The cancer prevention framework I apply to my patients, and myself, the evidence behind each decision, and a printable checklist to take to your next appointment.
This is a moving way to mark ten years, and turning that loss into something practical for other families is a generous thing to do.
The point that does the most work here is the one you make about the 40% figure: a hereditary predisposition does not shrink the modifiable share of risk, it raises the stakes on it. That reframing matters, because the family-history conversation so often collapses into surveillance alone, as if genetics sets a fixed ceiling. Holding both at once, the inherited fraction and the part you can act on, is the harder and more honest framing.
Thank you so much, Dr. Efevretis. You captured exactly what I was trying to say. Family history may raise the baseline risk, but it also makes the modifiable factors more urgent, not less relevant. The more honest approach is to hold both truths at once: respect the inherited risk, and still act on every lever we can influence.
Lisa, thank you so much, and yes, there can absolutely be a reason to re-test.
Genetic testing has changed a lot. Older testing often looked only at BRCA1/2, or a limited set of mutations. Today, broader panels can include other important cancer-risk genes like PALB2, CHEK2, ATM, RAD51C/D, BRIP1, and others.
I’d especially revisit it if testing was done many years ago, if the result was negative but the family history is strong, if there was a “variant of uncertain significance,” or if new cancers have appeared in the family. A negative result is helpful, but it doesn’t always mean “no inherited risk.” This is where a cancer genetics specialist can be incredibly valuable.
Is there ever a time when estrogen therapy is okay? I've been taking very low estrogen replacement since I had a total hysterectomy at 39 you. My mother had breat cancer in her late 40's and lived to 89 you. One sister had liver cancer which she fought for 20 years before dying of a heart attack after bout of covid. My other sister passed away of ovarian cancer. My dad had prostate cancer and died at 78 yo. No other known family history of cancer. Is it safe to continue the estrogen therapy now, at age 76? No smoking, 23 BMI, alcohol <1/week. I exercise at least twice weekly. I am a an RD, so i eat very responsibly too. Any advice other than more exercise? Thank you for your thoughtful informative and helpful advice here to all reading your post.
Dear Christine, I'm so sorry for your losses. Thank you for sharing your story.
To answer your questions directly:
Is there ever a time when estrogen therapy is okay? Yes. Estrogen-only therapy in women without a uterus, which is your situation, has a meaningfully different risk profile than combined HRT. The evidence does not show a significant increase in breast cancer risk with estrogen-only use. For many women, the benefits to bone density, cardiovascular health, and quality of life outweigh the risks, particularly when started early and continued under monitoring.
Is it safe to continue at 76? Given your profile (estrogen-only, BMI 23, no smoking, minimal alcohol, active, eating well), you are in the most favorable risk category for continuation. I can't give you a personal medical recommendation, but I can tell you that nothing in what you've shared would make me immediately alarmed. The conversation to have is with your gynecologist or a menopause specialist, with your full history on the table.
Any advice other than more exercise? The first is Zone 2 cardio: a sustained, comfortable effort where your heart rate is elevated but you can still hold a conversation. Brisk walking, steady cycling, swimming, an elliptical or rowing machine all count. The second is resistance training. Once or twice a week is enough, and the sessions don't need to be long. Twenty to thirty minutes of simple movements (getting up and down from a chair, wall push-ups, resistance band rows, step-ups, some core work), is sufficient to make a difference.
Thank you Dr. Redondo! Im so grateful for your response, for your knowledge and your willingness to share. You are a blessing in this space and in our world.
Thanks for sharing - why haven’t you done the genetic test if it’s something you recommend with family history? My link is ovarian cancer in my grandmother but when she was 96
My mother was first diagnosed with metastatic disease, which made identifying the primary tumor difficult. For years, different doctors told us different things (some said lung, some said ovarian). We've been living with that uncertainty.
On your grandmother at 96, the pattern that raises the hereditary syndrome flag is early onset, multiple affected relatives across generations, or multiple cancer types in the same line. One case at 96 is most likely sporadic. That said, if it's been weighing on you, a genetics counselor can put a number on your actual risk in under an hour.
My mom is 66 with pancreatic cancer. She's stage 3 it's in her liver, chemo worked for months then stopped and June 2nd we learned it's growing bigger. So now we are trying a clinical trial. But my mom has no time- none of her genetic labs like the Brac genes or any genetics were there. My moms dad is 92 alive and great. Her mom died at 83 after kidney disease following a 15 year old heart transplant. So my mom
Really thought she'd live to 83. My mom smokes cigarettes and had to
Give up drinking beer and rum and cokes at the bar when she found out. I think smoking and drinking ( and not that much ) did this. If my mom knew that her stress/ her 2 bad habits greatly increase her life being cut short 20 years I think she'd had taken in more seriously. But my mom didn't know them combined really increase bad health .
I’m so sorry. Pancreatic cancer is devastating, especially when treatment stops working. Please don’t let this become blame. Smoking and alcohol can absolutely increase cancer risk, but cancer is usually caused by many overlapping factors, like genetics, inflammation, metabolism, exposures, immune function, and chance. The most practical thing now could be to ask her oncology team whether she has had germline genetic testing and tumor molecular profiling. In pancreatic cancer, these can sometimes reveal mutations that open the door to targeted treatments or clinical trials. And yes, you’re right. People deserve much clearer prevention conversations long before crisis.
Yes thank you she is supposed to get a call Tomorrow about this trial but it's been a week in the making. She doesn't know how I feel about this cancer and her risk factors/ I'm sure my mom thought if it's sold at every gas station , pharmacy, and grocery store that it couldn't be that bad. Especially because cigarettes have warnings and drinking I don't think does? So I'm not blaming I told her I'd like to ask her dr- but he has signed off of chemo and idk If she will let me but I will try.
Yes, exactly. When something is sold everywhere, it sends the message that it must be relatively safe, and that is one of the biggest failures in public health communication.
For the trial call, you could simply ask: “Has she had germline genetic testing and tumor molecular profiling, and could either change her trial options?” Even if her chemo doctor has signed off, the trial team may still be able to guide that part.
Hello and thank-you for this post. Sorry about your Mom. Is that picture San Fran?
I never thought about my risk even though a relative had BC. I have a dude friend that got BC. His Mom had it. I read about ApoB/A1 ratio as an under-used indicator too- so maybe add that B to the test regimen?
When you ascribe reasons for the increase in cancer rates the discussion MUST include the "Dr. Day Tapes"! If you are not familiar-it is time. I have known of the Day tapes for 30+ years. Pretty much soured me on the entire manufactured reality that has been DESIGNED for us ie "modern" society.
Thank you for reading and for sharing about your friend. Male breast cancer is genuinely underdiagnosed, and the BRCA2 link in men is one of the most important things most people don't know. You're right to flag it.
On ApoB/A1 ratio, absolutely valid suggestion. I cover these extensively here: https://www.zenithwithin.com/p/apob-apoa1-ratio-heart-risk, and you're right that it belongs in a cancer metabolic monitoring discussion too. The metabolic-cancer connection runs deep.
On alcohol, I love that you're honest about it. For you, one beer may be a reasonable quality-of-life trade-off, that's a decision each person makes with their own risk profile in mind. My decision is different, for reasons specific to my family history and my genetics. Neither of us is wrong. The point is to make the decision consciously, with the data in front of you, rather than not knowing the data exists.
On the links and names, I try to stay anchored to peer-reviewed evidence, so I won't be heading down those roads. Not because I think all institutions are beyond question, but because the tools I use professionally require a particular kind of evidence standard to be useful.
The picture is from Madrid, that's where I'm from.
This is a moving way to mark ten years, and turning that loss into something practical for other families is a generous thing to do.
The point that does the most work here is the one you make about the 40% figure: a hereditary predisposition does not shrink the modifiable share of risk, it raises the stakes on it. That reframing matters, because the family-history conversation so often collapses into surveillance alone, as if genetics sets a fixed ceiling. Holding both at once, the inherited fraction and the part you can act on, is the harder and more honest framing.
Thank you so much, Dr. Efevretis. You captured exactly what I was trying to say. Family history may raise the baseline risk, but it also makes the modifiable factors more urgent, not less relevant. The more honest approach is to hold both truths at once: respect the inherited risk, and still act on every lever we can influence.
Best wishes,
Sara
Thank you for this article. I am so sorry for your loss, I have to imagine your mom is so proud of the work you are doing to honor her.
Question for you about genetic testing. As the science and technology evolve is there an argument to be made for re-testing?
Lisa, thank you so much, and yes, there can absolutely be a reason to re-test.
Genetic testing has changed a lot. Older testing often looked only at BRCA1/2, or a limited set of mutations. Today, broader panels can include other important cancer-risk genes like PALB2, CHEK2, ATM, RAD51C/D, BRIP1, and others.
I’d especially revisit it if testing was done many years ago, if the result was negative but the family history is strong, if there was a “variant of uncertain significance,” or if new cancers have appeared in the family. A negative result is helpful, but it doesn’t always mean “no inherited risk.” This is where a cancer genetics specialist can be incredibly valuable.
Best wishes,
Sara
Is there ever a time when estrogen therapy is okay? I've been taking very low estrogen replacement since I had a total hysterectomy at 39 you. My mother had breat cancer in her late 40's and lived to 89 you. One sister had liver cancer which she fought for 20 years before dying of a heart attack after bout of covid. My other sister passed away of ovarian cancer. My dad had prostate cancer and died at 78 yo. No other known family history of cancer. Is it safe to continue the estrogen therapy now, at age 76? No smoking, 23 BMI, alcohol <1/week. I exercise at least twice weekly. I am a an RD, so i eat very responsibly too. Any advice other than more exercise? Thank you for your thoughtful informative and helpful advice here to all reading your post.
Dear Christine, I'm so sorry for your losses. Thank you for sharing your story.
To answer your questions directly:
Is there ever a time when estrogen therapy is okay? Yes. Estrogen-only therapy in women without a uterus, which is your situation, has a meaningfully different risk profile than combined HRT. The evidence does not show a significant increase in breast cancer risk with estrogen-only use. For many women, the benefits to bone density, cardiovascular health, and quality of life outweigh the risks, particularly when started early and continued under monitoring.
Is it safe to continue at 76? Given your profile (estrogen-only, BMI 23, no smoking, minimal alcohol, active, eating well), you are in the most favorable risk category for continuation. I can't give you a personal medical recommendation, but I can tell you that nothing in what you've shared would make me immediately alarmed. The conversation to have is with your gynecologist or a menopause specialist, with your full history on the table.
Any advice other than more exercise? The first is Zone 2 cardio: a sustained, comfortable effort where your heart rate is elevated but you can still hold a conversation. Brisk walking, steady cycling, swimming, an elliptical or rowing machine all count. The second is resistance training. Once or twice a week is enough, and the sessions don't need to be long. Twenty to thirty minutes of simple movements (getting up and down from a chair, wall push-ups, resistance band rows, step-ups, some core work), is sufficient to make a difference.
You're doing remarkably well. Keep going!
Best wishes,
Sara
Thank you Dr. Redondo! Im so grateful for your response, for your knowledge and your willingness to share. You are a blessing in this space and in our world.
Thank you so much Christine.
Thanks for sharing - why haven’t you done the genetic test if it’s something you recommend with family history? My link is ovarian cancer in my grandmother but when she was 96
Dear Sax, thank you.
My mother was first diagnosed with metastatic disease, which made identifying the primary tumor difficult. For years, different doctors told us different things (some said lung, some said ovarian). We've been living with that uncertainty.
On your grandmother at 96, the pattern that raises the hereditary syndrome flag is early onset, multiple affected relatives across generations, or multiple cancer types in the same line. One case at 96 is most likely sporadic. That said, if it's been weighing on you, a genetics counselor can put a number on your actual risk in under an hour.
I'm grateful you're here.
Warmly,
Sara
My mom is 66 with pancreatic cancer. She's stage 3 it's in her liver, chemo worked for months then stopped and June 2nd we learned it's growing bigger. So now we are trying a clinical trial. But my mom has no time- none of her genetic labs like the Brac genes or any genetics were there. My moms dad is 92 alive and great. Her mom died at 83 after kidney disease following a 15 year old heart transplant. So my mom
Really thought she'd live to 83. My mom smokes cigarettes and had to
Give up drinking beer and rum and cokes at the bar when she found out. I think smoking and drinking ( and not that much ) did this. If my mom knew that her stress/ her 2 bad habits greatly increase her life being cut short 20 years I think she'd had taken in more seriously. But my mom didn't know them combined really increase bad health .
Dear Jennifer,
I’m so sorry. Pancreatic cancer is devastating, especially when treatment stops working. Please don’t let this become blame. Smoking and alcohol can absolutely increase cancer risk, but cancer is usually caused by many overlapping factors, like genetics, inflammation, metabolism, exposures, immune function, and chance. The most practical thing now could be to ask her oncology team whether she has had germline genetic testing and tumor molecular profiling. In pancreatic cancer, these can sometimes reveal mutations that open the door to targeted treatments or clinical trials. And yes, you’re right. People deserve much clearer prevention conversations long before crisis.
Sending you and your family my very best wishes,
Sara
Yes thank you she is supposed to get a call Tomorrow about this trial but it's been a week in the making. She doesn't know how I feel about this cancer and her risk factors/ I'm sure my mom thought if it's sold at every gas station , pharmacy, and grocery store that it couldn't be that bad. Especially because cigarettes have warnings and drinking I don't think does? So I'm not blaming I told her I'd like to ask her dr- but he has signed off of chemo and idk If she will let me but I will try.
Yes, exactly. When something is sold everywhere, it sends the message that it must be relatively safe, and that is one of the biggest failures in public health communication.
For the trial call, you could simply ask: “Has she had germline genetic testing and tumor molecular profiling, and could either change her trial options?” Even if her chemo doctor has signed off, the trial team may still be able to guide that part.
I hope the call brings a real option for her.
Hello and thank-you for this post. Sorry about your Mom. Is that picture San Fran?
I never thought about my risk even though a relative had BC. I have a dude friend that got BC. His Mom had it. I read about ApoB/A1 ratio as an under-used indicator too- so maybe add that B to the test regimen?
When you ascribe reasons for the increase in cancer rates the discussion MUST include the "Dr. Day Tapes"! If you are not familiar-it is time. I have known of the Day tapes for 30+ years. Pretty much soured me on the entire manufactured reality that has been DESIGNED for us ie "modern" society.
Sage Hanna has many posts on the subject.
READ THIS and your life will not be the same!
http://www.sweetliberty.org/nobarbarians1.htm
Do you follow Dr Makis or 2nd Smartest Guy?
Did you see the book 'cancer is a parasite" or some such?
I think about the gov alcohol position that NO booze is healthy.
That might be from a physical standpoint,
but life without beer wouldn't be worth living!
Same with hot dogs.
They might kill you eventually, but boy o boy they sure hit the spot! ;-)
Everything in moderation...including moderation!
Also, vax status is now part of the big C equation, according the the good Dr. Dalgleish...
https://imahealth.substack.com/p/a-steam-train-coming-down-the-tracks?r=nvjqb&utm_campaign=post&utm_medium=web
Thank-you for all you do.
Dear Johnny,
Thank you for reading and for sharing about your friend. Male breast cancer is genuinely underdiagnosed, and the BRCA2 link in men is one of the most important things most people don't know. You're right to flag it.
On ApoB/A1 ratio, absolutely valid suggestion. I cover these extensively here: https://www.zenithwithin.com/p/apob-apoa1-ratio-heart-risk, and you're right that it belongs in a cancer metabolic monitoring discussion too. The metabolic-cancer connection runs deep.
On alcohol, I love that you're honest about it. For you, one beer may be a reasonable quality-of-life trade-off, that's a decision each person makes with their own risk profile in mind. My decision is different, for reasons specific to my family history and my genetics. Neither of us is wrong. The point is to make the decision consciously, with the data in front of you, rather than not knowing the data exists.
On the links and names, I try to stay anchored to peer-reviewed evidence, so I won't be heading down those roads. Not because I think all institutions are beyond question, but because the tools I use professionally require a particular kind of evidence standard to be useful.
The picture is from Madrid, that's where I'm from.
Thank you again for being here.
Warmly,
Sara