Women's Bodies, Women's Wisdom (77 page)

What treatment is recommended often depends on whom you consult. Surgeons tend to recommend surgery for DCIS. Radiation oncologists recommend radiation. Medical oncologists recommend tamoxifen or other antiestrogen pills. Unfortunately, a 2009 study of more than a thousand women with ER-positive breast cancer (not just DCIS) shows that women who take tamoxifen after lumpectomy or mastectomy for at least five years more than quadruple their risk of developing a rare but more aggressive and more difficult-to-treat cancer (known as ER-negative breast cancer) in their healthy breast.
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Using tamoxifen for less than five years wasn’t linked to the more aggressive cancer, but women don’t get the full benefit of the drug until they’ve taken it for five years. Here’s the bottom line: While the majority of women with breast cancer will lower the risk of cancer recurring by taking tamoxifen, one-quarter of them will actually
increase
their risk of getting an even more deadly form of breast cancer—odds I’m not very comfortable with, especially when you consider the fact that this drug also raises the risk of blood clots, stroke, and uterine cancer. Though this study was in women with cancer, not DCIS, women with DCIS are routinely put on tamoxifen. Given that most DCIS isn’t going to go on to become invasive cancer in the first place, is tamoxifen worth the risk?

In general, chemotherapy other than tamoxifen is recommended only when there is evidence of inva sion. Women should clearly recognize that they have plenty of time to consider all their options. DCIS does not grow rapidly. Some goes away. We know that some untreated DCIS may eventually go on to become invasive cancer, but we do not know which types, when, or why. Researchers are looking for markers but unfortunately have not found the perfect one. Others are looking at the “cross talk” between cancer cells and normal cells around them and how they keep a balance. The good news is that the chance of dying from DCIS is very, very low, about 1 to 2 percent. Conventional treatment efforts are aimed at minimizing the risk of the DCIS recurring in the breast and becoming invasive. Given the new data mentioned here showing that many early breast cancers, including DCIS, disappear without treatment, the angst, fear, and confusion women go through when diagnosed with DCIS create more havoc with their health than the actual disease. The only way out of this dilemma is to realize you have the ability to improve your breast from the inside out, regardless of whether or not you’ve been diagnosed with DCIS. Here’s a better way: Screen with thermography, not mammography; institute lifestyle and nutritional changes; and then do regular follow-ups. (See my Program to Promote Healthy Breast Tissue, page 352.)

BREAST CANCER

Statistics show that one in eight women in the United States will get breast cancer if you distribute the risk over her entire lifetime, up until the age of ninety. Let me put this into perspective. According to the National Cancer Institute, at age twenty, the risk of getting breast cancer is 1 in 2,500; at forty, 1 in 63; and at sixty, 1 in 28 . . . far different from 1 in 8! Still, breast cancer is the leading cause of cancer death among American women who are forty to fifty-five years of age. On the other hand, lung cancer is by far the leading cause of cancer death in women of all ages. Cardiovascular disease trumps them both—killing six times more women than breast cancer.
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When I was in medical school, I was taught that one in twenty-five women would get breast cancer. No one is sure whether the incidence of breast cancer is actually on the increase or whether we are simply di agnosing it earlier these days, with the increase in mammography and public awareness. Regardless of statistics, however, most of us know at least one person who has had or currently has breast cancer.

For this to be the case, clearly something is out of balance. Evidence is accumulating that certain environmental pollutants contribute to estrogenic activity and may contribute to the incidence of breast problems in the industrialized world.
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It is well documented that estrogen and estrogen-like chemicals (known as xenoestrogens) stimulate the growth of breast tissue and, in excess, may increase the risk of breast cancer. It is possible that these factors, along with suboptimal levels of vitamin D and iodine, are contributing to earlier signs of puberty in young girls. I’m also concerned about the possible effects on breast tissue of recombinant bovine somatotropin (rBST), also called bovine growth hormone (BGH), which is given to cows to increase milk production.
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In addition, environmental contaminants such as PCBs, PBBs, and mercury are probably significant as well. Fifty percent of girls in the United States now show signs of breast budding before age ten, while 14 percent are showing breast development by age eight. The average age of breast budding for African American girls is just under nine years, with a significant percentage growing pubic and underarm hair before age eight.
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Every woman should be proactive about her breast health
now.
Why wait until further studies on environmental tox ins come in or the definitive treatment for breast cancer is figured out when you can start, through your thoughts, emotions, and daily choices, to create breast health now—even if you’ve already got cancer?

The breast is an estrogen-sensitive organ. Many women who have been on birth control pills or estrogen replacement have found that the medication resulted in enlarged and often tender breasts. The effect of these medications, plus the inflammation-causing standard American high-glycemic-index, low-fiber diet, which overstimulates breast tissue, is a setup for breast cancer.

The Breast Cancer/Diet-Hormone Link

Breast cancer has been associated with high levels of certain types of dietary fat and low levels of some nutrients, such as iodine, vitamin D, and selenium, for many years. As far back as 1973, a study at the National Cancer Institute showed that countries with the highest intake of animal fat had the highest mortality rates from breast cancer.
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But it’s not so simple. In 1996 an analysis of 337,000 women in seven prospective studies suggested that there is no association between women’s intake of dietary fat and their risk for developing subsequent breast cancer. The researchers found no difference in breast cancer rates between those whose intake of dietary fat ranged from more than 45 percent of their calories to less than 20 percent. It didn’t seem to matter whether the fats were from saturated, monounsatu rated, or polyunsaturated sources.
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Interestingly, an Italian study showed a decreased risk of breast cancer with increased fat in take but an increased risk of breast cancer when the intake of available carbohydrates in the form of starch (breads, pasta, etc.) was increased.
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Scientific data are rapidly accumulating on the link between sugar, insulin levels, and breast cancer.
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Here’s my current thinking. High-fat, nutrient-poor diets in industrialized societies almost always include large amounts of partially hydrogenated fats (also called trans fats) and are usually associated simultaneously with high consumption of refined carbohydrates and sugar along with a low intake of fresh fruits and vegetables, iodine, and antioxidants. It is not the fat per se but the type of fat combined with a diet that raises blood sugar that is the real culprit. This combination is a setup for chronic inflammation at the level of the cell—especially when you add in the biochemical effect of certain emotional states, which I’ve already mentioned. Excessive estrogen (relative to progesterone) over the life cycle that is related to diet and obe sity also appears to be associated with increased risk of breast cancer, at least in some individuals.
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Emotional stress; a nutrient-poor diet full of refined carbohydrates and low in vitamin D, iodine, magnesium, and omega-3 fats; environmental toxins—any and all of these can increase cellular inflammation. And inflammation precedes cancer. (By the way, a 2009 study indicated that chronic cellular inflammation in women who had been diagnosed with breast cancer may also increase the chances of the cancer recurring. Researchers found that elevated levels of C-reactive protein [CRP], a marker for cellular inflammation, measured as long as seven years after the subjects were successfully treated for early-stage breast cancer, were associated with reduced survival rates.)
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PROGRAM TO PROMOTE HEALTHY BREAST TISSUE

This program is designed to eliminate breast pain and decrease your risk of breast cancer. Choose from the options in this section on the basis of what ap peals to you and what you can easily do without stressing yourself out unduly. You don’t have to do everything I’ve listed here all at once, un less it feels right to you.

First, consult your health care provider.
This is to make certain that you have no signs of breast cancer. It is ideal to have a physician who can also offer you the emotional support you need for dealing with breast pain, a breast lump, or both.

Minimize estrogen and inflammation.
Follow a low-sugar diet that minimizes excess estrogen and also decreases cellular inflammation (see
chapter 17
, on nutrition) in your system. Breast tissue is exquisitely sensitive to high-refined-carbohydrate (high-sugar) diets, which raise estrogen, insulin, and blood sugar levels, resulting in cellular inflammation. Excessive estrogen production stimulates breast tissue, resulting in breast pain and cyst formation in many women.
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Many cancerous breast tumors are stimulated by hormones such as estrogen. Tamoxifen, a drug used to treat breast cancer, works by lowering estrogen’s effect on breast tissue. The higher the percentage of body fat (because body fat manufactures estrogen) and the higher the insulin levels from too many refined carbohydrates, the higher the estrogen levels and the greater the risk for breast and other gyne cological cancer.
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Plenty of soluble fiber in your diet from vegetable sources helps increase the excretion of excess estrogen.
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Lentils and beans are good sources. You can also supplement with psyllium or slippery elm. The cruciferous vegetables (cabbage, broccoli, kale, Brussels sprouts, turnips, and collard greens) all contain the plant chemical indole-3-carbinol, which has been shown to decrease estrogen’s ability to bind to breast tissue, thus making the body’s own estrogen less apt to promote cancer.
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This substance is also available as a supplement. About 80 percent of women with cyclic breast pain get relief from dietary change alone be cause a whole-food, inflammation-reducing diet changes hormonal levels and has been shown to significantly reduce the severity of breast ten derness and swelling.
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Get enough phytoestrogens (soy, flax) in your diet.
Asian women who consume a traditional diet—including the soy-based products tempeh, tofu, miso, and natto—excrete estrogen at a much higher rate than those who don’t. They also have a much lower risk of breast cancer. These soy products, rich in what are known as phytoestrogens, which are plant substances that have biochemical properties similar to weak estrogens, ap pear to be protective against breast cancer, in part because their weak estrogenic activity tends to block estrogen receptors on the cells from excessive estrogen stimulation from other sources.
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A Singaporean study showed that diets high in soy products con ferred a low risk of breast cancer in premenopausal woman.
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Soy even helps women who have already been diagnosed with breast cancer.