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Breast Cancer – What can be done to reduce your risk?

Breast Cancer – What can be done to reduce your risk?

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Breast cancer results from uncontrolled growth of breast cells. About 1 in 8 Canadian women will develop invasive breast cancer over the course of her lifetime. Only 20% 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 5 to 10% of cases. This means that most breast cancer occurs in women without a family history.

Women living in the US have a 10-fold greater risk of dying from breast cancer than do women living in Thailand. When women migrate from areas with a low incidence of breast cancer (i.e. Asia) to the US their, breast cancer risk increases. These facts suggest that environment, diet and lifestyle play an important role. Unlike gender and age, these modifiable risk factors can be controlled by; maintaining a healthy weight, diet, regular exercise, restoring hormone balance, avoiding alcohol, and avoiding environmental toxins that can serve as transforming agents for breast cancer (i.e. xenoestrogens and carcinogens).

The following is a list of scientifically based interventions to reduce your risk of developing breast cancer.

Recommend dosagesRestore Hormone Balance

The phase prior to menopause (lasting 5 to 7 years) is marked by increasing levels of estrogen and falling progesterone as the ovarian follicles are no longer capable of producing efficient ovulation. As well, there is a significant shift in the balance of the three forms of estrogen as menopause approaches with falling levels of estriol (E3) and estradiol (E2) and increasing levels of estrone (E1). E1 continues to be made in postmenopausal women as it is converted in fat tissue and the adrenal glands. The surplus of E1 and low levels of protective progesterone are major contributors to the rise in breast cancer after menopause.

Recommend dosagesOptimize Estrogen Metabolism

Estrogens are broken down by the liver and tissue into three major metabolites -two of which have potent activity at the estrogen receptor and are both mutagenic and carcinogenic to the breast. A high “2/16 ratio” of favourable metabolites (2hydroxy-estrone) to toxic metabolites (16hydroxy- estrone) is considered protective and can be enhanced through nutritional factors that optimize the hydroxylation of estrogen. Factors that can increase the 2/16 ratio include:

  • cruciferous vegetables
  • indole 3-carbimole (400mg)
  • di-iodomethionine (DIM)
  • soy
  • flax
  • rosemary
  • vitamin D3

The supplement from femMED, Breast health containing indole-3 carbinol, milk thistle extract, calcium-D- glucarate, Schizandra chinensis fruit extract, stinging nettle, lignans and vitamin D recently underwent a double-blind, placebo-controlled clinical trial. Researchers were pleasantly surprised to discover consumption of the femMED supplement significantly increased the mean urinary concentration of 2- OHE in pre- and post-menopausal women (by 110% and 88%, respectively), suggesting a risk- reducing effect. The Breast Health supplement was well-tolerated, and displayed no adverse side effects. The study was published in Breast Cancer: Basic and Clinical Research.

Recommend dosagesEnhance Elimination of Toxic Estrogen Metabolites

Phase 2 detoxification involves methylation and glucuronidation to enhance elimination and inactivate toxic estrogen metabolites. Phase 2 detoxification requires many important enzymatic pathways (sometimes affected by gene mutations) and nutrients such as vitamin B6, B12 folic acid, magnesium, glyceine, as well as a healthy working gastrointestinal tract. Fatty acid balance and mitochondrial function are critical to these processes and can be optimized through nutritional supplements such as omega 3 (DHA/EPA) and co-enzyme Q 10 found in femMED Heart Health.

Recommend dosagesDecrease Aromatase Activity

After menopause, the ovaries no longer produce estrogen (E2). Instead, post-menopausal estrogen is converted from androgens by an enzyme called, aromatase predominantly in fat tissue. Fat derived “estrone” is a potent stimulator of breast tissue and tightly binds to estrogen receptors. It is strongly associated with breast cancer. Losing weight decreases estrone production. Aromatase activity is inhibited by flax, green tea extract (EGCG), vitamin C, chrysin and flavinoids. Prescription medications such as letrozole also block this enzyme.

 

Lifestyle Interventions

 

Recommend dosagesMaintain a Healthy Weight

Carrying an extra 10 pounds of body fat after age 30 increases the risk of breast cancer by 25%. Fat is metabolically active and the major source of estrone following menopause. Maintain a healthy body weight (BMI less than 24) and avoid eating excessive dietary animal fat (less than 20% of daily calories).

Recommend dosagesExercise regularly

Regular 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 have better survival rates.

Recommend dosagesAvoid Alcohol

Excessive consumption of alcohol is one of the most important risk factors for breast cancer following family history. Drinking more than 3 glasses per week increased the risk of breast cancer by 5-fold in the Nurses Health Study.

Recommend dosagesConsume plenty of Fruits & Vegetables

Cruciferous VegetablesFruits and vegetables are rich in anti-oxidants (vitamin A, C, E and selenium). The more colourful -the better. Anti-oxidants reduce free radical damage to DNA. Cruciferous vegetables contain indole-3-carbinol, which increases the 2/16 ratio by aiding in estrogen metabolism. Consuming at least 3 servings daily of broccoli, nappa cabbage, cauliflower, brussel sprouts, and kale or using a dietary supplement like femMED Breast Health can correct the ratio.

Recommend dosagesEat Organic

Industrial pesticides (DDT, lindane) and colorants (Red Dye#3) can bind to estrogen receptors and are linked with breast cancer. Consuming organically grown produce to avoid these pesticides and toxins is recommended. Furthermore, commercial livestock is often treated with hormones that can stimulate the breast. Selecting organic meat and dairy can help avoid these hormones.

Recommend dosagesAvoid industrial plastics/chemicals

Bisphenol-A (banned in Canada in 2010), polystyrene and other compounds present in plastic food packaging and bottles binds to estrogen receptors and are carcinogenic. Use glass cookware for microwave heating foods. Use hair dyes with caution as some of the chemicals used in hair dyes are known carcinogens. The scalp is more absorbent than the skin and chemicals in hair dyes can bind estrogen receptors. Several studies have shown an increased risk of breast cancer with regular use of hair dyes.

Recommend dosagesManage your Stress

maintain mind-body balanceMind-body balance is critical to wellbeing and good health. Constant stress contributes to prolonged high cortisol levels which in turn impairs the function of our immune system. We are dependent on our immune system to detect and eliminate cells damaged by free radicals. It is not uncommon that a woman is diagnosed with breast cancer following a stressful life event such as divorce or death of a loved one. Stress reduction techniques include meditation, moderate exercise, tai chi and yoga and pleasurable activities such as enjoying a massage or bath.

There are many other factors that are emerging as risk factors for breast cancer including exposure to synthetic hormones such as those used in oral contraceptives and in menopause hormone therapy, tobacco smoking, direct trauma or injury to the breast and radiation.

Regular screening for breast cancer enables early detection (not prevention) and has been shown to save lives. It is important to partake in regular screening programs involving mammograms performed every 1-2 years after menopause.

Research suggests that by time breast cancer can be visualized by mammogram it has been developing for over 7 years. For this reason, it is important to utilize additional tools in conjunction with mammography to identify women at increased risk include ultrasound, thermography, evaluation of estrogen metabolism, and ductal lavage or nipple aspirate fluid collection.

While our understanding of the factors that transform healthy breast cells to cancer remains in its infancy, it is clear that much of the risk is amenable to interventions under our control. For too long, the focus of intensive research has been on the detection of breast cancer and not its prevention. Dr. Pearlman believes it is time to shift the focus and welcomes the opportunity to discuss how these recommendations can be used to empower you and protect you.

Dr. Jennifer Pearlman
Dr. Jennifer Pearlman is a medical doctor with a focused practice in the area of women’s health and wellness.

She is a NAMS Certified Menopause Practitioner certified by the North American Menopause Society (NAMS) and is attending staff physician at the Menopause Clinic at Mount Sinai Hospital in Toronto. Dr. Pearlman has been awarded a focus practice designation by the Ontario Medical Association to enable her to work as an expert consultant to other physicians in the area of women’s health.

Dr. Pearlman completed her medical school and residency training at The University of Toronto. She graduated with Honours and received numerous scholarships and awards.

Dr. Pearlman is an active member of the Canadian and Ontario Medical Associations, the College of Physicians and Surgeons of Ontario, and the College of Family Physicians of Canada. She is an active member of the North American Menopause Society (NAMS) and the American Academy of Anti-Aging Medicine (A4M) and is completing a Fellowship in Anti-Aging Regenerative Medicine (FAARM).

Dr. Pearlman is passionate, approachable, caring and committed to enhancing the life of midlife women. Offering the best of both conventional and integrative approaches, Dr. Pearlman helps her patients achieve optimal health and wellbeing.

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