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%.
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:
- 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.
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.