Preventing Breast Cancer: Your 8-Step Personal Action Plan


Angelina Jolie, in her Op-Ed column in The New York Times, disclosed that she had a prophylactic double mastectomy. Jolie is the carrier of the brca 1 gene which substantially increases a woman’s risk of breast and ovarian cancer, lost her mother to breast cancer, and did not want to subject her children to this same experience. She hits a nerve when she says that cancer is a word that “strike’s fear into people’s hearts, producing a deep sense of powerlessness.” How true.

Indeed, there is much to discuss about the political ramifications of breast cancer screening, including genetic testing, exaggerated breast cancer rates (the 1 in 8 women who will develop breast cancer in their lifetime is bandied about but this is actually not applicable across all ages; it applies to women over 65) and over-diagnosis, that was not effectively addressed in Jolie’s piece. Gilbert Welch addresses this topic in detail in his book Over-Diagnosed (though he is critical of breast cancer screening, he is not dismissive, and acknowledges that his wife had breast cancer). I do believe, that despite the limitations of her article, Jolie’s intention was a sincere desire to open up conversation about a difficult topic.

This article is not about the politics of breast cancer screening or diagnosis – it focuses solely on measures that are health promoting, possibly preventive of breast cancer, and which we can take into our own hands.

Worries About Breast Cancer

Few women are immune to worries about breast cancer. Most of us know someone who’s had it – some among us have grandmothers, mothers, aunts, or sisters who died of breast cancer. If we haven’t been touched by it directly, we are all affected indirectly by anxiety provoking advertisements that remind us that we should have breast cancer screening, reminders of this at the doctor’s office, or in articles, such as Jolie’s. We internalize the picture that our breasts are not safe places. Certainly the worry has crossed most of our minds at least once. Jolie’s story has, no doubt, led to a flurry of women calling their doctor’s office for appointments for genetic counseling and screening which, for most is unnecessary, and for some, unaffordable.

I am also not immune to worry about breast cancer. I discovered a lump in my own breast not long ago. I tracked it for enough time to know that it wasn’t changing in size with my monthly cycle – which is not a good sign. So although it was tender, mobile, and regular in shape under my frequently probing fingers during self-exams – all signs that tell a physician that this is much more likely to be a cyst than cancer – the fact that it was not fluctuating in size made it suspicious. I went to an ob-gyn colleague who was also concerned and immediately referred me to a breast surgeon. “Immediately” though, actually meant a 2-week wait until my appointment. It was one of the most terrifying two weeks of my life. I imagined the worst – getting the news that I had breast cancer and how I would react, telling my husband and children, the treatment, possibly dying – if you’ve been there, you know. I barely breathed for 2 weeks.

During that 2-week wait I took some comfort in the thought that if the ob-gyn were really worried I’d have gotten an appointment “stat” (what we say in medicine when we mean ‘do it yesterday’). Unfortunately, though, such delays and long waiting periods filled with anticipation and worry are common for women waiting for a diagnostic procedure appointment – or awaiting the results of one – a potential peril of routine breast cancer screening.

I also took some comfort in knowing I have no family history of breast cancer, convincing myself that this somehow mitigated my risk. There is no cancer in my family at all, in fact, except my grandfather who died of lung cancer after a life of heavy cigar smoking. Cancer becomes less scary when we can justify to ourselves that there was a causative factor, and check that off the list if we don’t have that habit. Like smoking and lung cancer. It’s that same feeling when we discover that a random act of violence wasn’t actually random – that it was targeted with a motive. We can take ourselves off that uncertainty list.

Family History Does Not Mean No Risk

Most of us find relief in the thought that we have no major risk factors for breast cancer – no immediate family history, for example. But the reality is that most women (more than 9 out of 10) who develop breast cancer have no predisposing genetic risk, and 50% have no conventionally recognized risk factors at all, thus making it all the more terrifying a specter.

The vast majority of women who get breast cancer have NO genetic risk factors…Far too many women are already getting prophylactic mastectomies…The combination of Jolie’s celebrity and the current fear of breast cancer is a most unfortunate situation for most women. And yes — there are instances in which prophylactic surgery is indeed a sound choice. But they are very very rare. ~ Christiane Northrup

In fact, my protective factors were that I ate a healthy diet, didn’t drink alcohol, had my children at a young age, had breastfed practically ad infinitum, and my mother hadn’t taken DES nor had I had any known overt toxic environmental exposures – just the usual day-to-day exposures of living in a semi-toxic world.

I was lucky. An ultrasound ultimately revealed a cyst in my right breast and no further testing was needed. I stopped drinking the coffee I had become accustomed to using to get through the stressful, exhausting hours of residency and the lump promptly resolved. I also subsequently released some of the things (and people) in my life that weren’t making me happy and made some major life decisions during what turned out to be a mini-wake up call, because I know that unhealthy stress negatively affects immunity and immunity influences cancer.

Breast Cancer Prevention … Naturally

Jolie, because she is positive for the brca 1 gene and has a significant positive family history for breast cancer, chose, appropriately for her, to mitigate her high risk of developing breast cancer by having a preventative double mastectomy. Though always a complex decision medically and emotionally, she is past her childbearing and thus breastfeeding years, and the quality of life given by peace of mind that you’ll more likely be there for your kids is an argument winner for many women over keeping their breasts. I totally get this. Jolie will likely also have a bilateral ovariectomy as her risk of ovarian cancer is similarly increased as a carrier of this gene. But most women will not benefit from brca gene testing as most women do not have it, says the U.S. Preventive Services Task Force, in an updated draft recommendation on screening for brca-related cancer risk.

So how do the rest of us prevent breast cancer? Clearly a double mastectomy is not indicated for all of us with breasts – it is major surgery with attendant risks and most of us will never develop breast cancer and do not carry the brca 1 or brca 2 genes that increase breast cancer risk.

Yet we, too, are at risk. Are we just meant to be victims of what appears to be Nature’s Roulette? Absolutely not! While we don’t know exactly what causes breast cancer in any given woman, we do know that breast cancer is likely a complex interplay of genes, genetic damage, and immune health, all of which are influenced by lifestyle, diet, and our environment.

As Jolie says, “Life comes with many challenges. The ones that should not scare us are the ones we can take on and take control of.” While there is no “fool-proof” method of 100% preventing breast cancer, there are steps we can take to prevent it. We are not powerless in that we can make choices, as did Jolie, to protect our health. Prevention may in fact be the most important way we can take control of our health. And though hard scientific evidence may be lacking about the role of healthy diet and certain supplements in breast cancer prevention, given the increasing prevalence of this disease, the rate of which has tripled in the past few decades, and lack of any insight into prevention from the medical community other than surgery, we can’t go wrong in applying common sense health practices.

This 8-Step Breast Cancer Prevention Action Plan is health promoting in general, reducing your risk of diabetes, heart disease, and colon cancer as well. These practices are your daily health affirmation so that breast cancer prevention is just a natural part of a healthy way of life!

 

1. Eat only high quality, natural foods, and include olive oil and dark leafy greens every day

Processed, fast food, and nutrient deficient diets have co-arisen with breast cancer rates. Is there a correlation? Probably. Is there any harm in eating a healthy diet? Nope. And we do know that diets rich in a wide variety of fruits and vegetables and good quality fats, particularly olive oil, can help to reduce damage to your genes and protect against breast cancer.

  • A number of large studies have looked at the role of fats in the diet. Though the Nurses’ Health Study did not demonstrate an increased risk of breast cancer in women consuming animal fat, polyunsaturated fat, or saturated fat, and even suggested an increased risk of breast cancer from high intake of fish oil in the diet, many other large studies have shown a breast cancer protective effect from olive oil and fish oil. The Journal of the National Cancer Institute (1995) demonstrated a 25% lower risk of breast cancer in Greek women who consumed olive oil regularly. Two other European studies also suggested a protective effect of olive oil. One of these studies also showed an increased risk of breast cancer in women who consumed saturated fat. A 3-year survey of 61,471 Swedish women reported a 45% reduction in breast cancer risk among women who regularly use canola oil and olive oil. I recommend 2 Tbs of olive oil daily. (Upwards of 90% of the canola oil manufactured in the US is produced from genetically modified seed and I avoid its use.)

A low fat diet, rich in insoluble fiber, has been shown to decrease the circulation of estrogens between the intestines and the liver and decrease plasma estrogen levels, thereby potentially reducing the risk of hormone-related cancers. ~ Tori Hudson, ND

  • Seeds and whole grains contain significant amounts of a chemical (lignans) which can weakly block estrogen’s effects on the breast. Vegetarians with a high lignan diet do in fact appear to have lower rates of breast cancer. A high intake of seeds and whole grains may have a cancer protective effect.
  • Vegetables in the Brassicacae family, including broccoli, kale, collard greens, cabbage, Brussels sprouts and mustard greens can be eaten daily, 1-2 cups per day, for their specific ability to help detoxify and eliminate estrogen, a culprit in some breast cancers, as well as other environmental toxins. A Swedish study comparing the diets of 232 postmenopausal women diagnosed with invasive breast cancer with 2,650 postmenopausal women of the same age with no history of breast cancer found that women who had consumed an average of 1 ½ servings daily of vegetables in this family had a 25% decreased risk of breast cancer. These vegetables are also high in fiber, speaking of which…
  • …A high fiber diet, particularly fiber from vegetables (rather than fruits and grains) is part of our detox system, which I will describe below, and can assist in the elimination of endogenous and environmental hormones and other chemicals that can disrupt that physiology of the breast, affect our genes, and lead to cancer. Amount? About 35 grams/day.
  • Avoid artificial ingredients and processed foods. Our genes have co-evolved with plant and animal based foods over millions of years, and are highly specialized to maintain our health. “New to nature” chemicals, including preservatives, dyes, and man-made molecules may interfere with our natural detoxification processes and may interfere with our genetic functioning in ways to predispose to cancer development. If it has ingredients that you can’t pronounce, isn’t real food, or your great-grandmother wouldn’t be able to get it – don’t eat it!
  • Studies on the contribution of dairy products to breast cancer have been mixed. There is a great deal of conjecture that the hormonal residues in dairy from growth factors fed to dairy cows may contribute to tumor growth though this has not been thoroughly evaluated in humans; one study showed a protective effect from dairy consumption, attributed to the protective effects of vitamin D. While the jury is still out on the role of dairy products on breast cancer, eating organic dairy free of growth hormone is important should you choose to consume it.
  • Soy is a controversial food in the natural health world. Its pros and cons are discussed separately. Many studies have shown a lower rate of breast cancer in populations of women consuming soy as a regular part of their diet since childhood, for example, in Japan. The isoflavones in soy do appear to competitively bind with stronger estrogens produced both in a woman’s body and circulating xenoestrogens, thus mitigating their breast cancer promoting effects. Overall the studies on soy and breast cancer seem promising enough to suggest that in those not averse to or intolerant of traditional soy products, they may provide some added protection against breast cancer.

 2. Don’t drink alcohol – or at least drink less

While a few glasses of red wine/week may have cardio protective actions, we do know that more than 7 glasses of alcohol per week modestly increases a woman’s risk of breast cancer, and more recent research suggests that even just a few glasses may do so. Therefore, I encourage women to avoid alcohol except on rare occasion, certainly keep it to no more than 2 4 oz. glasses of wine per week, and get your cardio protective benefits from the many other ways we can do this – including following the other recommendations in this plan. I get it, not drinking may be less than fun; breast cancer is even less fun. The studies are clear: the more you drink, the higher your risk of breast cancer, with 2 drinks per day increasing risk by as much as 70%.

3. Supplement

We do our best to eat well, but specific vitamins and minerals, taken in amounts beyond what we get in our food, may have an additional protective role against breast cancer, mostly through supporting our body’s natural ability to detoxify and prevent damage to our genes. Supplements that may support breast cancer prevention include:

  • Selenium
  • Vitamin D
  • Vitamin C
  • Vitamin A (retinal and carotenes)
  • Indole-3-carbinol (I3C) found in that Brassicacae vegetable family, and available in supplement form as DIM (diindolylmethane)
  • Active folate

4. Avoid harmful environmental exposures – including unnecessary hormones

The data is unequivocal and just keeps pouring in – many of the 100,000+ environmental chemicals that have been introduced into our ecosystems and thus our body-systems cause cancer, and our breast tissue is especially at risk because many toxins preferentially affect them. Even low exposures of BPA, for example, a common chemical in plastics, including water bottles and food containers, can increase our risk of breast cancer because it has estrogen mimicking biological activity. Without a shadow of doubt, we must reduce as many of our toxic exposure risks as possible, from our food sources to our cosmetics, to our household cleaners to our furnishings. I know this can be overwhelming, but our health depends on this – and because we vertically transmit chemicals to our children through pregnancy and breastfeeding, so does the health of subsequent generations. Please visit the Environmental Working Group website for information and accessible, helpful guidance in how to transform your life from toxic to green.

5. Maintain healthy blood sugar balance and healthy weight

Aside from sugar causing numerous other health problems, eating sugar leads to insulin spikes and insulin leads to storage of body fat, and body fat is one of the sites of estrogen production in the body. Excess estrogen is a problem for women predisposed to estrogen receptor positive breast cancers. See my blog – Balance Your Blood Sugar with 4 Easy Habits.

6. Nurture your natural detox systems

What do you think of when you hear the word detox? Diets, juice fasts and cleanses? Likely so. But this is not actually what I mean by detox – though sometimes a brief fast can be useful for therapeutic reasons. When I say “Detox” what I am referring to are the body’s natural mechanisms for breaking down and eliminating a whole range of chemicals that come from our food, our hormones, our metabolic processes, and also environmental exposures (toxins, medications, etc.). Our bodies are beautifully designed to make sure that we break down, package, and eliminate chemicals and chemical by-products that can cause us harm were they to linger in our bodies. Most of our detox happens in our liver, though there are multiple sites where these processes can occur. In the liver we have a 2-phase process of detoxification. Toxins in our food and environment can overburden our intrinsic detox systems and damage our cells. Amino acids from high quality proteins, B vitamins, and antioxidants such as Vitamin C and E help to break down these chemicals, while fiber from vegetables and flax seeds (2 Tbs freshly ground taken daily with food) help bind and excrete them properly through our stool. A number of herbs and supplements can also improve and support your natural detox-abilities, including magnesium, B-complex with active folate, curcumin (found in turmeric), dandelion root, garlic, artichoke leaf (Cynara), milk thistle, pomegranate (even just 2 oz. of the juice daily), fresh apples and berries, and IC3 and DIM from dark green leafy vegetables. Make sure your bowels are moving daily – this is the body’s equivalent of “taking out the trash.” Without effective elimination, harmful by-products of estrogen metabolism actually recirculate, giving your breasts a double whammy of exposure! Also, healthy gut flora are essential for the proper detoxification and excretion of estrogen from the intestines, so add a probiotic to your daily routine.

7. Stress less, sleep better

Stress and lack of sleep both lead to weight gain, blood sugar dysregulaton, and increased estrogen production. Poor sleep and stress impair immunity function (ever noticed how you get sick when you are more exhausted or after a stressful time or event?) and detoxification, and may keep us from vitality-promoting lifestyle habits! Try to get 7.5- 8 hours of sleep most nights, and build a yoga, meditation, or relaxation practice into your life, even if just for 5 minutes a day. It can make a world of difference in your health and outlook.

8. Exercise

Exercise helps to keep your insulin and blood sugar levels in better control, keeps your weight down, gets rid of stress hormones, and improves sleep – so it basically enhances almost every facet of Your 8-Step Breast Cancer Prevention Plan!

Bonus tip: Breastfeed!

I know this recommendation might not relate to you – you might be well before or way after your childbearing years, but the benefits may be significant so I wanted to include it for any of you who might eventually become pregnant, who are pregnant and deciding whether to breastfeed, or are close to being a grandmother and want to share this news with your daughters. Several studies have shown that breastfeeding may reduce breast cancer risk, though other studies shown mixed results. Importantly, one large study, based on data from the Nurses’ Health Study, found up to a 59% reduction in risk in breast cancer in premenopausal women who had breastfed for any length of time, even though all of these women had a first degree relative (mother, sister) with breast cancer. This rate compares favorably with hormonal treatments such as tamoxifen given as a preventive measure to women at high risk for breast cancer. Breastfeeding provides multiple benefits for mother and baby; thus it should be encouraged whenever possible.

 

Bringing It Home

I know breast cancer is incredibly scary to consider. Many of you may have already had this dreaded disease and will have wisdom to share with us in the comments section below. All of the recommendations above can be part of a lifestyle to prevent recurrence as well. While we cannot completely control what happens to us, we can take substantial control of our health through our diet and lifestyle. This is a powerful concept and one I hope you will take to heart. I have seen it make a difference in the health of thousands of women – and I hope it will for you, too.

Love to hear from you in the comments below. And please share this information with the women you love.

<3 Always,

AJR Sig

 

 

 

 

 

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Laura

Thank you for writing this. My mother died of breast cancer when she was 50. I have been concerned with this for myself since she passed away. I have never stressed over it too much, though, until last night after reading Jolie's Op-Ed piece. I didn't think it bothered me that much, but I had horrible dreams that I had cancer and suffered horribly. It made me feel like cancer was just a given and I should give up. Of course, I could get skin cancer, lung cancer, or stomach cancer, so why not just get all of those things removed and get implants- oh wait, that isn't really an option and if it were it would be a bit ridiculous. I feel that this issue could have been better addressed by her. I know that the best prevention can come how we live and what we do with our bodies- what we put in them, first and foremost. I wish she had addressed these kind of prevention options as well.

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Simone

I just want to thank you for writing this. I actually had a friend who recently told me her doctor wants to do some genetic tests on her. Her mother died when we were in high school of cancer, she is 35 (her mother was 45) and they are already talking about removing her uterus and ovaries, etc. She has one daughter but wants more children. I tried to respond in the best way that I could and told her we would do some research but couldn't find any real valuable information and now I have this article as a starting point. I recognize that Angelina's choice was best for her but as with any celebrity action there is always a reaction.

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Jennifer Zint

Thanks for addressing such important topics in a way that makes it easy to understand and share this information with others . My mother had a stage 2 tumor removed last year and underwent 6 weeks of radiation .She opted to not take the pills they recommended to decrease her risk of reoccurence by 2 % more .She has gotten yearly or biyearly mammagrams for many years due to fibrocystic breasts (she is 69 now ). We differ in our health thinking and this article covers some ways we can work together to improve our health .

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Trudi Taylor, Ph.D.

Thank you for the lovely article. It clearly outlines what we can do to cut down our risk of breast cancer without creating panic. Prophylactic surgery is a choice for some people (1 out of every 100 people treated for breast cancer is male) but not the only choice to deal with our fear.

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Lydia

Thank you for sharing these tips. Both Jolie's and a recent NYT Magazine article "Our Feel-Good War on Breast Cancer" (do a Google search to find it online) highlighted mainstream options, but I'm always also glad to read about complementary/alternative options.

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Kim

Thank you for a great article. I was diagnosed with breast cancer last year at the ripe old age of 41. Other than being female, I did not have any of the risk factors - I am petite, eat well (mostly organic), use non-toxic products, exercise (although could do more), breastfed both of my daughters for a year. But, I was indulging myself by having a glass of white wine about 5 nights a week while I cooked dinner or during dinner. Was this the culprit? I'll never know. And, even if I did, the answer probably isn't that simple. But now that I am done with surgery (I chose a double mastectomy) and treatment and life has gotten back to what I call the "new" normal, I am only indulging with a glass on Friday or Saturday nights. I don't think most women know about the link between alcohol and breast cancer. It certainly doesn't get a lot of press. So thank you for bringing it to women's attention. It may not be fun to hear, but having breast cancer certainly isn't ANY fun at all.

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Julie Andews

Thank you Aviva for such a thoughtful and eloquent discussion of this challenging subject. I so enjoy your contributions and hope one day I will get to reconnect with you in person.

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Rachel

Well written! Great advice on a sensitive subject. Each of us must live with the choices we make and when we make good choices, we know we have done what we can do. Fear never heals. Great attitudes can go a long way in wellness. You give us information that is empowering. Blessings.

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Chara

Aviva, thank you for this. Can you PLEASE tell us something about how to determine whether to have mammography or thermography? I am turning 40 and am very confused about this issue. Sincerely, chara

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    aviva

    This is a very complex topic - and yes, I will write a full blog on the issues and recommendations for breast cancer screening to answer this question. Warmly, Aviva

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Meghan

Thank you for this sound and helpful guideline. Currently breastfeeding mom. Are pro-biotics safe to take while nursing?

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    aviva

    Yes, they are.

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Shawna

What if cancer were caused by an emotion? According to Dr. Ryke Geerd Hamer's scientific research it is a "nest worry" if it affects the breast tissue. Anyone interested in not letting the fear of cancer control your life check out German New Medicine. Thanks for addressing this controversial topic and providing a less invasive way to deal with illness. Everyone should adopt the recommendations you outlined and not just those trying to avoid cancer.

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Eileen

This was forwarded to me by my daughter and is very helpful. I am 2 weeks past a bilateral mastectomy, and awaiting final recommendations for further treatment. I am very interested in following this dietary and lifestyle advice in addition, and maybe in lieu of certain of the likely suggestions.

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    aviva

    Please be sure to find an oncologist that you can work with and who can follow you appropriately! Life is really precious and sometimes a blend of conventional and complementary therapies is most helpful. Be well! Aviva

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      Eileen

      Yes I agree! My oncologist (a woman) is her department head at a top hospital, and very easy to talk to. We are both factually oriented professionals. I am sure we will end up with a blend of therapies, as you suggest. Thank you for your support and for this website!

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Amy

Thanks so much! My mother had post-menopausal breast cancer, which was caught early, and she had a mastectomy. I am in my thirties and trying to be careful with a healthful lifestyle. I too look forward to the post about screening. I have been advised by my ND to have periodic ultrasounds starting at age 40...

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Amy Jean Smith

Hello Aviva - Thanks so much for this blog! I was wondering if there was a particular Vitamin D supplement/type that you'd recommend or if there are any that you'd definitely avoid? With a history of skin cancer I have to be really careful about sun exposure. Thanks

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    aviva

    Hi Amy, I don't have a particular brand over another but I do recommend vitamin D3. Vegans can use D2 but D3 is more readily active. :) Aviva

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      Heather

      After a lot of research, I found a D3 source that's vegan called Vitashine and it seems to be working well for me! http://www.vitashine-d3.com/

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Maria

Thank you for posting this, Aviva. Your book on Vaccinations, the thoughtful parents' guide was incredibly helpful for our family at the time when we needed a balanced inquiry into that topic. I appreciate a similar approach here; this is a hot topic, like vaccines, and you wade into it with compassion and valuable suggestions that are aimed at finding a baseline of health in a toxic world. Fear. Cancer is scary. I was diagnosed with breast cancer nearly three months ago. I knew the lumps were there. I'd felt them for a while. Two separate ultrasounds revealed them to be noncancerous fibroids, according to the very experienced and well-respected physicians who performed them. They were quite confident in this diagnosis, and very content to tell me I didn't have cancer as they ran the equipment over my left breast. But they recommended a biopsy, which found cancer. Which is "true"? I don't know. I am behaving as though I have cancer that needs more attention from me than I had been giving my body. I am considered by most who know me to be "super healthy." I am 45, a healthy weight, I pay scrupulous attention to my diet. I breastfed both my kids for several years each. I had a few bits of trouble starting out in life. I had major surgery at two days old, I wasn't myself breastfed. I lived directly above a leaded gas station as a child for seven years. I also lived in Poland for two years, a country that had a horrible environmental record when the Wall fell in 1989, and I lived there soon after. What's the culprit? I have no idea. I do know my current approach and am proceeding with a tremendous amount of awareness as to what nourishes my body. I do not know where this path leads, however. I did not get the mastectomy the surgeon recommended. I just stopped when I got the diagnosis for about a week. And I grieved. I felt all the betrayal that my body could "do this" to me when I felt I had done everything in my power to treat it well. I felt sad and scared and utterly bewildered. Then I started to do research. I discovered I should go as raw as possible and vegan. So I did. I read that a juice fast clears you out, I fasted about a week. I also found out enemas, especially coffee enemas, are powerful ways to detox. I perform at least one enema a day. Simultaneously, I looked deep into myself and very seriously asked the question: What do I have to live for? My kids, well, that's what Angelina Jolie said in part inspired her decision. I love my kids. I practice Attachment Parenting, I homeschool them. But they are not my reason to live. They are meant to outgrow me. I dug deep and found a hunger for a deeper connection to the more-than-human world and discovered I had an affinity for plants, and a toughness well-suited to survival outings, where I forage my own food, build my own shelter, make my own fire, in community. I have still not sought treatment from an MD, though I am working with an oncological nutritionist who is well-versed in holistic treatments for cancer. I have more instructions and recommendations from him than I can get my mind around, but I am very inspired that there is a way that feels closer to my way. I have had surgery. I have been poisoned by chemicals. For me it feels like there is another way that I have the barest hint of, that the details fill in as I proceed in the direction I am going. I am not afraid of cancer. I am afraid of not living my life to the fullest. A woman I know responded thusly to the news of my diagnosis recently: "Well, it's time to get real, isn't it?" Indeed it is. I truly wish for anyone who chooses mastectomy that it is a choice made from full awareness. I get very nervous about irreversible choices made out of fear. We have created a culture of fear around cancer. It bothers me that a few people are profiting from our fear. Cancer is part of me. It is most certainly an unwelcome guest, but it's here. I very much appreciate Pema Chodron's quote: "Nothing ever goes away until it has taught us what we need to know." My approach to cancer is not something I'd recommend to anyone. It is hard. Detoxing the chemicals my body had taken in was incredibly difficult. I have faced so many demons as my body releases long-standing habits. I have tried to break many of the patterns that have defined me as an adult. I have parted with friends and possessions I thought I could not live without. But I am ready. I am ready to learn. I feel better and look better than I have in a decade. I don't know what is next, but I am healing my body and walking with the cancer as I do so. To my sisters who are living with cancer or who have been directly affect by it by losing a loved one, I offer a deep bow to you. We are all in this together. We all make our choices as best we can. My thoughts and prayers are with you and with all of us that we find the healing our body needs.

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    aviva

    Dear Maria, Thank you so much for generously sharing your story. My heart really goes out to you. I remember even just anticipating what I would have to do in terms of the work of caring for myself if I did have cancer and how overwhelming it seemed.I really appreciate the integrity of your words - in the truest sense of that word which means wholeness. You sound whole and clear even in the midst of a heavy burden. You also reflect something really important: healthy women who have breastfed can still get cancer. I was really disappointed recently to see a colleague describing cancer in terms of something that happens when our thoughts and intentions are unclear. I completely disagree - sometimes it just happens. I trust that you will make smart and loving decisions for your body and health, and with all my heart, wish you all the best and hope that if in the midst of your path, you might have time to tell us how you are doing down the road. I offer a deep bow to YOU. With love, aviva

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    Tess

    You are a heroic women in a corporate war on our health. I know chemo killed my Dad, not the cancer. By taking the low seat you are Going higher, you are doing so great. Much love . Tess

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barb

Thanks for this wonderful article. What can you tell me about Micro calcifications. My last mammogram discovered a cluster of micro- calcifications and I was very fast pushed into a core biopsy. Unfortunately it was a failed attempt and they couldn't get a good sample. Now they want me to go to a surgeon for a wire localization and surgical excision. I have always had normal mammograms till now and am 62 years old. I eat very healthy and have now cut all sugar and drinking, other than occasional glass of wine. I think I want to take the "wait, watch and approach but my doctor is pressuring me to be aggressive and get the surgery. do you have any experience with this?

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    aviva

    Hi Barb, Super tricky. Often they are stable and just hang out and never become anything. Sometimes they do become breast cancer. I think close follow up, additional unrelated opinions (ie another MD group) and a non-rushed decision of any kind is important! More to come in future blogs - thank you for bringing up this topic. And best wishes! Aviva

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Sharon

I have to make a comment that I am afraid is going to be seen as controversial, even though it shouldn't be. Can I ask why, in section number 4, you never mention the birth control pill? I didn't know until recently that the combination pill (which is the one most often used from what I can tell) is rated by the World Health Organization as a class one carcinogen - known to cause cancer in humans. I know this sounds like off-the-wall nuttiness, but it is not - the information is clearly available on The American Cancer Society's webpage. Really, your excellent advice here doesn't go far enough: "Without a shadow of doubt, we must reduce as many of our toxic exposure risks as possible, from our food sources to our cosmetics, to our household cleaners to our furnishings." In fairness to women, we need to also add "to our contraception".

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    aviva

    Hi Sharon, Very important. The main reason is my blogs are already SO long that I try to keep succinct and just overlooked it in my attempt to do so. Also, I will have a future blog on birth control which will address safety issues. The data on increased breast cancer risk in women with a primary breast cancer relative still allows for its use - though cautiously. IT makes me nervous and I tend to recommend other options. I agree - we need to reduce all possible exposures and the estrogen in OCPs not only affects the user - we all become users from the literal downstream effects of what is excreted in women's urine! Not too controversial at all! Keep the fire going! :) Aviva

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Shannon

Thank you for this! I was diagnosed with ER/PR+ breast cancer at 33, tested positive for BRCA mutation (paid for in the rare time I had decent insurance) and have had, at age 40, an oophorectomy (thanks to Swedish Hospital's amazing charity care program). I told my oncologist that I didn't want a hysterectomy because my life had become like the game of Operation and I was over it. I also opted not to have nipple reconstruction because "The jig [was] up!". Humor is the best medicine, no? Bi-lateral mastectomy, chemo (and the subsequent oophorectomy) were absolutely the right choice for me. And, while I gave pause for the children I might not have, I knew I could adopt later. Plus, I already had one I needed to be around for. I know that's not such an easy choice for persons who don't yet have, and want, biological kids. I was the first to have it in the family, 2 years later my aunt got it and would not get tested for the gene, opting to have a lumpectomy and not see an oncologist. 3 years later it returned, having metastasized. As members of my family (those who can afford it) get tested, I've had to reassert, over and over, that even if you have the gene, it doesn't mean you will CERTAINLY get breast cancer, or that prophylactic surgery is the only way; there are other options in prevention. But it's an exhausting probability game, really, and we have to do what feels right for us at the time. As worried as we all are for her, I try to support my aunt in her decisions, even if they aren't ones I would make. I don't know what I would have done had I tested positive but not actually had the disease. The thing I appreciated about Jolie's article is her addressing the affordability, or lack thereof, of genetic testing. It's about information: the power it can give you to try and take charge of your health - no matter what your prevention looks like. Unfortunately, not all are so lucky to have access to the tools of information - genetic, medicinal or otherwise. As a woman of color, I see what the breast cancer statistics say about us and diagnosis, treatment and mortality/survival. Lack of access to information and privilege....in diagnosis, and preventative/treatment options. With all its glaring holes, the article *at least* points to that. Your article is valuable and I'll be sure to pass it on - eeeeeeven though I'm sure they're all sick of me and my "botanical mumbo jumbo" as they lovingly call it. I just call it "food".

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Julie Bennett

I too was diagnosed with breast cancer last year, after 2 operations chemo and radiation i feel i have finally turned the corner. I was lucky enough to find a very forward thinking oncologist who worked hand in hand with my natropath to give me the best possible health care. Thank you for your article, very informative.

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Ana

Thank you for your article, all very well-and interesting. Just a comment : Angelina Jolie will be 38 next June : thus it's a little bit early to say she's past her childbearing years :)

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    aviva

    well, i mean likely past having more babies.... but you are correct!

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Sheila Hoffman

Thanks for this excellent article and the subsequent personal sharing. Both my Mom's sisters and 2 of my cousins on Mom's side all died of breast cancer. Mom was tested as negative for the brca genes so I can't have them. But 20+ years ago we both opted to do most of what you've written about (became vegan, exercise regularly, meditate, don't smoke, don't drink, etc). So far so good...she's 87 and I'm 63. Sometimes I get annoyed at all the research funds that goes into breast cancer cures when it seems there's little to none going toward prevention studies and education. As you point out "breast cancer is likely a complex interplay of genes, genetic damage, and immune health, all of which are influenced by lifestyle, diet, and our environment." Your article goes a long way. And I thank you for that. I just wish there were scientific studies to validate this approach. There won't be, since it's the pharmaceuticals that pay for the studies.

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    aviva

    Thank you for sharing your story - I really appreciate your comments particularly given your family history; thank you to all who have been sharing on such a personal and potentially painful topic. It means a great deal to me. Aviva

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Eileen OConnor

I developed breast cancer at the age of 38 and was following all the advice you are giving. Healthy diet and lifestyle and have no history of breast cancer in my family. I discovered that I was living in a cancer cluster with six young ladies diagnosed with breast cancer in our tiny village in Wishaw, West Midlands, UK. We lived for many years close to a cell tower and I have absolutely no doubt what so ever that this tower was responsible for casuing the cancer cluster and many other health related conditions. There is a very significant body of research published reinforcing the hypothesis that RF/EMF emissions are detrimental to health demonstrating that radiation exposures set within the current thermal ICNIRP guidelines can increase the probability of developing diseases following long term exposures, mainly cancer, tumours, and genetic damage. These are referred to as the stochastic effects of radiation, and are not included in the term radiation sickness. Stochastic effects often show up years after exposure. As the dose to an individual increases, the probability that cancer or a genetic effect will occur also increases. Many doctors and scientists worldwide believe there is a very real and significant risk to the general health of the public, wildlife and the environment. Unsuspecting members of the public are now expsosed to RF/EMF emissions as they cotinue their love affair with microwave technology while addicted to mobile phones, wifi etc. This needs to be taken into account urgently. I have no doubt that the increase in younger and younger woman diagnosed with breast cancer is due to the increase in microwave technology over the last 20 years. Best wishes, Eileen OConnor Director UK Radiation Research Trust

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    aviva

    Thank you for your very important contribution to this discussion, Eileen. Yes! Hope you are well and healed and so glad to see you are involved in the important work you are doing. Warmest regards, Aviva

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Theresa

Thank you for some great suggestions. It is great to be reassured that there are many factors within our own control to decrease breast cancer risk. Something to think about on #4, one hormonal exposure that carries with it an increased risk in breast cancer is hormonal birth control, ie The Pill. Women do not hear a lot about the risks with being on the pill for extended periods of time. These hormones also enter our water supply, and many municipal water systems do not try to filter these pollutants out of our drinking water. We researched Natural Family Planning methods, and this method has worked really well for our family. Plus, it's green and eco-friendly!

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roslyn

I was diagnosed with breast cancer when I was 35. I was called low risk, due to few predisposing factors, except smoking and drinking too much in my earlier years. I did however have a lot of stress a few years before working in a remote aboriginal community, working long and odd hours, constantly getting sick. I then moved away from an aging mother and into a new state, which I allowed to overwhelm me with grief and guilt. Guilt was how I dealt with many issues. I did the big three treatments, probably due to fear, and also falling back on my nursing knowledge. But now I thank the whole experience. I worked on my diet( which was pretty good anyway) , exercise and meditations, while I shut the gate and stayed in the bush to heal. I went deep within to reveal the hidden parts of me that were continuing to make me sick and feel guilt. I dropped out of life for over a year, and it was one of the best years of my life. In conclusion, I found that it was the emotional and mental issues that needed to be healed. I knew that if I just looked outside of myself, then I would not heal. I had many sychronistic experiences, that lead my path to healing. The best one was listening to a radio show, about a woman who was terminally ill, heal herself by just telling herself that her body was healing. I practised this and the pain around my scar instantly stopped. Prior to this, whenever I felt a pain, I began a story....I hope the cancer isn't going into my lungs....and then visualised myself dying!!! As soon as I learnt the power of the mind, all pain stopped, and continues to have stopped, 17 years later But that is my journey, and only mine, I have never been able to influence others with my journey, as they are on their own. And I bless them in hope they find their healing path. Thanks for the article. THe only thing I think was missing (again this is my stuff) was to do the inner search. I got to the point of discovery, where I was able to accept the option of death, and now have no fear of it. I often hear of women who choose to keep working and keep busy, to keep their minds of having cancer. For me there was no other choice but to have my mind on it, and what lay inside of me to have caused it.

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    aviva

    Dear Roslyn, Thank you for your beautiful email. It sounds like you made exactly the right decisions all along the way - and learned a great deal about yourself. Powerful! Glad you are telling yourself better stories. I always work on this too, about other things -- the stories we tell ourselves can hold a great deal of power. Stay well! <3 Aviva

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Lindsay Wilson

Aviva ~ this is a lovely article. However, you only mention whole olive oil as a good fat. And, the Tony Hudson quote suggests that a low-fat diet is the way to go. I am surprised that you did not mention other stable, whole and nutrient-rich fats such as pastured butter, lard, tallow, ghee, whole red palm oil and coconut oil. Finally, olive oil is commonly mixed with canola oil (there are plenty of articles on contamination of olive oil floating around out there). I think all the fats listed are fats that are safe and healthy. I just wonder why you only mention olive oil.

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    aviva

    Hi Lindsay - You are so right! I try to be complte and then .... well... I just forget to include everything! :)) I do love butter! Don't have any experience with tallow or lard but would encourage people to make sure they are all from clean animal sources. Thank you! Aviva

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Lori

Hey Aviva, it's another great post! I love the information you provide here ...as a woman, and more particularly one who lost her mom to breast cancer at age 9. She was 35 when diagnosed and died after battling for 5 years. Her struggle and death has affected me very deeply everyday since. The loss is still overwhelming at times. I am always curious for more preventative tips, and incorporate most of them that make sense to me. (Even limiting time my breasts spend pent up in a bra!) After being exposed to the benefits of certain herbs in the childbearing year because of my doula training and experience, reading your books and others, I've made herbal teas and infusions a part of my life and encourage the women I work with to also. And I feel the best I ever have! I was really surprised you didn't mention any herbs for ongoing breast health. I'd like to hear your thoughts... The other thing I was a little surprised about was how you mentioned not being too worried about your lump because of having your kids young and breast feeding forever yet you don't list the former as prevention and the latter only deserved to be a bonus not an actual number. In the past, I've read about risk being reduced by both 1) total years you breastfed and 2) starting hving kids early and 3) number of kids you have - less time menstruating/cycling less exposure to estrogen...? And this is my own idea completely -but I believe a part of breast health is allowing breasts to move freely and be touched, massaged, etc. maybe that is why yrs spent nursing shows lowered risk. Since studies show its unrelated to time spent without ovulation, it could be either due to the making of milk OR breast movement. They are being 'used' as nature intended, yk? Just like body movement is important for out overall health, i think breast tissue needs movement too. A nursing toddler gives those breasts plenty of activity ;) I haven't decided what I'll do about the genetic testing but I know I'd love to hear I'm negative and that draws me to it. Since my mom had an early diagnosis after self discovery and tried everything natural, diet, vitamin supplements, juicing, enemas, etc as well as chemo and radiation and removing her breasts, and it eventually spread all over her body, I know that despite it being 20+ yrs ago and tests/treatments were different, it was aggressive, maybe rare. I spoke w her doctor not too long ago and she believes my mom was probably triple - and said especially bc of that guess, she'd recommend me getting the genetic test. But, I know I'd need to decide what I'd do with the news I'm positive first bf going in there. I'm only done hving kids bc my husband is. But I'm only 32. To my benefit, I did start hving kids at 25, hv had 2, and had been breast feeding or pregnant for 7 + yrs which just ended a few months ago when my 3 yo weaned. So I feel a sense of protection from that as well as my lifestyle and hving no other risk factors, but feel a lack of control over what genetically could hv been passed to me. I fear everyday lving my children without a mom. That was my reality. Although my mom believed at the time (late 80's) that hers was due to being on birth control pills for yrs. Her mom and grandmom and aunts all lived long healthy lives besides two who smoked and died from lung cancer and emphysema, but as geriatrics. So, what are my chances of carrying the gene? Who knows. I'll hv to be ready to remove my breasts and maybe ovaries bf I do it and I think that just takes time to decide and accept. But for someone in my or Angelina's shoes, there is no extreme or rash decision being made I don't think. I completely understand it, not everyone will. To remove your currently healthy well loved breasts...seems crazy maybe...unless you lost your mother because of the same gene you are carrying in you. Then, it's not so crazy. No matter how healthy you are and live. Again, thanks for your post and sensitivity on this subject, Dr. Aviva!

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    aviva

    Hi Lori Thank you for your really thoughtful post. It's so funny, because when i was writing it I started with the BF prevention at the top of the list. Then I did a review of the literature and the actual data was less certain and clear than I had personally always thought. So I moved it lower. Then I realized that most women reading the article might not be BF'ing so I moved it to a bonus. But yeah, BF our babies is so health promoting ion so many levels - and some studies do show cancer reduction. I know that fear of kids living without a mom - it's just now that mine are fully grown that it has let me be - and I don't have additional breast cancer risk. That's partly a mom thing - and then you get the double whammy with the extra worry.I know you'll make a great decision. I get Angelina's decision, from that perspective and others. With love, Aviva

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      Lori Daley

      Thanks, Aviva. So maybe there wasn't any or enough evidence to back up any use of herbs for promoting breast health/cancer prevention either? If not, I'd still love to hear what you might recommend even if just based on what you know of the herb's. You wrote up a list of those generally healthy and safe a while back - any of those or others you'd highlight or stay away from for breast health specifically? Thank you again, I appreciate your wisdom... :) ~ Lori

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Carol

Thanks for the great blog posts! I know you already mentioned why, but I was one of the ladies who was very surprised why you didn't mention birth control pills as a risk factor (especially since they're never a necessary "medicine"), and induced abortions. I realize that these could both be controversial topics, but relevant to many women. Listing birth control in with the other ways we take in unnecessary hormones seems very important to me. I was also surprised to see in one of your replies that extended breastfeeding doesn't have as much research as you had though... back in my LLL days, that was some encouraging news - I have always been so glad to know that having several children, starting before my thirties, and breastfeeding for a long time would be protective for me. I hope I wasn't mistaken in thinking this!

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Jeannie

Dear Dr. Romm, I am a 43 year old BRCA2 positive woman, and am having difficulty finding information on the safety of dandelion and milk thistle. Could you please share any information you have on the topic? Thank you, Jeannie

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    aviva

    Hi Jeannie, Neither dandelion nor milk thistle are pro-estrogenic or have any proliferative effects on breast tissue. In fact, they may be partly protective in that they help clear hormones and environmental toxins more effectively from the body. So all told, they are considered safe in women with histories of and risk factors for breast cancer. Stay well and best wishes! Aviva

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Carol DeSantis

I really enjoy your information, but wanted to correct one thing. I am an epidemiologist and publish breast cancer statistics. The 1 in 8 statistic, is indeed the lifetime risk for developing breast cancer and does not apply only to women over 65. It is the average risk of being diagnosed with breast cancer over the course of an entire lifetime from birth to death. http://seer.cancer.gov/statistics/types/lifetimerisk.html

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    aviva

    Here's the government data. The last five annual SEER* reports show these estimates of lifetime risk: 13.4 percent for 1997 through 1999 ("1 in 7.45," often expressed as "1 in 7") 13.5 percent for 1998 through 2000 ("1 in 7.40," often expressed as "1 in 7") 13.4 percent for 1999 through 2001 ("1 in 7.47," often expressed as "1 in 7") 13.2 percent for 2000 through 2002 ("1 in 7.56," often expressed as "1 in 8") 12.7 percent for 2001 through 2003 ("1 in 7.87," often expressed as "1 in 8") A woman's chance of being diagnosed with breast cancer is: from age 30 through age 39 . . . . . . 0.43 percent (often expressed as "1 in 233") from age 40 through age 49 . . . . . . 1.44 percent (often expressed as "1 in 69") from age 50 through age 59 . . . . . . 2.63 percent (often expressed as "1 in 38") from age 60 through age 69 . . . . . . 3.65 percent (often expressed as "1 in 27")

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mold killers

Having read this I believed it was extremely informative. I appreciate you spending some time and energy to put this content together. I once again find myself spending a lot of time both reading and commenting. But so what, it was still worth it!

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Touria

I had my memo gram and three biopsy each one different. Right breast was ADH result and right breast first biopsy was LICS and 2nd one DCIS. I am scheduled to see the s urgent and i don't know what to do. There is plan for surgery, but i am not sure if i should go for it or no. All diagnosis put me at high risk but every body has a risk. For me ere is no cancer, but i don't understand why i need to have surgery. Please advise.

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Amy

hi Aviva I am 34 and tested positive for BRCA2 a few months ago. I'm defiantly goin to have my ovaries removed in the next couple years but wondering if I should get preventative mastectomy also or just continue screenings and living a heathy life style as u described above? My mom is 60 and has gene and no Breast cancer. Her Mom died at 96 from congestive heart failure but did beat Breast cancer at age 70.

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