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Best Practices for Breast Cancer Prevention

October might be Breast Cancer Awareness month, but practicing healthy habits that can help reduce your risk of contracting this disease should be a year-round affair. Breast cancer will claim the lives of roughly 40,000 Americans this year, and according to the National Breast Cancer Foundation, 200,000 news cases will be diagnosed. The rate at which breast cancer has been diagnosed has increased substantially in recent decades, from 1 in 20 women in 1960 to approximately 1 in 7 today. Some of the increase in diagnoses can likely be attributed to better screening and more awareness (all those pink ribbons!). Though 80% of breast lumps are non-cancerous, 70% of breast cancers are initially found through breast self-exams. They’re important for everyone — though women who have a family history of breast cancer (especially a close relative, like a mother, sister, or daughter who has been diagnosed) or who have tested positive for the BRCA gene are at a much higher risk, about 80% of women diagnosed with breast cancer do not have a family history of the disease.
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Early diagnosis is key to keeping breast cancer from being a deadly disease. At the same time though, in an extensive review of the research into lifestyle and breast cancer, the American Institute of Cancer Research estimated that approximately 40% of breast cancer cases could be prevented with lifestyle changes — and other experts believe that estimate may actually be low. Read on to learn more about this disease, and the common-sense steps that you can take to reduce your risk.
Breast Cancer Basics
There are numerous risk factors for breast cancer, with sex being primary. Though it is often thought of as women’s disease — and women are much more likely to be diagnosed with breast cancer than men — the National Breast Cancer Foundation estimates that roughly 1,700 American men are diagnosed with breast cancer each year, and 450 die from the disease. Due perhaps in part to the focus on women, men are more likely to be diagnosed when they are older and at a more advanced stage of the disease, making it more difficult to fight. In men, it is believed that men who have “diabesity,” a condition linking obesity with prolonged exposure to elevated blood sugars and/or diabetes face an increased risk of developing breast cancer due to the increased inflammation associated with diabesity. For women, those of Caucasian descent are more likely to be diagnosed with breast cancer, though African-American and Latina women are statistically more likely to die from the disease. Age is also a risk factor; though women who develop breast cancer while young tend to face more aggressive forms of the disease.
“Breast cancer” is actually an umbrella term that takes into account two main types of cancer, of which there are different forms. Noninvasive (in situ) breast cancer means that the cancer cells have remained in their place of origin and have not spread to other tissue. Sometimes also called “Stage 0” cancer, the most common form of noninvasive breast cancer is ductal carcinoma in situ (DCIS), where the cancer has formed in the milk ducts. A diagnosis of invasive breast cancer means that the cancer cells have spread outside the membrane lining a duct or lobule and infiltrated surrounding tissues. Depending on how advanced the cancer is, it is classified as Stage I, II, III, or IV.
A key part of prevention is attention to any changes that happen to the breasts. Regular self-exams are important, as these help you establish a baseline and note any changes relatively quickly. It’s important to know that early breast cancer is often hard to detect and it doesn’t always mean having a “lump” (just as finding a “lump” doesn’t always mean you have breast cancer). Though it is important to be on the lookout for any changes in texture or consistency, it’s also important to note any unusual nipple discharge, pain or tenderness, changes in the skin on your breast, changes in your breasts’ size or shape, and enlarged lymph nodes or swelling in your underarms. If you see any of these changes, make an appointment with your doctor and get it checked out (and before you completely panic, remember that these could indicate other issues). If you are over 40 or have a family history of breast cancer, regular mammograms are also vital to ensuring your breasts stay healthy.
A lesser-known test and accepted, but still valuable, test is the estrogen metabolism test which offers another way to assess breast cancer risk. This test, which can be performed noninvasively and conveniently with a urine sample, can be used to establish a baseline and provide monitoring, letting you know if you are at higher risk if you are on a particular diet or undergoing hormone therapy. This test allows Dr. Tang to evaluate the ratio of bad vs. good estrogens and how estrogen is being processed in your body by testing hydroxyestrogens in your urine. These estrogen breakdown products allow the doctor to assess whether your body is properly methylating to eliminate the bad estrogens. Estrogen metabolites may provide valuable information about your breast cancer risk, since estrogen can be a driver for breast cancer. The estrogen metabolites 16 alpha-hydroxyestrone (16 alpha-OHE1) and 2-hydroxyestrone (2-OHE1) can be examined with this test, allowing you to optimize their ratio. This can potentially help reduce the risk of estrogen-related diseases including breast cancer. Along with standard detection methods such as mammograms and self-examinations, urine estrogen metabolism tests give you the best possible chance to prevent and protect against this deadly disease.
Prevention 101: Diet and Supplements
Not surprisingly, research has found that what you put into your body can play a role in your risk of developing breast cancer. While some risk factors are out of your control (like pollution or exactly where you live, which some argue are why cancer is a “modern” disease), what you eat, drink, and supplement with is totally up to you. Here are some of the vitamins and nutrients that have been found to be important for breast cancer prevention.
What You Want to Get

  • Vitamin D: This vitamin can actually enter cancer cells and trigger cell death. In fact, a researcher at SUNY Albany found that injecting human breast cancer cells directly with Vitamin D was as effective as the toxic breast cancer drug Tamoxifen. If you don’t get adequate levels of Vitamin D from diet (and sunlight), you can effectively supplement with it. It is believed that up to 90% of patients are either deficient or suboptimal.
  • Vitamin A: Evidence shows Vitamin A can help prevent breast cancer, but it needs to be taken with care since it can actually negate the benefits of Vitamin D. Maintaining a proper ratio of the two vitamins helps you get the best of both — Dr. Tang can help you with guidelines on how much of each you need. Vitamin A is easily obtained through foods. Colorful vegetables are an excellent source of Vitamin A.
  • Omega-3: You often hear about taking Omega-3’s to support your brain, but it’s also important for reducing your breast cancer risk. A good quality fish oil of 3-mg of EPA and DHA is recommended. Dr. Tang highly recommends taking a krill oil supplement, which boasts the same benefits as fish oil (and actually is potentially more easily absorbed in the GI tract) but does not carry the same concerns about toxins and heavy metals.
  • Curcumin: Found in turmeric, this is a potent tool against breast cancer. In fact, in India where turmeric is widely used in cooking and for its medicinal properties, the prevalence of four common U.S. cancers (colon, breast, prostate and lung) is 10 times lower. Curcumin is not easily absorbed by the body, however, so it has to be modified (one way to do this is by mixing it with boiling water, which can be drunk once it has cooled).
  • CoQ10: Coenzyme Q10 is a compound that naturally occurs in the body and is used both for cell growth and protecting cells from damage that could lead to cancer. Though studies have not shown it to have a definitive impact on breast cancer, it has been demonstrated to help improve resistance to other cancers.
  • DIM and I3C: These bioactive natural compounds are found in cruciferous vegetables like broccoli, kale, cabbage, bok choi, brussels sprouts, cauliflower, and even turnips. Both DIM and I3C are antioxidants that neutralize free radicals. Of particular importance for estrogen-driven cancers like breast cancer, I3C and help stop aggressive estradiol from binding to cellular receptor sites and wreaking havoc inside the cells. DIM in particular has been shown to restore p21 gene activity, which prevents the synthesis of DNA for new cancer cells and suggests it can stop cancer formation or growth. A study in the Biochemical Pharmacology Journal also showed that DIM may decrease HIF-1 alphas, stopping tumors from acquiring a supply of blood. A study from the medical school of The Ohio State University demonstrated that oral supplements of IC3 destroy the Cdc25A molecule, which is responsible for the rapid cell division in cancers including breast, prostate, colorectal, esophageal, liver, and lymphoma.
  • Calcium-D-Glucarate: In vitro and animal studies have been used to show that this compound inhibits beta-glucuronidase, potentially preventing carcinogenesis and inhibiting the initiation and promotion of cancer cells. Calcium-D-Glucarate also increases the elimination of carcinogens and hormones, including estrogen.

colorful vegetables
What You Should Avoid

  • Bisphenol A (BPA): One of the most common chemicals we’re exposed in everyday life, BPA is the building block of polycarbonate plastic and is also used to manufacture epoxy resins that are found in many consumer products (even thermal receipts). BPA is weakly estrogenic (in other words, its structure imitate estrogen), and studies have shown that BPA acts on breast cancer cells in the same way that natural estradiol does, interacting weakly with with the intracellular estrogen receptor and potentially causing breast tissue to grow. Though there has been considerable controversy over BPA exposure, a large amount of data indicates that it is associated with increased risk for cardiovascular disease, miscarriage, decreased birth weight, breast and prostate cancer, reproductive and sexual dysfunctions, altered immune system activity, metabolic problems and diabetes in adults, and cognitive and behavioral development deficiencies in young children. When you’re purchasing household products and anything containing plastic (especially products that will be used with food or drink), look for labelling that indicates it’s BPA-free or go with an alternative (like buying a reusable glass water bottle rather than metal or plastic).
  • Charred Meats and Veggies: If you cook on the grill, it’s important not to overdo the charring (same goes for flame-broiling). This has been linked with increased cancer risk because it creates the carcinogen acrylamide.
  • Smoke: Avoiding smoking, as well as second-hand smoke, is crucial, but you should also avoid smoke from barbecues (for the same reasons you should skip charred foods) as well as fumes coming from gasoline pumps.
  • Unfermented Soy: Unfermented soy is high in plant estrogens (also known as phytoestrogens or isoflavones). Breast cancer has often been linked to high estrogen levels, and some research has indicated that plant estrogens may work with regular estrogens to cause breast cells to proliferate — upping your cancer risk.
  • Excess Alcohol: If you don’t want to avoid alcohol entirely, try to limit your alcohol consumption to one drink per day. A 2011 study published in the Journal of the American Medical Association found that breast cancer risk increases the more a woman drinks — even having one alcoholic drink per day increased the risk by 1.2 times compared to women who never drink. What does booze have to do with breast cancer? Well, alcohol increases levels of estrogen and other hormones, which researchers believe may relate to a higher risk of hormone receptor-positive breast cancer.
  • Simple Carbohydrates: A study in the International Journal of Cancer found that having a high “glycemic load” increases the risk of breast cancer. Simple carbs (like white bread and potatoes) have a high glycemic index and create a sure in blood sugar, so a diet high in simple carbs ups your glycemic load — increasing your risk of developing this disease. In addition, if you have gluten sensitivity, you should avoid all forms of gluten since this can cause an inflammatory state which can be associated with an increased risk of many forms of cancer including breast cancer.
  • Excessive Iron: Though too little iron is problematic, too much iron can be too — and elevated iron levels are common in post-menopausal women. Extra iron can act as an oxidant, increasing the levels of free radicals in your body. Iron levels can be monitored by looking at levels of ferritin, the protein that transports iron in the body. If it is too high, you can actually reduce it by donating your blood.

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Prevention 102: Lifestyle Factors
While there are many risk factors for breast cancer that can’t be controlled — like your age, race, sex, and genetic makeup — those associated with choices you make are better under your control. In addition to the food, drink, and supplements we listed above, there are also lifestyle changes that you can make to reduce your risk. To make it a little less overwhelming, we’ve also listed some of the things you don’t need to worry about — there’s a lot of misinformation out there about what “causes” breast cancer, and it’s important to separate fact from fiction.
Changes You Should Make

  • Maintain a healthy weight: As if there aren’t enough good reasons to maintain a healthy body weight and get exercise already, yes, these are also excellent ways to reduce your risk of breast cancer (not to mention a host of other maladies). In the case of breast cancer, a healthy weight is especially important because fat produces estrogen—reducing excess fat also means removing excess estrogen. Weight gain during adulthood has been consistently associated with an increased risk of breast cancer post menopause. After the ovaries stop producing hormones, most of the body’s estrogen comes from fat cells — the more fat tissue, the higher your estrogen levels, and the greater your risk.
  • Get enough exercise: Regular physical activity has been shown not only to decrease the likelihood of developing breast cancer, but also to decrease the likelihood of dying from the disease by 50% for those who have been diagnosed. There’s a likely here back to weight loss and decreased body fat, which again decreases your exposure to estrogens produced by fat.
  • Reduce toxin exposure: While you can’t control everything around you, using more natural cleaning and personal care products can reduce your exposure to chemicals that are estrogen-like and that some worry contributes to increased incidence of breast cancer. Though many have expressed concern that parabens — which are found in many beauty and personal care products — are directly linked to breast cancer (a study found them in a large percentage of breast tumors), an actual causal link has not been proven. Still, excessive parabens are relatively easy to avoid — products that don’t contain parabens usually tout that fact on their labels, and unlike other chemicals which are byproducts rather than actual ingredients (such as 4-nonylphenol), you can look for it on the list of a product’s contents.
  • Keep your digestion regular: A study in the medical journal Lancet found that women who had two or fewer bowel movements per week had a whopping 4 times the risk of breast diseases (both benign and malignant) than women who have one or more bowel movements per day. It appears that constipation allows many kinds of waste within the body to build up — including excess estrogen, which the researchers found was especially high in those who ate meat. Bacteria within the colon become less effective at clearing out bad estrogen, allowing it to be reabsorbed into the body.
  • Avoid synthetic hormone replacement therapy (HRT): The synthetic estrogens taken by menopausal women have been linked to breast cancer, though it is unclear whether they should be considered a causal factor or something that promotes cancer. If you are experiencing symptoms of menopause and you are concerned about the risks of HRT, you should consider bioidentical hormone replacement therapy. This uses hormones that are molecularly identical to the ones your body produces, and many believe that it allows you to avoid many of the risks associated with HRT.
  • Find the right birth control: Though there was considerable alarm this year when a study published in Cancer Research seemed to link use of the hormonal birth control with increased breast cancer risk in young women. The results were actually more nuanced: While the researchers did find an increased relative risk with high-dose estrogen birth control, they did not find that risk increased with low-dose estrogen birth control. Other studies have had mixed results, so there’s not a clear causal link (though it’s also definitely not 100% safe). It’s important to remember that “The Pill” actually encompasses a wide range of options — if you’re concerned about birth control and breast cancer risk, you should talk with your doctor about finding an option that will work for you and that you can feel comfortable with. It’s also important to remember that there are non-hormonal birth control options out there, like IUDs.
  • Control your sugar intake: Another important lifestyle change to take is making sure that your blood sugar is kept under control. This affects not only your body weight, but also the potential for developing inflammation. Many see chronic inflammation as a precursor for different cancers (including breast cancer), as well as hypertension, heart disease, and diabetes. Diabetes substantially increases your risk for breast cancer (a 1.2-1.5 fold increase) and has an even stronger association with other forms of cancer. It’s important to remember that a large number of Americans suffer from diabetes but have not been diagnosed, and still more have “prediabetes” (elevated blood sugar levels that do not yet meet the diagnostic criteria for Type 2 diabetes, but that substantially increase the risk of developing the disease). Have your blood sugar tested, and make sure to maintain a healthy, nutritious, low glycemic diet.

What You Don’t Need to Worry About

  • Your Bra: There have been claims that underwire bras cause toxins to accumulate by compressing the lymphatic system in the breasts, but these have been dismissed as unscientific. Scientists conclude that the kind of bra you wear, how tight it is, how long you wear if for, and so on, do not have any connection to breast cancer risk.
  • Deodorants and Antiperspirants: There is a widespread belief that using deodorants and antiperspirants causes breast cancer, a claim often backed up with the explanation that metals enter the body through razor nicks from shaving and that breast cancer often develops in this area. Breast cancer is often found near the underarms, but that is due to where lymph nodes are located and the fact that this quadrant of the breast tends to have more tissue. Studies have demonstrated that there is no link between the use of antiperspirants and deodorants and an increased risk of breast cancer. If you are really concerned about the metals or other chemicals in these products, try using an all-natural deodorant or a deodorant crystal rather than a conventional antiperspirant. In general terms, heavy metal toxicity, due to environmental issues as well as everyday products is definitely a concern — this has been related to increases in all kinds of cancer, not just breast cancer. If you are worried about the levels of heavy metals in your body, this can easily and painlessly be checked via a urine test.
  • Breast Implants: Having breast implants does not impact the risk of breast cancer. The only possible issue is that implants may make mammography more difficult, so sometimes additional x-rays may be needed to get a full view breast tissue.
  • Having had an abortion or miscarriage: Some people have expressed concern that because having had an abortion or experienced a miscarriage creates major changes in hormonal levels, there’s a potential link to an increased risk of developing breast cancer. Though multiple studies have examined this, no link has been found.

If you want to learn more about many of these areas — including testing your vitamin or heavy metal levels, estrogen metabolism testing, whether you’re a candidate for bioidentical hormone replacement therapy, and finding beauty products that are free from estrogen-like chemicals — Rejuvé can help. Call us at 408-740-5320 to make an appointment to talk with Dr. Tang.