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This is a conversation between Samantha and Dr. Jen about Samantha's breast cancer recurrence and ways to mitigate the risk of recurrence. Samantha shares her journey and the changes she made to her lifestyle after her initial diagnosis. Dr. Jen discusses the possibility of unnecessary treatment for breast cancer and the importance of considering environmental factors that can affect gene expression. They also touch on chronic infections, oral health, and the role of epigenetics in breast cancer. Despite the risk of recurrence, they emphasize that living in fear is not necessary and that taking steps to mitigate the risk is important. Hello, your healthiest, healthy community, everyone who is joining us live on Instagram and on Facebook, I'm so touched, moved, I have like so many words and so many emotions with this breast cancer recurrence and being able to share with each of you right now about a lot of, not only my journey, but the questions that you have. And I want to just start by saying none of my sharing is meant to create worry and anxiety and fear in any of you who have had a breast cancer diagnosis and are now also, as we always are as survivors, worried about a recurrence. That is never my intention, so any fear and anxiety that I have somehow brought up in any of you who are watching with my recurrence, please know that I'm hoping we will calm a lot of your fears, answer as many questions as we can, and make sure that you have the guidance and support to thrive and live your healthiest, healthy life possible. So a quick bit about me and then I'm going to bring in our guest expert live with questions as well. So some of you may know my TV background as the host of Dancing with the Stars for eight seasons and Entertainment Tonight for many years. And then in 2014, with daughters who were just three and six at the time and an incredible husband who I'm so grateful to have in my life, I was blindsided, as many of you were, by a breast cancer diagnosis. And it was leaning into my journalism background to uncover, because I had no hereditary link, because only 5 to 10% of breast cancers are genetic, why so many of us, one in eight women, are being diagnosed with invasive breast cancer every single year. And I learned it's what we put in, on, and around our body, oftentimes the epigenetics or lifestyle factors that can turn on or leave off these cancer DNA strands, but also for type 2 diabetes and heart disease and neurodegenerative disorders. And so the changes that I began to make to become my healthiest healthy really helped mitigate disease, recurrence, and future disease outcomes of all different types of chronic diseases. And I don't want to answer the questions today all by myself, because I always, as you know, am about science and research and really having the validity of fantastic doctors who are behind me. And one of my favorite go-to experts is a former breast surgeon oncologist turned integrative oncologist, Dr. Jen Simmons. And Jen, thank you for taking time today to be here with all of us to be able to answer all of these questions as well. Of course. It's my pleasure. And you know, I love to be with you. You're a dear friend. And I'm always there for you. Always. You are. You are. And for so many others as well. And for those who are on Instagram, if you see me looking off camera, it's because I'm looking at the Facebook and the recording side of things, but I'm here with all of you as well. So again, I know a lot of you had a lot of questions. Why the heck? And one question I'm getting so often, because I ask for some questions ahead of time, and I'll be looking through your questions as we're going through this live as well. Why the heck, Samantha, you've made all these changes in your life since cancer in 2014. How 10 years later could you have a recurrence? Well, first of all, cancer is a funny thing. It doesn't. Yeah. Not in a ha-ha way, right? Right. Definitely not in a ha-ha way. And it doesn't discriminate. And no matter what we do, can we control a hundred percent of the factors we can't? But that's not to say that we can not do, just say we can't sit here and just not do anything. We can do a lot. So, Dr. Jen, I'm going to kick off with a question that came in from so many different people, which is, Samantha, you had a double mastectomy in 2014. How could you get a recurrence in 2024, all these years later? What's the short answer on that? Yeah. So the short answer is that even when you think you're removing the breast, you can never, ever, ever remove all of the breast tissue. It is literally impossible to remove every single breast cell. And so when we see recurrences like this that are 10 years later, we think about what was the initial process, what was happening there, and did we mitigate that? Now, I'm going to talk about something that is going to be really hard for people to hear. But in the United States, and I think the other countries around the world mimic this, but in the United States, and we just started to get an echo. I don't know what changed, but we just started to get an echo. Okay. We were getting an echo for other people before, so I was trying to change things on my end, but I'll go back to the original. You guys on Instagram, let me know how that is. Okay. Go ahead. So in the United States, somewhere between 20% to 30% of the women that we treat for breast cancer are treated unnecessarily. And that's a really hard statistic to hear. That's a fifth to a quarter of the people that are treated for breast cancer, they undergo surgery, some of them undergo chemotherapy, radiation, they take hormone-blocking drugs that put them into menopause and have lots of side effects. Those women are treated unnecessarily. And it happens because of our paradigm now, because of the way that we screen for breast cancer, and because of the kind of trigger to get treatment. And I don't, I'm not saying that that was the case for you. I don't know. I honestly don't know. But that some of these screen cancers that we're finding that are tiny, tiny, tiny, and yours was tiny, tiny, tiny. I mean, like, I think that you found yours because you are super duper vigilant, but that is not something that would otherwise show up if you weren't really, really, really looking for it. Now, we kind of have to go back to what causes breast cancer, right? So there is a genetic component. There's no doubt about that. But that is the vast minority of the case. Even in women who have genetic mutations, that genetic component is not the majority of what's happening. The majority of what's happening is what you started to allude to, the epigenetics, the things in our environment that enhance, that affect our genes and affect our gene expression. So most of the genes that we associate with breast cancer are not breast cancer genes. They're tumor suppressor genes. And when you have a defect in your tumor suppressor genes, you are more likely to get breast cancer because you are more vulnerable to environmental insults. So we think about chronic infections like parasites and yeast and mold and things like that, things that cause chronic inflammation over time, for instance, like H. pylori. H. pylori, we know, is a causative organism for gastric cancer. And we know that from all of the data out of Japan, but that it also causes chronic inflammation in everyone. And we have an H. pylori epidemic. I mean, nearly everyone that I test has some H. pylori there. So that's- Hey, Jen, I'm going to pause you for one second so I understand why there's an echo. You guys, give me a thumbs up if you're still getting an echo on the Instagram. So here's what I think, Jen. Turn your Instagram volume up, turn on your computer, turn your Facebook or your Zoom volume all the way down. That way- Should I mute my Zoom volume? Well, just turn your computer volume down. Sorry, you guys. It's a technical thing. I want to make sure this is all such important stuff. All right. But my computer volume isn't really on because, I mean, tell me, do you still hear me? I hear you fine, but that's because I have my Instagram volume off and my computer volume on because we're doing Facebook and Instagram both live. Sorry, you guys, we're going to get this. Okay. Well, so now is it better? Because my volume is in my ears and my computer isn't on at all. Do we still have an echo? You guys, give us a thumbs up. Does this sound better for you on Instagram and for you on Facebook? Can you guys let us know if it's okay as well? Sorry that I wanted to make sure we do this quick bit. Let me know if there's still an echo. Oh, I hear the echo now. You hear it because I think you're hearing it from... Sorry, you guys. You're hearing it from two different locations as was I. So you need to have just your Facebook, your phone volume on and only have one volume of me, only your Instagram. Only have your Instagram volume on on you, Jen, and I only have my Instagram volume on you. So we are only hearing ourselves on Instagram, but we're okay. You guys on Facebook okay? Let me know. Does it sound better now? Okay. If you guys on Instagram, can you guys let us know? Jen is good on Instagram now. Echo. Anyone else? Okay. AWIC says it's better, but DJ Girl says it's bad. Technology. I know, right, Hansel? Facebook's okay. All right. What about Instagram? Instagram, good. Thank you, ZDoggBlue. Nurse Theresa. Hi, nurse. Hi, Theresa. Okay, good. Instagram's good. Yeah? It is? Okay. Okay. All right. We're good to go. We're good to go. And I'll try to ignore the echo that's in my head, which I can't figure out why. Okay. But it's okay. It's fine. It's just me. I don't care. You were talking about H. pylori. I want to make sure, too, by the way, we have so much to cover today. And I know that you're talking about H. pylori, so we'll get back on that. But I want to make sure we don't go down the rabbit's hole too quickly. People are like, I have a mastectomy. Do I need to live in fear now that it's going to come back, Samantha and Dr. Jen, like it did for you, Samantha? Yes. And the clear answer is no. But the answer is, is it possible? Yes. But okay. Go ahead. Let's figure out the why, right? So, there's no way to absolutely positively prevent a recurrence, right? It's not going to happen. There's no magic thing. But that, thinking about why breast cancer happens and trying to mitigate that, that is super important. So, chronic infections, yes. Parasites, yes. Metals, yes. So, thinking about your oral health, that's super important. Knowing if you've had root canals in the past, if you've had a metal amalgam for cavities, yes, you have to have that checked out and make sure that your mouth is healthy. And then I think about things like childhood trauma and, you know, how that continues to hurt you today, how that continues to cause inflammation. Because if you have been hurt before and you haven't dealt with that, you continue to express that hurt in different ways, sometimes in physical ways and physical manifestations. And then the obvious thing is toxins that we know about. Plastics and phthalates and fragrance and harsh cleaners, antibiotics, xenobiotics, all of those things that are in our environment. The xenoestrogens. And one of the biggest xenoestrogens is the birth control pill. So, we know from the Danish study of 1.8 million women that your risk of breast cancer is linearly related to how long you took birth control pills. Because birth control pills are synthetic estrogens. And I have to say, it is incredibly frustrating how many gynecologists, when you directly ask and even challenge them, will taking birth control affect my chances of getting it? I don't want to go down a rabbit hole with birth control, but you should say this. But most traditionally trained, conventionally trained OBGYNs will say, oh, no, no, there's not a chance. We know that's been disproven. Birth control does not lead to breast cancer. So, Dr. Jen, you're pointing studies. Not just one, but multiple studies. Is that right? I mean, it's a study of 1.8 million women, right? 1.8 million women. Like, those statistics don't lie, right? It's just too, it's too big a study to not be correct. And so, you can't avoid everything, right? You're never going to avoid all the toxins in the world. But we need to think about our why, and we need to do our very best in trying to mitigate those circumstances. Another one is chronic stress. And we're so stressed. We're too busy. We're doing too many things. We're too burdened. We're too everything. And we're spending way too much time in that sympathetic fight or flight state. And when you spend too much time in that state, you don't have time for rest, repair, and relaxation. And that is when the healing happens. So, if you're not in that state enough time, you're just simply not healing. We all make cancer cells from the very young to the very old and everyone in between. And it is a matter of our immune system being strong enough to mitigate that before it reaches a mass, before it becomes a tumor. And so many of us are just, we have a weakened immunity. We walk around essentially immunocompromised because we're just too overworked, too much stress. So, you know, there's so many, you know, everything that I did to change how I was living my life after cancer. First of all, do not blame yourself for your cancer. First and foremost, we immediately go to the blame game of, I should have done this differently. I should have, should have, should have. Right now, you have an opportunity, an opportunity to be able to take even better control of your well-being, to make small, manageable steps. You guys, I mean, that's what my book, Your Healthy is Healthy, is all about, which is small, manageable steps. By the way, that was not a plug for the book because you can buy it for like two cents anywhere. So, but the point is that to live your healthiest, healthy life, we can start to slowly integrate new, small changes into how we're dealing with stress, adding in, as Dr. Jen said, you know, better sleep, moments of relaxation, breath work, you know, meditation, all the different facets. By the way, that's still my biggest struggle 10 years in, is finding time for all of that. But it's about creating the time because we're even more productive, we're even more present when we create that time for ourselves. But also about mitigating the toxins in our makeup and our skin care. If you guys are watching and you want my Clean Beauty PDF, it's free. I created it after testing, oh gosh, dozens and dozens of different brands when I shot 65 episodes of my game show from, on Game Show Network. And just DM me on Instagram or Facebook with the words Clean Beauty, Clean Beauty. I will send it to you guys. But basically, we can start to just weed out the toxins in our skin care, in our makeup, in our cleaning supplies. And we can, by the way, go down the rabbit hole and create more anxiety if we're like, oh, and I need to change all my clothing and my bedding and my mattress. There is room for all of that, if that's what works for your life. But just start with one thing, small, manageable steps. Now, I know I feel like I'm going down to your healthiest, healthy rabbit hole. The first episode of my podcast and episodes, I think, three and five also tackle all those things that Dr. Jen just mentioned in depth. But I know a lot of you guys are here today specifically because you wanted to know more about my recurrence and these types of questions that you guys are all having. So one of the questions we got a lot of times was, okay, if you had some tissue left over from mastectomy, did you have clear margins? And did they just not get it all? Okay, when you look at my MRI, which we did a year after my double mastectomy in 2014, it was all gone. I mean, there is – anyone who looks at that MRI is like, wow, there is no breast tissue left. But when they say there is no breast tissue left, Dr. Jen, what does that mean? Yeah, so all of the imaging studies that we currently have, they don't have the ability to discern if there's 100 cells left, 1,000 cells left. Like, their threshold to pick up breast tissue is anywhere from 300,000 to 400,000 cells, right? So this is not – you can't say that there's no tissue left. You can say that you did the best you could, but there is never going to be a surgery that eliminates every single cell of that cell line. It just won't happen. And so when I say to people, look, we know that, what, it can take 8 to 10 years for breast cancer microscopic cells to actually turn into something we can feel, is that right? Yes, absolutely. Okay, so I'm at the 10-year mark. By the way, the surgeon that I had here in Los Angeles is one of the – everyone who's had a breast surgery, you know, you get the sentinel node taken out, right? He was on the team of doctors who came up with that whole concept that is now standard of care for every breast cancer surgery. So I know I was in great hands, and he's the one who just did my surgery again last week. But even so, we have those microscopic cells. And I found the lump – so to answer a lot of those other questions that are coming, I found the lump right here, 3 o'clock position, right breast, exactly where my initial tumor was. Now, here's the really exciting part about it, you guys. I remember every time I would talk to my surgeons, and Jen, as a former breast surgeon as well, I'm sure will second this, but when your patients would ask you, well, gosh, I now had a, you know, double mastectomy or a single mastectomy, and I have – this is just for those who chose mastectomy – and now I have implants, how will I ever find if a cancer comes back? And I was told again and again, we're going to feel it. Even by a medical oncologist, we're going to feel it, because you got nothing left, and it's right on the surface. Well, guess what? And by the way, for those who keep asking specifically, great pathology results. It took clear margins from the surgery last week. This biopsy took out itty, itty, itty, bitty 3 millimeters from the biopsy, and when they went back in for this wide excision, partial mastectomy, not really a lumpectomy, a little more than that that we just did, and I'll explain what that is later, and Jen doesn't have to say that if she doesn't want to. But when they went back in, the really great news is there was less than 1 millimeter of cancer, and they took samples of other tissue, and all those tissue samples were benign. So the best possible outcome I could have hoped for. There was also a lump on the non-cancer side, a tiny little nodule that I found just below the nipple that I found maybe 2 or 3 years after my initial diagnosis that I've just been watching. I had my plastic surgeon put her hands on it years ago, and she said, oh, it's scar tissue, and it wasn't until this other lump on the cancer side had reared its head about a year ago that we've been watching through ultrasound that I also ultrasounded the other breast. Why did I end up having that biopsy? Well, after, here's something again, be your own best health advocate. I went in. I had 3 months of having 2 medical oncologists and my wonderful plastic surgeon all say it's nothing. But one of my medical oncologists did in September of 2023 order an ultrasound. That ultrasound came back normal. It was a RAD4, which means I believe really, really certain that it was benign. Would that be right, like RAD4? No? RAD4 is suspicious for malignancy. So it's probably. Oh, then maybe I'm wrong. Whatever came back with the ultrasound, it said there was no suspicion. They were like 90 some percent certain it was nothing. They wanted to see me in 6 months. This was back in September. And I said, I don't feel comfortable with 6 months. Can I come back in a month? They said, no, the soonest you can come back is in 3 months because that gives us enough time to see if there's any change. One month, we won't see any change. So I went back every 3 months. On the June ultrasound, it showed that it did not change size, but it changed shape. And that's when we biopsied. I went on my fabulous trip to Croatia. I came back. I got that biopsy at the beginning of July. And that's when we found out it was actually ductal carcinoma, invasive ductal carcinoma. And that's 3 millimeters. Now what's so interesting is that this is all going to change with QT imaging. Because with mammogram, even with MRI, which is considered like the standard of care for the breast imaging, that threshold is still much, much higher in terms of what it's able to pick up. Now QT imaging, for those of you who don't know what QT imaging is, this is a relatively new technology. It's FDA cleared. It uses sound waves, so similar to ultrasound, but it is both reflective, which is what our conventional ultrasound is, and also transductive. So and it has an enormous algorithm, which allows it to collect 200,000 times more data points than MRI and have 40 times the resolution of MRI. And so what this brings to the table that none of the other things do is that, first of all, it is able to pick up things far smaller than what our current imaging can. But we don't want to just do that because, again, overdiagnosis is a huge problem. Overbiopsy and overdiagnosis is a huge problem. So what we can do, for instance, you were told you couldn't come back for a minimum of three months, but preferentially six months. And what this allows you to do is to re-image in 60 days. Oh, interesting. And QT imaging, you guys, and for those who live in Jen's area, she's opening a center that will have this QT imaging. On Monday. Is it Monday? Monday. Monday, the 26th. Okay, so Jen is opening. So the QT imaging will be more, it's FDA approved now, it'll be more and more readily available for people to get from mammograms is right now. So my center is in the suburbs of Philadelphia, but there are three centers in California. There is a center in Scottsdale. And I am talking to 20 people around the country who I'm partnering with to make sure that everyone who wants access to this technology will get access to this technology. I mean, I plan on opening 50 centers in the next five years. And, you know, it's so cool. It's really cool that you're that you're bringing just to life and knowledge and, you know, the fact that science, thankfully, is moving so fast, and breast cancer is well funded, but it's still, it's like quick, but slow. So unfortunately, it's funded in the wrong places, because there's a lot of funding going towards research for chemotherapeutic drugs, but that is not what's making the difference. So ultimately, what's making the difference is we need to figure out who needs to be treated and who doesn't. And that's what's so exciting about this technology is that we can screen someone, see something, bring them back in 60 days, and rescreen them and get a doubling time. And we know that things that are cancerous and meaningful have a doubling time of less than 100 days. And those are the people that need intervention. And things that have slower doubling times, doubling times of 150 or 200 or 300 days, we don't need to intervene there. So will everyone walk away with a diagnosis? No, right? But you'll walk away with the knowledge that you do not need to intervene in that. That is not something that is meaningful. And it's not something that's going to hurt you. So I have been so curious to see what your QT scan would have been like. And in the future, I mean, that's what we're going to follow on you. But this is really going to change, forever change how we image the breast, how we screen for breast cancer, and who we biopsy and who we treat. So this is going to be really, really meaningful and impactful. And I'm just, I'm excited that we have the first vehicle of meaningful change in the breast cancer world in decades. Absolute decades. And thank you for sharing with people about QT imaging because it is so new and so many people haven't heard of it yet. And the fact that you're bringing it to your own clinic on the East Coast, and there's some others that are around the country as well. So a couple of questions. So someone asked, Michelle Maybel, I love that. I asked, how long after MRI did I find the lump? No, I found the lump well before. I found the lump myself without any imaging. I'm the one who pushed three different doctors until I finally started to get ultrasound. That ultrasound where there was a change in the shape, not the size, before ultrasound or three ultrasounds in, I guess, so nine months after I first ultrasounded, is what led to also an MRI. The MRI did not show at all, did not show any irregularity, any malignancy. It barely even showed the speck. It was, again, it was tiny, tiny, tiny. So the MRI didn't even show it. You could see it on the ultrasound, but barely. I had to really guide the text each time to say, no, no, it's right here. It's right exactly. Okay, there it is. And then they found it, which is great, thankfully. And so it's, again, really important to be your own health advocate. I know that I found my first breast cancer lump 11 days after a clear mammogram. Now, am I saying don't get screenings? I'm still a national ambassador for Susan G. Komen. They still advocate for that. But as Dr. Jen is saying, too, as much as I'm so grateful that QT is coming to the marketplace, it's sadly not available everywhere yet. So listen to your doctors, get the screenings, but know your body. Really notice those changes when they come. Another question we have. So Myra had asked, what about thermograms? And then Susan, thank you for chiming in that thermography did not pick up your cancer. And Tammy Brick, you also wanted to know about thermography. And Dr. Jen, when we had dinner a couple weeks back, you said, I think you should get a thermogram. Can you tell us what that is first? And it is beneficial here. Yeah, so a thermogram is exactly what it says. It takes a picture and looks for a heat signal. Now, I love thermography, but I want to be clear. Thermography is not a screening tool for breast cancer. It's not. It's not. It's a screening tool for inflammation. Now, we know that 80% of breast cancers are a result of chronic inflammation. So when I order a thermography on someone, I am ordering that thermography for the purposes of identifying where is the inflammation happening in their body? What do I need to pay attention to? What is at their what is at the root of their disease processes so that I can address it? Sometimes cancers have enough of an inflammatory response to show up on thermograms. So there are some people that they will find their breast cancer from thermography combined with ultrasound. However, if you do not have a significant inflammatory response, you can have no change on thermography and have a cancer in the breast. Now, I will argue that maybe that cancer is one that will never hurt you and maybe doesn't need treatment. And we would need a really good clinical trial to demonstrate that. But in the meantime, I want people to understand the power of thermography. It is to identify inflammation, but it is not a screening tool for breast cancer. Thank you. I think that's important to know. And some of the other questions are asked about PET scans. And should we be getting CTs, number one? Number two, are CT scans definitive? So my answer to that is absolutely not. It is so much radiation, 10 times the amount of radiation of a mammogram. And I don't even advocate for mammograms. So and we can we can talk about why. But, you know, I'm talking about studies of hundreds of thousands of women that show no survival benefit for women that screen with screen with mammogram. And the reason that is the case is because when you when you use a tool to screen for cancer, that cancer has to have a linear growth pattern. So that starts small, reaches some critical size, at which time it is more likely to metastasize. And if you find it before then, you can change the trajectory of the disease. And that is true for some cancers like colon cancer. Colon cancer has a very linear growth pattern. But it is not true of breast cancer. It's also not true of prostate cancer, which is why the prostate cancer screening program failed and why mammography should not be done. But right now, the status quo, the powers that be are very happy with it because they diagnose a lot of people and treat a lot of people that don't benefit. So for every thousand women that we screen with mammogram, you can potentially save one woman's life. And you will treat 10 women for breast cancer that didn't need to be treated. And there's a big problem with that because our treatments for breast cancer make us more likely to have cardiovascular disease, neurodegenerative disease, osteoporosis. And then it's all the other things. It's the loss of libido, the loss of self-esteem, the depression, the anxiety, just the anxiety from treatment and also the anxiety about a recurrence. So these are very, very significant ramifications of treatment. So I personally believe that we should not be screening with mammogram at all. And if you have had breast cancer, in terms of how you screen for the future, how you look for metastasis, that kind of thing, I do not believe in PET scans. I do not believe in CAT scans. And the major reason why I don't believe in them is identifying metastasis early also does not change outcome. So for me, I monitor a lot of things. So I'm looking for markers of inflammation. I'm following tumor markers. They're not helpful in everyone, but they're helpful in some people. And I'm following metabolic markers. And when those things change, I say something's happening in the terrain. We need to fix that. We need to fix the environment because that is what's influencing tumor growth. So it's a completely different, it's a different mindset. It's a different way of looking at it. We are always promoting health and always thinking, how can we optimize this environment so that it fosters health instead of supporting disease? So one of the questions that I'm also getting a lot that have come in from before were, you know, once we've had a double mastectomy or whatever our treatment was, but specifically double mastectomy, how do we continue to monitor the best? And especially when we're not getting CTs because of the radiation, we're not getting a mammogram because, well, we have no breast tissue to, you know, find a mammogram to image. And then we also have the radiation, which is why you don't like mammograms. And so, you know, what are we supposed to do? Besides, I know we do the CA-25 and the different blood screenings, but as my medical oncologist likes to say, I do them, but don't hang your hat on it. It just gives me something to at least feel like we're doing something. Yeah. So the most meaningful thing for local recurrence, recurrence in the breast is physical examination. And like you said, once you remove the breast tissue, if there's going to be a recurrence, you're going to be able to feel it. It's going to be right there underneath your skin. So you can just feel that with your fingertips. Some people are just, so if the implant is in front of the tumor and that's underneath the implant, or would it not be? So some people are putting the implant above the muscle. Some people are putting it below the muscle. Either way, doesn't matter. If there's going to be breast tissue, it's going to be adherent to the skin side of things, and you're going to be able to feel it. Thank you. So the implant is not going to change anything either way for you. Is it possible that you have a recurrence in your muscle? And if the implant is sitting on top of it, you know, will you miss it that way? I mean, technically, yes, that's possible, but it's not probable. So the place that there's usually breast tissue remaining is the skin side of things. Okay, thank you. I think that will help calm a lot of fears. Ladies, like we always say, do your monthly self-exams pre-cancer. Well, even if you've had breast cancer, keep filling yourself up. Know your body. But also pay attention to symptoms, because if you're going to have a recurrence on your muscle, that muscle is fairly well innervated. It has nerves, and you will be able to feel something. You'll have a new pain. You'll have new discomfort. So we all need to be mindful of what's happening in our body. We need to be super in tune with what's happening in our body. And if you have a new symptom that lasts for two weeks that you cannot explain, right? Like I know when I bumped into the table that I'm going to have a big bruise on my leg, and it's going to hurt and all of that. So that I can explain. But if you have new pain that lasts for more than two weeks that you cannot explain, that's something that should be worked up. That's something that should be investigated. Thank you. One thing, by the way, for those of you who are still unclear on what type of cancer I had before, what the type of cancer, the grade, the staging, all of that. I will get to that. I don't want to keep Dr. Jen for that. But I have other questions that I do want to make sure I get answered that you sent in for Dr. Jen. And the topic I want to switch to for a moment is some supplementation. So first of all, one question is, are collagen supplements or even collagen powder in your smoothie or your coffee, is that something that breast cancer survivors should stay away from? Especially as we're getting older and we have sarcopenia, which is the loss of muscle mass, so we all need more protein. And especially if we're trying to focus on a more plant-forward life, too. Is collagen something that you recommend we include, stay away from, or just use on occasion? Yeah. So I think it depends on your own personal situation and where you are in terms of your journey. So if you have active cancer, you're in a situation where you have metastatic disease, something like that, you have to be very careful about the protein balance. You don't want too little because that can lead to severe cachexia, which means that the cancer continues to have needs and it will start to digest your muscle, right? So you need to have enough protein, but you don't want to have too much because that's going to encourage tumor growth. So my recommendation is that you get a gram of protein per pound of ideal body weight. Now, that's per pound, not per kilogram. So I think that there's probably a difference if you're pre-menopausal or post-menopausal. So pre-menopausal, we do a lot better with digestion, with absorption, with utilization. Post-menopausal, not so good. So post-menopausal, you're going to need more protein to do the same thing. So, and a lot of women who have breast cancer are rendered post-menopausal. So at a minimum, it would be a gram per kilogram, but most women need a gram per pound. That's a lot of protein we're looking at. We're looking at most women are going to need somewhere between 100 per, per your guidance of a one gram per pound, 115 to 200 plus grams of protein in a day. That's a lot, especially... Well, there's not a lot of women whose ideal body weight is 200 pounds. Ideal body weight, right? So you can basically use that, like if you're five feet tall, maybe your ideal body weight is somewhere between 90 and a hundred pounds. And then you just kind of add five pounds per inch and go up from there. So there's going to be very few women whose ideal body weight is 200. There's going to be very few women whose ideal body weight is even 150. Right? Most women, their ideal body weight is going to be somewhere between 100 and 130. And that is, and I also expect people to be mindful about making sure they have enough stomach acid, making sure they have enough digestive enzymes, and making sure that they are doing weight bearing exercise at least three days a week in order to maintain and build muscle, because that is the center of our metabolism. And metabolic health is the key to all of this. There are so few women that have metabolic health and certainly not ideal metabolic health. And so we have to aim to achieve that and set ourselves up to achieve that. So that means adequate protein intake, but not too much. Right? So you want the right balance there. This is definitely a Goldilocks nutrient. And then you have to couple that with weight bearing exercise. You just have to. You just have to. Well, and also the weight bearing exercise and resistance training is so important because also of glucose regulation. Yeah, you have to lift heavy things. You just have to. And I love Dr. Chatterjee, who keeps a kettlebell by his coffee machine. So every time he goes to get a cup of coffee, he has to lift up the kettlebell. And that's really important, the insulin resistance. One thing that I remember being really surprised with was for many of us who end up going on endocrine therapy. So another answer to a lot of your questions is, were you on tamoxifen or anything? So I was 40 when I was diagnosed. I was on tamoxifen for seven and a half years. I was going to stay on actually for 10 first fives and they decided to keep me on for another five to get to the 10 year mark. I had uterine cysts that kept just popping up because that's what tamoxifen sometimes does for some people as a side effect. But because I was still menstruating, thankfully with each cycle, those little polyps would go away until finally in the end of 2021, there was one of those uterine, ovarian polyps that decided to not go away, but also to get bigger and bigger to the point that my, and this is again another example of advocating for yourself and sometimes thinking out of the box. So many conventionally trained doctors, to no fault of their own, even the best in the world, and I have many who are conventionally trained and they have saved my life, but they also tend to oftentimes think sort of just in a tunnel of vision. And so I was told by this gynecologic oncologist, okay, well, Samantha, I'm either, why don't we schedule surgery? I'll take both your ovaries and a fallopian tube just because if I'm going in for one ovary, I'll take both. That way this ovarian cyst that's grown won't burst. And I said, well, I don't want to do that. She said, well, your other option is just to wait, but it might put you into emergency surgery because it might just burst and bust through your ovary and you'll call me in the ER and we'll do surgery then. I said, how about option three, doc? How about I call my oncologist and see if I can go off Tamoxifen because I'd never had these before I was on Tamoxifen. Why don't I see if I can go off for just three months, see if it takes care of itself? My two medical oncologists who I consult regularly said, absolutely fine. I went off. Thank goodness. It disappeared. And when I went back to them to say, okay, I can go on, you know, back on Tamoxifen. I can stay on for the next two and a half years to complete the 10 years of the regimen. She said, you know what, Samantha, you have made so many changes in your life to live such a healthy life after cancer. Go enjoy it. And I threw those pills, flushed them right down the toilet, and man, was that a great moment. So, again, but a reason to advocate for yourself. And so, yes, I was on Tamoxifen. But one thing I didn't know, sorry for that sidebar, one thing I didn't know was that when we were on an estrogen blocker, I didn't realize how important estrogen is for our insulin regulation. And here I was, I was wearing, you know, I love biohacking. I have two different podcast episodes that are so long about all different ways to biohack because I'm fascinated by it. And I was wearing a continual glucose monitor for the better part of five months and learning so much about how sleep, food, stress was affecting my body. And I couldn't believe I said to my integrative primary care physician, I don't understand why am I borderline pre-diabetic in this healthy life I'm living? He said, Samantha, you're on an estrogen blocker. Not one doctor had told me, hey, anyone who goes into menopause or any of you who are breast cancer survivors on endocrine therapy to block estrogen are at risk of higher levels of insulin resistance. So, Dr. Jen, can you chime into what can we do to take our power back, whether you guys are watching and you're not a breast cancer survivor, but you're going into menopause or you're already there, or this is something that you're facing because of an estrogen blocker? Yeah, so I want to be clear. First of all, Samantha, I love your book, but I want to remind women that I did write a book called The Smart Woman's Guide to Breast Cancer, which kind of lays out everything that you need when you get a breast cancer diagnosis and helps you to prevent another one. So, with regard to blood glucose and metabolic health, we definitely see enormous shifts in metabolic health when women go through menopause. And the data is resoundingly clear that the importance of estrogen in your long-term health is monumental, right? It is protecting your bone. It's protecting your brain. It's protecting your heart. It's protecting your bones. It's protecting your mood. It's protecting your bladder. It's protecting your libido. It's protecting your skin, your muscles, your joints, your everything. And with regard to metabolic health, you know, we talked about that this is a major, major risk factor for relapse. And this is one of my major objections to medicines like tamoxifen or the aromatase inhibitors, because it takes someone who's already compromised, right? If you already have a breast cancer diagnosis, we know that something is already compromised. Your ability to overcome whatever that is in your environment is challenged. And we take that same person without giving them any other tools, and we challenge them further. And I don't think that the data on the benefits of those drugs is compelling enough to take them. And oftentimes, I am not recommending taking them. Now, do I think that you should understand how your detoxification processes work, how you are metabolizing estrogen? Yeah, absolutely. I think that that's very important. And there are genetic tests that you can do. I use the nutrition genome with my patients, and it gives a very detailed outlook on how you manufacture your hormones, how you break down your hormones, and what support you might need around that. But I'm also advocating for hormone replacement in nearly all of my breast cancer patients. I am so glad you're jumping all. To re-transition, that's one of the questions that are coming in. I know that there is so much just confusion around, okay, we're hearing for those of us who are either breast cancer survivors or not, we're hearing so much about, thankfully, the benefits of HRT and how much it can help us reduce our risk of diabetes and heart disease going forward. So we now know HRT is really beneficial, and yet a lot of the gynecologists and other experts out there who don't specialize in breast cancer are so hesitant, and we're fearful as survivors to say, well, should we be on an HRT? Whether it's an oral pill, or it's a topical, or it's, you know, there's lots of different delivery methods. How do you decide? And I know we're all so unique with our own diagnoses to figure that out, but is there a general? And then where, who do we go to to find out the right information? So, you know, I'm starting a program right now, and each one of my imaging centers, each one of my perfection imaging centers will be offering hormone replacement, especially to the breast cancer population. Now, what I require is I want to figure out why you had breast cancer, right? So I want to look at all the why's, and I also want to make sure that you don't have any active disease now. But I want to be clear that hormone replacement, while it can make a world of difference and really be protective in the long run, I mean, the reason to go on hormone replacement is to keep women out of nursing homes, wheelchairs, and adult diapers, right? This is the reason why, because we want to prevent dementia and Alzheimer's. We want to prevent the osteoporotic fractures. We want to prevent cardiac disasters. And we want to, we want to be able to have women be independent and not be reliable on diapers and, you know, not being able to go out because they don't know where the bathrooms are. Well, and hip fractures lead to what? I think it's 50% of women with hip fractures over the age of 60, I might be off on that, die within a year. Well, so this, this is the amazing statistic that we never talked about. As women die every single year as a complication of a fracture as due of breast cancer, where are the ribbons for that? And, and these things are preventable. So when I prescribe hormone replacement, I am first working people up to figure out why they got cancer and also to make sure that they don't have active cancer. So I'm running my, my panel of labs. I'm doing imaging. I am asking them to have a circulating tumor cell count, just to make sure that there's not active disease that we're missing. And then I am providing hormone replacement, but in the context of making sure that they are on a nourishing diet, making sure that they are moving in a way that is meaningful and helpful for them, making sure that they are prioritizing sleep, that they are avoiding toxins, that they have detoxification practices and making sure that we have dealt with any trauma, making sure that they are connected, that they are supported. Because hormone replacement alone is not going to take care of everything. But what it can do is enhance all those other practices. So a couple of questions. Allie, thank you for being honest with us, saying that this is all so helpful. And yet also at the same time, and I feel you, it's overwhelming. So first of all, everybody listening, everybody watching, I want you to know, Dr. Jen and I, as well as many other wonderful experts out there, are here for you to guide you, to advise, to suggest, to, I mean, Jen's case, she can prescribe, she can see. Now, I don't know, I know that there's limits on your time, but you see so many people at your Philly practice. And you also, you do telehealth as well, correct? Let's see, Jen froze up on me. Jen, can you hear me? I can hear you, but my computer froze. Ah, okay. It just came back. There you are. First of all, don't be afraid to reach out. Reach out. Follow Dr. Jen. Follow me. There are so many, you know, if I, if we don't, well, Jen knows a lot more answers than I do, but I know a lot, and I've changed a lot, and I've walked the walk you guys have been on, and I have had to also be overwhelmed and figure out how to slow down and how to break it down into small, manageable steps so that I wasn't overwhelmed, so I could take my power back, so I could take even better control of my health and well-being as to what is the gift of living your healthiest, healthy life. And so I'm here to help, you know, handhold as many of you as I possibly can as well. And Dr. Jen has so many fantastic insights and guidance, so make sure that you are following her and watching her and reaching out as well. You know, one of the questions that we're also getting, and I know we're all, we're coming up on an hour for Dr. Jen, and for those who have been with us from the beginning, thank you, and I'm going to stay on a little bit after Dr. Jen goes off, just so I can try to finish answering some more questions that are more personal that you guys had. So anyone who wants to hang out with me, let's hang out, have a little party. All right, so just a couple of other questions. Oh, gosh, I mean, there's so many. Thank you, guys, for submitting them. Let's see, we are going to go with, okay, we talked about scans, we talked about some of the supplementation, we talked about insulin, and we talked about wear recurrence. One other question on the recurrence, you said, Jen, that it can be more, really, mostly is in the, attached to the skin. And one of the questions from Susan, I think it was, said, well, what about the chest wall? So mine was right up against the sternum, against the chest wall, which is where my initial diagnosis was, as well, in 2014. So does the chest wall, in that matter, mean literally within the chest wall, separate from the breast cavity, or does that just mean it's, kind of, it's a location point that's near the chest? So I'm just going to call on my surgery skills to tell you that when you picture the anatomy, the breast sits between, so it's starting from the outside in, it's the skin, and then it's the subcutaneous, below the skin, fat, and then it's the breast, and then underneath the breast is the chest wall, it's the pectoralis muscle, right? So when you take the breast off, it's very easy to take it off of the muscle, and not so easy to take it off of the fat underneath the skin. So when there are cells left, they're almost always left on the skin side of things, and not on the muscular side of things. Like, people really take all of the breast tissue off of the muscle. I am not saying muscle recurrences don't happen, but that, when we say chest wall, that's what we mean, the muscle. Okay, thank you, thank you. Okay, so I'm not saying that there aren't recurrences that happen on the chest wall, on the muscle, but they are extremely rare as compared to the recurrences that happen on the skin side of things, because it's nearly impossible to take every cell off of the fat underneath the skin, because it just kind of gets in there, it interdigitates. So, but that's why I'm saying, if you're going to have a recurrence on the chest wall, you're probably going to feel it. It's probably going to be something that you, that you feel in your muscle. You're going to feel a tightness, or an aching, or a symptom, or something. If you have one of those aching, or symptoms, or something, and I know I'm frozen again on, on the life. But if you have a symptom, that's what needs to be investigated, and that's what you're going to need imaging for. But I don't think that you should have imaging unless you have a symptom. Now, that's a local recurrence, a systemic recurrence, something happening outside of the breast and axilla, which is, you know, that's the stuff that you can feel. A systemic recurrence, I believe you should only be working that kind of thing up if you have a symptom. Like, if you have back pain for two weeks, that is unrelenting, that you cannot otherwise explain, that's something that requires imaging. That's the time to get a bone scan, or a CAT scan, or something like that. And I want to be clear, I have a radiation protection protocol on my website. If you are going to get a mammogram, an X-ray, a CAT scan, a PET scan, anything that involves radiation, you should be using some kind of radiation protection protocol. A couple hundred milligrams of melatonin, 100, 200, 300 milligrams of melatonin, and 2,000 to 4,000 milligrams of liposomal vitamin C, an hour before your study, and then I tell you to take it three days afterwards. Anything to kind of mop up those free radicals that are created when you undergo radiation. Okay. But looking for local recurrence...
