Most women aren't thinking about breast cancer when they're taking a shower, yet that is the moment when their whole world can change. A new hard lump sends a shock wave from the fingertips to the mind, heart and gut. Undergoing the tests that lead to a diagnosis creates alternating states of determined optimism and worrisome fear that interrupt normal sleep and even simple conversations.
Once breast cancer is diagnosed, the challenge is decision making. The best choice isn't always obvious, and advice comes from everyone about what should be done. And then there's breast cancer treatment.
We all know a woman who has had breast cancer, and for most women it is the disease they fear most. Decades of pink ribbons have secured notoriety for breast cancer, focused primarily on early detection and treatment research. Mammograms and chemotherapy regimens, however, offer nothing to an individual woman determined to prevent breast cancer or its recurrence. We are uncertain whether to have a drink, do our own breast exams, or submit to x-rays before an international flight.
As a physician, as a woman, as a daughter of a woman with breast cancer, I am vitally interested in breast cancer prevention, both primary and secondary.
The risks of breast cancer are a little hard to describe, because age matters so much in determining risk. If your high school club starts out as 16 women, imagine that half survive beyond the age of 80. When they are 85, it is likely that one of the surviving eight will have had breast cancer. Breast cancer is a terrifying disease, but not the major cause of death for American women. That designation goes to heart disease. Breast cancer and heart disease as well—as lung and colon cancer—are increased in smokers, so perhaps smoking should actually be listed as the leading cause of death.
Breast cancer might be diagnosed at any stage, from pre-cancerous breast cancer to metastatic breast cancer, each indicating a different sort of management or treatment. There are different types of breast cancer, some quiet and benign, others ravaging. In addition, breast cancer in men is not uncommon and male breast cancer must be taken seriously.
Cancer at times, including some breast cancers in particular, can be imagined as if in a tug-of-war with the immune system. There are some highly malignant cancers - such as inflammatory breast cancers and some melanomas - that wield irresistibly fatal forces. There are other cancers that conceivably arise, then linger or regress. Less hazardous cancers include many prostate cancers, some breast cancers, superficial melanomas, and some thyroid cancers.
A cancer patient's lifespan is not affected, if their immune system can take and hold the upper hand. The person survives, sometimes with, sometimes without, the help of conventional medical intervention.
Many breast cancer risk factors have been identified, argued and proposed, and we will learn of more as research continues. Cancer risk factors beyond our control include our genetic background and events already past in our lives. I prefer to focus on what you can choose to do about your health.
Although breast cancer rates in women have declined somewhat since 1996, the incidence of all cancers has risen cumulatively since 1950, according to the Annual Report to the Nation on the Status of Cancer 1 , 1975-2005, Featuring Trends in Lung Cancer, Tobacco Use, and Tobacco Control, this is probably due to reductions in both smoking and the use of conventional post-menopausal hormone therapy.
Only belatedly has conventional medical research turned to the question of environmental causes influencing breast cancer risk. In a laudable nudge from the Susan G. Komen foundation, the Institute of Medicine (IOM) reviewed the current evidence on breast cancer and the environment. Acknowledging gene-environment interactions the IOM makes careful evidence-based recommendations for women to follow. A summary version and the full study are available online. They have taken a very cautious stance, hesitating to call out any cancer risks that are not absolutely certain. Relative to where medicine has been, this study is a bold and radical warning about the environment.
I take a view that is cautious in a different way: if something has been suspected of being hazardous, let's talk about it. If it's not quite proven, but easy for an individual woman to control, that would be her choice pending additional research.
So, how can a woman prevent breast cancer or its recurrence?
For the greatest risk reduction with the fewest steps, follow these three recommendations.
- Limit alcohol. Safest is to avoid it or just have one drink daily and supplement with Thorne Research Calcium-d-Glucarate, take 1 daily.
- Avoid obesity. If possible, return to your weight from the age of 18-20. Think of good exercise during most days of the week and good sleep every night.
- Da Vinci A, D, and K, take 1 capsule daily or enough to keep your vitamin D level 50-70 ng/mL.
A comprehensive cancer prevention program involves many areas in which action steps can be taken, gradually or all at once. Start by following DrDeborahMD's basic nutrition and healthy lifestyle guidelines, with the following modifications:
Foods to Enjoy
· Real eggs. Eggs from pasture-raised hens are rich in choline, helpful for breast health and cognitive function, among other benefits. The cholesterol in eggs is only a potential problem if it oxidizes: avoid this by keeping the yolk intact while cooking (fry, poach, or boil). Women with high choline (in the yolks) intake have a significantly lower risk of breast cancer.
· Organic Meat and Dairy. Animal meats and fats are healthy if they come from organic, grass-fed animals. Animals raised on grains, hormones, and conventionally fattened, concentrate harmful chemicals in the fat of the meat or dairy. High dairy intake is associated with reduced risk.
· Cruciferous vegetables. Three or more servings of cabbage a week are associated with reduced incidence of breast cancer. Sauerkraut counts, too, and if it's lacto-fermented sauerkraut, it helps your immune system and bone density as well. Other vegetables can also be healthful. Sprouted broccoli seeds might be the nost beneficial.
· And what about fruit? Conventional dietary advice often refers to "lots of fruit and vegetables", but I would re-phrase that to say your best plan might be lots of cruciferous and green leafy vegetables, a reasonable assortment of other vegetables, but fruit... Fruit is problematic because of the special affinity between fruit sugar—fructose—and the health of our liver. I can definitely suggest that fruit juice has no place in a health-conscious menu, but limited amounts of fruit might be fine, especially dark-colored berries eaten with a well-balanced meal.
· Freshly ground flax seeds. Take 1-2 teaspoons of whole seeds, grind them and eat within 20 minutes. Add to yogurt, or rice. Many people like to mix their ground flax seeds with olive oil and salt. (Taking flax seeds can be helpful for women with high levels of estrogen, because flax offers a weaker and less breast-stimulating form of estrogen.)
· Iodine-rich foods. Seaweed and seafood, such as Wild Alaskan Salmon, are the best sources: eat twice weekly. Skip iodized salt and go for sea salt. Women with a history of thyroid problems or fibrocystic disease should probably be checked for adequacy of iodine levels to consider supplementation.
· Folate-rich foods. Liver and dark leafy greens (romaine lettuce to collard greens). See Recipe for Liver Pate.
· Healthy fats particularly important for cancer prevention are the omega-3's in fish oil or cod liver oil, which effectively slow down tumor growth in estrogen-sensitive cancers such as breast-, prostate- and colon cancers. Also the healthy fats in butter and yolks should be enjoyed.
Foods to avoid
· Sweets, especially sugars. Cancer loves sugar and requires it to grow.
· Conventionally raised meats. Conventional meat is produced in such a way to lower the naturally present conjugated linoleic acid as well as the omega 3's and the meat may have hormonal and drug residues.
· Inflammatory foods. Industrial seed and vegetable oils are inflammatory for everyone and have been associated with breast cancer risk. If you have systemic or local inflammation, it's worth a trial of food eliminations and gut healing to see if a particular food has been the cause. I'd suggest starting with the elimination of gluten. Read about food elimination here.
· Alcohol. The most clearly problematic substance is alcohol. Women who drink perhaps as little as one drink daily may have an increased risk of breast cancer, but there are a few qualifications. For best safety, limit to maximum 4 ounces wine at a time, or a less-than-generous serving of beer, a scant ounce of alcohol.
o High folate intake appears to reduce risk, and folate (the form found in food or in some supplements) is safer than folic acid. So, research suggests not drinking or staying with one drink or less daily keeps risk lower if you have a high folate diet or safe folate supplementation.
o A recent study showed that drinking 8 oz. of red wine (but not beer or spirits) nightly resulted in certain laboratory findings associated with a reduced risk of breast cancer. If you are going to drink alcohol, red wine might be the safest choice.
· Vitamin D3. Breast cancer risk is reduced if your vitamin D level is normal or higher. Normal levels would be 40-65 ng/mL, which usually requires supplementation to achieve. Da Vinci A, D, and K3 is an ideal supplement, usually at a dose of 5000 i.u. (see package for details) daily to normalize levels. Take with food.
· Barlean's Omega 3 Swirl or Nordic Naturals ProOmega 2000s are readily available forms of high potency and high quality omega-3’s.
· Thorne Research Melaton-5. Past the age of 50, or if you have a history of night work or sleep difficulties, it's wise to supplement with melatonin, even on a regular basis, to reduce breast cancer risk.
· Calcium. For a full discussion, please see Dr. Deborah's blog post. If you do not eat much calcium in your diet (dairy, dark leafy greens), supplementation with Thorne Research Calcium-Magnesium Citrate, one with meals, would provide more calcium.
Cancer Prevention Lifestyle:
· Breast feed your baby for at least a year.
· Don't smoke.
· Enjoy the sun. Sun exposure is the best way to get vitamin D. Enjoy sun and avoid burning.
· Exercise. Three times a week, exercise strenuously enough to make conversation difficult for 20-30 minutes.
· Sleep regular night hours in a dark room. Avoid shift work if possible that keeps you awake at night and depletes your natural melatonin levels. Multiple studies confirm the importance of 7 or more hours of sleep a night, and recent evidence suggests that any light that brightens your room lessens the healthy effect of sleeping in the dark, by reducing melatonin production.
· Iodine. Iodine and thyroid health are related in uncertain ways to breast health. Certain population evidence (low cancer incidence in Japan) suggests that optimal iodine levels are cancer-protective. Iodine levels are tested by a single urine test, and levels should be over 150 mcg/L to be optimal. Iodine supplementation is best discussed with a knowledgeable health care practitioner. Iodine supplementation can be effective with a low dose, less than half a mg. (Supplements that offer much higher doses of 10-15 mg are useful for toxic radiation exposures, but way more than anyone needs on a regular basis!)
· Avoid obesity. If possible, return to your weight from the age of 18-20. The Low Carb Weight Loss Plan is an excellent diet for reducing cancer risk, including breast cancer.
· Cook meat gently. Charred meat contains carcinogenic compounds: bake, roast, or steam. If you are going to cook over high temperatures, marinade the meat for at least 2 hours before cooking.
· Avoid xenoestrogens in plastic and body care products. When you must use plastic water bottles, choose BPA free ones, and look for organic skin care products. As a general boost to your liver's ability remove xenoestrogens, consider a simple supplement such as Thorne Research Calcium-d-Glucarate, take 1 daily.
· Conventional hormone therapy. Postmenopausal hormone therapy with conventional drugs such as Premarin and Provera clearly raise the risk of breast cancer. It is likely that birth control pills might increase the risk also. Treatment with bio-identical hormone therapy might have a favorable or negligible impact on breast cancer risk. Bio-identical hormone therapy, particularly Estradiol applied to the skin (cream, gel or patch) appears to reduce the risk of developing breast cancer.
· Lower your insulin levels. Elevated insulin levels, such as those seen in women with type 2 diabetes, are associated with increased risk: cancers seem to be well-fed by sugar, ushered into the cell by insulin. If your insulin levels are high, or if you have been told you are diabetic, or pre-diabetic, follow a healthy, low-carbohydrate lifestyle as described here to reduce your risk of breast cancer and to heal from diabetes.
The question of screening for breast cancer deserves an article of its own. Recently both mammography and self-breast exams have come under scrutiny for the possibility of missed diagnoses as well as "overdiagnoses", those instances where treatment is administered for a condition that would not have caused serious morbidity or mortality. Although not as well studied, the most modern techniques of thermography offer a safe tool for breast cancer detection, that will reveal certain aspects of breast physiology missed by mammograms. Currently not covered by most insurance, thermography is not prohibitively expensive, but make sure that your study is interpreted by a trained and licensed thermography clinician. Most importantly, discuss with your own health care provider the real indications and probabilities associated with the different screening techniques, and do what you can to keep your own risk of breast cancer low.
I have a long personal and professional interest in breast cancer. My mother and her mother both died of breast cancer. My mother's struck when she was 48. When her cancer recurred, 19 years after her mastectomy (no chemotherapy), it clearly had a mind of its own. It grew first slowly then quickly, gradually eroding her quality of life and becoming progressively more indifferent to oncologists' treatment plans. She died peacefully, with our family at her bedside, well attended in the hospice room at our local Ashland Community Hospital.
Doing the math, I realized that what I wanted for myself and for my daughter was not an early-detection or treatment plan. What I wanted was the strength of my mother's immune system during those 19 years she fended off a recurrence. She had great secondary resistance to her cancer. I wanted to learn all I could about optimal prevention of breast cancer for everyone, inspired by her great work during those 19 years!
My suggestions for reducing breast cancer risk are only the current synthesis of the most significant findings about breast health. Sign up for mynewsletter, where I always give breast cancer news a place of importance as it becomes available.