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E215
October 30, 2026
Dense Breasts, Family History and Mammograms: How to Know Your Breast Cancer Risk
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In this episode of unPAUSED, Dr. Mary Claire Haver continues her conversation with breast oncologist Dr. Eleonora Teplinsky, author of Beyond the Pink. In part two, they shift from treatment to breast cancer risk, prevention, and early detection. They start with dense breasts, which about half of women have and which can both hide cancer on a mammogram and raise breast cancer risk. Dr. Teplinsky explains which breast density categories call for added breast cancer screening with MRI or ultrasound, along with why the radiation from a mammogram is lower than many women fear.

From there they turn to family history of breast cancer and why it is so often misunderstood. Only 5 to 10% of breast cancers are hereditary, so most women who are diagnosed have no family history at all, and skipping mammograms for that reason is a mistake. Dr. Teplinsky explains how to know your breast cancer risk through a formal risk assessment starting at age 25, and what happens when lifetime risk reaches 20% or higher, including referral to a high risk breast program. She walks through who should get genetic testing, why family history means both parents’ sides and several generations, and why a negative result does not bring a woman with a strong family history back to average risk. Other topics include blood tests and full body scans that promise early detection, and why women of color are offered genetic testing less often and receive inconclusive results more often.

For women with a BRCA mutation who have never had cancer, often called previvors, Dr. Teplinsky explains what a lifetime breast cancer risk of up to 80% means for decisions about risk reducing mastectomy and ovary removal. She shares new data showing that previvors in surgical menopause can use menopause hormone therapy without raising their breast cancer risk, and explains why a menopause plan should be in place before surgery, since menopause before 45 raises the risk of heart disease, cognitive decline, and osteoporosis.

The conversation then moves to life after cancer treatment. Dr. Teplinsky explains why anyone who has had chemotherapy should get a baseline bone density scan, how chemo brain mirrors menopause brain fog, and how radiation, chemotherapy, and early menopause can affect heart health and cholesterol. She also closes the conversation with ways listeners can tell ordinary fear of recurrence apart from fear that takes over daily life, and shares practical ways to cope with body image changes after mastectomy, including finding a support community that fits.  

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Chapters

00:00:00 – Why family history doesn't tell the whole story
00:01:35 – Why breast cancer screening matters without family history
00:02:39 – Genetic testing and breast cancer risk assessments
00:05:05 – Understanding BRCA mutations and prevention options
00:07:55 – Full-body MRI and blood tests for cancer detection
00:10:33 – Breast cancer risk models and AI screening
00:11:47 – Dense breasts and when additional imaging matters
00:14:41 – Is radiation from mammograms dangerous?
00:15:22 – Hormone therapy after preventive ovary removal
00:17:42 – The difficult decisions behind risk-reducing surgery
00:20:00 – The long-term risks of premature menopause
00:21:08 – Genetic testing disparities for women of color
00:22:13 – Why a negative genetic test isn't always reassuring
00:22:56 – Bone loss during and after cancer treatment
00:25:04 – Exercise and strategies to protect bone health
00:26:14 – Chemo brain and cognitive changes after cancer
00:28:27 – How cancer treatment affects heart health
00:31:07 – Managing fear of cancer recurrence
00:33:06 – Body image and recovery after mastectomy
00:34:44 – What every woman deserves from her medical team
00:35:49 – The future of cancer and menopause care
00:36:48 – Rapid-fire myths about estrogen and breast cancer
00:37:35 – Beyond the Pink and starting the conversation

About the guest

Dr. Eleonora Teplinsky

Dr. Eleonora Teplinsky is a board-certified medical oncologist specializing in breast and gynecologic cancers, a nationally recognized educator, and a trusted voice in women’s health. Through her clinical work, research leadership, and digital platforms, she translates complex medical information into practical, patient-centered insights that empower individuals to advocate for their health.