Virtually all women have fears about developing breast cancer; for women that have already been diagnosed with breast cancer in the past, there is significant worry about recurrence. There are simple and natural things that can be done to optimize breast health and reduce risk of breast cancer as well as reduce risk of recurrence. Breast cancer prevention starts with healthy habits and various factors that you can control! Most people do not realize that an excess of estrogen in the body, or poor balance of estrogen with progesterone, causes a higher rate of cell growth in breast epithelial cells as well as endometrium and prostate. I recommend that your hormones be tested and strategies implemented as follows to optimize breast health and to reduce your risk of breast cancer:
o ESTROGEN LEVELS: If your lab results show that estrogen levels are too high, I recommend pursuing estrogen reduction strategies. This includes improved nutrition, exercise, increased fiber in the diet, and adding appropriate nutritional supplements, as described below.
o PROGESTERONE: Always make sure that your estrogen levels are balanced with appropriate progesterone throughout your life. Progesterone is a natural anti-estrogen and also helps with safe estrogen clearance from the body. As has been shown in the worldwide literature for decades, estrogen dominance (low progesterone with respect to estrogen) significantly increases risk for development of breast lesions including cancers. It also increases risk of endometrial and other estrogen dependent cancers, Alzheimer's disease, cardiovascular disease, and stroke.
o TESTOSTERONE: Always make sure that your testosterone levels are at appropriate physiological level throughout your life. Physiologic levels of testosterone limit estrogen mediated mammary proliferation by reducing estrogen receptors on cells (Dimitrakakis C, Zhou J, Wang J, Belange A, LaBrie F, Cheng C, Powel D, Bondy C. A physiologic role for testosterone in limiting estrogenic stimulation of the breast. Menopause 2003 July-Aug:10 (4): 292-298).
o CORTISOL (STRESS HORMONE): Abnormalities in stress hormone (cortisol) levels impact breast cancer survival rates. Clinical studies have shown that flat adrenal cortisol curves predicts earlier mortality in metastatic breast cancer. Furthermore, elevated night time cortisol also has an adverse effect on breast cancer survival by suppressing the immune system resulting low NK cell counts and suppressed NK cell activity (Sephton SE, Sapolski RM; Kraemer HC; Spiegel D. Diurnal cortisol rhythm as a predictor of breast cancer survival J Natl Cancer Inst. 2000 June 21;92 (12): 994-1000). Stress hormone levels can be abnormal in a number of conditions, including psychological/situational stressors, inflammatory processes, blood sugar dysregulation, and sleeping disorders.
o VITAMIN D: Levels must be optimized for breast health. Breast cancer mortality rates in the U.S. vary according to the geographic region so that the highest rates are in the Northeast and urban areas, the lowest rates are in the south and rural areas. This is explained by the variation in sunlight and the subsequent Vitamin D production. Recent studies show that reduction of high estrogen (estradiol) levels can be obtained by taking Vitamin D (Vitamin D association with estradiol and progesterone in young women. In Cancer Causes Control. 2010 Mar;21(3):479-83). For optimum breast as well as thyroid health, a blood level of 60-80 is recommended.
o IODINE: Iodine is absolutely essential for appropriate metabolism of estrogens. If you are deficient, iodine should be replaced. Lab testing is needed to determine whether you are deficient, as adding iodine and causing excess iodine has detrimental effects.
o FERRITIN LEVELS: Ferritin levels commonly increase with older age. Ferritin is the storage form of iron; if it is too high it can increase risk for development of breast cancer by accelerating free radical damage. The level should be between 40 and 60; if it 100 or higher there should be treatment to correct this.
o PROBIOTICS: The type of intestinal microflora present in the gut play a key role in the levels of circulating estrogens in the body. Certain microflora act by deconjugating (freeing up) bound estrogens that appear in the bile, thereby permitting the free hormones to be reabsorbed by the intestine, back into the body, causing elevated hormone levels. (Rev Infect Dis 6(suppl 1):S85, 1984; N Engl J Med 307:1542, 1982). The same effects occur in men, raising testosterone levels. By changing the microflora with use of probiotics, more estrogen is excreted in the feces, resulting in less estrogen in the body.
o NUTRITION: Consume as many fruits and vegetables as possible. The "superstars" for breast cancer protection include all cruciferous vegetables (broccoli, cabbage, brussels sprouts, cauliflower); dark leafy greens (collards, kale, spinach); carrots and tomatoes. The "superstar" fruits include citrus, berries, and cherries. A low glycemic, high protein, high fiber diet will decrease risk of chronic diseases and cancers. There should be a strong effort to reduce or eliminate processed foods and refined starches and sugars, and to completely eliminate high fructose corn syrup. These items will trigger hormonal changes including insulin spikes that can promote cellular growth in breast tissue. Fats are an important part of the proper diet, but fats should be natural fats (found in plants and animals) and should exclude trans fats and saturated fats. The best and healthiest fats are monounsaturated oils (canola, olive oil, nuts/seeds, avocados) and omega 3 fatty acids (oily fish: salmon, tuna, mackerel, sardines, lake trout, herring). Minimize consumption of omega-6 fats (sunflower oil, soy oil, margarine, safflower oil, corn oil, cottonseed oil).
o XENOESTROGENS: Reduce consumption of synthetic and environmental estrogens (xenoestrogens). Pursue an organic diet high in fruits and vegetables, as organic products help to reduce consumption of environmental estrogens. Consume only organically grown meats, if at all possible, and reduce consumption of red meats. Limit/reduce dairy products to prevent consumption of hormones in cows; consider organic dairy products especially milk, cheese, and butter. Do not take any pharmaceutical (synthetic) estrogens in any form. This includes Premarin and Prempro (Wyeth Pharmaceuticals) and oral contraceptives. Try to avoid heating foods in plastic or Styrofoam containers. The plastics leech chemicals that activate estrogen receptors in the body. Use skin care products that certify that they are hormone-free or free of any animal by-products. Avoid vehicle exhaust and other forms of air pollution; research shows a link between breast cancer and exposure to polycyclic aromatic hydrocarbons. Avoid dry cleaning your clothes, as the cleaning detergent PCE is harmful to human health.
o PHYTOESTROGENS: Some plant products have estrogenic properties, such as soy, tofu, tempeh, edamame, roasted soy nuts, soy milk, and miso. These products are best avoided since their estrogenic properties can contribute to breast cellular growth. They also disrupt proper thyroid function and should NEVER be consumed if there is evidence of hypothyroidism (hypometabolism).
o EXERCISE: Exercise is an important and powerful factor in the reduction of cancer risk, and should be considered to be a powerful "drug". Many studies have shown that regular exercise provides a powerful protection against breast cancer. Make sure that you are participating regular exercise, which is absolutely essential to help your body metabolize estrogens appropriately, as well as optimize sensitivity of insulin receptors. The Department of Health and Human Services recommends at least 150 minutes per week of moderate aerobic activity, in addition to strength training exercises at least twice a week. If you are just starting a physical activity program, start slowly and build intensity gradually.
o METABOLISM OF ESTROGENS: Steer estrogen metabolism away from carcinogenic metabolites: There are natural supplements that can help to enhance estrogen metabolism. Indole-3-Carbinol (I3C) or Diindolylmethane (DIM) supplementation: A compound found in cruciferous vegetables, I3C forms the dimer DIM when it comes in contact with stomach acid. These compounds affect estrogen metabolism, shifting the breakdown of estrone and estradiol toward the less carcinogenic of their metabolites. These are also thought to induce CYP450, support apoptosis and have estrogenic receptor agonist and antagonist activity. Calcium D-glucarate: While I3C and DIM work to optimize estrogen metabolism, calcium d-glucarate works by reducing absorption of estrogen in the intestine, thus decreasing circulating levels.
o PREVENTION OF ESTROGEN REABSORPTION IN THE INTESTINES: The typical process of metabolizing and excreting estrogens in the human body involves metabolic conjugation in the liver, excretion into bowel contents, and eventual elimination via bowel movements. If the bowels move slowly or the patient has constipation, the transit time of the bowel contents is slow, and water and other compounds may be RE-ABSORBED into the blood stream before they are excreted in the feces. Estrogens can be easily reabsorbed and thus increased blood estrogen levels may occur. This can be easily remedied by increasing fiber and water consumption in order to speed up transit time of intestinal contents. The goal is to have at least one and preferably two bulky bowel movements per day; if you are experiencing less than this, you should consider increasing your fiber intake. The recommended water intake per day is approximately 64 to 72 oz. per day. There are many helpful fiber supplements available. If needing to increase fiber, consider Ortho Molecular's Fiber Tablets. DO NOT use laxatives.
o ESTROGEN METABOLISM IN LIVER: Enhance estrogen metabolism by being kind to your liver. Eliminate alcohol and caffeine consumption. Alcohol is the most well established dietary risk factor for breast cancer. The Harvard Nurses' Health Study, along with several other studies, has shown that consuming more than one alcoholic beverage per day can increase breast cancer risk by as much as 20% to 25%. Additionally, excess weight results in fatty liver and reduced liver function.
o BODY WEIGHT AND OBESITY: Strive to maintain a healthy body weight (BMI less than 25) throughout your life. Weight gain in midlife has been shown to significantly increase the risk of post menopausal breast cancer. The most common way estrogens are synthesized in the body is from conversion of androgens to estrogens in fat tissue by the action of enzyme AROMATASE. So, to reduce estrogens, simply LOSE FAT (LOSE WEIGHT!!) I strongly recommend starting the day with a very large protein meal, or with a protein shake; for example Glycemic Foundation (Ortho Molecular). This product has many benefits, including low glycemic index (does not cause a rapid increase in blood sugar or insulin); high protein (maintains blood sugar at a steady level for hours; no sudden drop that leads to hunger, sugar cravings, fatigue/sleepiness, etc), and high fiber (increases rate of movement of bowel contents, decreases constipation, decreases re-absorption of estrogens and other undesirable compounds from the intestinal contents).
o NATURAL AROMATASE INHIBITORS: Aromatase is the enzyme that converts androstenedione to estrone and testosterone to estradiol (so is converting androgens to estrogens). Several natural products such as bioflavonoids including chrysin, luteolin, and resveratrol have been shown to partially block the action of this enzyme, therefore reducing the production of the estrogens. (In patients with estrogen receptor positive breast cancer, the prescription aromatase inhibitor Arimidex is used)
o BRA WEARING HABITS: In a study done by Singer and Grismaijer in 1995, 3 out of 4 women studied who wore a bra for 24 hours a day developed breast cancer, versus 1 out of 168 who wore a bra rarely or never. The bras do NOT cause the cancer initially, however they can restrict the flow of lymph fluid within the breast tissue, thereby hindering the normal cleansing process of the breast tissue.
o GENETIC TESTING: Having a family history of breast cancer may increase your risk. If an immediate female relative in your family has had breast cancer, it is important to let your doctor know. Studies have shown that breast cancer can be genetic. Genetic testing and counseling is available for those concerned with their risk.
o SELF BREAST EXAM: Be vigilant about breast cancer detection. If you notice any changes in your breasts, such as a new lump or skin changes, consult your doctor for an evaluation.
o BREAST THERMOGRAPHY INSTEAD OF BREAST MAMMOGRAPHY: This has emerged as a much safer alternative to the radiation of mammograms. Thermography (Digital Infrared Thermal Imaging) creates images that illustrate heat patterns in the breast. The thermal images are analyzed by board certified radiologists for abnormalities which may be signs of disease and/or inflammation in the breast. It is important to note that the U.S. Preventive Services Task Force issued new guidelines in 2009, which states that there is NO recommendation for women under the age of 50 to undergo routine mammograms unless there are underlying risk factors. There is NO demonstrable benefit for women in this age group. A single mammogram exposes a woman to the same amount of ionizing radiation exposure as 1000 chest xrays. Ionizing radiation as been well documented to be a significant cause of cancer induction. Furthermore, mammograms produce a significant number of false positive results as well as false negative results.
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