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

Hey, it's friend Mal, and welcome to the Mal Robbins podcast. I'm so excited for you to meet our expert today, Dr. Tais Ali Abadi is a world-leading OB-GYN, and she will tell you at the very beginning of the conversation. And I quote, "I promise you, by listening today, you may save your own life, the life of a loved one, and together we can save millions and millions of lives around the world. Because we're talking about cancer today. Cancer is an impact women, and the exact screenings and tests that you need to be asking for and discussing with your doctors right now. Now, it's important for you to also understand that Dr. Ali Abadi, in 25 years of clinical practice, has never lost a patient under her care to cancer, who did exactly what she told her to do. And today, she is going to share the specific protocols and tests that she uses with her patients. And she's going to go decade by decade and explain in detail what you and every woman you know needs to be asking her doctor for in her 20s, in her 30s, 40s, 50s, and beyond. And Dr. Ali Abadi is convinced that you're not getting the screenings or the medical treatment that you deserve and it's not your fault. She's going to explain what is likely happening at your annual well visit and tell you exactly what you should be asking for instead. You're going to leave this conversation with a detailed list and resources that could save your life. And the more that you and I share this information with women that we care about, we could together save the lives of millions of women around the world. I was so shocked by how much I didn't know about my own health. And I'm also surprised by how empowered I feel after this conversation. Because Dr. Ali Abadi is not just a fierce women's health advocate, she's also a breast cancer survivor. And she's going to tell you, if it can happen to me, a doctor, it can happen to you. And there are questions you need to ask, there are things you need to pay attention to. And after this short word from our sponsors, we're going to start the show so you can learn everything that you need to know. Hey, it's your friend Mel and welcome to the Mel Robbins podcast. I am fired up for the conversation today because the expert that you are about to meet has shown up here with a level of passion and commitment to you. And I just want to say before we jump into this, if you are new, if somebody shared this with you, thank you. Thank you for being here. Thank you for making the time to listen to something that our guest today says, we'll save millions of women's lives and your life or the life of one that you love could be one of them. You're going to learn everything that you need to know about cancer and exactly how to get listened to and to get better care. Dr. Tais Ali Abadi is a world-renowned OB-GYN and women's health advocate. She goes by Dr. A and she's been a practicing OB-GYN in Los Angeles for over three decades, caring for patients while also performing cutting head surgeries with outcomes achieved by fewer than one percent of gynecologic surgeons in the United States. For the past 25 years, she has not lost a single patient to cancer under her care. She is the official gynecologist for royal families and celebrities, including Rihanna, the Kardashians, Halley Bieber, and Olivia Munn. For 24 years, Dr. A is also taught resident to medical students, state-of-the-art surgical techniques at Seater Sinai Medical Center, and today she's here for one reason. She is here for you, and she is on a mission to save women's lives and to empower and educate you so that you can save yours. Please help me welcome Dr. Tais Ali Abadi to the Mel Robbins podcast. Dr. A, I've been dying to get you on this podcast, so I want to start by saying thank you for taking time from your extraordinarily busy clinical practice from all the speaking that you're doing and teaching that you're doing to be here with us. You say this conversation could save the person who's listening life or the life of their sister or their mother or their daughter, but I want them to hear it from you. Why did you want to be here today and what are we going to learn from you? To your listener, I will say that I am here for you. I'm doing this for you, and by listening to this podcast, I will promise you it will change your life. I want you to know that majority of women get dismissed in the current healthcare system. Their pain is minimized, they're told it's in their head, they're anxious, they're stressed, they're not sleeping. Well, they come up with a million reasons without truly diagnosing the underlying condition. And I'm here to tell you that you need to become your own health advocate by the end of this episode. I will teach you the most important things you need to know about women's health. I will teach you how to calculate your life and risk of breast cancer before you get cancer. I will talk about how to diagnose yourself early on if you're at risk for dementia, for heart disease, for stroke, and how to prevent it. I'm going to teach you about genetic testing. I'm going to tell you how to lower your risk of female cancers under my care for the past 25 years. I've never lost a patient who did exactly everything I told her to do. And if you listen to this podcast, I will promise you at the end of it, you may save your own life, the life of a loved one, and together we can save millions and millions of lives around this world. Well, Dr. A, I believe you. I believe this conversation could save the person who's listening's life. And one of the reasons why I believe that when you say it is because you're not only a physician in clinical practice, you're also a breast cancer survivor, and you have not lost a patient in your practice in 25 years. What do you attribute that to? I am hyper-visualment when it comes to prevention, and I probably order a lot more tests than most doctors do, but I do that and it has worked and I want every woman to have access to this level of care. What do you do if you go to the doctor and you feel like you're still not getting answers? Let me tell you, as far as my own story with breast cancer, when I was 48, I had no family history of any cancers. I didn't have any genetic mutations. I've never smoked, I've never done drugs. I've had maybe 20 alcoholic drinks all my life. I've never been overweight. I was never on hormones. So I was the poster child for someone healthy who was not supposed to get breast cancer, right? At 48, I had an atypical biopsy. I had an abnormality on my mammogram. The biopsy, they're like, oh, it's just atypical cells. Let's remove that area. You're good to go. So what does atypical cells mean? These are cells that have the potential to become cancer, right? They removed the tissue and they told me, go come back in six months. So that day, I went back to my office and because I had this atypical biopsy, I'm like, you know what? My risk was always less than 10 percent, but let me check it now with this atypical biopsy. So I recalculated my lifetime risk of breast cancer, and this number popped up on my screen, 37 percent. I almost fell off my chair and I'm like, what? Wait, what? Me? 37 percent chance of getting breast cancer. I called my doctor. I'm like, you told me come back in six months, but 37 percent. Back then, I had three daughters and I had not adopted my little daughter yet. And I called her and I'm like, I have these little kids running around. I don't want to get breast cancer. She's like, don't worry. You have no family history. You're so healthy. You have no genetic mutation. Don't worry about it. Mel, if I told you, you were about to board a plane that had it, 37% chance of crashing. Would you board that plane? Absolutely. With your family. No. No. So I said, "Remove my breasts." And they're like, "No, you're crazy. Why are you so paranoid? Why are you so anxious? You don't have any family history. It's a mutilation. I could care less about my breasts. I loved my family. I loved my husband. I loved my children. I love my job. I love my patients. I didn't want to get breast cancer. Finally, I found a doctor. She was willing to do my double mastectomy because I might take these off. I can't come every six months and go into these machines and then wait for a few days to get the results. It's too much for me. I couldn't handle it. And the day before my surgery, she's like, "I just want you to know, I'm still not agreeing with your decision." And I'm like, "Why? Why is it so hard for you guys? It's my body. It's my breasts. I don't care about it. Why do you care so much?" You know what she said? We have really good chemo for breast cancer. To a mother of three children, to a busy doctor, I don't want chemo. Take these breasts off. So finally, she did it. A week goes by, get a call from my plastic surgeon, not my surgeon. And my plastic surgeon said, "I just got off the phone with a pathologist." Any time a doctor calls you and says, "I got off the phone with a pathologist. It's cancer until proven otherwise." Because unfortunately, that's the only time the pathologist called us. As soon as he said this, my brain shut down. I asked him, "I might do I have cancer?" He said, "Yes." So all this time, they were digging in my left breast. They found invasive breast cancer in my right breast when they removed the tissue. You're kidding. I was devastated. I was devastated because so many of my doctors of my friends, of my colleagues called me crazy paranoid, anxious. You name it. I heard it. Thank God I didn't listen. I didn't care. what people said and I pushed for what I wanted. Otherwise, I don't know if I would have been here today. I was devastated, but more than devastation, I was so angry. I was so angry and the day my first breast cancer surgeon who did the initial excisional biopsy, she called me, she said, "Taiese, you're so lucky. You're so lucky you caught your cancer early." I'm like, "I'm not lucky. I've been asking for this and everyone called me crazy." Long story short, it didn't end there. After two weeks, I realized that I had a lot of breast tissue and I put myself through another MRI because I kept saying, "I don't think you removed all my breast tissue." And my doctor kept saying, "No, I removed all of it." I'm a gynecologist. I do breast exam. I know breast tissue. So the first two radiologists who reviewed my imaging said, "No, there's no tissue left." And it got to a point my husband was like, "Just let it be. You're fine. There's no tissue left." I follow up with another surgeon, friend of mine, at Cedars, and he walks in and he said, "Taiese, I'm so sorry about this MRI post mastectomy." I'm like, "Why?" He's like, "There's so much breast tissue left." I started bawling my eyes out in his office. And I'm like, "What are you talking about? Two doctors told me there's nothing left." He's like, "Let me take you to a radiologist." This third radiologist tells me I have all this breast tissue in my breast. So I forced him to do a second double mastectomy. He didn't want to do it because I had just done one and I had blood transfusion. And I didn't do well with the recovery. So he finally did another one six weeks later. I got more blood transfusion. And after I woke up, he said, "I'm so glad you had me do it." They had left 35% of your breast tissue behind. And listen, Mel, you know what I always say? As a gynecologist, I consider myself one of the biggest women's health advocates on this planet. My mission, my passion is to change the world of women and to lift the standard of care for women. So if someone like me, a gynecologist in this business, a women's health advocate goes through our health care system, gets dismissed, people tell her she's crazy. Do you think other women have a chance? No. In fact, hearing the story, it makes me scared. You better be scared. I'm here to scare you because I want you, unless I scare you, you won't be your own health advocate. You're going to say I'm fine. I don't have a family history. I didn't have a family history. I had no genetic mutation. So now I'm fine. I'm cancer-free. I was stage one. I got lucky because I pushed for this, right? But this lifetime risk calculator saved my life because 37% you need to know what that number is. An average American has a 12.5% chance of getting breast cancer. An average American. If you have dense rest, that goes up. If you have family history of breast cancer, that goes up. If you have a genetic mutation, it goes up. If you're overweight, it goes up. If you have any history of any atypical biopsy like I did, it shoots it up. If you get older, it goes up. So you need to know what this number is. You need to know your lifetime risk of breast cancer. It's mandatory, it's non-negotiable. So how do you calculate? So I use the tire Q-sick. Tire Q-sick is a tool, it's a formula. Okay. So tool we use to calculate a woman's lifetime risk of breast cancer. You have to enter your height, your weight, your density of your breast, which you can only get it from your breast imaging. Look at your mammogram, and they have to report on the density of your breast. It asks about when you got your period. If you've gone through menopause, if you're on hormones, if you've had a biopsy, what your family history is, all of it. You enter everything, and then you press enter. It takes two minutes to calculate your lifetime risk of breast cancer. But this number can make a huge difference why? If your lifetime risk of breast cancer is 20% or more, you fall into the category of high risk. For high risk patients with lifetime risk of breast cancer, 20% or more, these women need to start their breast imaging as early as 30. So don't come to my office and tell me that you have no family history of breast cancer and you're not 40 yet. The age 40 for mammogram is completely misleading. You need to know your own lifetime risk of breast cancer and based on that number, then we give you directions on when to start your breast imaging. So for women, 20% or above, you start at 30. In addition to a 3D mammogram, which we use for women with dense breast tissue and 50% of women have dense breast tissue, we also add ultrasound and we also add a breast MRI. So mammogram and ultrasound alone are not enough for women at high risk for breast cancer. For women in intermediate risk, 15 to 20, I do the mammogram and ultrasound. Usually I get a baseline in my practice at 35 because I think 40 is too late and I also might do an MRI every three years on these patients. For women who are low risk, they start mammogram, they can start at 40. I still in my practice get a baseline at 35. And if they have dense breast tissue, I order a breast ultrasound. Usually we can go back 10 years. So if you have an aunt who was diagnosed at age 43, then you have to start your breast imaging 10 years earlier than that. But if there's one message, I want everyone to understand is the importance of this lifetime risk number that will determine when and what type of imaging you get. So I know that I'm going to leave this conversation and go calculate my lifetime risk. And I'm also thinking, okay, I got to log into my patient records and get my breast density. No, but you should know your breast. I have no idea what it is. I'm 58 years old. 50% of women have dense breast tissue, right? Dense breast tissue A makes it difficult for a radiologist to basically look and find cancer because dense breast tissue on mammogram looks white and cancer looks white. So it all blends and it's hard for the radiologist. That's why you need a 3D mammogram instead of 2D. So the radiologists can see better. But dense breast tissue itself increases your risk of breast cancer. I had extremely dense breast tissue. You need to know what you have because if you have dense breast tissue, mammogram alone is not enough. Not only you need a 3D mammogram, but you also need an ultrasound. How do you know if you have dense breast tissue? Look at your mammogram report. Well, what if you're 30 and you've never had one? You just skip that. Okay. And by skip that, you mean do the test anyway and you can just skip it. But I'm telling you, 50% of us have it. If you've ever had a mammogram go look at it, they report it. Well, I know the person listening because I feel this way is now wanting to go calculated. We're going to link to this in the show notes because these tests are free. But I want to add one thing before we leave breast cancer. For years, I couldn't figure out why I had breast cancer, right? My genetic tests were negative. I had no family history and I had no real risk factors. Until about four months ago, I did a full genome sequencing of my DNA. I use simplified genomics, which is a genetic one of the companies that runs whole genome sequencing. They look at maybe 6.4 billion DNA pairs, millions of variants, and 2100 diseases. And they give you literally a 30, 40 page report. What do you think the first thing slagged on my report? Breast cancer. At high risk for breast cancer. Why? Because some of us walk around with major genetic mutations. Remember, Angelina Jolie came out and said, "I have the BRCA gene mutation." But less than 5% to 10% of women who get breast cancer have a major genetic mutation. The rest of us fall into this category. We don't know why we got it, but we have some family history. I didn't even have a family history. But these full genome sequencing now look at your polygenic risk score. Have you heard of that? No. Polygenic risk score means you don't have a major genetic mutation in your DNA. But you have a ton of these tiny little markers, these variants that individually don't have power. But some of us, like me, walk around with tons of those that can increase your risk, sometimes as high as a genetic mutation. Wow. So I was one of those people. So that's why my genetic test was always negative. But this full genome sequencing showed my polygenic risk score at three times more likely to get breast cancer than another person. So if I had this information 10 years ago, no one would call me crazy anymore. That's true, right? That's true. And my family, what are you going to look into my family history? My dad had no siblings. So maybe if he had a sister, that sister would have had breast cancer. So that's why don't come to my office and tell me, I don't have family history of breast cancer. So I'm not going to get breast cancer. It's not true. 85% of women who get breast cancer don't have a family history of it. That's unbelievable. 85% of women with breast cancer don't have family history. No, but you don't know what's in your DNA. And you don't know what you've done in the environment, right? Alcohol being obese increases your risk, having atypical biopsies, having had radiation to your chest, having dense breast tissue. The other thing I want to address is the genetic testing. If you have family history of breast. cancer, ovarian cancer, pancreatic cancer. You need to do your genetic test. Remember those major gene mutations. You still need to get tested for those. There are 11 gene mutations, if I'm not mistaken, that are directly linked to breast cancer. You have to take that test, and I want you to take that test by 25. So usually at 25, I do that test because if someone has a genetic mutation, let's say someone like Angelina Jolie, she would have started her breast imaging at 25. If she had had the genetic test. And is this something that you can just do at your doctor's office? And is it just like a blood draw? How do you do it? It could be a sputum test. It could be a sputum. Like you spit. Oh, that's easy. Or you can do a blood test. So just go to your doctor and say, I want to do a genetic. I have a family history. I just heard this podcast with Mel Robbins and Dr. Ray. And I would like to get just a full spectrum of genetic test done. Yes. And if they can also, you know, the whole genome sequencing is the way to the future. It's more personalized care, right? It basically gives me your information, not based on your mom. Your family history and your tire cusic is still very important. How is breast cancer diagnosed biopsy? And that's the only way, right? That's the only way. Okay. I don't want you to mix up. Listen, you can have a breast imaging, right? You can have a mammogram, ultrasound, MRI. And the radiologist can say this lesion is suspicious or highly suspicious. But at the end of the day, you need to have a biopsy. And that's the only way to diagnose breast cancer. That biopsy will tell you what type it is, what grade it is, what are the biomarkers? Is it estrogen receptor positive, progesterone positive? Is it her two positive or negative? So it's like the driver's license to that tumor because not all breast cancers have the same treatment. And then you need surgery, they need to address your lymph nodes to stage it. But ultimately, it's biopsy. But in order to get to the biopsy, you need to do the screening tests. You need to have your mammogram. You have dense breast, you need an ultrasound. If you're high risk, you also need an MRI. If you're high risk, you start at 30, not at 40. And by the way, for your listeners, I want every single woman between 25 and 30 to calculate her lifetime risk of breast cancer. That's number one. So you have to do all this. I never, ever have a patient under my care show up to my office at 35 with stage four breast cancer. That has never happened to me. You can't tell me this is luck. I don't believe it is. I think you are giving the patients under your care, the preventative screening that we all deserve. In every one of us, I know that I speak for anybody listening right now. Don't you wish Dr. A or your doctor? Well, my mission for this episode was for Dr. A to pour into everything that you needed to know that she is teaching to her patients that she's doing on behalf of her patients so that you, no matter where you are in the world, can advocate for yourself and the women that you know and love. So Dr. A, thank you. I also want to thank you for sharing this and for being here. And we're going to take a quick pause because our amazing sponsors are supporting this show and allowing me to bring you extraordinary resources and experts like Dr. A. But don't go anywhere. Stay with me. Mel, if I told you you're about to board a plane that had it 37% chance of crashing, would you board that plane? The answer for me, and I'm sure it's for you, is no, I would not board that plane. And by the way, that was Dr. Tais Ali Abadi explaining why knowing your lifetime cancer risk matters so much. And Dr. A, I just want to thank you for giving us that visual because it really amplifies why it's so important to know. And now, I would love to have you give us the list of the tests that we should be walking into our doctor and asking for. At 25, if you have family history of cancer, ask your doctor for genetic testing. Okay. You walk in and you say, I have family history of X, breast cancer, ovarian cancer, pancreatic cancer, aggressive prostate cancer, colon cancer, I need a genetic test. Do you offer that genetic test in your office? Yes, great. Can I have that test? No. Can you refer me to someone who can do that genetic test for me? Terrific. By 30, know your lifetime risk of breast cancer. If that number is 20% or more, start your breast imaging as early as 30, find out if you have dense breast tissue for women with dense breast tissue ask your doctor for an ultrasound. If your lifetime risk is 20% or more, go back to your doctor say, I calculated my lifetime risk and it's 20% or 25% or 30% or 37% and you didn't order an MRI for me. A lot of times insurance companies will not approve an MRI. I had to pay $3,000 for my MRI even though my lifetime risk was high. But if your doctor writes on the prescription that you have a high lifetime risk, a lot of times it will get approved. So just so I'm tracking, if you're 30 years or older, your lifetime risk is above 20%, you can calculate that risk for free by just going to the show notes and clicking on the link and you also coach your doctor into saying, please when you order the MRI right on the order that I have a high lifetime risk, which is anything over 20% that will increase the chance that your insurance will pay for it. That's the test that you want. And sometimes I send patients, let's say at 34 and she has a 30% lifetime risk of breast cancer. She calls my office. She's like, I went to this center and they're telling me, why are you here? You're not even 40. Why are you doing a breast MRI? I fight for my patients every single day, every single day because I feel like I have to advocate for them. So they can advocate for themselves, you know, and they still get pushback. Is there anything else after you get the MRI? That's a good question. So for women who have a very high risk for breast cancer and I consider that 35% or above, they have two options. They can take tamoxifen, which is a hormone blocker for five years. And by taking that, they can reduce that risk by 50%, which is huge. Or choose what I did, which a lot of people still think I'm crazy, but a double mastectomy was the best decision I've made for myself. Okay. Now, not everyone has access to the plastic surgeon that I went to or could afford this surgery, but a lot of times it's covered by insurance. The outcomes are different depending on who the reconstructive surgeon is, but it's the best decision I've ever done in my life. Doctorate, what do you wish every woman understood about breast ovarian cervical and uterine cancers? So all of these cancers are completely different. I want to move to ovarian cancer. Ovarian cancer is very tricky. Okay. And one thing I want your listeners to understand is that when it comes to ovarian cancer, know your family history. Make sure you don't have a genetic mutation. The Brocka gene mutation can increase your risk of ovarian cancer. Lynch syndrome can increase your ovarian cancer. So if you have family history, ask for the genetic test, right? And make sure you know your family history. If there's one other thing, I would change in this country and make it mandatory, I would have every single woman on the planet get an annual pelvic ultrasound. Do you think women get that? No, no, I don't even know the last time I got one. You're looking at me. But can I tell you something? Yes. That's why my patients don't die. Do you know I diagnosed and when I say this, I had an oncologist who used to work with me. He's like, he called me one day. He's like, you know, you're the only person and he was so well-known in Los Angeles. He's like, you're the only person I know who sends me ovarian cancer stage one and two. Why? Because I do pelvic ultrasounds on every single patient. And if you have family history of ovarian cancer, guess what I do? Either at menopause, again, I'm very aggressive. This is not standard of care, but this is aliabadi standard of care, okay? I remove those ovaries once they're completely dead. But for people who want to keep their ovaries and they're at high risk, did you know that if you remove someone's fallopian tubes, you can significantly reduce the risk of ovarian cancer because they did a study 65. Some people say 85 percent of ovarian cancers start in the tube. I had a patient three weeks ago. I met this woman in July. She came to me. She had long history of endometriosis. Endometriosis bumps up your risk of ovarian cancer. And I was talking to her and I said, you know what? Also, there's a slight increase in your risk of ovarian cancer. She said, I don't want cancer. Can you remove everything? I'm not saying everyone run and remove your ovaries, but I pick and choose my patients. This one, I said, yes, I will because she had long history of inflammation in her pelvis. And I already knew she was a little at risk. I did her surgery and the pathologist called me. Again, you don't want the pathologist to call you. She said, how did you diagnose this patient? Why did you do her surgery? I'm like, you know, she was at risk. So I removed her tubes, tubes and ovaries because she was like, six years old. And she said she has high grade serous fallopian tube cancer. Seven millimeters, you know, how little seven millimeters I saved her life. How invasive is the surgery to remove your fallopian tubes? For me, it takes me 10 minutes, but you have to go. Maybe 15 minutes is very fast. I do it laparoscopically, you know, the recovery is a couple of days. No core exercises for four weeks, but I don't care if you're at high risk. I'm removing your tubes. Well, I'm glad you're talking about this because I have a very good friend who's the chief operating officer of breakthrough cancer, which is this foundation that's funding collaborative research. And one of the breakthroughs is the research they've funded around the fact that the majority of ovarian cancer begins in the tubes. And the fallopian tubes can be removed in like a 10 to 15 minute procedure. And it's life saving. Yeah. For some people, it can take longer, but you don't need to be cut open for a tube removal. It has to be done laparoscopically. It's outpatient. If you are at risk, remove your tubes. The only group of patients, let's say a bronca patient who has a very high lifetime risk of ovarian cancer, in those patients at 40, you also want to remove their ovaries, not just their tubes. But for the rest of us, like if someone showed up to me and said, I'm done having kids 42 years old. And my mom and aunt died of ovarian cancer, I would remove her tubes. And after menopause, I would go probably remove her ovaries. But while she's done having kids, I would remove her tubes. So is removing ovaries a much more invasive. Not really. Not really. No. What happens when you remove somebody's tubes? Like do you spin into menopause? So if you remove someone's ovaries, absolutely, because you put them in surgical menopause, you don't want to do that. You want your ovaries. You want to keep them. The exception are women with a positive genetic test. Let's say bronca. Those women need their ovaries out by 40. And yes, we do put them in surgical menopause because they have a high lifetime risk of ovarian cancer. For the rest of them, if you remove the tube, the ovaries are still functioning. You're still ovulating. And you've profoundly reduced your risk of cancer, significantly reduced your risk of ovarian cancer. But don't forget your pelvic ultrasound. How do you get a pelvic ultrasound? Ask your doctor bag if you have to. You need a pelvic ultrasound. I don't have a single patient who doesn't have a pelvic ultrasound. And let's go to uterine cancer next. I'll tell you why ultrasound is so important. After menopause, when I do an ultrasound, the inner lining of your uterus, can I show you my model? I would love to see your model. Okay. So here's the model I brought for you guys. So this is the vagina. This is the uterus where the baby grows. These are your fallopian tubes. And these are the ovaries. Right. So the hormones are secreted from the ovaries. And the fallopian tube, the job of the fallopian tube is it grabs the egg as the sperm comes up from the vagina into the uterus and into the tube they meet. And then the embryo implants into the uterus. So removing the fallopian tubes will significantly reduce your risk of ovarian cancer. But when it comes to uterine cancer, after menopause, the lining we call it endometrial echo complex. It's the lining inside the uterus. And if that's what we're shedding when we menstruate. Correct. Okay. After menopause, you want that lining less than four millimeters. So if you're my patient and you come to my office every single year, I'm doing your ultrasound and I measure your lining and let's say it's three millimeters, right? Yeah. And then one year, you show up and it's suddenly seven millimeters. You have no symptoms. You have no bleeding. Guess what I'm going to do? I'm going to do a biopsy of your uterus. I'm going to investigate why this lining that's always been three millimeter is suddenly seven millimeter. Do you know how many uterine cancers I've caught over the years, stage one, because of my transvaginal ultrasound? Because I'm checking this lining. And what is the width that triggers you to do a anything past four millimeters? Now let's say, you know, if a patient comes to me, she's a new patient and says, oh, I've had an ultrasound or I did, they did a biopsy of this lining two years ago. I always, my lining is a little too thick. I'll document. I get her ultrasound and her path report. I put it in the chart, but if she doesn't know and she's postmenopausal and her lining is thick, again, I don't watch anything. It takes me 10 seconds to biopsy the uterus. Why would I not do it? Why would I hesitate to biopsy someone when it takes 10 seconds? So, and what's the last one? Servical cancer. Listen, no one should die of cervical cancer. Almost all cervical cancers start with HPV human papilloma virus is sexually transmitted virus. Get your pap smears and get screened for HPV. There is no reason why anyone should ever die of cervical cancer. It's almost 100% preventable since I've left county USC. That's where I trained. And we would see cervical cancer every call. Women would come, oh, my last Papster was 10 years ago. I'm bleeding. It was like a common thing on call every time every week. We would have a bunch of women with cervical cancer. That has ended. We have the HPV vaccine. We screen for it. So, that is 100% preventable. Talk to me about the vaccine. Everyone should get it. Yes. 9 to 46. Now it's part of childhood vaccination 9 to 11. It works. There are 100 different strains of HPV. About 30 of them affect the general area of the 30. 15 of them are high risk, meaning they can cause cervical cancer of the 15. Two of them, number 16 and number 18 HPV are highly associated with cervical cancer. Those are the patients you need to watch very closely. Those are patients who come in with a negative pap smear. If your HPV 16 or 18 is positive and your pap smears negative, guess what? You still need a hyposcopy. So we can look at the cervix and take a biopsy of areas that are suspicious just to make sure we're not missing cervical cancer. If you didn't get an HPV vaccine as a child, should you do it as a woman as an adult? Up to age 46. Dr. A, what should women do every day just to stay aware of changes that might be happening in their body? So I don't want to put this fear in you that you have to do something every single day. But as a woman, you need to know your body. You need to know what your breasts feel like. You need to know what the skin looks like on your breasts. You need to know what symptoms you experience. You need to know if your periods are regular. You need to know if you have acne. You have to notice hair loss. You have to notice if you're bloated all the time. So you just need to be aware of yourself. Don't ignore your symptoms. Our health care system has taught us to dismiss symptoms, to ignore pain. And it has normalized everything we feel, bloating. It doesn't matter what we feel. They say it's normal. And the other thing I want to talk about is if your doctor tells you, if you feel like something's wrong and the doctor looks at your labs and says, no, your labs are normal. You're good to go. That's not true. It doesn't work that way. You can have a completely normal lab and have breast cancer. So don't tell me that your labs were normal. Well, Dr. A, I am not going to tell you that my labs are normal, but I am going to go get my labs done. I really appreciate how passionate you are because you're making me and the person who's listening right now understand how passionate we have to be on our own behalf. I don't want to take a pause, but I need to take a break so that we can give our amazing sponsors a chance to share a few words because they're the ones that allow us to bring you the extraordinary medical expertise of Dr. A. But while we do, please, I've asked from the very beginning, I really want you to take this episode and send it to women in your life that you care about. We all need Dr. A. And as she said at the very beginning together, we could save millions and millions of women's lives. We all need this conversation and don't go anywhere because when we come back, you're going to want to have a pen and a piece of paper because Dr. A is going to walk you through the specific tests to ask your doctor about to help you understand your risk for stroke, heart attack and dementia. Stay with me. We'll be right back. I don't expect you to be a doctor, but I do expect you to advocate for yourself because no one on this planet cares about your body or your health as much as you do. So you need to advocate for yourself. That was Dr. Tais Ali Abadi. She's a world-renowned OB-GYN. She is here teaching you and me exactly what you need to know, what you need to ask for and what you need to advocate for when it comes to your health. And I love listening to you, Dr. A, because I can tell that even though we need to be our own advocates, you are such a fierce advocate on our own behalf. And one of the things that you're passionate about is your annual OB-GYN visit, the well-woman visit. So can you tell me specifically what exactly should I be advocating for? By 18 to 20, I get an account baseline account on every single patient at count is AMH anti-malarion hormone. is a simple blood test that you can do at your doctor's office. You can do it with your primary, you can do it with your gynecologist. You can do it with your family practice doctor. And basically, it tells me about your ovarian reserve. Having a high AMH doesn't mean you're going to get pregnant and have all the babies you want and having a low AMH doesn't mean you're infertile. But it tells me where you're sitting with your ovarian reserve. So it's very important information. And then by age 25, I ask every single woman. I talk about family history. And if they have any family history of any cancers, I will do a genetic test on them. But at this age, I've also done a baseline hormone panel on the patients. We'll check testosterone-free end total. I check prolactin levels. I check DHEAS. It's a hormone secreted by the adrenal gland that can have symptoms similar to PMOS. But it's mostly stress-related. And I do a full thyroid panel. For patients who are overweight, I check their hemoglobin A1C at this point. So once I do, I have a baseline hormone panel. The pap smear, you know, it starts at age 21. And I usually combine a pap smear with the HPV test. For women who are sexually active before that, we usually start your pap either at 21 or three years after the first intercourse, whichever one comes first. By age 30, I calculate everyone's lifetime risk of breast cancer. If that lifetime risk of breast cancer is 20% or more, I start their breast imaging, mammogram, ultrasound, and MRI as early as 30. By age 28, if my patients are not in a relationship and they don't have any plans or they're not dating, I usually start talking about egg freezing, unless their egg count was low and I had done it earlier. But between 28 and 32, I push my patients to freeze eggs. How come? Because as we get older, the count goes down and the quality of the egg goes down. And because in my practice, I see a lot of PMOS and endometriosis patients and egg quality becomes an issue I always recommend egg freezing in these patients, in my patients. The problem is, Mal, when women are young and they have great eggs, they can't afford it, they can't afford egg freezing. When they're older and their egg count and quality is gone, then they can afford it. What does it typically cost? I realize it varies, but what is the procedure? So basically it costs anywhere from 10,000 up to 35,000 dollars per cycle. In your 30s. Yeah, you're in your 30s, you're going to your annual origin. In your late 30s. So then I talk also I get my patients ready for pregnancy. That's the age mostly women get pregnant, but that's a whole podcast by itself. But usually by 35, even for low risk patients, in my practice, I do a mammogram baseline mammogram and ultrasound. And then this is when a lot of women believe it or not, can't start parrymenopause. Average age of menopause is 51 and a half. The range is 45 to 55, but seven to 10 years before menopause women go through parrymenopause. So if your body is programmed to go through menopause at 45, at 35, you can start having parrymenopausal symptoms. So I watch my patients very closely. These are patients who suddenly show up and say, I don't feel good. Something's wrong. Something's changing in my body. I'm not sleeping well. I'm angry. I'm yelling at my kids. I want to kill my husband. I'm irritable. I have hot fashes. I have night sweats. I'm gaining weight. I don't know whatever. I use everything I used to do to control my weight is not working anymore. I'm losing hair. My joints hurt. Sex suddenly hurts. I don't know why I'm peeing so much. Those are all parrymenopausal symptoms. And you could see those between the ages of 35 or late 40s. Yes, absolutely. Got it. You know, it's less common in your late 30s, but it can absolutely happen. So when you start to experience a parrymenopause symptoms, whether you're in your late 30s or mid 30s or you're mid to late 40s, you can start HRT based on symptoms. Absolutely. As long as you don't have breast cancer and you don't have any contraindications for hormone use, the best form of progesterone, which we prescribed micronized progesterone for parrymenopausal and postmenopausal women, progesterone has a calming effect on the brain. For patients with brain fog, which is a very common symptom. They forget things. They have hot fashes, night sweats. They're more irritable. They feel depressed. They can start estrogen patches at 45. I want to have a baseline colonoscopy, right? If you have family history of colon cancer, you start 10 years prior to that. So if you had an uncle who had colon cancer at age 48, then you start your colonoscopies at 38. You don't wait for 45. I always, I love getting bone density on my patients in their 40s. I want to know what the baseline is. I don't wait until you're 60 to get a bone density. So I get a baseline bone density on my patients in their 40s. And if it's low, I watch them. I, you know, if I have to treat it, I treat it. If I have to recommend exercise, weight bearing, get whatever it is. But I don't want to suddenly wait for menopause. The biggest loss in menopause happens the first five years of menopause with bones. So you want to build up the bone. So when you lose it, you don't drop into the osteoporotic range. But one of the things that I do on every single patient, as soon as they're sexually active, is a pelvic ultrasound on my annual exams every single year. So as soon as you're active, I'm doing a pelvic ultrasound. It takes me one minute to look at your ovaries, tubes, and uterus. If you tell me that you don't want an ultrasound, it's like covering my eyes and asking me to drive. I literally have no idea how gynecologist treat patients on their well-woman exam without doing an ultrasound. So let's say you are now past having kids, your past perimenopause, you are in menopause. And you have not had your period. So you're kind of 50 and over. What should you be asking for at your well-woman exam? So one thing I'm very passionate about is longevity, right? And a lot of women do not see another doctor. They don't have a primary care who takes care of them. They only go to their gynecologist once a year. What do they get? A pap smear, a breast examined by manual pelvic exam, and maybe an SCD check, and off they go. Maybe a prescription for birth control. That's not well-woman, right? A well-woman exam, you need to rule out everything I talked about, but you also have to address longevity. What is longevity? Is my patient at risk for stroke? Is my patient at risk for heart attack? These are simple tests. Is my patient at risk for dementia? There's a simple blood test, APOE4, 20 to 25% of women carry the APOE4 variant, okay? If you have the APOE4, so 20 to 25%, I'm one of them. 20 to 25% carry one copy, 2% carry two copies. People who have the APOE4 variant are at a higher risk for having Alzheimer's disease. So these are the patients you have to intervene. One information is exercise. Exercise makes a huge difference in these patients. It doesn't mean you're going to get dementia. It means you're at a higher risk than the general population. Two is sleep. These patients need to get at least seven hours of restful sleep at night, right? Three, omega-3s are very important. Four, avoiding alcohol, avoiding smoking, avoiding processed food, and keeping these patients' homocysteine down, which is another blood test I check on every single patient. If your homocysteine is high, it means that you're not methylating well. So these patients, I usually prescribe methylated B to them. The other data we recently have is that if you put patients with APOE4 on hormone replacement within the first seven years of menopause, you can reduce the risk of Alzheimer's in life, which is huge, right? So you don't want to miss that window. So that's your APOE4. Ask your doctor to check your APOE4 level. The other test is your APOB. We used to look at cholesterol and LDL, and it's great. We tried glycerides. We still look at all of that. But one new value we look at is your APOB. And I think every single woman listening to this podcast needs to know her APOB. Imagine a bucket of four particles in your blood that can make plaque and increase your risk of heart attack. Heart attack is the number one killer, right? So don't you want to know what that bucket is? Yes. In this bucket of APOB, there are four particles, like a protein little A, which is genetic, 20% of us have it. You either have it or you don't have it. LDL, ideal, and VLDL. In this bucket of APOB, the 20% of women who have this lipoprotein little A, it pushes their APOB to go high. And these are women who tend to have earlier heart attacks. Like you look at these some families that like everyone in our family has a heart attack at age 50. Well, their APOB was not checked. In my practice for longevity, I always tell my patients it's not a magical number, but I want to keep that number below 60. There's a longevity cardiologist that I work with. He says bring it down to below 40 if you want to live to be 100. Do you know how many women, they look healthy, right? They exercise, they do everything right. They eat healthy, they don't drink, they don't smoke, but their APOBs are in the hundreds. So you need to know if you haven't heard of your APOB, go ask your doctor. It needs to be fasting. There are two centers that run a correct APOB. One is Cleveland Clinic and the other one is Boston Heart. So a lot of random labs can run APOBs. It could not be as accurate. Again, go see a cardiologist, ask about these values. Take a note and add these to your to-do list. So when you go for your fasting blood test, you're asking for all these tests. It makes me uncomfortable knowing how little I've asked for. And that brings me to a very realistic question, knowing that every woman typically gets about 15 minutes with their doctor. After listening to this conversation with you, what specifically should we walk into our annual visit and ask for and say and do? I hope that everything I covered, you know, I covered the most important topics, I didn't cover all of it. But I want you to take a piece of paper. Make a long list of everything you want. If you want to advocate for yourself, educate for yourself. Go into that meeting empowered, educated. I don't expect you to be a doctor, but I do expect you to advocate for yourself. 'Cause no one on this planet cares about your body or your health as much as you do. Get that piece of paper ready. If you have family history, you know what to do. Now you know how to calculate your lifetime risk. You don't need your doctor to do it. Make sure if you need mammogram ultrasound MRI, you have it on your to-do list. If you think you have PMOS, ask your doctor. If you think you have endometriosis, ask about endometriosis. If you're doing your fasting blood test, add everything I told you to the list. Say, doctor, are you also checking my APOB? I'm Perry Manopausal. Are you checking my hormones? Are you checking my APOE4? Am I at risk for dementia? Are you ordering a bone density for me? Am I due for my colonoscopy? Do I need genetic testing? Write it on a piece of paper. 'Cause that's 15 minutes. You don't want to waste a minute of it. Go in with a mission in mind. Well, that's why I'm grateful that you're here today because you just educated us. It will save millions of lives, Mel. If you drop everything and don't care about anything, just take the breast cancer lifetime calculator. Imagine if every woman calculated her lifetime risk of breast cancer, do you know how many millions of lives you will save with your podcast today? Millions. Dr. A, what are your parting words? My parting words is when it comes to women's health, don't let them dismiss you. Don't let them tell you it's in your head. Don't let them tell you it's normal. Don't let them tell you your labs are normal so you don't have the condition. If you get dismissed, go get a second opinion. If you still get dismissed, go get a third opinion. No one said you need to be stuck. I didn't stay with my first doctor's opinion who told me I was okay and I didn't need a double mastectomy. I kept pushing and pushing the boundaries until I get the care that I deserve. And you deserve the best care on this planet. There's no reason why you should ever be dismissed. Don't let anyone tell you that you're anxious, that you're stressed, that it's in your head, fight for it, educate yourself, empower yourself and become your own health advocate. That's the only way to survive this healthcare system. As you said, Dr. A, no one cares about your health as much as you do and you deserve the best care on the planet. And I want to thank you on behalf of the tens of millions of women who will listen to this, who will share this with the women in their life. I want to thank you on behalf of the men who love the women in their life, who have educated themselves by listening to this. And I know there's no doubt in my mind that based on the information that you shared with us today and the way in which you shared it, there will be people whose lives are saved. And I believe it will be in the millions because every time someone listens and they take all this information and they empower themselves to take responsibility for demanding the care that they deserve. You are saving a life and you're improving it. And so thank you for the extraordinary work that you do. - Thank you for sharing this beautiful mic. Thank you for everything you do. Thank you, Dr. A, and thank you. Thank you for listening to something. I know you don't have a lot of time. So thank you for making the time to listen to something that will educate you. And thank you for being extraordinarily generous with this episode. I am going to ask you personally to take a minute and copy the link and text it, email it, send it to every woman you know. We covered information that is critical for every teenage girl all the way up to every woman that you know through the end of her life. And this is a free resource with a world-renowned expert who wants you to have the best care on the planet and having the best care on the planet means educating yourself and advocating for that. And so together we can support women all over the world and we can smirk them and not only advocating for themselves but also in advocating for the women in their lives and the girls in their lives that they know. Alrighty, in case someone else tells you as your friend, I'm also going to remind you that I love you and I believe in you and I believe in your ability to create a better life. Alrighty, I'll see you in the next episode. I'll welcome you in the moment you hit play. - You've already done the hardest part. - Yeah, you got here. (laughs) We went to the wrong address too. You're gorgeous, but you look even prettier in person. - Oh, thank you. - People are like the face-soon themselves so much when you meet them, you're like, "Wow, you." I walked in, I was like, "Wow, you're stunning." - Can I run to the bathroom? - You're killing it, how do you feel? - I feel great. - I wanna go see if my lipstick has a line 'cause I have four more questions for you. - I'm definitely coming to see you. Let's do the full genome on you. - I would love to. - Oh, and one more thing. And no, this is not a blooper. This is the legal language. You know what the lawyer's right and what I need to read to you. This podcast is presented solely for educational and entertainment purposes. I'm just your friend. I am not a licensed therapist and this podcast is not intended as a substitute for the advice of a physician, professional coach, psychotherapist or other qualified professional. Got it? Good. I'll see you in the next episode. (upbeat music) - Sirius XM podcasts.