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L.J. Rohan

L.J. Rohan

Gerontologist

Food as Prevention in Stopping Breast Cancer

In drilling deep into breast cancer prevention for women, I find recommendations based on several factors. In aiding prevention for women before mid-life, prevention for postmenopausal women, and what suggestions help postmenopausal women who have had breast cancer, there exists some common approaches which are very encouraging.

Regular, focused exercise across the lifespan wins the day as the number one risk reducer. I know this seems like I never get off this one subject, but think of how many positive benefits we get from regular exercise, not the least exciting result is a trimmer figure and higher metabolism–allowing for the occasional pizza splurge, since isn’t the holy grail about having pizza? For me it is, but, I digress.

On the subject of diet, the latest research reveals some strong pros and cons for what we put on our plates. Several very large studies from both the US at the National Cancer Institute and The Oregon Health and Science University, and in China through The Shanghai Breast Cancer Study (SBCS), and including research from Vanderbilt University, indicate making friends with vegetables is a great idea, especially a family of veggies call cruciferous vegetables. Don’t ask me to pronounce it, but I know them when I see the on the produce aisle:

  • Arugula
  • Bok Choy
  • Broccoli
  • Cabbage
  • Cauliflower
  • Collard greens
  • Horseradish
  • Kale
  • Radishes
  • Rutabaga
  • Turnips
  • Watercress
  • Wasabi

This wide variety of vegetables can lower our risk of breast cancer (50%) and pancreatic cancer (38%), and a man’s risk of prostate cancer (46%) or pancreatic cancer (35%). One serving a day for postmenopausal women without a history of breast cancer gave them a 50% advantage over non-cruciferous vegetable eaters. That’s some heavy leafy armor. More studies are going on as I write, and I am hopeful the above finding are further supported by these study results. If the vegetables were rated for firepower, the Bazooka Award would go to the simple cabbage and humble turnip, both vegetables readily available in many, many parts of the world and still pretty much ignored by Top Chefs.  

To give us a little protein, eat fish, but stick to low mercury fish. A list of these low-mercury swimmers is regularly updated on www.nrdc.org, the top contenders by potency: mackerel, salmon, cod liver oil, herring and oysters. Red meat does not make the list, and on the big no-no list is charred (grilled) red meat. It seems that crusty, (slightly) burned areas are very carcinogenic (poisonous) for us humans and turn the breast cancer risk-meter way up.  Cutting out food which appears high on the glycemic index (www.dlife.com), something, along with insulin resistance, I discussed in my blog post Move it and Improve It can trim our risk.

The science dovetails nicely with what we know makes up a healthy diet, providing many crossover benefits which raises our resistance to breast cancer, while making our hair shinier, our skin clearer, lowering inflammation throughout our bodies, and helping us sleep better, and last, but such a bell-ringing winner, feeding our brains to improve our cognitive functions. Give those veggies a gold medal! (Cue national anthem ;-).

Until next time…Be Vibrant!

Food as Prevention in Stopping Breast Cancer

  • Can breast cancer ever be cured? What is the percentage of return if contracted before menopause? After menopause?

Using the word “cure” is problematic because it doesn’t answer the question of WHY the cancer developed in the first place. A better way to look at this is “what do we know about preventing breast cancer recurrence?” The number of breast cancer survivors in the United States continues to increase. A review article quoted that there were 2.5 million breast cancer survivors in the United States in 2012 and showed the number expanded to 3.4 million in 2015. This is happening because of improved early detection, improved chemotherapy options both during treatment and after treatment is completed, and a better understanding of hereditary breast cancer with the use of proactive “prophylactic” surgeries. If breast cancer is detected before menopause, we know there is an increased risk of a second cancer whether it is in the same breast in the same location (considered a recurrence) or in a different location in the same breast or in the opposite breast (considered a second primary cancer) over that patient’s lifetime. Why is this? Again, as I said before, one of the biggest risk factors is age. Increasing age will increase the risk of cancer. The percentages of recurrence or, a second primary cancer, is difficult to pin down. We know that one in five women will develop either a recurrence or, a second primary cancer, after completion of five years of post-treatment adjuvant therapy (tamoxifen for example). Recurrence rates are related to:

  • The initial stage of cancer (how far it had spread)
  • The type of breast cancer or grade (what the cells look like or what part of the breast tissue is involved)
  • The family history or presence of a gene associated with increased risk
  • Other treatment related factors such as radiation therapy
  • Post treatment anti-estrogen therapy
  • The use of granulocyte colony-stimulating factors (such as Neupogen™, Granix™ etc.) during treatment

BUT NOW let’s talk about what we know that reduces the risk of recurrence!  Increasing good carbohydrates (fruits, vegetables, legumes, beans/lentils, whole grains, and natural soy products) and good fats (flaxseed, omega-3 fatty acids and nuts) are associated with improved survival. (Conversely, decreasing animal protein such as beef and pork along with trans-fats used in fried food will decrease your risk.) Increased exercise of 30 minutes five days a week is protective. Stress management techniques such as heart rate variability training (HeartMath™), meditation and decreasing body weight to less than 30 kg/m2 is protective. Avoiding tobacco use completely (both smoking and “vaping”) and limiting alcohol consumption to one drink/day is also protective.

  • Are there any symptoms to watch for?

Screening for breast cancer comes down to knowing your body and taking advantage of the technology that exists for screening. Watch for a lump in the breast or chest wall or armpit area. I often use the analogy of a grain of rice dried and stuck to the countertop when I teach women to detect their own cancer with their fingertips. Cancer is often (but not always) fixed or “stuck”, irregular to touch and associated with a skin dimple where it is pulling on the supportive ligaments of the breast. Nipple retraction, nipple discharge either clear or bloody, redness, scaling or thickening of the nipple can also be found. A rash on the breast that is unresponsive to antibiotics should be evaluated. Symptoms of recurrence can be new-onset localized bone pain, persistent chest pain, persistent cough, persistent abdominal pain, unintended weight loss, persistent headache, personality changes, new-onset seizures or loss of consciousness.

  • Does contracting breast cancer before menopause increase the risk of getting it again after menopause?

The short answer is yes. Cancer incidence increases with age – likely due to a cumulative effect of cell damage and less efficient repair. See the survivorship answer in question seven…

Breast cancer rates are increasing. Why? Is that for both pre and post- menopausal women?

 Actually, the risk of being diagnosed with breast cancer in the United States began decreasing in the year 2000 after increasing for the previous two decades. The risk dropped by 7% from 2002 to 2003. One theory is that this decrease was partially due to the reduced use of hormone replacement therapy by women after the results of the large study called the Women’s Health Initiative that showed a connection between hormone therapy use (specifically conjugated equine estrogen or Premarin™ and synthetic progestagens Provera™) that was published in 2002.  Reasons for the increased rates in the 1980’s and 90’s is likely related to improved screening techniques and increased numbers of women receiving screening.

  • Is post-menopausal breast cancer hereditary?

Although post menopause breast cancer can be hereditary about 10% of the time, most women with a genetic mutation causing breast cancer develop the tumor statistically earlier in their lives.

I am very grateful to Claudia for her thoughtful answers to some of the most pressing questions women have regarding breast cancer. I hope you have found them helpful, I know I have.

Until next time…Be Vibrant!

Great Information on Breast Cancer Prevention

We ride the Pink Wave and talk about breast cancer, and I hope not to rehash the same old lettuce. We will begin by answering some of the most frequently asked questions by women 55+. Since I am a gerontologist, and breast cancer is not an area I can speak about with authority, I went to an expert in the field, Dr. Claudia Harsh.

Claudia Harsh, MD is board certified in ob-gyn, was fellowship trained in integrative medicine through the University of Arizona and is trained in medical acupuncture through the Helms Medical Institute. She retired from Texas Oncology at the Sammons Cancer Center in Dallas, Texas working in gynecology surveillance and survivorship.

Here are some of the most frequently asked questions about breast cancer at mid-life.

Q: Can a woman get breast cancer from going through menopause?

Dr. Harsh: I think this question is asking: does menopause increase our risk of getting breast cancer?

We know that our risk of breast cancer increases as we age. About 95% of breast cancers occur in women over age 40. We also know our lifetime risk of getting breast cancer is 1 in 8 but if we break that down by decades it looks like this:

  •  At age 30 we have a 0.44% or a chance of 1 in 227
  •  By age 40, 1.47% or a chance of 1 in 68
  •  Age 50 means 2.38% or a chance of 1 in 42
  •  At age 60, 3.56% or a chance of 1 in 28
  •  And age 70 we see a 3.82% chance, or 1 in 26

But, these chances are averaged across all women of all ethnicities. Maybe the question we should be asking is “who doesn’t get breast cancer and why?” and that’s where a lot of the interest in lifestyle, medicine and nutrition, can help change the conversation and the risk numbers.

Q: I don’t have a family history of breast cancer. Why did I get it?

Dr. Harsh: About 10% of people who get breast cancer have a family history of the disease. (Or, put another way, 90% of people with breast cancer do NOT have a family history!)

We’ve known for years that some families have an increased risk of breast cancer and once we analyzed the human genome (the genetic “book of life” that resides in our cells – one half from our mother and one half from our father), the first gene associated with breast cancer was BRCA1. This was identified in the early to mid 1990’s and has been shown to be a gene that codes for proteins that repair damaged DNA. For this reason, it is known as a tumor suppressor: if there is a mutation in this gene, it is unable to repair damage and the cell can grow and divide without control and form a tumor.

This field of study is exploding with information – now there are dozens of genes that may impact our risk of breast, ovarian, endometrial or colon cancer (to name just a few!). Genetic counseling makes sense if cancer plays a strong role in your family. It is because of this that the term “previvor”[sic] has been developed for someone who found out they have a high risk genetic mutation and took proactive measures such as having a mastectomy or oophorectomy (removal of breasts or ovaries) to reduce their lifetime risk of the disease.

Q: What are the most important risk factors for breast cancer?

Dr. Harsh: Again, this is an area that is exploding with information. I mentioned before that our risk increases with age. This implies that there is a hormonal association (post menopause vs. pre menopause).

Another important risk factor is family history (genetic mutations) – accounting for approximately 10% of all breast cancers.

Mammographic breast density is a risk factor. Women with denser breasts (more ducts, glands and connective tissue) have an increased risk of cancer mostly because the tumors are harder to see on mammogram.

Personal history of breast cancer increases a woman’s chance of developing a recurrent cancer. Biopsy findings in the ducts can develop into cancer. Previous radiation therapy to the chest prior to age 30 for cancers such as Hodgkin lymphoma has been shown to be a risk factor.

Reproductive/menstrual history: Starting menstrual cycles before age 12 and/or concluding menopause after age 55 are both associated with an increased risk of breast cancer. Long-term use (more than 5 years) of postmenopausal hormonal therapy is associated with an increased risk of breast cancer.

Ethnicity may be a risk factor for breast cancer. To date more cancer is found in Caucasian women than in African American/black, Hispanic/Latina, Asian/Pacific Islander or American Indian/Alaska Native women. The degree to which this is due to increased screening in the white population is still being determined.

Research continues into sleep cycles and their association with breast cancer incidence, nutrition, vitamin and nutritional supplementation (especially Vitamin D), and stress management.

Q: How does age at menopause effect breast cancer risk?

Dr. Harsh: As mentioned before, our risk of breast cancer increases with chronologic age.

Two strong factors are likely the culprits here – increased cell DNA damage over time and a change in our hormonal production.

If we look at the hormonal question, we know that reproductive hormones estrogen and progesterone are produced by a woman’s ovaries and serve to stimulate cell growth in her breasts to prepare for nursing and her uterus to prepare for pregnancy. Anything that prolongs the duration and/or levels of exposure to this stimulation (late age at first pregnancy or never having given birth) increases breast cancer risk.

On the flip side, anything that shortens the duration of exposure (pregnancy or breast feeding itself for example) reduces breast cancer risks. There is a theory that breast feeding causes the cells in the breast to change or differentiate and they then become more resistant to becoming transformed into cancer cells.

Q: Will breast cancer show up in a blood test or in blood work?

Dr. Harsh: No. Although there are types of specialized testing that are designed to pick up circulating cancer cells, at this point there is no well-researched commercially available blood test to detect breast cancer.

Having said this, there are several measurements called “tumor markers” that can be checked in someone with a cancer diagnosis. Examples such as CA27-29 or CA125 are markers that can be elevated in some cancers. It is the standard of care to measure a variety of markers at the time of diagnosis to see if the blood tests can be used to mark the presence or recurrence of disease.

Similarly, some traditional blood chemistries such as calcium level, liver enzymes and electrolytes help point to the health of liver, kidneys and bone both at the time of diagnosis and throughout treatment.

In my next post we will return to answer more questions about breast cancer and some good news about prevention!

Until next time… Be Vibrant!