When it comes to breast cancer, leading science is redirecting our race for the cure to a journey of prevention and risk modification.
Breast cancer results from uncontrolled growth of breast cells. About one in eight Canadian women will develop invasive breast cancer over the course of her lifetime. Only 20 per cent of women diagnosed with breast cancer have a family history of breast cancer and known gene mutations (such as BRCA1 and BRCA2) account for only five to eight per cent of cases. This means that most breast cancers occurs in women without a family history.
Women living in the U.S. have a ten-fold greater risk of dying from breast cancer as compared to women living in Thailand. When women migrate from areas with a low incidence of breast cancer (i.e. Asia) to North America their breast cancer risk increases. These facts suggest that environment, diet and lifestyle play an important role in shaping risk and combine with our genetic predispositions to determine our health, aging and risk of chronic disease and cancer.
Breast biology is largely determined by hormonal and tissue factors. Estrogen is the dominant hormonal signal stimulating the breast and in more differentiated cancers the most common hormonal trigger for metastatic spread. Other tissue factors such as inflammation and injury (chemical, physical or radiation) can also increase risk.
The transformation of a normal breast cell to a cancer cells often proceeds the diagnosis by seven years. During this critical window, early breast cancer remains below the detection limit of our screening tests such as mammograms and physical exam. But in the early subclinical stage, there is the greatest possible impact of risk reduction and prevention through hormone balance, estrogen metabolism and detoxification support and anti-inflammatory, anti-oxidative therapy.
The following six steps provide a complete plan for breast healthy living:
1. Balance your hormones
Through the menopause transition hormone levels fluctuate. In peri-menopause, estrogen increases while progesterone, which blocks estrogen's stimulatory effects, decreases. Unopposed estrogen is a potent stimulator of breast tissue and linked with hormone-sensitive breast cancer.
After menopause, there is a shift in the type of estrogen produced in the body. Ovarian estrogen falls and estrone, an estrogen converted in fat tissue by an enzyme, aromatase, from testosterone becomes the predominant form. Estrone can have more toxic effects when it binds the estrogen receptor and increase the risk of breast cancer and stroke.
Maintaining hormone balance throughout the transition can support breast health. By maintaining a health body weight and consuming nutrients including omega3, green tea extract (EGCG), chrysin and flavonoids, you can support hormone balance. Prescription medications called aromatase inhibitors such as letrozole work in treating and preventing breast cancer by inhibiting this enzyme.
2. Detox your estrogens efficiently
Detoxification and inactivation of estrogens is a complex process that occurs largely in the liver. The first phase of estrogen metabolism involves the cytochrome reactions to increase water solubility for elimination. The 2/16 ratio compares favourable to unfavourable metabolites and when found to be low in premenopausal women has been linked to an increased risk of breast cancer.
Phase 2 detoxification involves conversion of estrogen metabolites into a form that can be excreted by the kidneys. Methylation is one of the most important phase 2 processes that aids in the elimination and inactivation of potentially toxic estrogen metabolites. Women who are poor methylaters may be at increased risk of breast cancer due to accumulation of toxic intermediaries.
Dietary factors found in cruciferous vegetables, such as kale and broccoli are known to improve the 2-16 ratio and phase 2 conjugation. Cruciferous consumption (unlike total fruit and vegetable consumption) has been associated with reduced risk of lung, colon and breast cancer. The effect is dependent on variations within human genetics and the presence of the ideal gut flora needed to activate the protective compounds.
3. Maintain a healthy body weight and shape
Deep abdominal fat is most toxic to the body as it is metabolically active and triggers inflammation. Fat also is the major source of estrone production following menopause. Women who gain more than 50 pounds from age 18 years have double the risk of breast cancer after menopause. Whereas, women who lost weight after menopause had a lower risk.
4. Exercise regularly
Regular aerobic exercise reduces insulin resistance and body fat and independently can reduce the risk of breast cancer. Data from the Nurses Health Study has shown that even after a diagnosis of breast cancer, women who exercise enjoy better survival rates.
5. Avoid alcohol
Excessive consumption of alcohol is an important risk factor for breast cancer ranking after family history and obesity. Alcohol is a known liver toxin and impairs estrogen metabolism. Drinking more than three glasses per week increased the risk of breast cancer by five-fold in the Nurses Health Study.
6. Limit environmental exposure to xeno-estrogens and hormone disrupters
Over 85,000 chemicals have been produced and released into the environment since the end of the Second World War. Chemicals in industrial plastics, pesticides and herbicides (i.e. DDT) as well as colorants can bind to estrogen receptors. These hormone disrupters are called xeno-estrogens and have been linked to early puberty and breast cancer in women and infertility in men.
By consuming organically grown produce and reducing intake of red meat, which can bio-accumulate toxins, you can reduce your dietary exposure to xenoestrogens.
Regular screening for breast cancer enables early detection -- but not prevention. Screening mammograms have been shown to save lives. It is important to partake in regular screening programs involving mammograms every one to two years after menopause. But there is growing interest and demand for prevention.
Differing rates of breast cancer across the globe suggests lifestyle factors play an important role in shaping risk. Following this six-step breast healthy plan can help shape risk so as to prevent breast cancer. An ounce of prevention is worth a pound of cure.
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Understand your risk: We often hear the statistic about how one in nine Canadian women will develop breast cancer in her lifetime, but it doesn’t tell the entire story. About 11 in every 100 women in Canada can expect to develop breast cancer over the course of an entire lifetime, according to Rethink Breast Cancer, but that’s a period of 90 years. Only five per cent of breast cancer diagnoses are in women under 40 in Canada. And even those with particular risk factors aren’t guaranteed to get the disease — it just means that their overall risk is higher than for those without those factors.
Men can get it too: Most cases of breast cancer are diagnosed in women, but the disease can occur in men as well. The disease is rarer, according to the Mayo Clinic, and most likely to occur in older men. It is often diagnosed at a more advanced stage because men are reluctant to have changes in the breast investigated or think they cannot get breast cancer, the Mayo Clinic says, so any of the signs of changes that would apply to women should be investigated in men as well.
Watch for lumps: The most common first symptom of breast cancer is a lump in the breast, according to the Canadian Cancer Society, and that is usually found by the patient themselves. However, sometimes a mammogram will find a lump before it can be seen or felt without a scan.
But know not all lumps are created equal: Not every lump in the breast is a sign of a problem, even if you aren’t prone to lumpy breasts. According to the Canadian Cancer Society, those that are most concerning are lumps that are present all the time and ones that don’t shrink or go away with the menstrual cycle. You should also look out for lumps that can’t be moved (they may feel attached to the skin or chest wall), lumps that feel hard or irregular or somehow quite different from your breast tissue, and lumps that are tender but not painful.
Don’t just pay attention to your breast: Sometimes a lump indicating breast cancer shows up first in the armpit and not the breast itself. When found in the axilla, these lumps can be small and hard and may indicate that the cancer has spread to the lymph nodes, according to the Canadian Cancer Society.
Look for skin changes: Sometimes problematic changes within the breast show up visibly on the breast skin. "There are skin changes that can be seen in breast cancer,” says dermatologist Dr. Tsippora Shainhouse. "In particular, inflammatory breast cancer, a rarer, quick-spreading, aggressive version (up to five per cent of breast cancers) may not present as a lump of tumour, but rather with specific skin changes caused by invasion, inflammation, and blockage of lymph vessels and lymph nodes,” she says. Some of these changes include peau d’orange, a skin puckering that looks like an orange peel; a pink/red/purple area that is not painful but won’t heal; an area that feels hot as if infected; or breast or nipple itching that isn’t relieved by normal anti-itch medications or creams.
Check out unilateral changes: If something changes in one nipple and not the other, that could be an indication of a problem in one breast, Shainhouse says. “Inverted or inward-turned nipples can be normal, but if one nipple suddenly inverts, you must get examined,” she says. By the same token, sudden asymmetry between the breasts — for example, a lump or a rapid increase in size in one breast — should be checked out as well. Breast asymmetry is perfectly normal, but a new change in one breast is not.
Is nipple discharge a problem?: The appearance of discharge from the nipple can be alarming, but it’s not necessarily a sign of cancer, the Canadian Cancer Society says. Most of the conditions that cause nipple discharge are benign, but discharge that is blood stained or comes only from one nipple should be investigated. Crusting, ulcers, or scaling on the nipple can be a sign of some rare types of breast cancer, the society says.
Pregnancy doesn’t rule out examination: If you’re pregnant, Cancer.org notes, and see something that seems unusual, don’t hesitate to get it checked out. "Breast cancer can develop in pregnancy and often can be evaluated and even treated during or immediately after pregnancy,” Shainhouse says. "It is safe to get a breast exam and even mammogram in pregnancy, if needed."
Breast cancer and trans people: Research released in 2015 found that trans people don’t appear to have a higher risk of developing breast cancer, despite the use of hormone therapy. That’s good news, but it’s still important for trans individuals to discuss their individual risk profiles with physicians and determine their best plan for screening, the same as everyone else, Fenway Health notes.
Later-stage symptoms: There are several symptoms that are potentially signs of breast cancer that has grown larger or spread to other parts of the body, the Canadian Cancer Society says. If you have these symptoms without known cause, get them investigated: bone pain, nausea, loss of appetite, unexplained weight loss, jaundice, shortness of breath or cough from fluid build-up around the lungs, headache, double vision, or muscle weakness.
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