Emerging research into the complex genetics of breast cancer and estrogen metabolism are opening the door to new risk markers that will better enable preventative health strategies and early detection. Find out what you can do to reduce your risk!
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 8% of cases. This means that most breast cancers occurs in women without a family history.
Women living in the US have a 10-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 cell often proceeds the diagnosis by 7 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:
- 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 can increase the risk of breast cancer and stroke.
Maintaining hormone balance throughout the transition can support breast health. By maintaining a healthy 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.
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. These intermediates can be measured through specialized testing and can provide insight into risk. If the ratio of good to bad metabolite is low or unfavorable it has been shown to confer increased risk of breast cancer in premenopausal women.
Phase 2 detoxification involves conversion of estrogen metabolites into a more water soluble compound that can be excreted by the body. Methylation is one of the most important phase 2 reactions 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. Genetic risks, nutritional deficiencies and toxic exposures can all affect methylation status and therefore may increase cancer risk.
Dietary factors found in cruciferous vegetables, such as kale and broccoli support both phases of estrogen detoxification. 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.
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- Combat Age related weight gain!
Carrying an extra 10 pounds of body fat after age 30 increases the risk of breast cancer by 25%. Deep abdominal fat is most toxic to the body as this fat store (unlike cellulite) is metabolically active and triggers inflammation. Fat also is the major site of estrogen production after menopause. Women who gain more than 50 lb from age 18 years or 30 lb through the menopause transition have double the risk of breast cancer after menopause. Whereas, women who are able to loose weight after menopause are rewarded with a lower risk.
- Get Going- move your body!
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.
- Give Sobriety a try!
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 3 glasses per week increased the risk of breast cancer by 5-fold in the Nurses Health Study. More recent research suggests that there may be no safe limit. In the pan-European ECHO study, women who consumed within the recommended guidelines still faced a higher risk of breast cancer, all cancer and death.
- Live Clean- Mind your exposures!
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 chemical additives to food as personal care products as colours and flavours 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. Xeno-estrogen exposure can be limited by consuming organically grown produce, avoiding plastic food containers -especially when rewarming food, and reducing intake of red meat as industrial pollutants bio-accumulate up the food chain.
These six breast health tips are designed to help you live your best life and take a proactive targeted approach to prevention. But a preventative health plan is not intended to replace the need for regular screening with mammograms. Breast cancer that is detectable on mammography has likely been evolving for over 7 years. This means that prevention is needed at least a decade before routing screening typically begins, which in Ontario is in a woman’s 5th decade. Screening mammograms have been shown to save lives through early detection. While the provincial screening program begins at 50 years of age, early baseline testing may be recommended if risk factors are present.
It is never too early to get started with a proactive approach to health. This six step Breast Healthy Plan has been designed as a road map to help you get started. Prevention is within reach. New science, tests and technology can help to precisely build your plan. An ounce of prevention is worth a pound of cure.