Three Doctors, One Body, Nobody Talking
The gap between OB/GYN and oncology isn't a knowledge problem. It's a coordination problem. And women have been paying for it for a long time.
The Gap Between the Rooms
A few years after my cancer treatment, a hormone specialist prescribed estrogen replacement. She was managing the full picture—cardiac health, bone density, and libido. These are legitimate concerns, and she was doing exactly what she was trained to do.
Four weeks later, my radiologist called me:
“Joelle, what did you do? Your breasts have been calm for years and now they’re lit up and I don’t like it one bit.”
The hormone doctor didn’t know what estrogen would do on a breast MRI. The radiologist didn’t know what the hormone doctor had prescribed. I was the only person in all three rooms, and I didn’t know enough to connect the dots.
This isn’t a story about doctors who failed; it’s a story about how women’s bodies are divided among specialists operating without awareness of one another. Oncology, Gynecology, and Radiology live in different worlds.
The full episode with Dr. Abigail Liberty is on Spotify, Apple Podcasts, and YouTube.
The Manchester Revelation: Progesterone vs. Estrogen
Two years ago, Dr. Abigail Liberty (OB/GYN at OHSU) attended a conference where Dr. Sasha Howell presented research on anti-progestins.
For forty years, breast cancer prevention has been organized around estrogen (Tamoxifen, Aromatase inhibitors). However, the science points to a different driver:
The Luteal Phase: During the two weeks after ovulation, progesterone surges. Breast cells swell, immune cells flood in, and tissue remodels. Dr. Liberty describes it as the breast “preparing for battle.”
The Risk: This monthly high-activity window has a high error rate.
The Solution: Anti-progestins interrupt this cycle, keeping the breast in the quieter, lower-risk follicular phase.
The Invisible Medication
When an oncologist asked why this wasn’t being used in America, the answer was startling. The drug already exists—it’s called Ella (ulipristal acetate). It has been in U.S. pharmacies for twenty years as emergency contraception. The oncologists in the room had never even heard of it.
“I realized that oncologists had never heard of it. The medicine I prescribe every day — they had no idea it existed.”
— Dr. Abigail Liberty, OB/GYN, OHSU
Three Barriers to Progress
The reason Ella hasn’t crossed into cancer prevention isn’t due to science, but three structural barriers:
