An Ounce of Prevention is Worth a Pound of Cure
When it comes to Breast Cancer, leading science can now take us beyond the Race for the Cure to root out disease through Prevention and Risk Modification
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 cells 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.
Here is an EIGHT STEP PLAN to reduce risk as part of a BREAST HEALTHY LIFESTYLE;
- Restore Hormone Balance
In peri-menopause, the phase prior to menopause which can span 5-7 years, levels of estrogen increase while the anti-estrogen hormone, progesterone, decreases. With the ovarian follicles becoming resistant and no longer ovulating efficiently or at all, progesterone will fall precipitously. Unopposed estrogen is a potent stimulator of breast tissue and linked with hormone sensitive breast cancer. The loss of protective progesterone and related hormonal imbalance in the perimenopause period contribute to the rise in breast cancer risk through the menopause transition.
- Decrease Aromatase Activity
After menopause, there is a shift in the balance of estrogens as levels of ovarian estrogen; estradiol (E2) fall and levels of fat derived estrone (E1) rise. The predominant form of estrogen after menopause is estrone, which is more carcinogenic and thrombogenic than ovarian estrogen leading to increased risk of breast cancer and stroke. Estrone is converted from androgens by an enzyme in fat tissue called, aromatase. Estrone (E1) is a potent stimulator of breast tissue and tightly binds to estrogen receptors. Maintaining a healthy body weight and fat percentage can help decrease the amount of estrone produced from testosterone. Dietary factors can block aromatase activity including omega3, green tea extract (EGCG), vitamin C, chrysin and flavinoids. Prescription medications called aromatase inhibitors such as letrozole work in treating and preventing breast cancer by inhibiting this enzyme.
- Optimize Estrogen Metabolism and Detoxification
Phase 1 Detoxification
The first phase of estrogen metabolism occurs in the liver along one of three pathways. The “2/16 ratio” considers the ratio of favourable metabolites (2hydroxy-estrone) to less favourable metabolites (16hydroxy-estrone). A high ratio has been shown to confer protection in pre-menopausal women and low levels are associated with fibrocystic breast, increased breast density and breast cancer recurrence. The 2-hydroxy pathway can be supported through dietary factors found in cruciferous vegetables, such as kale and broccoli. These vegetables are rich in glucosinolates; phytochemicals that induce Phase II of detoxification and inactivate carcinogenic chemicals. 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 glucosinolates to protective compounds known as isothiocyanates and indoles (i.e. sulforaphane and indole-3-carbinol or I3C). These phytochemicals increase urinary excretion of estrogen and may help to prevent both breast and endometrial cancer.
Phase 2 Detoxification
Phase 2 detoxification involves conversion of intermediate estrogen metabolites into a form that can be excreted by the kidneys. Methylation is one of the most important phase 2 processes that aids in the elimination and inactivation of potentially toxic estrogen metabolites. Women who are poor methylaters may be at increased risk of breast cancer due to accumulation of toxic intermediaries. Because methylation also plays a role in inactivating neurotransmitters, these women may have a personal or family history of mental health problems such as; depression, alcoholism, or attention deficit disorder. Glutathione conjugation is another major mechanism of estrogen inactivation and depends on a set of transferases whose activity can be affected by variations in genetics, nutrition and the presence of gut flora.
- Enhance Elimination of Estrogen Metabolites
Phase 3 detoxification is thought to involve a process wherein the metabolic intermediates are excreted through the GI tract. This process depends on a healthy mix of gut bacteria (known as the microbiota) and proper function of the GI tract. Fermented foods, fiber and cruciferous vegetables such as broccoli are key to supporting this phase of detoxification and elimination.
- Maintain a healthy Body Weight
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 it is metabolically active and triggers inflammation. Fat also is the major source of estrone production following menopause. Maintain a healthy body weight and body composition (which reflects percentage of body fat and abdominal fat).
- Exercise regularly
Regular aerobic exercise reduces insulin resistance and body fat and independently can reduce the risk of breast cancer. Data from the Nurses Health Study has shown that even after a diagnosis of breast cancer, women who exercise enjoy better survival rates.
- Avoid Alcohol
Excessive consumption of alcohol is an important risk factor for breast cancer ranking after family history and obesity. Alcohol is a known liver toxin and impairs estrogen metabolism. Drinking more than 3 glasses per week increased the risk of breast cancer by 5-fold in the Nurses Health Study.
- Eat the Colour Wheel
Fruits and vegetables are rich in anti-oxidants (vitamin A, C, and selenium). The more colourful the food –the better. Anti-oxidants reduce free radical damage to DNA. Cruciferous vegetables are perhaps the most important food group in breast cancer prevention. These vegetables contain indole-3-carbinol (13C), which increases the 2/16 ratio and sulfurophanes, which enhance phase 2 detoxification. Consume at least 3 servings daily of cruciferous vegetables such as; broccoli, nappa cabbage, cauliflower, Brussel sprouts, and kale.
- Limit Environmental Exposure to xeno-estrogens and hormone disrupters
Over 85,000 chemicals have been produced and released into the environment since the end of the Second World War. Chemicals in industrial plastics, pesticides and herbicides (i.e. DDT) as well as colorants can bind to estrogen receptors. These hormone disrupters are called xeno-estrogens and have been linked to early puberty and breast cancer in women and infertility in men. 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.
- Be Skin Safe
Our bathrooms , like our kitchens, is one of the most likely places in our homes where we may be exposed to xenoestrogens like parabens. Parabens are a pervasive preservative used in almost all commercial skin and sun care products. The scalp is even more absorbent than the skin and some of the chemicals found in hair dyes are carcinogenic and bind estrogen receptors. Research has linked hair dyes and parabens to increased risk of breast cancer.
- Manage your Stress
Mind-body balance is critical to wellbeing and good health. Constant stress contributes to a prolonged state of 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.
Following the eight tips above can help you better manage the emerging risk factors for developing breast cancer. Unlike mammograms, these breast healthy lifestyle practices can help shape risk of disease. As goes the wise adage, an ounce of prevention is worth a pound of cure.
There are emerging risk factors for breast cancer including exposure to synthetic hormones such as those used in oral contraceptives and in certain forms of menopause hormone therapy, tobacco smoking, direct trauma or injury to the breast, radiation, stress and environmental exposures.
Regular screening for breast cancer enables early detection –but not prevention. Screening mammograms have been shown to save lives. It is important to partake in regular screening programs involving mammograms every 1 to 2 years after menopause. But there is growing interest and demand for prevention. Research suggests that breast cancer may begin its transformation up to 7 years prior to detection is possible with mammograms. And so, breast healthy lifestyle practices compliment routine screening with a comprehensive approach to improve hormone balance and reduce risk.