?
Dr. Felice Gersh: Well, in that particular study, there was no statistical difference for breast cancer deaths either.
But there are other observational studies where there was some reduced incidence of breast cancer deaths. It wasn't huge, but there was a statistical finding of reduced breast cancer deaths in other observational studies, not in the Canadian, but when they looked at all cause mortality, there was no difference.
So this is what makes it very challenging. And part of the problem as well is when they [00:18:00] look at reduced breast cancer mortality, and they're looking at screenings. They often are now using the number and it's very iffy, you know, there's a huge range in terms of estimations of this sort, where they'll say, if you screen with breast cancer, screening modalities, mammography, you will reduce breast cancer deaths.
By 20%. Okay. So that's sort of an overall number, but it's very iffy because you can see numbers from as low as like 1%, you know, up to like 30 something percent. It's not much above that in any study. But when they say that, well, half of the breast cancer deaths are reduced or eliminated by the new treatments, not really by the screening per
JJ Virgin: se.
Well, it's just the screening is just Finding out early enough to be able to do the treatments,
Dr. Felice Gersh: right? That's the hope, but when you find the breast cancer and then it's treated, they're attributing half the breast cancer [00:19:00] mortality reduction to the treatment, not to the actual finding of it. And so in some studies that are published, they're saying that the reduction actually from breast cancer screening is like in a few percent.
The numbers are really all over the place. That's what makes it so challenging, but we do know that when they look out 20 and 30 years and then they look at screen versus unscreen and they look at, you know, all cause mortality, it doesn't seem to save lives from all causes of death. So every woman has to think, well, what does this mean for me?
It really makes it hard. Like for me, believe me, I thought long and hard about what made the most sense. And when I looked at as much of the data as I could, I felt that I was more likely to be harmed by going through repeated mammographies. And I was one of those people who had plenty of callbacks, you know, you have a cyst or let's take another view.
And it's like. Okay, [00:20:00] you know, then been there done that, but it's not a simple, clean decision because you can't say there's no evidence that screening saves some lives. In one interesting study, they looked at like 1000 women once again, age 50. For 10 years, and when they did the computations, they came up with one life was saved.
JJ Virgin: So let's unpack this a bit. I kind of look at this and I go, what are other options to be able to do early detections? One of my close, close girlfriends is a radiologist, and this was her whole world for years, which was drummed into me early detection, right? What are those options for early detection?
What are the true things that are risk factors for breast cancer? But before we go there, like someone going and getting a mammography, like because it seems crazy to radiate the very area. We are concerned about getting cancer with something that's carcinogenic like that. Just like what you know. But what are the risks when you do mammographies, the real risk?
[00:21:00] Are there any stats on it, or I just think they probably don't have those stats, do they? In
Dr. Felice Gersh: general, what I can tell you, it's… And this was quite a few years ago, it was estimated that 6% of all cancers, all cancers in the U. S. are created by medically used radiation. I mean, it's like phenomenally high. CAT scans are used like water in hospital settings, like CAT scan after CAT scan.
We know that the younger you are, The more radio sensitive you are so like that's why like children that get cat scans of their brains, unfortunately, have a higher risk of developing, you know, brain cancer later. So, like the younger you are now, this is like the interesting thing when they looked at breaking down mammography by decades.
And this is, like, very pro mammography groups, by the way, you know, which really does tank a lot of the data, which I can tell you about. There were studies that were done specifically to refute other studies that [00:22:00] showed mammography was not particularly beneficial or had a lot of over diagnosis, so, you know, talk about a little bias going in.
But the bottom line is that radiation is a carcinogen, as you said, and when they looked at different decades, they found that women in their 40s, which are now the standard, like the American Cancer Society and so on, they recommend starting mammographies annually at age 40. They showed no statistical saving of lives from breast cancer deaths for women in their 40s when they found breast cancer, it tended to already be very aggressive and already metastatic.
So the finding of the breast cancer didn't save those women's lives. So they did not show statistical benefit. In women in their 40s. Now, this has been reworked and rehashed and so on to, and then they came up and said, well, it's still good to do it. It's better to do it. But the reality is that the data is really weak for women in their 40s, but we do know that women in their 40s [00:23:00] who have more functioning, active breast tissue, because most of those women are still in the reproductive years, they have functioning ovaries.
And they have active ductal cells in their breasts and so on. They are more sensitive to the adverse effects of radiation. If you gave mammography, especially the higher dosed 3D, to women every year in their 40s, and then you figure between 40 and 50 that half of them are going to get callbacks for additional mammographies just based on the callback situation, then the amount of radiation is definitely at risk.
And there are papers written. saying that women in their 60s getting breast cancer may be related to the radiation exposure they had from doing mammography in their 40s because there's always a lag time. That's what makes it so hard to prove cause and effect because you get the radiation exposure in your 40s and then 20 years later.
You are diagnosed with breast cancer, [00:24:00] and the average age for breast cancer is about 62. So, you know, who's to say what's the cause? I mean, that's the problem. So it's impossible to prove and who's going to do some kind of a study of, you know, proactive looking study. It's not going to happen. So the bottom line is, you know, the best guesses that we can have based on, you know, looking at population studies and women who are getting breast cancer in their 60s, how many of them had annual mammographies in their 40s, and what were all the other risk factors that come into play, very hard to separate things out.
And so, no matter what you do, there's always going to be a lot of risk in having the exposure to the radiation, but if you're going to look for the most advantageous decade to get mammography, when the most medically probable benefit is going to occur. It's between 50 and 60. There's actually quite a bit of data to say if anyone is going to have their life saved from breast cancer [00:25:00] death from being screened, it's to do it between 50 and 60.
Between 60 and 70, if there's going to be benefit, that's another decade when there's some benefit. There doesn't seem to be any real provable benefit. From mammography screening between 40 to 50 and over 70. I mean, they just have trouble finding that you're saving breast cancer lives in those decades.
But of course, they're still advocated up to typically 75. To do annual type screenings and starting at 40 and the problem is that we don't have any great screening. There are some people who have high risk like they carry the BRCA1 or 2 gene and they are told to do MRIs. So MRIs is another screening modality that can be used for breast cancer.
It has even more false positives. And the problem is in order to do an adequate MRI of the breast, you have to [00:26:00] use a contrast material called gadolinium, which has its own set of toxicities. So if you're starting at a young age. You know, to do MRIs, and you're doing them frequently, over time, you're going to accumulate an awful lot of gadolidium, and it does tend to like to get sequestered in the brain, you know, it's a problem.
JJ Virgin: All right, well, that's not very happy news. Let's talk first, you know, there's the BRCA1, BRCA2 genes, because we hear about that being a risk factor for cancer. But from everything I've heard… The genetic side of breast cancer is low compared to, like, the lifestyle sides. What are the big risk factors? How big of a deal are those genetics?
What should we be looking for?
Dr. Felice Gersh: Unfortunately, nowadays, if someone carries the BRCA1 or 2, their risk of breast cancer is incredibly high, which was not always the case. I mean, this genetic finding has been around forever. If you went back a couple of hundred years ago, it was still an added risk factor, but maybe the risk of getting breast cancer if you carried the gene [00:27:00] was maybe 20%.
And now it's at least 80%. That's why it's, it's not an easy thing to ignore if you carry those genes because of our toxic world, we live in a world of endocrine disruptors, and, you know, carcinogens at every turn chemicals, and it's really interfering with our normal metabolic function. So it's really a big deal if you carry those genes and.
Most women are getting very aggressive and doing prophylactic mastectomies and oophorectomies, it's a horrible thing, but fortunately, as you were mentioning, it's a very small percent, you know, like maybe 5% of all breast cancers. Are actually related to that genetic finding, but when people have it, it's a big deal.
JJ Virgin: So then if someone has those, what are your thoughts about the prophylactic mastectomies and that?
Dr. Felice Gersh: Well, I mean, I hate the whole concept of doing that sort of thing. The problem is [00:28:00] that we really know that even people who try to live a healthy lifestyle because of the environment that we live in, those genes put a woman at such a high risk.
That I have to agree that once a woman has finished childbearing and she hits, you know, around the age of 40, they actually officially recommend around 35, you know, it's so young to have these prophylactic surgeries to remove ovaries and breasts. And now they're throwing in for BRCA1, the uterus is also, and it's not just that.
I mean, the thing that there are organs you cannot remove like the pancreas. There's actually increased risk of other cancers like pancreatic cancer. You know, these are big time problem genes, but This wasn't the case forever. I mean, this is like the crazy thing to recognize that although these were actually always predisposing to higher risk of these horrible cancers, the risk was nothing like what it is today.
So this is really, I think, a [00:29:00] huge indictment on our environment, our lifestyles, our diets, and what it's done to create this massive toxic burden.
Genes are all about expression, right? The gene expression so that these genes, which were kind of like quiet monsters, now they've become like screaming out loud monsters because they're being expressed and it's from, you know, unfortunate lifestyle. So these genes really unfortunately should be tested for in at risk populations and women should seriously consider the different surgical alternatives.
Unfortunately, that is not the majority of women, and that's horrible when it happens.
JJ Virgin: So then, really, any woman who on either side has a history of breast cancer in the family should have her genetics tested?
Dr. Felice Gersh: Well, it is no harm in getting it tested, as far as I can see. But, you know, certainly the way that the standard insurance [00:30:00] companies think about it is not simply, you know, breast cancer in the family, but rather women under the age of 50 and having multiples, not just one person, but having at least two family members, women on the same side of the family under the age of 50, but who cares what insurance covers?
This is your life. It's right. It's your life. So my feeling is if in doubt, just get it tested because knowledge is power.
JJ Virgin: So, if someone did have those genes, then is the recommendation to get mammography? Are there other options besides that?
Dr. Felice Gersh: Well, the thing is that in those women that carry those genes, they often will have breast cancer.
And, you know, we talk about breast cancer at younger ages. A young aged woman, mammography is not very useful, that's a part of the problem. And this, this actually holds true when women are on hormone therapy and menopause, because estrogen causes the ductal cells to proliferate. That's not a bad thing.
You know, that's when you [00:31:00] use it appropriately, the right dosing and you use progesterone and properly and so on. It's not a bad thing. It's like rejuvenating the breast, you could say, but a younger breast is going to have a lot of density on mammography. And density makes it hard to see detail because it gives you like a white, the whole thing looks white and you can't see any detail.
So trying to do mammographies in young women who are at risk for breast cancer, isn't terribly fruitful. You can't really see much. That's part of the reason why screening mammographies on women in their 40s don't seem to yield a lot of benefit because you can't see the cancers even if they're there and they're small.
So the thing with it is that people are turning to the MRIs once again. So MRIs have a lot of false positives, you have the gadolidium, so it's really a mess. And you can do ultrasounds, but ultrasounds are not early detection. They're really defined to look and evaluate masses that are already seen. And just to see are they cystic [00:32:00] or are they solid and so on, and used as a way to target, you know, biopsies, directed biopsies.
So now there are people doing research on better quality types of ultrasounds. And I have hope that sometime in the next decade, we'll have an ultrasound way of looking at at risk younger breasts, that we can actually see something and actually maybe make a difference. You know, but it brings up the whole issue that I wanted to touch on of overdiagnosis and that is that the whole foundation of mammography is sort of a house of cards because it's based on this original assumption that breast cancer starts and it's little.
And it grows at some linear rate, you know, so it's like a predictable linear thing and it just gets bigger and bigger as each year goes by until it hits some unknown but magical size when it suddenly metastasizes and you have to find it before it hits that magical metastasizing size. That isn't how breast cancer really [00:33:00] functions, though.
It can metastasize at any size because the function of metastasis is not based on size. It's based on cohesiveness of the cells. And that's a function of hormones and the genetics of the cancer and other factors that don't relate to size. It relates To cohesiveness, because if the cells break apart, that's when they can enter the lymphatic system or the blood vessels and then travel to distant places in the body.
So this idea that if you find it when it's little, you'll save a life is unfortunately not founded in truth. That's why there are some breast cancers that are quite large, like the size. Of a baseball and they're invasive locally, they're invasive cancers and they'll grow and grow and grow in the breath, but they don't break off into little particles and then travel in the blood or the lymphatic system.
So they're never going to metastasize. And this is like part of the problem [00:34:00] when you have an aggressive breast cancer in a young woman, they kill, and they, they're very small and by the time you find it, it's already metastasized, you don't change the ultimate outcome. That is a big deal.
JJ Virgin: And is it a different type of Cancer, it sounds like rogue, like these are traveling cells versus ones that just stay put.
Is there any way to tell this Felice? I keep looking at what else can you do? I know we're all supposed to do breast self exams. I never freaking remember to do this. Early on there was thermography. I don't know what's going on with that. I heard about some lab tests are supposed to be able to detect everything like is there any other screening devices that can tell this, especially if it doesn't matter if you catch it when it's small, if it could go rogue and metastasize.
Dr. Felice Gersh: Well, that's the thing about breast cancer is that it grows in different women at very unpredictable rates. Like I said, it grows very rapidly. It spreads early and others. It grows very slowly. In some cases, it stops growing. In some cases, it [00:35:00] regresses. You know, that's the problem right now. If they do a biopsy and they look at breast cancer, they have no way of knowing it just from looking at it.
You know, if it has spread yet, if it will ever spread, if it's going to regress and part of the problem with breast cancer. Findings is that many of them, in fact, almost a third of all breast cancers that are found a mammography or what they call ductal carcinoma in situ. So it looks like cancer cells, but they've not even broken through the basement membrane.
They've not spread. It's not invasive cancer, but they're treated pretty aggressively and no one dies of ductal carcinoma. And a small minority of them actually will convert into invasive cancer, but no one can tell that's a problem. You do a biopsy and it's ductal carcinoma in situ. And they don't know.
Is this going to be like the majority of them that never change to anything that will kill you, or will this be that one that converts into invasive cancer and grows rapidly and then can kill so nobody knows. So every woman gets [00:36:00] treated generally, and there's some voices against it. But right now they're treated quite aggressively, you know, with surgery and drugs that block, you know, hormones and radiation treatment.
And of course, all these treatments have a lot of harm to the body. They're doing a great deal. That's where the over diagnosis and over treatment comes into play. But we can't predict. Of course, there's this incredible goal to detect cancers. And I'm glad that you mentioned like the blood test. So we really don't have it.
Sometimes we just have to accept what is that's Sort of my way of living these days is accept what is like, we don't have a great tool like thermography. Okay. So what is thermography? Because I think that's important to touch on. It's a test to look for heat, temperature, therm, right? So if you have inflammation, inflammation can be anywhere in the body, including in the breast.
And inflammation underlies many cancers because chronic inflammation [00:37:00] causes ultimately DNA instability and damage and breakage, and then you have cancer. So if you have a breast that looks hot, you know, when you do a thermogram and it shows all these hot spots, well, that shows you have inflammation in your breast.
So that's a risk factor. Of course, it doesn't mean you have breast cancer, but you can also do an HSC or a P. You know, you could do blood tests to look for inflammation markers. And you can also just be clinically smart and look at a person, you know, like, do they have a lot of visceral fat? You know, what's their lifestyle, you know, and so forth.
So there are many ways to sort of discern if somebody has inflammation in their bodies. So if you have levels that are high, then that's a warning sign that you may have increased risk. It doesn't mean you have cancer. It doesn't mean you don't have cancer. It's just another risk. But you know, there are many ways to ascertain risk.
So what are you going to do about that? Well, you want to change lifestyle and in different ways to try to lower your status of [00:38:00] inflammation. But then the next step though, is go have a mammogram. So, I mean, the bottom line is that almost every woman at a certain point in life is probably going to have some heat coming out of her breast showing that there's some inflammation.
So they're all going to get told, go have a mammogram anyway. So in the end, have you really saved much of anything? Not probably too much. I wish it were better than that, but if you just want to know if you have inflammation in your breath. That's the way to go about it.
JJ Virgin: Well, we're going to unpack this.
So we give people like what you would do if I were you type of thing. But what about lab tests? Because I heard there was some blood tests coming out. You know, first of all, there was a blood test for colon cancer. There's going to be a blood test. That will basically look for every cancer. I'm like, really?
So what's the latest on this?
Dr. Felice Gersh: It's out. Okay. The one that's being marketed like crazy costs, it's out of the insurance world and it's like 950 a pop. The company [00:39:00] making it is recommending that everyone 50 plus. Get it every single year for the rest of their lives. Wow. What a great business model. Exactly.
Now this is their best data. So this is like, take it for what it is. They're putting the best face on this. They can. Okay. They say, if you have a hundred people who get this blood test, now this blood test is looking for different types of markers. We'll say that you can find in the blood that would indicate cancer is present somewhere.
Now, they can't say for sure where there's some correlation with certain types of markers that may suggest certain types of cancer. So there may be some correlation, but it's not 100%. So you get 100 people lined up. These are not high risk people. They're just regular people. They're not getting this test because of symptoms.
It's not considered for diagnosis. It's a screening test. So you just get random 50 year olds. And you get 100 of them. Of that 100 people, 2 will test [00:40:00] positive. So they're told, okay, we found cancer markers in your blood. So of those 2, what they found is that 1 of the 2, they'll find a cancer. They'll find it somewhere by doing, you know, CAT scans of everything.
Now, the majority of those cancers that they're finding are already metastatic. They didn't save a life. They found, will be terminal, incurable metastatic cancer. And it was actually a very small number that they found stage one, you know, they stage cancer based on how much there is and if it's spread. So it's a very small number of that one that they actually found stage one cancers.
And now what about the other one? So there was one person of the two that tested positive. They can't find any cancer anywhere. So it's just a false positive? We don't know. That's the problem. They don't know.
JJ Virgin: Oh boy, that person's now stressed out. Totally. And is it that they are finding [00:41:00] more metastatic?
Is it that you have to be at that level to have those markers show up in the blood? A level one or level two isn't going to show our stage one stage two isn't going to show up yet. So it's only going to show up at the point you've got metastatic cancer. Most probably. Which may be at that point.
Dr. Felice Gersh: It'd be better not to know.
You know, the data is very limited. That's the reality. They're still trying to get data. It's being released into the marketplace before it's really ready for prime time, is my belief about it. Because you're going to get a very tiny number of people. Whose lives are safe now, maybe like 20 years ago, it was really the rage to do total body cat scan.
You were going to find cancers. And yeah, total body cat scans. Of course, that was a lot of radiation. Occasionally, they found a pancreatic cancer, a renal kidney cancer. At a very early stage and probably did save that person's life. But how many people ended up, and I saw these people, they had doodads.
They saw a doodad in their [00:42:00] lungs and they ended up actually having invasive lung surgery. They cracked their chest open and it turned out it was benign. So, you know, these are like what we call incidental lomas. Like when you're not even looking for them and you get a cat scan for something else, and then you see something right.
But they were doing this, and so they did a great deal of harm. So they kind of fell by the wayside. But now they have the blood test. So the people who have the positive, that 1 in 100, and they can't find, they've got CAT scans everywhere. They're recommending repeating the test. So just think, it's positive again, and now you still can't find the cancer anywhere.
Or it's negative. So you're just going to keep repeating because you don't know. Well, maybe the cancer cells weren't putting out those markers when you did the repeat one, or how could this be positive and then be negative? Like what's going on here? So those poor people are going to be in this mill of having CAT scans upon CAT scans and MRIs.
And the anxiety level thinking they're going to find cancer at any time and nobody knowing what to do about them. Literally no one knowing what to do. And [00:43:00] the ones that do test positive and they find the cancer, keeping in mind that only a small percentage actually are going to have their lives saved.
So for me, I made a decision about this test as well. I said, no, I'm just going to keep eating my vegetables and working on my stress and my lifestyle and just accepting that I am going to do everything I can to lower my cancer risk and not spend my life trying to find it. What
JJ Virgin: you look for, you find.
What we focus on expands. If we're looking for the thing, I'm like, holy smokes. And you just said something super important. It's just, if you look at the research about exercising cancer, if you are fit, your risk of cancer is so low, it's ridiculous. You know, what if you took all the time that you were worrying and you worked out instead?
Dr. Felice Gersh: This is like a really important point that you just like kind of brought up for me to mention. The number one risk factor for postmenopausal breast cancer is the development of [00:44:00] obesity. The number one risk factor is obesity. And there are things we can do. There are things that are beyond our control.
But we can control the food we choose to eat. And we can't always choose the air we breathe. You know, and we can't choose what happened to us if we were sprayed by pesticide and didn't know it when we were kids and so forth. But the thing is that there is so much that we can do to prevent cancer, and that's what I focus on in my own life, in my practice, and you know, it's not that I'm against like colon cancer screening, because people are right now, if you do colon cancer, and you do a colonoscopy, we don't even know when the colonoscopy is negative, by the way, that doesn't guarantee you don't have colon cancer.
I mean, some of these colon cancers are very flat, and they're hard to find and you. The gastroenterologist was really busy that day. So there's never a guarantee, you know, even when you do every screening test in your power, there is no guarantee that if you do have a cancer, it's going to be found. If [00:45:00] it's found, it's going to matter, you know, because of the treatment.
Or what would have happened if you never found it, right? So I just take the power that I have to try to do everything to help my patients and myself lower cancer risk. I mean, exercise is like the magic medicine for everything. Isn't it? Oh my
JJ Virgin: gosh. You know, Felice, I started out in this world as an exercise physiologist, right?
And I literally ran out of classes in my PhD program. I ran out of classes. And because they didn't even talk about exercise and hormones back then, which is like such a big deal. I got the first textbook on exercise endocrinology. I was so excited after I was out of school, but I was literally taking classes in the dental school at USC.
I go, this is stupid. I'm paying like 4500 dollars for a class and I'm in the dental school learning how to write. Abstracts, but I have come full circle because you look at everything and you go, gosh, oh, dementia exercise. Oh, cancer exercise. Oh, cardiovascular risk exercise. Oh, all cause mortality [00:46:00] exercise.
So, you know, I think the bigger provocative thing and it happened when you spoke at MindShare I went, oh, we're supposed to do this and I didn't question it. And all of a sudden I went, oh, colonoscopy. I am at almost the lowest risk possible. All these things. I do every possible thing. I've looked at my genetics and I'm going, I do not have high risk on any of these things.
Why am I putting myself at the risk of the screening tools, which actually are creating more risks than what I have in the first
Dr. Felice Gersh: place. Absolutely. I'm with you. And you know, I just want to put in a plug if I can for hormones in menopausal women.
JJ Virgin: Oh, amen. You can
Dr. Felice Gersh: plug away, man. Or estrogen. You know, I defend estrogen at every turn because estrogen, which by the way, is a family of hormones.
Estrogen is not a hormone. It's a family of hormones. And so, like anything that comes in a variety, they're not all the same. The estrogen produced by ovaries is called estradiol. The symbol is E2. Now, what happens is that when you get older, and [00:47:00] especially if you don't have a great lifestyle, and you don't have hormones at all, like after menopause, and you're not replacing with human identical, Your body becomes more inflamed because estradiol basically modulates every function in the body, including the immune system.
So the immune system. Turns on inflammation when you need it appropriately, like to fight off an infection or deal with trauma and then it turns it off and then you go into resolution and healing and regeneration. Well, estradiol is really runs the switch to turn on and then turn off inflammation. When you don't have enough estradiol, you get stuck in on mode.
So you go into a pro inflammatory state all the time. Now, inflammation upregulates an enzyme called aromatase, which is present in fat tissue. And as we get older, and we're not healthy, we end up producing more visceral fat, like the belly fat around the internal organs, which increases [00:48:00] also in the liver, non alcoholic fatty liver.
And not only just in the liver, you get fatty bone marrow, fatty heart, fatty pancreas, all these things. You get. You know, abnormal fat deposition. Well, fat has the enzyme aromatase. When you have inflammation, this enzyme is turned on in an upregulation mode. So it is the enzyme that converts androgens.
That's like the male type hormones. The dominant amount is made in the adrenal gland in postmenopausal women like DHEAS. And then it converts to DHEA. And that's converted to estrone, which is not estradiol, it's a different estrogen and it's made in fat tissue. Now it turns out when you have inflammation, it blocks the enzyme to allow conversion of estrone to estradiol.
So there's an enzyme that can convert from estradiol estradiol. That enzyme becomes down regulated, so it doesn't work well in an environment of inflammation. So you have the [00:49:00] perfect storm now, breast cells. Are like the ductal cells are in a breast that's full of fat. Breasts are full of fat. Breasts make estrone in inflamed postmenopausal women.
Now, estrone works only on one estrogen receptor type called alpha. Breast cancer that's estrogen receptor positive, which is the majority, has a receptor only alpha. The one that Estrone works on, and now you're in an environment where your inflammation is in the on mode. You have overproduction of estrone, which is stuck as estrone.
It can't be converted to estradiol. And you have chronic inflammation in the breast. Inflammation leads to DNA instability. You don't have the estradiol there. So you don't have programmed self suicide. So crappy old cells can't be eliminated. You don't have autophagy because [00:50:00] that's estradiol modulated, so you don't have renewal of cells, so you end up with these yucky old cells, and they're all in an inflamed environment, and they can get DNA instability and turn into cancer.
And because they're estrogen in an environment, they end up with estrogen receptor positivity. And then in the breast itself, with all this inflammation and the fat in the breast, you have an environment of estrone. Estrone is not causing the breast cancer, but it is not able to reduce the inflammation.
The reason that inflammation upregulates the enzyme aromatase is that in a healthy woman who's not chronically inflamed, you get estradiol, and estradiol runs the on off switch for inflammation. And the reason that's in breast tissue is because in a woman who is breastfeeding who had a baby, she isn't making much estrogen at all from her ovaries, right?
The ovaries are in an off mode, right? Right after a woman has baby. [00:51:00] So if she gets a breast infection, how is that going to be regulated and controlled? Well, the breast will make its own estradiol to turn on and then turn off the inflammatory process in the breast. But in postmenopausal women, it's totally in disarray.
You only have estrone, you can't turn the inflammatory process off, you're stuck in that mode, you get breast cancer, and then the estrone is fuel to the fire. It's like an accelerant, it's like pouring gasoline on a fire. It didn't cause the fire, but it accelerates the fire. Now you have positive breast cancer, estrogen receptor positive, being fed by the estrone that's being produced in the breast itself and also in other fat tissue, so you have more circulating estrone.
Why did this even happen in the first place? Because that woman lost her ovarian function. She lost her estradiol, which is the regulator. Of all of this inflammation. So if you have a woman that goes on hormone replacement therapy right at the beginning, like [00:52:00] perimenopause, before she really gets into this inflamed state, before she starts making all this excessive amounts of visceral abdominal fat, before all the bad stuff sets in, then you can maintain that immune regulation status.
And you won't have all of this upregulation of aromatase and estrone production and all this excess fat and all this other stuff going on and the body can control inflammation and can keep everything in proper homeostasis so you don't get into this situation. So, this is why obesity is such a risk factor, because obesity feeds inflammation, the fat tissue itself creates estrone.
So it's like the perfect storm. But this is preventable by maintaining as close as possible, we don't have a new set of ovaries that anybody can have, a normal hormonal status for women throughout their lives. Both perimenopausal and postmenopausal for the rest of their lives [00:53:00] with no end date, never an end date.
And by doing that and adding in all the lifestyle stuff like, you know, proper diet and exercise and sleep and stress and environmental toxicant exposures and so on. Guess what? Breast cancer will plummet in postmenopausal women. This is a preventable disease, but it's not because women take bioidentical hormones.
It's really because they don't, or when they do, they're not taking it properly, a sufficient dose and in a proper rhythm to maintain proper immune function in the body. So you don't get into this chronic inflammatory state where you have DNA breakage and cancer and then feed the fire of the cancer.
That was so
JJ Virgin: profound. Oh my gosh. I was like, you're on such a roll. But that was so. Beautiful, because there's so much fear. I'm thinking about friends I've had in the field who don't take estrogen because they're so afraid now because they had breast cancer. I'm looking at them going, I'm [00:54:00] watching their bones.
You know, I'm watching their frailty. That was fantastic. Thank you so much for that.
Dr. Felice Gersh: There was one study, which is totally ignored by oncologists, where they gave women with breast cancer. An aromatase inhibitor, so that blocks that enzyme aromatase, so they can't make estrogen anywhere, including in their breath, right?
So that you don't have that. But then what did they do? They gave them estradiol. They gave it back so that all the organs that need it, including the breath, they have estradiol, not estrone, and these women did great.
JJ Virgin: Why is this not the standard of care? I'm thinking of someone we both know who's just miserable because she can't have anything that could elevate her estrogen.
I'm going to ping you afterwards about that one. Anyway, I have to catch a plane. So I want to tell everyone about your free ebook on menopause, the menopause SOS. You know, I think that last rant was a preview, but is it telling people the [00:55:00] lifestyle things they need to do to get perfect? Like how fabulous.
And thank you for a great preview of that. You. You have like had quite a career here man and i love the way that you just are critically open minded i heard that once i said you know be critically open minded just be able to question all of these things go what makes sense and i hope you listen realize that's the real key here so what makes the most sense.
For you based on your risk factors. So I'm going to put that guide, the ebook at jjvirgin.com/mammo M a M M O since we talked so much about mammograms and we haven't unpacked that at all. So this was fantastic. And thank you so much, Dr. Felice Gersh for hanging out with me. My pleasure. Be sure to join me next time for more tools, tips, and techniques you can incorporate into everyday life to ensure you look and feel great.
And more importantly, that you're built to last and check me out on Instagram, Facebook, YouTube, and my website, JJVirgin.Com, [00:56:00] and make sure to follow my podcast. So you don't miss a single episode at subscribetoJJ.Com. See you next time.

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