1. At what age should I begin getting mammograms? I've heard conflicting reports-some say to start at age 40, and others recommend waiting until 50.
In response to new evidence on the efficacy and safety of mammograms, the U.S. Preventive Services Task Force recently made the following changes to its mammogram recommendation protocols: A) Annual mammogram recommendations for women over 50 were extended to once every other year; B) Women over age 40 should wait until age 50 to start screening.
However, while mammography was once considered the "gold standard" for detecting breast cancer, new data suggests that we need to take a closer look at this practice. The truth is that mammographic X-rays fail to detect as much as 20 percent of breast cancer in women over 50, and as much as 40 percent in younger women. The density of breast tissue is a very important factor in visualizing breast tumors because common (fibrocystic) dense breast tissue is difficult to distinguish from a tumor. Women before menopause generally have denser breasts than postmenopausal women due to the influence of cycling hormones. Postmenopausal women who are taking hormone replacement therapy (HRT), whether synthetic or "bioidentical," tend to continue to have denser breasts while taking HRT. Women can find out their breast density by requesting a copy of their full mammogram report. If breast density isn't included on the report, this information can be requested separately.
An alternative strategy is to add thermography to the screening process, which is 100 percent safe and can be more accurate than a mammogram. Thermograms can often detect cancer patterns much earlier than mammograms, and can reflect other indicators of breast health such as estrogen balance. Ultrasounds are also very helpful and provide another way to detect suspicious-looking densities. Also, a new technique called elastography is currently being added to ultrasound computer software. This involves a process in which measurements are taken during the ultrasound procedure that detect differences in the consistency of a solid mass, i.e., the firmness or stiffness of the tissue. These changes are fairly accurate in predicting abnormal (as opposed to normal) solid tissue. Elastography also increases the detection capabilities of a traditional ultrasound.
In my clinic, I like to create a strong baseline for patients by doing a mammogram with thermography, as well as an ultrasound. If all three imaging results are normal, I have the patient follow up with an ultrasound and thermography every 6 months or so, and increase the duration between mammograms to minimize exposure to potentially harmful ionizing radiation. Blood tests that screen for levels of various breast cancer risk factors, including elevated galectin-3 proteins, elevated estrogen, low vitamin D, low thyroid, and low iodine, are also important. If your lab results are out of range, work with an integrative physician to implement targeted prevention strategies.
It's important to keep in mind that most breast tumors have been growing 8-10 years, on average, before they are picked up by mammography. There is still value, however, in the use of mammography. The reason for this is its ability to detect not only masses but also tiny calcifications that are often present in areas of abnormal breast tissue. Other detection methods are not able to show these microcalcifications. These calcium deposits often appear at sites of chronic inflammation, which can be a precursor to cancer.
2. Is radiation exposure from mammograms harmful?
Yes. Mammograms may increase the risk of breast cancer as a result of the regular exposure to ionizing radiation. The mechanical pressure from a mammogram can also injure breast tissue.
3. Are self-exams necessary?
Self-exams are important-to know your breast tissue and detect changes early. They should be performed monthly.
4. Can diet really help to prevent breast cancer?
Important dietary habits for reducing the risk and progression of breast cancer include the following: adopting an anti-inflammatory, alkalinizing diet that emphasizes low-glycemic (low-sugar) foods and plenty of fiber. A high-fiber diet is helpful because fiber works to bind excess estrogen and remove it from the body. This helps prevent estrogen dominance and keep hormone levels balanced. Fiber also promotes a healthy bacterial population in the gut and enhances satiety, making it easier to maintain a healthy weight-another way to help guard against breast cancer.
Of all foods shown to fight cancer, cruciferous vegetables (such as broccoli, cabbage, kale, collards, and arugula) are among the most powerful. These vegetables and their sprouts contain unique cancer-fighting compounds: namely, glucosinolates and diindolylmethane (DIM), a compound that promotes healthy estrogen metabolism. These nutrients have been shown to help inhibit cancer growth, block metastasis, detoxify cancer-causing compounds from the body, reduce inflammation, and boost immunity on a genetic level.
Foods to Watch
Fatty red meat has been linked to breast cancer, especially meats cooked at high temperatures. A 2008 study of more than 15,000 women found that high-fat foods were associated with an increased cancer risk.
Sugar intake increases IGF-1 (insulin like growth factor), which is associated with increased estrogen, as well as "cancer aggressiveness."
High-fat (but not low-fat) dairy was shown to be correlated to a higher risk of mortality among breast cancer patients, accordingto a 2013 study.
5. Should I avoid soy?
Soy contains phytoestrogens-compounds found in whole grains, nuts, seeds, botanicals, fruits, and vegetables-which have a mild estrogenic effect. These foods are often associated with a reduced risk of breast cancer, as well as reduced cancer recurrence.
The breast cancer/soy controversy has become heated at times. The issue is complex, with some studies showing that eating soy early in life can reduce breast cancer risk. Conversely, the consumption of concentrated soy extracts has been shown to increase the proliferation of breast cancer cells in some studies. Other studies show a protective and/or neutral effect from eating whole soy foods.
My recommendation? Eat whole soy foods such as edamame and tofu in moderation-no more than a few servings per week. Fermented soy foods such as miso and tempeh are even better options. And avoid soy protein isolates and supplements containing concentrated soy isoflavones.
6. What about exercise?
Physical activity such as daily walking (20-30 minutes per day) is associated with a reduced cancer risk, and it is important for balancing hormones, maintaining muscle mass and a healthy weight, and reducing the influence of stress-related imbalances.
Especially helpful for stress reduction are mind-body practices such as yoga and Qigong, which incorporate meditative breathing with strength, stamina, and flexibility exercises. Research has shown that two 90-minute sessions per week of Qigong for 10 weeks improved quality of life and mood in cancer patients, while decreasing fatigue and inflammation markers. Yoga has been shown to benefit postoperative breast cancer patients by accelerating healing, reducing hospital stays, and enhancing quality of life. Yoga has also been shown to reduce cortisol levels, increase melatonin production (a critical antioxidant-rich hormone shown to fight breast cancer), and increase the expression of numerous genes associated with immunity. Regular practice, three times per week, can make a difference.
7. Should I be concerned if my breasts become sore and swollen before my period?
This is a very common hormonal issue and not something to worry about. One approach that can be helpful is breast and lymphatic massage (the area under the armpits). Avoiding pro-inflammatory foods such as sugar and refined flours is also important to reduce swelling and pain. Cruciferous vegetables contain nutrients that help reduce inflammation and metabolize excess estrogens, one of the contributors to breast swelling. Mixed tocopherols and tocotrienols from the vitamin E family, as well as fish oil and evening primrose oil, can also help reduce inflammation and balance hormones.
Molecular iodine (potassium iodine) may also help with premenstrual breast tenderness. While iodine is probably best known for supporting thyroid health, the mineral is also thought to play a role in optimal breast health. Molecular iodine, in particular, has been shown to help alleviate symptoms associated with fibrocystic breast condition (FBC), the medical term for premenstrual breast discomfort that is triggered by hormonal shifts. Potassium iodine is available in supplement form.
8. Can supplements help prevent breast cancer?
Research shows that maitake D-fraction, an extract from maitake mushrooms, induces apoptosis (death) in breast cancer cells. It is widely available in supplement form. Additionally, I recommend a research-backed combination of natural compounds, including DIM (diindolylmethane from cruciferous vegetables), curcumin, quercetin, astragalus, and skullcap, as well as botanically grown medicinal mushrooms. This blend has been shown in multiple studies to directly fight breast cancer cells and down-regulate the expression of genes involved in breast cancer proliferation and metastasis, in both estrogen-receptor-positive and hormone-receptor ("triple")-negative breast cancers.
A recent study from Indiana University, presented at the 2015 American Association for Cancer Research Annual Meeting, showed that a breast health formula featuring the remedies mentioned above worked alone against estrogen-receptor-positive breast cancer, and also worked synergistically with the drug Tamoxifen to increase apoptosis of estrogen-receptor-positive breast cancer cells, in vitro and in an animal model. The animal model used human breast cancer cells implanted into mice.
Another breast-protective supplement is modified citrus pectin, derived from citrus fruit, which has also been shown to prevent cancer growth and metastasis by binding to the inflammatory protein galectin-3. At elevated levels in the
circulation, galectin-3 fuels inflammation, fibrosis, cancer growth, and metastasis. By binding and blocking the effects of excess galectin-3, modified citrus pectin helps to prevent and fight cancer growth and limit metastasis. Modified citrus pectin is also a powerful detoxifier and immune-supporting ingredient. And the nutrient blend mentioned above has been shown to work synergistically with modified citrus pectin in protecting against breast cancer.
Vitamin D3 is also an important supplement for women with concerns about breast cancer, as low levels are associated with an increased risk of the disease. And medicinal mushrooms offer important support for breast health, particularly varieties such as coriolus, reishi, agaricus, cordyceps, umbellatus, and maitake.
9. What supplements can I take if I'm being treated for breast cancer?
The dietary supplements mentioned in Question 8 are often prescribed by integrative oncologists for use in conjunction with conventional breast cancer treatments to promote cellular health. In fact, the nutrient blend discussed in Question 8 has been shown to work synergistically with Tamoxifen in the treatment of estrogen-receptor-positive breast cancers.
Work with an experienced integrative doctor or naturopath if you want to take additional supplements during cancer treatment. Visit naturopathic.org or acam.org to find a doctor in your area.
Shopping Guide for Healthy Breasts
Mushroom Wisdom Maitake D-Fraction Pro 4X
Specializing in mushroom extracts for 20 years, Mushroom Wisdom introduced maitake to the U.S. in 1991.
Nature's Way DIM-Plus Estrogen Metabolism
"I believe just about everyone should take [DIM-Plus]," said one breast cancer survivor in a product review. The formula boasts a "BioResponse" DIM complex.
NOW Foods Modified Citrus Pectin
From one online review: "This product has been an important part of my arsenal in my treatment following a breast cancer diagnosis. So far, so good."
Solgar Full Spectrum Curcumin
Solgar has transformed poorly absorbed curcumin, making it immediately body-ready, more bioavailable, and more quickly absorbed.
Super Nutrition Simply One 50+ Women
This iron-free women's formula provides 3,000 IU of vitamin D3 in one tablet. It's also non-GMO and made by a family-owned company.