Perspectives on 20 Years of Breast Cancer Awareness

Menopause, A Hormone Balancing Act – by Dr. Deanna M. Cherrone
Bioidentical Hormones Replacement – by Henry C. Sobo, MD
Do You Really Know What Hormones Do?

As a 52 year-old-woman and a naturopathic physician who has specialized in women’s health for 20 years, I am acutely aware of how breast cancer affects our lives.  We are inundated with breast cancer statistics, wrapped up in pink ribbons, saddened by widely publicized stories of celebrities’ breast cancer journeys, confused by changing recommendations for mammograms and self breast exams, and unsure of breast cancer causes, prevention and cures.

My patients have many questions about breast cancer. If there is no family history of breast cancer are they still at risk? Do mammograms cause breast cancer? Do hormone support therapies cause breast cancer? What lifestyle choices can help prevent breast cancer?

Breast cancer is the second most common cancer diagnosis in the United States. The incidence of breast cancer increases with a woman’s age. Postmenopausal women account for 74% of diagnosed breast cancer. The statistic we all hear, “one out of every eight adult women will be diagnosed with breast cancer,” becomes true by the time we are in our eighties. Family history of breast cancer is found in only 5 to 10 percent of women. Women with a parent, sibling or child who has breast cancer are at twice the risk for developing the disease. Women with a strong family history, who are positive for the genes BRCA1, BRCA2 and p53, have a 40 to 85 percent lifetime risk of developing breast cancer.

These statistics can be intimidating. Breast cancer is the second most frequently diagnosed cancer in the United States  because of frequency of occurrence, and because mammograms are very effective at finding breast cancer. Mammograms detect about 90% of breast cancers and become more accurate as we age, when our breast tissue becomes less dense. In Connecticut, by law, a woman is entitled to have a breast ultrasound if a mammogram determines she has dense breast tissue. Mammograms have not been found to increase the risk of breast cancer, and are associated with an overall decreased risk of death from breast cancer.

When should we start having mammograms? The American Cancer society recommends annual mammograms starting at the age of 40. More recent recommendations advise starting at 50 years old. I suggest patients make an informed decision about mammograms based on their individual concerns. Is there any family history? Do they have dense breast tissue? Are they confident with their own self breast exams and the clinical breast exams by their physicians? It’s not unusual for my patients to tell me they’re afraid to check their own breasts because they are lumpy and bumpy. Breast tissue texture is not smooth and uniform because breasts are composed of ductal and lobular tissue, connective and lymphatic tissue, fat, and beneath all that, muscle. I encourage patients to get to know their breast lumps and bumps, which we check together at their annual exams. Also keep in mind, for women still having their menstrual cycle, breast tissue changes during the cycle. Contrary to some research that says breast palpation exams are not effective for detection of breast changes, I’ve seen many women who were the first to notice something different about their breast, which thankfully, most of the time, is benign. For women who can’t do self breast exams, women with a family breast cancer history, and women on hormone replacement or hormonal birth control, I do recommend annual mammograms.

Some patients ask if breast thermography can be done in place of mammograms and ultrasound. Breast thermography was approved by the FDA in 1982 as a tool for detection of breast tissue irregularities. It is a technology of displaying temperature and vascular variation in breasts which can be useful for observing potential problematic changes to breast tissue. The interpretation of the thermograms relies on the expertise of the practitioner reading the results. I suggest that women who are interested in breast thermography ask the physician who does their annual gynecological exams how to best incorporate it into their breast care plan; a plan which should include mammography for most women over 40.

Many of my patients have perimenopausal or menopausal concerns. Some women want to consider hormone replacement as part of their treatment plan. The question often arises if hormone replacement therapy will increase their risk of getting breast cancer.

In 2002, the Women’s Health Institute published findings that menopausal women on PremPro had more diagnosed breast cancer incidence then women not on PremPro, or women on Premarin alone. (Premarin is combination of several estrogens from pregnant horse urine and synthetic progesterone (progestins). Further follow-up on this study has shown that women on synthetic progesterone as part of their hormone therapy are at risk for more breast cancer. Studies also indicate that women who have taken birth control pills, which contain synthetic estrogens and progesterone, for 10 years or more, have at slightly higher breast cancer risk. I’m often asked if bio-identical or natural hormones are safer than synthetic hormones. This is a long, complicated, and highly debated topic. It is apparent that synthetic progesterone is problematic. It’s not entirely clear that natural hormones are safer. Even estrogen therapy slightly increases the risk of breast cancer. Estrogen and progesterone probably don’t cause breast cancer, but most breast cancers have estrogen and progesterone receptors that, when stimulated by these hormones, may increase the rate of breast cancer growth. So the short answer to the hormone question is that any hormone therapy slightly increases breast cancer risk. Some of my patients still choose hormone replacement therapies because of the severity of their menopausal symptoms and sexual health concerns. For some women, improving the quality of their life with a well thought-out personalized hormonal support therapy, is the right health choice for them.

What lifestyle choices can we make to improve our breast health and possibly prevent breast cancer? As always, fresh, clean, nutritious food is the first and best medicine for ensuring vital health. Vitamins, minerals and herbs may have a role in maintaining or balancing health but they’re a drop in the bucket compared to a healthy diet. Many studies confirm that a high intake of colorful fruits and vegetables decrease the risk of breast cancer recurrence in women who’ve had breast cancer, so they may play a role in prevention too. Five servings of vegetables and fruits appears to be the daily minimum. Be sure to include the cruciferous vegetables such as broccoli, cauliflower, brussel sprouts, and cabbage.

Regular exercise and a good nutrition appear to be a powerful combination against breast cancer. A 2007 study that was published in an oncology journal reported that women with breast cancer who exercised 30 minutes 6 days per week, and who ate 5 servings of vegetables and fruits daily, cut their risk of dying from breast cancer in half . There isn’t a drug available that can make that same claim.

Patients also ask how alcohol, sugar, or being overweight affects their chances of developing breast cancer. There is a definite relationship between the amount of alcohol women consume and increased risk. The more alcohol women drink, the greater the risk. Some literature states 3 to 5 servings per week may be safe while other studies haven’t determined any amount is safe. Over-consumption of sugar also contributes to breast cancer risk, both because it can contribute to unhealthy body weight and can lead to insulin resistance. Insulin resistance occurs when the body is overwhelmed with excessive sugar and simple carbohydrate consumption. A high Body Mass Index (BMI) makes women more susceptible to insulin resistance and breast cancer. Maintaining an ideal body weight reduces breast cancer risk.

Better nutrition, less sugar and alcohol, regular exercise, and maintaining a healthy weight helps protect us from breast cancer and other cancers, and helps prevent heart disease and diabetes, two additional serious health concerns that affect women. Again, food is our first medicine.

There are some supplements I often encourage patients to incorporate into their lifestyle. Green tea has been shown to be protective against breast cancer. Drinking 3 to 5 cups daily provides important hydration and powerful antioxidants. Omega-3 fatty acids from fish oil beneficially modify the body’s inflammation pathways, helping the immune system work well. I usually recommend 1000mg to 3000mg daily of a reputable brand. Vitamin D3 research has shown it is important to the prevention of breast cancer and improves the outcome for women diagnosed with breast cancer. I’ve checked the vitamin D levels of more than 500 patients in my practice. Only 75 women had optimal levels. I suggest women have their physicians include vitamin D3 with their regular lab work, and supplement appropriately.

Our increasing knowledge about breast cancer has provided us with more research, information, and treatment options, but it also has contributed to our fears. On one hand, our society perceives our breasts as an integral aspect of motherhood and sensuality and on the other hand, as a potential center for disease. I encourage women to consciously regard the sometimes overwhelming amount of information about breast cancer and about many other health challenges and choices that comes at us every day. We need to know what holds true for us personally, so we can embrace our bodies and health with respect and optimism, not fear.  A lifestyle and attitude of calm awareness empowers our minds and bodies in every way and creates an immense potential for healing. We can all give ourselves this gift no matter where we are in our journey to health.

Dr. Michelle J. Pouliot has been providing women with comprehensive naturopathic care for the past twenty years in Connecticut’s northwest corner. She recently opened the New Hartford Naturopathic Health Center LLC .The center can be reached at (860)238-7983. See ad on page 34.