Insulin Resistance and Cancer Risk: The Connection Most Women Never Hear About
September 14, 2026
What if cancer prevention needs to begin years — or even decades — before a tumor ever appears on a scan?
That’s one of the biggest questions I explored with Dr. Lorna Brudie, a dual board-certified OB-GYN and gynecologic oncologist who spent much of her career treating women after cancer had already become a reality.
After years of seeing the endpoint of disease, Dr. Brudie began asking a different question:
How did this woman get here — and where could we have intervened earlier?
That question changed the way she practices medicine.
Today, instead of looking only at cancer cells, tumors, genetics, and hormones, she also looks upstream at metabolic health — including insulin resistance, visceral fat, chronic inflammation, body composition, and other factors that may influence long-term disease risk.
And one of the biggest pieces women may be missing is insulin resistance.
What Is the Connection Between Insulin Resistance and Cancer Risk?
Insulin resistance occurs when your cells become less responsive to insulin. Your pancreas compensates by producing more insulin to keep blood glucose under control.
That means your blood glucose can still appear “normal” even while insulin levels are climbing.
This is why Dr. Brudie believes looking only at glucose can cause us to miss an important part of a woman’s metabolic picture.
Elevated insulin, visceral adiposity, and chronic inflammation can exist together as part of a metabolic environment associated with cardiovascular disease, type 2 diabetes, and certain cancers.
Instead of waiting until glucose finally rises high enough for someone to diagnose diabetes, Dr. Brudie’s approach is to ask whether we can identify metabolic dysfunction much earlier.
Can You Have Insulin Resistance Without Being Overweight?
Absolutely — and Dr. Brudie is a perfect example.
In her late 40s and early 50s, she was doing virtually everything we’re told to do.
She exercised.
She strength trained three times per week.
She did cardio.
She carefully monitored what she ate.
She was hormonally optimized.
And she weighed 119 pounds.
Yet she couldn’t change her body composition and didn’t feel right.
When she finally checked her fasting insulin, it was 31.
Dr. Brudie says she prefers fasting insulin to be under 10 — and ideally under five.
Suddenly, the pieces came together.
She was insulin resistant.
That’s an incredibly important lesson because metabolic health and body weight are not the same thing.
A woman can be thin and metabolically unhealthy just as a woman living in a larger body can have very different metabolic markers than someone might assume based solely on her appearance.
Why Isn’t Normal Glucose Enough?
One of the most important questions raised in this conversation is whether we’re waiting too long to intervene.
Think about how conventional medicine often works.
We wait until bone loss becomes severe enough to call it osteoporosis.
We wait until blood pressure becomes high enough to diagnose hypertension.
We wait until glucose reaches a particular threshold before diagnosing diabetes.
And in oncology, we often wait until a tumor becomes detectable before we call it cancer.
But disease doesn’t necessarily begin on the day we finally give it a name.
Metabolic dysfunction can develop gradually.
That’s why fasting insulin may be worth discussing with your healthcare provider, particularly if you’re experiencing signs of metabolic dysfunction despite glucose or A1C numbers that haven’t yet crossed a diagnostic threshold.
How Are Visceral Fat, Inflammation, and Cancer Connected?
Body fat isn’t simply stored energy.
Visceral fat — the fat surrounding our internal organs — is metabolically active.
Dr. Brudie describes a cascade involving insulin, inflammatory signaling, and hormonal activity that may contribute to an environment associated with chronic disease.
This is particularly important in menopause.
After menopause, adipose tissue can continue contributing to estrogen production through aromatization. At the same time, insulin resistance and inflammatory signaling can create additional metabolic stress.
This is one reason Dr. Brudie doesn’t believe we should look at hormones, obesity, insulin, or inflammation in isolation.
We have to look at the whole terrain.
Did the Women’s Health Initiative Make Women Afraid of Hormone Replacement Therapy?
We couldn’t have this conversation without talking about the Women’s Health Initiative.
Dr. Brudie trained during the era when the WHI dramatically changed how physicians and women viewed hormone replacement therapy.
The study created enormous fear surrounding hormones and breast cancer.
But Dr. Brudie’s argument is that we need to understand exactly what was studied.
The original WHI hormone trials did not simply test the individualized bioidentical hormone regimens commonly discussed today. The trials included conjugated equine estrogen, with one major arm also using medroxyprogesterone acetate.
The age and health of the women participating also matter when interpreting the results.
Dr. Brudie’s larger point is that the results helped create a sweeping cultural message that “hormones cause cancer.”
She believes the reality is far more nuanced.
Does Hormone Replacement Therapy Cause Cancer?
There isn’t a responsible one-size-fits-all answer to this question.
And Dr. Brudie makes that very clear.
Hormone replacement therapy should be an individualized discussion that considers factors such as:
- Personal medical history
- Family history
- Genetics
- Cancer history
- Metabolic health
- Individual risk factors
- Symptoms
- The hormones being considered
- Dosage and route of administration
Her argument isn’t that every woman should take hormones.
It’s that we shouldn’t make blanket statements about every woman either.
And that becomes particularly important for women who have experienced cancer.
Can Cancer Survivors Take Hormone Replacement Therapy?
This is where the conversation becomes especially nuanced.
Cancer patients and survivors have historically often been told that hormones are completely off the table.
Dr. Brudie challenges the idea that every woman with every cancer history should automatically receive the same answer.
Instead, she believes these decisions should involve careful evaluation of the individual woman, her cancer, genetics, metabolic health, treatment history, symptoms, and overall risks and benefits.
She also points out something we don’t discuss nearly enough:
Surviving cancer isn’t the end of a woman’s healthcare journey.
What Happens After Cancer Treatment?
We celebrate when a woman completes cancer treatment — as we should.
But then what?
What happens to her hormones?
Her cardiovascular health?
Her bones?
Her brain?
Her metabolism?
Her sexual function?
Her psychological health?
Dr. Brudie shared the example of a young colorectal cancer survivor whose radiation treatment severely affected ovarian and vaginal function. Treatment saved her life, but it also dramatically affected her sexual health.
Dr. Brudie was eventually able to address those consequences with approaches that included vaginal estrogen, systemic bioidentical hormone therapy, and vaginal dilators.
Her point is simple but profound:
Treating the cancer and caring for the woman shouldn’t be two separate goals.
Cancer survivorship should include helping women thrive after treatment — hormonally, metabolically, cardiovascularly, psychologically, and sexually.
What About GLP-1 Medications and Cancer Risk?
Dr. Brudie is also a strong proponent of GLP-1 medications when they’re used appropriately in the right patient.
She used one herself after discovering her insulin resistance.
The emerging research around GLP-1 medications and obesity-associated cancers is an area she’s watching closely.
This doesn’t mean GLP-1 medications are cancer treatments or that everyone should take them.
But it does raise an intriguing question:
If metabolic dysfunction and obesity contribute to the risk of certain cancers, could improving metabolic health also influence that risk?
This is an evolving area of research, and one worth watching.
What Should Women Ask Their Doctors About Metabolic Health?
If there’s one thing I want you to take from this episode, it’s that “normal” isn’t always the end of the conversation.
If you don’t feel well, keep asking questions.
Depending on your individual situation, that conversation might include asking your healthcare provider about:
- Fasting insulin
- Blood glucose
- Hemoglobin A1C
- Blood pressure
- Lipids
- Inflammatory markers
- Waist circumference and visceral adiposity
- Body composition
- Hormone status
- Family history
- Genetic risk
- Sleep
- Stress
- Exercise and muscle mass
No single marker tells the whole story.
The goal is to understand the pattern.
Cancer Prevention May Begin Long Before Cancer
This is what I found so powerful about my conversation with Dr. Brudie.
She spent decades seeing cancer at the endpoint.
Now she’s reverse engineering what she saw.
Instead of only asking how we treat disease once it appears, she’s asking where the trajectory could have been changed five, ten, or twenty years earlier.
That’s a very different way to think about women’s health.
Your weight doesn’t tell the whole story.
Your glucose doesn’t tell the whole story.
Your hormones don’t tell the whole story.
Your genetics don’t tell the whole story.
And one “normal” lab result certainly doesn’t tell the whole story.
We have to start connecting the dots.
Because cancer doesn’t begin the day someone gives you a diagnosis.
And taking ownership of your metabolic and hormonal health today may be one of the most important things you can do for the woman you’ll be ten or twenty years from now.
This content is for educational purposes only and is not a substitute for individualized medical advice, diagnosis, or treatment. Decisions regarding hormone therapy, GLP-1 medications, cancer treatment, or cancer survivorship should be made with qualified healthcare professionals familiar with your individual medical history.
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