DOCTOR WHO CAUGHT ACTRESS OLIVIA MUNN’S BREAST CANCER ALSO DIAGNOSED HER OWN

DOCTOR WHO CAUGHT ACTRESS OLIVIA MUNN’S BREAST CANCER ALSO DIAGNOSED HER OWN

The doctor who caught actress Olivia Munn’s breast cancer also diagnosed her own: ‘I don’t want another woman to go through what I went through’

What are the odds you’ll develop breast cancer in your lifetime? Not a woman’s average risk—13%, according to the American Cancer Society—but your personal risk based on your age, genetics, family history, and other risk factors?

That’s a statistic you should know off the top of your head, Dr. Thaïs Aliabadi, an OB/GYN in Beverly Hills, California, and cohost of the new podcast SHE MD, tells Fortune.

“I was diagnosed with breast cancer myself, so it’s a condition that’s near and dear to my heart,” she says. “I don’t want another woman to go through what I went through.”
According to Aliabadi, at 49 she had no genetic mutations, no family history of breast cancer, and her mammograms, ultrasounds, and MRIs were benign. However, she says a breast biopsy seven months earlier had shown precancerous cells. She knew other components of her medical history—such as having dense breasts and giving birth for the first time after age 30—heightened her risk. She determined her lifetime risk of developing breast cancer was 37%; the American College of Radiology considers women with a lifetime risk at or above 20% to be high-risk. Aliabadi asked her doctor for a prophylactic double mastectomy, a surgery in which both breasts are removed to lower chances of getting breast cancer.

“Someone with 37% lifetime risk, they need regular imaging every six months and I didn’t want to go through all that; I was too busy,” says Aliabadi, now 53. “I didn’t want to get diagnosed with breast cancer, I just didn’t want to deal with it. To me, that number was high, and it’s a very personal decision.”

Her doctors insisted a double mastectomy was unnecessary. Still, Aliabadi went through with the procedure. A week later, she was notified cancer had been present.

“Do you know how many doctors at my hospital approached me the following month—’cause I’d made a post on Instagram—and asked me, ‘How did you calculate your lifetime risk?’ And these were gynecologists,” Aliabadi tells Fortune. “I realized I got breast cancer so I can change this in the world.”

How do you calculate lifetime breast cancer risk?

Aliabadi says her dream is for every woman to know her lifetime risk of breast cancer—information that could potentially save her life.

Earlier this month, actress Olivia Munn announced on Instagram that she’d been diagnosed with luminal B breast cancer in 2023. The 43-year-old had tested negative for BRCA1 and BRCA2 gene mutations, and her imaging results were normal. In spite of this, Munn’s doctor, Aliabadi, assessed her breast cancer risk, which was also 37%. Further testing revealed cancer and Munn, too, opted for a double mastectomy.

“I wouldn’t have found my cancer for another year—at my next scheduled mammogram—except that my OB/GYN, Dr. Thaïs Aliabadi, decided to calculate my Breast Cancer Risk Assessment Score,” Munn wrote in a March 13 Instagram post. “The fact that she did saved my life.”

Aliabadi will soon offer a risk calculator of her own on the SHE MD website and declined to tell Fortune which algorithm she used on Munn. Several free variations are accessible online, including the Breast Cancer Risk Assessment Tool (BCRAT), the IBIS/Tyrer-Cuzick Risk Assessment Calculator, the Breast Cancer Surveillance Consortium (BCSC) Advanced Breast Cancer Risk Calculator, and the Black Women’s Health Study Breast Cancer Risk Calculator.

Each has advantages and limitations. The BCRAT, for example, is simple but based on limited biomedical data for nonwhite women. The IBIS/Tyrer-Cuzick tool eliminates race but incorporates more of your reproductive history, and the BCSC calculator doesn’t apply to women under 40. Collectively, they analyze factors such as:

Age

Age at time of first menstrual period

Age at time of first childbirth

BRCA1 and/or BRCA2 gene mutations

Breast biopsy history

Breast density

Breastfeeding history

Family history of breast and prostate cancer

Height and weight

Hormone replacement therapy history

Menopausal status

Oral contraceptive use

Ovarian cancer history

Race and ethnicity

Depending on the tool, you’ll be given your short-term risk of developing breast cancer within five to 10 years and/or your lifetime risk. A number of calculators are publicly accessible but intended for use by medical professionals. Women should not only know their risk, Aliabadi says, but also discuss it with their health care team.

“This needs to be done at the primary care office, at the gynecologist’s office, at the family practitioner’s office, at the plastic surgeon’s office—offices that basically deal with women directly,” she tells Fortune. “I want this to be standard of care.”

The upcoming SHE MD risk assessment will include a printer-friendly action plan women can bring to their next medical appointment “and if their doctor refuses to do something about it, I want them to be empowered to be their own breast advocate and go find a doctor that would do the right thing for them,” Aliabadi says.

 

 

 

Rear view of an hispanic young woman getting a mammogram to check for breast cancer with the help of a female doctor at the imaging diagnostic center
What does my lifetime breast cancer risk mean?

No tool is perfect, with some underestimating risk among certain populations. A woman at low risk may develop breast cancer, while a woman at high risk may not. Your doctor can help you choose which assessment may give you the best estimate and determine whether additional screenings are necessary.

 

 

Don’t wait until you approach middle age to have these nuanced discussions with your doctor, says Dr. Rebecca Kaltman, an oncologist at the Inova Saville Cancer Screening and Prevention Center in Fairfax, Virginia, who tends to use the IBIS/Tyrer-Cuzick tool for her patients.

“We are working [to] educate primary physicians on quick models and tools that they can use to risk assess, so that we’re capturing people early on,” Kaltman tells Fortune. “For those that might be at risk from a hereditary perspective, screening would start a lot earlier. So instead of waiting until 40, when the guidelines say to start screening, we need to be thinking about women at a much younger age, in their 20s and 30s.”

The American Cancer Society recommends breast imaging for women in these age groups:

40–44: Annual mammograms optional

45–54: Annual mammograms

55+: Biannual mammograms, annual optional

Patient education is critical, particularly for women of color, Kaltman says, noting that while breast cancer is more common among white women, it occurs earlier and more aggressively among Black women. Early disease detection is a promising solution.

“I think that our obligation as providers is to make sure that we’re getting out into every community and educating women,” Kaltman says. “The more that we can empower patients to know what their risk is and bring this to their primary providers, be it an OB/GYN or an internist, the more likely they are to get risk stratified and appropriate screening going forward.”

 

Check out how to treat your cancer 

A 5-minute test can estimate your odds of developing breast cancer—but not if you’re biracial


The Breast Cancer Risk Assessment Tool (BCRAT) is an online calculator designed to predict a woman’s risk of developing invasive breast cancer in both the short term and their lifetime. But it doesn’t allow bi- or multiracial women to accurately input their race and ethnicity.
ALVARO MEDINA JURADO—GETTY IMAGES
Google searches for “breast cancer risk assessment” soared last week when actress Olivia Munn shared on Instagram that her OB/GYN had used the tool to predict her likelihood of developing the disease and “saved my life.” The 43-year-old was diagnosed with luminal B breast cancer two months after receiving a normal mammogram.

The Breast Cancer Risk Assessment Tool (BCRAT) is an online calculator designed to predict a woman’s risk of developing invasive breast cancer in both the short term, within five years, and their lifetime, up to age 90.
Using components of your medical history, such as your age at the time of your first menstrual period and how many of your first-degree relatives have had breast cancer, the tool is supposed to calculate your risk in about five minutes. It’s available for free on the National Cancer Institute (NCI) website but is intended for health professionals. Still, if you’re as curious as I am, you couldn’t resist completing the quiz-like form yourself.

Turns out it was a fool’s errand—the BCRAT wasn’t designed for people like me. Or Munn, for that matter.

In the demographics section, the assessment asks, “What is the patient’s race/ethnicity?” There were six options in the dropdown menu, in this order: “White,” “African American,” “Hispana/Latina,” “Asian American,” “American Indian or Alaskan Native,” and “Unknown.” None of these options alone would do—and I could only pick one.

I guarantee that if you ask someone who’s bi- or multiracial what it’s like to fill out a form, they’ll have a story for you. I, the daughter of a Black father and a white mother, have my share. Over the decades my options have expanded to such exotic categories as “Other,” “Biracial,” “Multiracial,” “Mixed Race,” “Some Other Race,” or “Two or More Races.” Sometimes I have the luxury of picking two.

It’s disheartening, but the lack of an appropriate racial/ethnic category on the BCRAT, however, may have serious consequences.

 

 

 

 

 

 

Mixed-race women are used to not fitting into one racial/ethnic box on forms. In 2024, they’re still being left out of an algorithm that may help gauge their breast cancer risk.
GETTY IMAGES
Cancer epidemiologist: Lack of data on nonwhite women mars risk estimates

The lack of a single bi/multiracial option makes sense; I assume my Black/white risk would differ from that of a woman with, say, an Asian/white background like Munn. But in the age of AI—not to mention a burgeoning multiracial population in the U.S.—surely the algorithm could let me choose two and calculate my risk?

The NCI acknowledges the BCRAT’s limitations, namely a lack of diverse racial and ethnic data, which can skew results. The tool may underestimate risk for Black women with previous biopsies and Hispanic women born outside the U.S., and offer inaccurate risk estimates for American Indian and Alaskan Native women.

“The more data you can give an algorithm or a prediction tool or an AI, the better it’s going to be in giving you an answer, in this case, a risk estimate,” Robin Hines, Ph.D., a cancer epidemiologist at the University of Central Florida College of Medicine, tells Fortune. “If I have 280,000 women, I’m going to have much less error in my estimate than I will have if I have just over 3,000 women.”

Hines is referring to the 280,000 white women in the Breast Cancer Detection Demonstration Project. Their data, along with information from the NCI Surveillance, Epidemiology, and End Results (SEER) Program, were used to create the BCRAT. Risk estimates for nonwhites are based on SEER and other study data for far fewer women in these racial and ethnic groups:

Black: 3,244
Hispanic: 2,497
Asian and Pacific Islander: 1,563
Dr. Mitchell Gail, now a senior investigator in the Biostatistics Branch of the NCI Division of Cancer Epidemiology and Genetics, developed the calculator in 1989, before the National Institutes of Health Revitalization Act of 1993 called for “an increase in the number of women and individuals from disadvantaged backgrounds (including racial and ethnic minorities) in the fields of biomedical and behavioral research.” Also known as the Gail Model, the BCRAT algorithm was last revised in 2017 and may be updated periodically as new data become available, according to the NCI.

 

 

 

 

 

 

The Breast Cancer Risk Assessment Tool (BCRAT) may underestimate risk for Black women with previous biopsies and Hispanic women born outside the U.S., and offer inaccurate risk estimates for American Indian and Alaskan Native women.
CECILIE ARCURS—GETTY IMAGES
Olivia Munn’s OB/GYN wants you to know your breast cancer risk

I took the BCRAT twice. When I input “African American,” the tool generated a lifetime risk of 9.8%, compared to an average risk of 10.1% among 35-year-old Black women in the U.S. When I input “White,” my risk jumped to 12.4%, compared to an average of 12.6%. I don’t know the nuances of the algorithm, but my biracial risk is probably more complicated than simply averaging the two scores.

How, then, did Munn’s OB/GYN, Dr. Thaïs Aliabadi, calculate the biracial actress’s risk? Aliabadi, who’s preparing to launch a calculator on the website of her new podcast, SHE MD, declined to specify which assessment tool(s)—the BCRAT is one of many—she used for Munn. But in her push to get every woman to understand her risk of breast cancer, Aliabadi tells Fortune the lack of racially and ethnically diverse tools is an issue.

“We have good tools to use for the general population but, obviously, we need to have more studies and focus more on different ethnicities,” she says. “Hopefully, by collecting a lot of data—and artificial intelligence—we’ll be able to put all this data together and come out with a better test.”

Progress is already being made. The Black Women’s Health Study Breast Cancer Risk Calculator launched in 2021 and estimates short-term risk for women between the ages of 30 and 70. It gave me a 10-year risk of 0.8%, compared to an average of 0.9%.

President Joe Biden on Monday signed the Executive Order on Advancing Women’s Health Research and Innovation, which concedes “we know far too little about women’s health across women’s lifespans, and those gaps are even more prominent for women of color, older women, and women with disabilities.” It calls for the investment of federal dollars in closing that gap.

For now, Aliabadi’s biggest concern is that not enough women—regardless of their race or ethnicity—are even aware of their ballpark risk, myself included. That I’m 35 and had never heard of a breast cancer risk assessment until Munn’s Instagram announcement is “exactly the problem,” she says. While I’m dissatisfied that most existing tools don’t, or can’t, account for biracial women, I do feel empowered with at least an idea of my risk. And though my estimates are relatively low, they’ve prompted questions I want to ask my doctor.

“I want to change that and make that standard of care for all women—not just high-risk women, all women,” Aliabadi tells Fortune. “It takes two minutes. Look at how much time we spend doing other things in life. What’s two minutes to calculate your lifetime risk of breast cancer?”

 

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