Why Younger Women Are Getting Breast Cancer at Record Rates (And How to Reduce Your Risk)

The guest calls this an essential complement to imaging: imaging detects existing tumors, while genetic testing identifies susceptibility years earlier. Hyman notes that in data from the 30s and 40s, BRCA carriers had lower cancer risk than the modern ~75%, which implies that something in the modern environment is increasing penetrance. The guest says the goal is not to frighten women but to let them adjust screening and prevention: MRI, chemoprevention, or surgery.

The guest says she is a gynecologist who runs lipoproteins on every patient because 'nobody else is doing it.' Hyman ties this to functional medicine: the labs are affordable through Function Health, and identifying these markers allows personalized lifestyle and supplement interventions before disease develops. For breast cancer specifically, metabolic dysfunction and inflammation are upstream drivers; measuring them gives patients levers to pull. She also stresses that this is not just for women at high risk — her own presentation was 'healthy, thin, never smoked, rarely drank,' yet her metabolic and polygenic markers told another story.

The guest calls walking after each meal 'one of the most important things for POS patients.' Hyman adds that basic lifestyle changes — whole foods, less starch/sugar, exercise, stress management, sleep — reduce risk but do not zero it out.

The guest describes her clinical algorithm: before prescribing HRT she already knows the patient's lifetime risk, genetic status, polygenic risk, and labs. If a patient has a 50% lifetime risk but wants HRT, she discusses tamoxifen for five years, which reduces risk by about half for the next ten years — but tamoxifen causes menopause-like side effects and cannot be combined with HRT. Alternatively, a woman who had a preventative double mastectomy without cancer could undergo risk reduction and then take HRT. For low-risk symptomatic women, she says HRT is beneficial and often begun too late: women don't need to wait until periods end.

The guest created the platform and supplement because she sees PMOS patients dismissed, misdiagnosed, or given birth control as first-line. She frames the quiz as a way for women to self-advocate and arm themselves with information before seeing a doctor.

She distinguishes two layers of genetic risk: single-gene pathogenic mutations (25% to 80% lifetime risk depending on the gene) and polygenic risk score, which aggregates many common small-effect variants. Testing now covers anywhere from 86 to 305 markers for polygenic risk. If a woman's polygenic score is above the 90th percentile, that elevates risk. In her own case, testing showed no mutations and no family history, but her polygenic risk score flagged high risk for breast cancer. Genetic testing therefore serves as another screening layer to inform when breast imaging and MRI should begin. Hyman adds that BRCA-associated risk has climbed historically — in the 30s and 40s data the gene risk was lower than the current ~75% risk — suggesting environmental factors modify genetic expression.

She explains that more than half of women over 40 who have mammograms have dense breast tissue, and density is now supposed to be reported by radiologists. A 2D mammogram report that says 'no findings' does not mean there is no cancer if the patient has dense breasts; it means the window was muddy. 3D mammography plus ultrasound acts like Windex to clear the view. She advises women to check their mammogram report: if it says dense breasts and it was a 2D mammogram, ask for a 3D next time; if they have dense breasts, ask for bilateral breast ultrasound; if lifetime risk is ≥20%, ask for breast MRI. She acknowledges that doctors often push back, but says women should not accept dismissal.