"The majority of cancer drugs are registered at the dose which is intolerable for the majority of women. It causes a lot of clinical and financial toxicity."
Dr. Andrea De Censi has spent his career asking one question: what's the lowest dose that still works? His answer to that question changed how tamoxifen is prescribed—and now he's testing whether a common diabetes drug combined with skipping breakfast could make cancer treatment more effective. He joins Joelle to share what decades of prevention research has taught him, and why so much of it never reaches patients.
They dive deep into:
- The clinical trial proving that a quarter of the standard tamoxifen dose reduces breast cancer risk by the same 50%—with no extra risk of serious side effects, and barely half an additional hot flash per day
- Why 30 to 50% of women stop taking tamoxifen altogether—and why lowering the dose is a real option worth asking your doctor about, even before official guidelines say so
- How metformin (a cheap, widely-used diabetes drug) blocks one of the main ways tumor cells get energy—and why pairing it with intermittent fasting cuts off the backup route too
- The simple eating window used in the trial: eat only between noon and 8pm, fast the rest of the time—and why women newly diagnosed with breast cancer stuck to it at a 100% adherence rate
- How researchers used a glucose monitor to confirm women were actually fasting—no morning sugar spike means no breakfast, full stop
- The WHO trial that was designed to prove synthetic hormones protect the heart—but instead showed they raised breast cancer risk and mortality, overturning decades of thinking about progesterone overnight
- A drug already used to shrink fibroids—liprystal—now showing early signs it may reduce breast cancer cell growth too
- Why once a drug loses its patent, research funding dries up even when there's still important work to do—and who ends up filling that gap
Learn more about scalp cooling from episode sponsor - www.coldcap.com
Learn more about UCSF RiseUp at https://riseup.ucsf.edu/
Get more stories, strategies, and science at www.kcapodcast.com
