Overview of The Mel Robbins Podcast Episode
Mel Robbins speaks with OB-GYN Dr. Thais Aliabadi about cancer screening, personal risk assessment, and advocating for care when symptoms or concerns are dismissed. Aliabadi shares her experience of discovering breast cancer after an atypical biopsy and describes the screening practices she uses with patients. Her recommendations are often more intensive than routine screening; she encourages listeners to discuss what fits their individual risk and circumstances with a qualified clinician.
Breast Cancer Risk and Screening
Aliabadi urges women to learn their lifetime breast cancer risk, using the Tyrer-Cuzick calculator, which factors in details such as breast density, biopsy history, and family history. She says a lifetime risk of 20% or more warrants earlier and more extensive imaging in her practice: mammography, ultrasound, and MRI, sometimes starting at 30. She also emphasizes that dense breast tissue can make cancer harder to see on mammograms, and that most women diagnosed with breast cancer have no family history.
She recounts that her own risk estimate rose to 37% after an atypical biopsy. Although doctors initially reassured her, she chose a double mastectomy and cancer was found in the other breast. She later learned that some breast tissue had remained after the first operation and pushed for a second surgery. Her experience underpins her message to seek further opinions when concerns remain.
Aliabadi also discusses genetic testing for people with relevant family histories and whole-genome sequencing, which can identify polygenic risk scores—many small genetic variations that may add up to increased risk. She explains that imaging can identify suspicious areas, but a biopsy is required to diagnose breast cancer and determine its type.
Ovarian, Uterine, and Cervical Cancer
Aliabadi stresses knowing family history and discussing genetic testing for ovarian cancer risk, including BRCA mutations and Lynch syndrome. She advocates for annual pelvic ultrasounds in her practice and discusses fallopian tube removal as a possible risk-reduction option for some people who have finished having children. She describes ovary removal as a consideration for selected high-risk patients, while noting that it causes surgical menopause.
For uterine cancer, she explains that ultrasound can measure the uterine lining after menopause. She says a lining thicker than 4 millimeters, or a notable change from a patient’s prior measurements, may prompt further investigation such as a biopsy.
For cervical cancer, she highlights HPV vaccination and regular Pap and HPV screening. She says a positive HPV 16 or 18 result may warrant colposcopy and biopsy even if the Pap result is negative.
Other Health Topics and Age-Based Checkups
Aliabadi outlines additional tests and discussions she raises with patients at different ages:
- In young adulthood, she discusses ovarian reserve testing, hormone panels, and genetic testing when family history indicates it.
- In the late 20s and early 30s, she raises fertility planning and egg freezing, particularly for patients with conditions such as PCOS or endometriosis.
- From the mid-30s, she discusses baseline breast imaging and symptoms that may signal perimenopause.
- Around 45, she discusses colonoscopy, earlier when family history warrants it, and bone-density testing in the 40s.
- For heart and brain health, she recommends discussing ApoB, ApoE4, and homocysteine testing. She connects risk reduction with exercise, sleep, nutrition, and avoiding smoking and excess alcohol.
Main Takeaway: Prepare and Speak Up
Aliabadi’s central message is to learn your medical and family history, keep track of changes in your body, and arrive at appointments with a written list of questions. If a clinician dismisses persistent symptoms or concerns, she encourages seeking another opinion. Mel closes by urging listeners to share the episode’s information with people they care about.