October is Breast Cancer Awareness Month, which is a good time to evaluate certain risks, lifestyle factors and habits that can impact breast health.
In honor of Breast Cancer Awareness Month, I'd like to take the next two weeks to discuss breast health. The occurrence of benign breast lumps, cystic diseases of the breast and breast cancer are rising. Perhaps as many as one in five women will develop breast cancer, and the number may be as high as one in three in heavily populated areas.
Medical literature has identified many risks for breast cancer, including oxidative stress (free radical damage), poor nutrition, obesity, chemical contaminants in food and the environment, smoking, alcohol, hormonal factors, pollution, electromagnetic radiation, diminished immunity and genetic risks. There is no doubt that many of these risks can be impacted favorably by healthy lifestyle, including good nutritional practices.
Taking care of breast health is a lifelong commitment for women, and regular self breast examination is absolutely crucial. Being self-aware of body structures, including the breasts, is an important initiative for women. In fact, women can benefit from keeping a personal record of self-examination of their bodies, including their breasts.
Vigilance and self-examination are so important because early detection of breast cancer can lead to a better outcome of treatment. Women are encouraged to follow the American Cancer Society's guidelines for breast cancer prevention. These guidelines involve monthly self-examination with an annual physical exam for women 20-39 years of age, and an annual mammogram and physical exam for women over 40. A family history of breast cancer often causes a need for more stringent monitoring of breast health.
Identifying Breast Cancer Risks
Table 1. below provides an overview of the major identifiable risk factors for breast cancer.
|Age||Older women have a higher risk.|
|Body type||"Apple shape" (extra weight in the upper body and stomach), as opposed to "pear shape" (extra weight in the hips and thighs), increases risk.|
|Diet||Poor diet (high in fat, low in fiber, deficiency of vitamins A, C, E and selenium) increases risk.|
|Heredity||Risk is greater for women whose mothers, sisters or aunts have a history of breast cancer.|
|Marital status||Women who have never married are at higher risk.|
|Menarche||Early menarche (prior to age 12) increases risk.|
|Menopause||Late menopause (after age 55) increases risk.|
|Motherhood||Never having given birth, or having a first child after age 30, increases risk.|
|Nationality||Women born inor have a higher risk. Recent trends indicate increased breast cancer occurrence in women of Hispanic, Asian and African descent.|
Table 1: Factors identified to increase risk of breast cancer.
Body type "Apple shape" (extra weight in the upper body and stomach), as opposed to "pear shape" (extra weight in the hips and thighs), increases risk.
Diet Poor diet (high in fat, low in fiber, deficiency of vitamins A, C, E and selenium) increases risk.
Heredity Risk is greater for women whose mothers, sisters or aunts have a history of breast cancer.
Marital status Women who have never married are at higher risk. Menarche Early menarche (prior to age 12) increases risk.
Menopause Late menopause (after age 55) increases risk.
Motherhood Never having given birth, or having a first child after age 30, increases risk.
Nationality Women born in or have a higher risk. Recent trends indicate increased breast cancer occurrence in women of Hispanic, Asian and African descent.
Some food scientists and researchers believe that all risk factors put together may not exert as much influence on breast cancer risk as good nutrition. The type of diet known to support breast health has multiple other health benefits, including the promotion of cardiovascular health. This healthy diet is low in saturated fat, high in omega-3 fatty acids (such as fish oil), high in fiber, nutrient-dense, and low in calories and simple sugars. It also must incorporate certain protective substances, such as antioxidants and other plant compounds found in fruit, vegetables and soy.
The wise woman must avoid the potential carcinogens in her environment. Some of these sources are summarized in Table 2.
|Alcohol||Consuming more than nine drinks per week is associated with increased risk of breast cancer.|
|Aflatoxins||Often found in moldy nuts, seeds and grains.|
|Burned proteins||From charred meats off the grill.|
|Cyclamates||Including artificial sweeteners such as saccharin.|
|Coal-tar-based food colorings||Also found in some cosmetics.|
|DDT||A pesticide banned in the U.S., but still used in other countries.|
|DES||Diethylstillbestrol, a synthetic estrogen.|
|Formaldehyde||An industrial solvent used in rugs, plastics and new clothing.|
|Nitrates and nitrites||Found in prepared foods such as hot dogs, bacon and lunch meat.|
|Pesticides||The Environmental Protection Agency identifies more than 60 pesticides as potential carcinogens.|
|Radiation||Low doses from environmental sources can accumulate in the body.|
|Smoked foods||Including bacon, ham, fish and cheese.|
|Tobacco||Smoking or second-hand smoke.|
Table 2: Potential carcinogens (cancer-causing agents).
Aflatoxins Often found in moldy nuts, seeds and grains.
Burned proteins From charred meats off the grill.
Cyclamates Including artificial sweeteners such as saccharin.
Coal-tar-based food colorings Also found in some cosmetics.
DDT A pesticide banned in the U.S., but still used in other countries.
DES Diethylstillbestrol, a synthetic estrogen.
Formaldehyde An industrial solvent used in rugs, plastics and new clothing. Nitrates and nitrites Found in prepared foods such as hot dogs, bacon and lunch meat.
Pesticides The Environmental Protection Agency identifies more than 60 pesticides as potential carcinogens.
Radiation Low doses from environmental sources can accumulate in the body. Smoked foods Including bacon, ham, fish and cheese.
Tobacco Smoking or second-hand smoke.
Dietary supplements are not to be used to treat or prevent any disease and discussions about the nutritional management of breast cancer must conform with this legality stated in the U.S Dietary Supplement and Health Education Act of 1994 (DSHEA, 1994). Thanks to emerging research, the power of nutrition in the management of breast health is becoming increasingly apparent. Part 2 of this newsletter published in Breast Cancer Awareness Month will focus on some modern concepts on the use of nutrition for breast health.
The promotion of breast health is a key public health initiative in the U.S. However, current breast cancer prevention strategies have some disadvantages and limitations. These strategies depend on early diagnosis and intervention, which may not always be possible through manual breast exams or mammograms. Fortunately, new strategies have shown promise for earlier and more accurate diagnosis or prediction.
It's been stated that overall breast cancer risk may be closely related to lifetime exposure to estrogen. Estrogen is made by the body (as estradiol, estrone and estriol), and its metabolic pathways are complex. Certain types of estrogen appear to be more "friendly" for health in comparison to others. Estradiol is the type of estrogen that is most often linked to breast cancer risk. In addition, exposure to synthetic chemicals in plastics and other consumer goods can flood the body with xenoestrogens, which are foreign and potentially hazardous types of estrogens.
There are many natural plant substances that have weak estrogenic activity, including soy isoflavones, certain lignans and red clover flavonoids. However, these natural substances are examples of biological response modifiers, not just simple estrogens. There is much misinformation broadcast about plant phytoestrogens. Soy isoflavones (genistein, daidzein and glyceitin) can downregulate effects of naturally occurring estrogenic hormones or xenoestrogens, especially in states of estrogen excess; and they can upregulate estrogenic stimuli in states of estrogen deficiency. Therefore, soy isoflavones are best perceived as substances that promote the body's normal estrogen balance.
A comprehensive review of medical literature shows that soy foods are associated with breast health support. These matters are discussed in detail in two of my books ("The Soy Revolution," Dell Publishing, NY, 2000 and "Soya for Health," Mary Ann Liebert Publishing Inc, NY, 1996, or available at www.stephenholtmd.com).
A useful baseline support regimen for breast health is to use multivitamins, supplemented with powdered extracts of fruit, vegetables, berries and greens. The phytochemical content of this regimen provides potential protection by antioxidant actions, inactivation of carcinogenic chemicals and inhibition of enzymes that encourage cancer growth. The most notable phytochemicals with protective effects include: carotenoids, flavonoids, indole-3-carbinol, sulforaphane and D-glucaric acid.
The incorporation of good dietary fats also plays a major role in breast health. Omega-3 fatty acids and omega-9 fatty acids appear to have protective benefits. Flax seed contains precursors of valuable essential fatty acids, but benefits are most likely related to fiber or lignan content. Flax is not a sufficient source of active omega-3 fatty acids, which are present in flax only in precursor forms. As little as two percent of precursor forms of omega-3 fatty acids are converted to active fatty acids such as eicosapentoic acid (EPA). Active omega-3 fatty acids are best taken in enteric-coated fish oil capsules, for enhanced absorption and reduced gastrointestinal side effects.
Phytochemicals with antioxidant actions are also ideal for use in synergistic formulations to promote breast health. My recommendations for evidence-based synergistic supplement approaches include: ellagic acid, Wakame seaweed, lycopene, bioflavanoids, garlic, green coffee been and green tea polyphenols, resveratrol, sulforaphane, evening primrose oil, Panax ginseng, calcium D-glucarate, flax seed, indole-3-carbinol, Maitake mushroom and turmeric.
I want to make it clear that antioxidants tend to work in a synergistic (additive) manner, and I recommend the use of mixed antioxidant preparations for health and longevity. Some of these matters were discussed in an earlier newsletter ("Antioxidant Combinations: Crucial for Health," available at www.holthealthnews.com).
Finally, internal detoxification is another important approach to maintaining breast health, especially for individuals living in geographic locations with a high occurrence of environmental contamination. The increasing industrialization of third world countries is occurring with questionable control of environmental toxins.
This newsletter may overwhelm the layperson in some areas, but I cannot simplify matters at the risk of distorting information. I hope my readers understand the complexities of discussions about the wide-ranging beneficial effects of nutrition on health and well-being. That said, I must make a strong disclaimer statement again that dietary supplements are not to be used to prevent or treat disease. This column contains third party literature allowed under DSHEA 1994, and it is not meant to support the use of any specific dietary supplement, nor is it to be perceived as part of any labeling statement.
The opinions I express may not be the same as those of other medical practitioners, and I strongly advise anyone with breast disease or concerns about breast health to visit his or her own healthcare practitioner for advice. I do not wish to provide information that will interfere with any healthcare practitioner/client relationship. I am not providing treatment advice, but I welcome you to share this information with any healthcare provider, and I respect the opinions of my colleagues. The purpose of providing references in this article is to help demonstrate that there is evidence to support some of the statements I have made. All consumers of dietary supplements must respect the rules and regulations that govern the use of non-prescription dietary supplement products. My books are available at www.stephenholtmd.com.
Stephen Holt, MD is a Distinguished Professor of Medicine (Emerite) and a medical practitioner in New York State. He has published many peer-review papers in medicine and he is a best-selling author with more than twenty books in national and international distribution. He has received many awards for teaching and research. Dr. Holt is a frequent lecturer at scientific meetings and healthcare facilities throughout the world. He is the founder of the Holt Institute of Medicine (www.hiom.org) and www.stephenholtmd.com
Stephen Holt, MD