FEATURE STORY
Tips to Reduce Breast Cancer Risk

IN THE NEWS
Stay Active to Reduce Breast Cancer Risk

CHECKLIST
Useful Herbs & Supplements

COOKING CORNER
What to Do with Those Fall Squashes

VITAMINS & HERBS
Don't Forget Folic Acid

HERBAL REMEDIES
Go with Green Tea

EVERYDAY ANSWERS
Is Yoga Good Exercise for Women with Breast Cancer?

More Health Info & Answers

October Is Breast Cancer Awareness Month
Tips to Reduce Risk

According to the Susan G. Komen Foundation, every three minutes one woman will be diagnosed with breast cancer. Yet when looking into the disease’s cause, only 5 to 10% of breast cancers are due to heredity, which means there is great hope for reducing your risk. The latest research points to promising prevention strategies.

A healthy lifestyle offers protection now. What changes can you make to reduce your breast cancer risk or ease your treatment? According to research or other evidence, the following self-care steps may be helpful:

• Get a checkup. See your healthcare professional once a year for a breast exam and mammogram to detect disease before it becomes advanced.
  
• Cut back on cocktails, but not on nutrition. Limit your alcohol consumption and take a multivitamin containing folic acid to reduce alcohol-related breast cancer risk.
  
• Eat risk-reducing foods. Add plenty of fiber, tomato products, soy products, and fish to your diet.
  
• Prioritize exercise. Maintain a regular exercise program throughout your life.
  
• Seek support. If you have breast cancer, join a weekly patients’ group for social support.
  
• Mix in melatonin. If you have breast cancer, take 20 mg of this hormone at night under medical supervision to possibly help shrink tumors and slow progression.

Read on to learn more about studies that have assessed whether certain vitamins, minerals, herbs, or other ingredients in dietary or herbal supplements may help reduce breast cancer risk or symptoms in people who have this condition.

This information is provided solely to aid consumers in discussing supplements with their healthcare providers. It is not advised, nor is this information intended to advocate, promote, or encourage self-prescription of these supplements for cancer risk reduction or treatment. Furthermore, none of this information should be thought to suggest that dietary or herbal supplements can or should be used in place of conventional anticancer approaches or treatments.

Certain studies referenced below are preliminary evidence only. Some studies suggest an association between high blood or dietary levels of a particular dietary ingredient with a reduced risk of developing breast cancer. Even if such an association were established, this does not mean that dietary supplements containing large amounts of the dietary ingredient will necessarily reduce cancer risk.

Dietary Changes That May Be Helpful

Alcohol avoidance
An analysis of studies using the best available methodology found that women who drink alcohol have a higher risk of breast cancer compared with teetotalers. Alcohol consumption during early adulthood may be more of a risk factor than alcohol consumption at a later age.

In a preliminary report, drinkers with low intake of folic acid had a 32% increased risk of breast cancer compared with nondrinkers; however, the excess risk was only 5% in those drinkers who consumed adequate levels of folic acid. In the same report, women taking multivitamins containing folic acid and having at least 1.5 drinks per day had a 26% lower risk of being diagnosed with breast cancer compared with women drinking the same amount of alcohol but not taking folic acid-containing vitamins.

Fiber
Insoluble fiber from grains delays the onset of mammary (breast) cancer in animals. In an analysis of the data from many studies, people who eat relatively high amounts of whole grains were reported to be at low risk for breast cancer.

Eating a diet high in insoluble fiber is best achieved by switching from white rice to brown rice and from bakery goods made with white flour or mixed flours to 100% whole wheat bread, whole rye crackers, and whole grain pancake mixes. Refined white flour is generally listed on food packaging labels as “flour,”“enriched flour,”“unbleached flour,”“durum wheat,”“semolina,” or “white flour.” Breads containing only whole wheat are usually labeled “100% whole wheat.”

Vegetarianism
Compared with meat eaters, most, but not all, studies have found that vegetarians are less likely to be diagnosed with cancer. Vegetarians have also been shown to have stronger immune functioning, possibly explaining why vegetarians may be partially protected against cancer. Female vegetarians have been reported to have lower estrogen levels compared with meat-eating women, possibly explaining a lower incidence of breast cancer that has been reported in vegetarian women.

Fruits and vegetables
An analysis of 17 studies on breast cancer risk and diet found that high consumption of vegetables was associated with a 25% decreased risk of breast cancer compared with low consumption. The same report analyzed 12 studies that found high consumption of fruit was associated with a 6% reduction of breast cancer incidence compared with low consumption. However, when data from only the eight largest and best studies were combined, high intake of fruits and/or vegetables did not correlate with protection from breast cancer. Therefore, the protective effect of fruit and vegetable consumption against breast cancer remains unproven.

Tomatoes
Tomatoes contain lycopene—an antioxidant similar in structure to beta-carotene. Most lycopene in our diet comes from tomatoes, though traces of lycopene exist in other foods. Lycopene has been reported to inhibit the proliferation of cancer cells in test tube research.

A review of published research found that higher intake of tomatoes or higher blood levels of lycopene correlated with a reduced risk of a variety of cancers in 57 of 72 studies. Findings in 35 of these studies were statistically significant. Evidence of a protective effect for tomato consumption was strongest for cancers other than breast cancer (prostate, lung, and stomach cancer), but some evidence of a protective effect also appeared for breast cancer.

Meat and how it is cooked
Most, but not all, studies show that eating meat is associated with an increased risk of breast cancer, probably depending in part on how well the meat is cooked. Well-done meat contains more carcinogenic material than does lightly cooked meat. Evidence from preliminary studies shows that women who eat well-done meat have a high risk of breast cancer. Genetic factors may determine which women increase their risk of breast cancer by eating well-done meat.

Fish
Fish eaters have been reported to have a low risk of breast cancer. The omega-3 fatty acids found in fish are thought by some researchers to be the components of fish responsible for protection against cancer.

Olive oil
Olive oil consumption has been associated with a reduced risk of breast cancer in several preliminary reports. Oleic acid, the main fatty acid found in olive oil, does not appear to be the cause of this protective effect, and scientists now guess that some as-yet undiscovered substance in olive oil might be responsible for the apparent protective effect of olive oil consumption.

The dilemma over dietary fat
While olive oil and fish are considered potentially helpful in protecting against breast cancer, researchers are concerned that other fat sources might increase the risk.

High-fat diets increase the risk of mammary cancer in animals. From country to country, breast cancer risk in women is proportionate to the level of total fat consumed in the diet. Estrogen levels, body weight, and breast density have all been reported to decrease when women are put on low-fat diets—all changes that are thought to reduce the risk of breast cancer. Moreover, breast cancer patients have been reported to reduce their chances of survival by eating a diet high in saturated fat. (Saturated fat is found mostly in meat and dairy fat.) Similarly, breast cancer patients have been reported to be at increased risk of suffering a recurrence if they eat higher levels of fatty foods, such as butter, margarine, red meat, and bacon.

Analysis of human trials, using a research design dependent on the memories of subjects, also has shown women consuming high-fat diets to be at high risk of breast cancer. In some cases, the correlation has been quite strong. However, most, but not all, “prospective” studies—which avoid problems caused by faulty memories—have not found any association between fat intake and the risk of breast cancer.

Why do some research findings suggest that fat increases the risk of cancer and other studies find no association? Some studies finding dietary fat unrelated to cancer risks have not factored out the effects of olive oil or fish fat; both may protect against cancer. Adding them to the total dietary fat intake and then studying whether “more fat causes more cancer” is therefore misleading. Some studies finding no association between fat intake and breast cancer have made one or both of these errors.

In the debate over whether dietary fat increases breast cancer risks, only one fact is indisputable: women in countries that consume high amounts of meat and dairy fat have a high risk of breast cancer, while women in countries that mostly consume rice, soy, vegetables, and fish (instead of dairy fat and meat) have a low risk of breast cancer.

The complex relationship between soy foods and risk
Countries in which soy and tofu consumption is high generally have a low incidence of breast cancer. However, the dietary habits in these countries are so different from diets in high-risk countries that attributing protection from breast cancer specifically to soy foods on the basis of this evidence alone is premature. These dietary habits might only be markers for other dietary or lifestyle factors that are responsible for protection against breast cancer.

The commonly held belief that consuming soybeans or isoflavones such as genistein will protect against breast cancer is far from proven. Possibly, consuming soybeans in childhood may ultimately be proven to have a protective effect. Doing the same in adulthood, however, may have very different effects.

Some scientists, at least under some circumstances, remain hopeful about the potential for soy to protect against breast cancer. These scientists recommend consumption of foods made from soy (such as tofu), over taking isoflavone supplements. Several substances in soybeans other than isoflavones have shown anticancer activity in preliminary research.

Sugar reduction
Preliminary studies have reported associations between an increased intake of sugar or sugar-containing foods and an increased risk of breast cancer, though this link does not appear consistently in published research. Whether these associations exist because sugar directly promotes cancer or because sugar consumption is only a marker for some other dietary or lifestyle factor remains unknown.

Lifestyle Changes That May Be Helpful

Exercise and prevention
Girls who engage in a significant amount of exercise have been reported to be less likely to get breast cancer as adults. Although some doctors speculate that exercise in preadolescent girls might reduce the risk of eventually getting breast cancer by reducing the number of menstrual cycles and therefore exposure to estrogen, these effects may occur only in girls engaging in very strenuous exercise.

Most, but not all, studies find that adult women who exercise are less likely to get breast cancer. Women who exercise have also been reported to have a reduced risk of high-risk mammography patterns compared with inactive women.

Exercise in adulthood might help protect against breast cancer by lowering blood levels of estrogen or by helping maintain ideal body weight. In addition to the preventive effects of exercise, aerobic exercise has been reported to reduce depression and anxiety in women already diagnosed with breast cancer.

Smoking and risk
Some studies have found an association between smoking and an increased risk of breast cancer, including exposure to secondhand smoke. However, several reports have either found no association or have reported an association between smoking and an apparent protection against breast cancer. Some of the studies reporting that smoking is detrimental have found that exposure to cigarette smoke during childhood appears to be most likely to increase the risk of breast cancer.

The mind-body connection
In some studies, the risk of breast cancer has been reported to be higher in women who have experienced major (though not minor) depression in the years preceding diagnosis. Some, but not all, studies have found that exposure to severely stressful events, such as death of a spouse or divorce, increases a woman’s chance of developing breast cancer. Although stress has long been considered as a possible risk factor, some studies have not found significant correlations between psychological stressors and breast cancer risk or the risk of breast cancer recurrence.

Exposure to psychological stress has been reported to weaken the immune system of breast cancer patients. Strong social support has been reported to increase immune function in breast cancer patients. These findings suggest a possible way in which the mind might play a role in affecting the risk of a breast cancer recurrence.

In one study, breast cancer patients with strong social support in the months following surgery had only half the risk of dying from the disease during a seven-year period compared with patients who lacked anyone to confide in. After 10 and 15 years, breast cancer patients with a helpless and hopeless attitude or with an attitude of stoicism were much less likely to survive compared with women who had what the researchers called a “fighting spirit.” In a five-year study, the same helpless/hopeless attitude correlated with an increased risk of recurrence or death in breast cancer patients, but a “fighting spirit” did not correlate with special protection against recurrence or death. One trial reported that psychological therapy for hopeless/helpless breast cancer patients was capable of changing these attitudes and reducing psychological distress in only eight weeks.

Several trials using a variety of psychological interventions have reported increased life expectancy in women receiving counseling or psychotherapy compared with women who did not receive psychological intervention—even in women with late-stage disease. In a now-famous trial, late-stage breast cancer patients in a year-long, 90-minute-per-week support group lived on average twice as long as a group of similar patients who did not receive such support.

Finally, relaxation training has been reported to reduce psychological distress in breast cancer patients, and group therapy and hypnosis have reduced pain in late-stage breast cancer patients.

Even extensive psychological support (weekly peer support, family therapy, individual counseling, and use of positive mental imagery) has not led to a clear increase in breast cancer survival in every study. Why some studies clearly find mind-body connections in regard to breast cancer risk, recurrence, or survival, while other studies find no such connection, remains unclear.

Overweight and risk
Being overweight increases the risk of postmenopausal breast cancer, a fact widely accepted by the research community. Overweight does not increase the risk of premenopausal breast cancer and even may be associated with a slightly reduced risk of breast cancer in young women.

Vitamins That May Be Helpful

Folic acid
Among women who drink alcohol, those who get relatively high amounts of folate from their diet have been reported to be at reduced risk of breast cancer, compared with women who drink alcohol but consumed less folate, according to a preliminary study. In a similar report, folic acid-containing supplements were associated with a lower risk of breast cancer in women who drank alcohol, compared with women who drank alcohol but did not take such supplements.

The damaging effect alcohol has on DNA—the material responsible for normal replication of cells—is partially reversed by folic acid. Therefore, a potential association between both dietary folate and folic acid supplements and protection against breast cancer in women who drink alcohol is consistent with our understanding of the biochemical effects of these substances. A combined intake from food and supplements of at least 600 mcg per day was associated with a 43% reduced risk of breast cancer in women who consumed 1.5 drinks per day or more, compared with women who drank the same amount but did not take folic acid-containing supplements.

No research has yet explored the effect of folic acid supplementation in people who have already been diagnosed with cancer. Cancer patients taking the chemotherapy drug methotrexate must not take folic acid supplements without the direction of their oncologist.

Vitamin D
Breast cancer rates have been reported to be relatively high in areas of low exposure to sunlight. Sunlight triggers the formation of vitamin D in the skin, which can be activated in the liver and kidneys into a hormone with great activity. This activated form of vitamin D causes “cellular differentiation”—essentially the opposite of cancer.

The following evidence indicates that vitamin D might have a protective role against breast cancer:

• Synthetic vitamin D-like molecules have prevented the equivalent of breast cancer in animals.
  
• Activated vitamin D appears to have antiestrogenic activity.
  
• Both sunlight and dietary exposure to vitamin D have correlated with a reduced risk of breast cancer.

Activated vitamin D
Activated vitamin D comes in several forms. One of them—1,25 dihydroxycholecalciferol—is an exact duplicate of the hormone made in the human body. Preliminary, nonclinical evidence supports the idea that activated vitamin D may be of help to some breast cancer patients:

In a preliminary trial, activated vitamin D was applied topically to the breast, once per day for six weeks, in 19 patients with breast cancer. Of the 14 patients who completed the trial, three showed a large reduction in tumor size, and one showed a minor improvement. Those who responded had tumors that contained receptors for activated vitamin D. However, other preliminary reports have not found that high levels of these receptors consistently correlate with a better outcome.

With a doctor’s prescription, compounding pharmacists can put activated vitamin D, a hormone, into a topical ointment. Due to potential toxicity, use of this hormone, even topically, requires careful monitoring by a physician. Standard vitamin D supplements are unlikely to duplicate the effects of activated vitamin D in women with breast cancer. The patients in the breast cancer trial all had locally advanced disease.

Melatonin
Melatonin has been reported to have anticancer activity against breast cancer cells in most though not all test tube studies. In a preliminary trial, breast cancer patients were studied who previously had responded either not at all or only temporarily to treatment with the drug tamoxifen. During the trial, these women were given tamoxifen again, this time with added melatonin. Blood levels of IGF-1, a marker for progression of breast cancer, declined significantly. Of fourteen patients, four showed evidence of tumor shrinkage that lasted an average of eight months. Most cancer trials studying the effects of melatonin have used 20 mg of melatonin per 24 hours, all taken at bedtime. No one should take such a high amount of this hormone without the supervision of a healthcare professional.

Coenzyme Q10 (CoQ10)
French researchers have reported that the lower the blood level of CoQ10 in breast cancer patients, the worse the chance of remaining free of disease. For several years, researchers from Denmark and the United States have been studying the effects of CoQ10 in a group of 32 breast cancer patients who were either at high risk of suffering a recurrence or had already been diagnosed with advanced disease. After 18 months, only one patient had suffered a recurrence, all were still alive, those who did not have advanced disease at the beginning of the trial had not progressed to advanced disease, one patient with advanced disease had stabilized, and two patients with advanced disease had significantly improved. Patients continued to do well after two years of supplementation, and after three to five years, surprising improvements were reported in two patients who had had advanced disease at the beginning of the trial.

At first, 90 mg of CoQ10 per day was used. In subsequent reports, the amount of CoQ10 was increased until some women were receiving 390 mg per day. Initially, the CoQ10 was accompanied by the use of many other supplements. The researchers of this trial have attributed the therapeutic effects observed primarily to CoQ10 and, in later reports, no further mention of other supplements was made.

This preliminary investigation has been conducted with no control group, and published reports have provided only sketchy details about the conditions of most of the women being studied. Some of the patients were given conventional treatments along with CoQ10. Therefore, CoQ10 remains unproven as a cancer treatment.

Herbs That May Be Helpful

Eleuthero (Eleutherococcus senticosus, Acanthopanax s.)
Also known as Siberian ginseng, eleuthero has been shown to enhance immune function in preliminary Russian trials studying people with cancer, particularly breast cancer. These trials typically used 1 to 2 ml of a fluid extract taken three times per day for at least one month. Most of the people in these trials were also treated with chemotherapy, radiation therapy, and/or surgery. Several of the Russian trials showed fewer side effects from conventional therapies among those who also took eleuthero extracts. No information is available on the ability of eleuthero to prevent cancer, nor have clinical trials yet explored whether eleuthero extracts affect either recurrence of breast cancer or survival in women with breast cancer.

European mistletoe (Viscum album)
Special extracts of European mistletoe injected under the skin has been studied in several positive and negative double-blind trials with cancer patients. A double-blind trial of women with breast cancer (all treated with chemotherapy) found that those who received mistletoe injections had improved immunity and quality of life compared with those who took placebo. The use of oral mistletoe preparations has not been studied in breast cancer patients. Mistletoe injections (usually of a product called Iscador) are available only through physicians and are not readily available in the United States. It is unknown if American mistletoe (Phoradendron leucarpum) would provide the same effect as European mistletoe.

Green tea
In one Japanese study, green tea consumption was associated with increased survival time and decreased spread of cancer to lymph nodes in women with early stages of breast cancer, but not in breast cancer patients with more advanced disease. Recurrence rates were found to be lowest in those who drank at least five cups per day. Despite these associations, however, no proof yet exists that green tea consumption helps breast cancer patients or helps healthy women prevent breast cancer.

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