Breasts
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If you have a family history of breast cancer prior to age fifty, your mother or father (whoever is blood-related to the person with cancer) should schedule a genetic counseling and risk assessment visit for her/himself, the result of which will further inform you about your own risks. Know, though, that breast cancer as a teen is a reportable phenomenon, with chances being less than one in a million.
Women in their twenties and thirties need to take breast health more seriously than they did when they were younger. If this is you, do your BSE once a month, one week after your period starts or the first day of every month if you do not have a period. Visit the gynecologist for an in-office manual exam, called a clinical breast exam (CBE), every three years, plus schedule a genetic counseling and risk assessment visit if it’s appropriate due to family cancers. Women under the age of forty with breast cancer have more aggressive tumors, so it’s crucial to stay aware.
A decade or two later, in your forties, continue doing a BSE once a month, but start seeing your gynecologist annually for a CBE for the rest of your life. You’ll also need to add a mammogram once a year, and if your breasts are dense, get an ultrasound too. And from here on out, that’s the deal, ladies, whether you’re in your fifties, seventies, or nineties.
If you’re considered high risk, we layer a little extra on top of all this advice. Various factors determine what makes a woman high risk, with the most outstanding being whether any marker lesions have been identified in your own breast tissue, and how many of your relatives have had breast cancer, especially under age fifty. If this sounds like you, take our anonymous, free genetics quiz at pinklotus.com/genequiz. Talk to your doctor about more frequent testing beginning ten years prior to the age of your youngest relative with cancer, and be sure to inquire about CBE twice a year, annual mammograms, and possibly ultrasound and/or breast MRI. You might also want to discuss the benefits of risk-reducing medications and operations. More on this in part 3.
WHAT IT MEANS TO LOWER YOUR RISK FACTORS
We’re going to spend a lot of time discussing risk factors for breast cancer in this book, so I want to be sure you understand what I’m talking about straight away. Simply put, a risk factor is anything that increases your chance of getting a disease, but does not definitely cause the disease. We don’t understand all of what causes breast cancer, so it’s impossible to eliminate every last variable and declare, “There, I prevented it!” with the same assurance that you could cry, “Five in a row. Bingo!” In that way, prevention doesn’t exist, but risk reduction does—and you, my friend, are in the driver’s seat.
Think of it this way: driving fast doesn’t automatically mean you will have a car accident, but it certainly increases the odds. Car accidents are caused by the collision of a vehicle with something else, and driving fast is just one risk factor for collisions. Deciding to drive fast backwards while also texting on a dark road in the rain combines multiple risk factors for a collision, but the actual cause would still be the undeniable imprint of that tree trunk smashed into your car trunk.
So how do you avoid colliding with breast cancer? Know your breasts, understand what they’re about, and take good care of them. This last point includes making the strategic and rather simple dietary and lifestyle improvements I outline in this book. After all, as I mentioned in my intro, researchers find that among women who, prior to menopause, (1) exercise, (2) don’t drink alcohol, (3) don’t smoke, and (4) shift their diet away from meat and dairy toward whole food, plant-based eating slash their odds of getting breast cancer in half. And postmenopausal women’s odds are sliced by 80 percent. In the medical world, this represents an incredible triumph when you consider that women endure chemotherapy for a mere 10 percent average improvement in survival over those skipping chemo.
How has all this powerful information eluded you so far? It’s hardly your fault. Evidence-based advice on breast health, particularly when it comes to cancer prevention, is publicly doled out in drips and drabs—a magazine article here, a brief morning show segment there. And when we do hear a tip, it’s often in isolation and gets lost in the shuffle of everyday life. So you might find out that consuming cinnamon improves breast health, but who, with so many spinning plates, remembers to make this part of her daily diet—and without guidance, who actually knows how? Our daily habits are set in stone or bring us comfort, so it’s hard to make changes to an established routine. But I will show you how.
I also need to point a manicured finger at our flawed educational system. During my four years of undergrad, four years of med school, five years of general surgery training, and my surgical breast fellowship, nutrition was a fleeting mention in the form of the Krebs cycle in the middle of one lecture—and for many of us physicians, that was twenty to forty years ago. Most doctors do not explore the science of eating or the impact of lifestyle choices to the degree that knowledge affects their own behavior, let alone yours. I know this is true because when I shared some of this book’s content with my cancer patients, countless times I heard, “Wow, I had no idea. You know, I asked my doctors what I should do and eat now that treatment has ended, and they just told me, ‘You did everything you were supposed to do. You’re fine; don’t worry about it. Live your life.’” Not so, my friend. You’re not done yet.
Even when doctors do recognize the nutrition–illness connection, part of the reason they don’t tell you much is a reimbursement issue. Just as insurance companies don’t pay for your gym membership, weight-loss program, or stress management course, they don’t reimburse us doctors to spend time detailing preventive strategies. Doctors already need to stay up-to-date on what you expect from them, like screening guidelines and the best treatments for all the diseases they handle, which leaves no time for researching and dispensing extra freebies like, “Hey, did you know that three cups of green tea a day cuts breast cancer risk in half?” (By the way, did you?)
So when you put all that together, the question isn’t how did you not know this—but how could you have possibly known at all? Nobody’s taught you to connect food and lifestyle to breast health the same way you might relate it to, say, the strength of your heart or brain. Which is funny, because your breasts coexist with the same body as these vital organs. The good news is that food science matters now more than ever, as the global health outlook becomes increasingly dismal. Both patients and doctors are becoming more interested in how nutrition and lifestyle affect risk reduction, causation, and reversal of disease processes.
Of course, my central concern right now is your breasts (well, and your heart, since the number-one killer of women is heart disease; lucky you, my advice helps both problems). Up to 90 percent of the risk factors that determine optimal breast health lie entirely in your hands—so you are in control of you. Not your doctors, genes, or fate. You are with your breasts all day long, every single day. If you spent that much time with anything or anyone—a child, a spouse, a pet, even a car—you’d make sure they were in good shape.
Why treat your breasts any differently?
TRUE, THAT’S FALSE
In coming chapters, we’ll discuss how to keep your breasts and body as healthy as they can be, but first let’s set the record straight on what does not cause breast cancer. Myths abound out there that puzzle my patients and the public, and they don’t hold up in studies. (Quoting studies is a theme you’ll find throughout this book because the pervasiveness of myths is such a peeve of mine.) If you’re aiming for optimal breast health, there’s no room for bogus claims.
CHAPTER 2
Debunking Breast Cancer Myths
In this book, we’ll talk at length about how to eat, drink, exercise, and behave in ways that optimize breast health and reduce your risk of cancer—all supported by credible, exciting research. But for as much useful information that’s out there, way too many myths persist that confuse and distract us from what we need to know. I can’t tell you how often patients come to me paralyzed with fear because they’ve read or heard that something they’ve done in the past—or currently do—will ruin their health. Genetic myths, hormone-related myths, dietary myths, environmental myths: I could play volleyball all day with all the false ideas flying around—set up, smash, repeat.
I know, I shouldn’t be carrying my cell phone in my shirt pocket . . .
My nutritionist said to eat grass-fed beef. That reduces cancer, right?
Did my IVF drugs give me this breast lump?
Oh, ladies. Let’s let go of the anxiety and misinformation you’ve unwittingly come to trust and start implementing the meaningful changes that science shows will help you live a longer and more vibrant life. It’s time to debunk the most common breast myths that have kept your armpits smelling and your cell phone ten feet from your wireless bra.
THE TRUTH ABOUT GENES, GENDER, AND DESTINY
As I’ve mentioned, genetics play a less important role than you probably think. Consider this fact: the identical twin sister of a woman with breast cancer has only a 20 percent chance of getting breast cancer one day—which, by the way, is the same risk as anyone with an affected sister.1 Since these twins share the exact same DNA, if genetics called all the cancer shots, risk should approach 100 percent—but it doesn’t, because genes aren’t the be-all end-all many people think they are.
Patient after patient tells me that there isn’t any breast cancer in her family, so she’s not really at risk. Yet 87 percent of women diagnosed with breast cancer do not have a single first-degree relative with breast cancer. In fact, only 5 to 10 percent of breast cancers currently prove to be hereditary, meaning that they occur because abnormal gene mutations pass from parent to child.
Of course, a vitally important part of assessing your risk includes genetic screening and family history, and I encourage every woman to use the free test on our website to see whether further testing would be warranted (pinklotus.com/genequiz). But if we can only blame our parents’ DNA 10 percent of the time, then factors outside of inherited genetics cause breast cancer 90 percent of the time. A major goal of this book is to teach you how to proactively make daily choices that reduce nongenetic cancer risk. Why passively await a breast cancer diagnosis when you can get actively involved in deterring it?
Patients also think their mother’s family history of breast cancer matters much more than their father’s. Clearly, you are 50 percent your father’s DNA. You inherit genes from both sides—your maternal and paternal family histories count equally. Even doctors get this wrong. So when assessing familial risk, don’t just pay attention to your maternal lineage. Look at first-, second-, and third-degree relatives on both sides: parents, siblings, and your own children; grandparents, aunts/uncles, nieces/nephews, your own grandchildren; great-grandparents, great-aunts/great-uncles, first cousins, grandnieces/grandnephews, and your own great-grandchildren. When reviewing your father’s side, look for breast and ovarian cancers hiding in the women of more distant generations. Especially when the family tree lacks ladies, pay attention to mutation-associated cancers that show up more frequently in men than breast cancer, such as early-onset colon, prostate, and pancreatic cancers.
And speaking of the guys, most think they can’t get breast cancer, but since they actually do have breast tissue, they’re susceptible too. Male breast cancer accounts for approximately 0.8 percent of all breast cancer cases, about 2,470 men annually.2 In American men, the lifetime risk of breast cancer approaches 1.3 in 100,000.3 Interestingly, stage for stage, men survive cancer at the same rates as women; however, due to a lack of awareness that male breast cancer is even a possibility, their diagnoses usually come at later stages, increasing overall mortality rates.
Another erroneous myth about breast cancer relates to age—that it only happens to older people. While certainly less common among premenopausal than postmenopausal women, breast cancer does not discriminate when it comes to age. In the United States, 19.7 percent of all breast cancers and 11 percent of all breast cancer deaths occurred in women under fifty years old (specifically, 48,080 invasive breast cancer diagnoses, 14,050 in situ cancer diagnoses, and 4,470 breast cancer deaths befall women under fifty years old).4 In fact, the median age of breast cancer in the US is sixty-two years old, which means that exactly 50 percent of breast cancers are diagnosed under age sixty-two, and 50 percent are diagnosed at or over age sixty-two. No matter what your age, cancer cells shrink at the sight of healthy living, so we can employ the anticancer strategies in this book during all decades of life.
Finally, the misunderstood stat that all women have a 1 in 8 chance of getting breast cancer is one of the most commonly quoted statistics out there. While it’s correct, truth be told, you don’t walk around every day of your life with 1 in 8 odds of getting breast cancer! If that were true, you’d probably have cancer by next month. Breast cancer risk increases as you get older. A woman’s chance of being diagnosed with breast cancer during her twenties is 1 in 1,567 (not 1 in 8); her thirties, 1 in 220; forties, 1 in 68; fifties, 1 in 43; sixties, 1 in 29; seventies, 1 in 25; finally reaching the oft-quoted 1 in 8 as a cumulative lifetime risk once she hits eighty.5 You know those pictures with a lineup of eight “woman” icons like the ones you see on a public restroom door? They sport a caption that reads, “One in eight women will develop breast cancer in her lifetime.” Really, the icons should not be youthful triangles. We need a few canes and wheelchairs in there to more accurately reflect risk as it pertains to age.
FACT: YOUR DIET MATTERS—A LOT
Frankly, one of the most dangerous falsehoods circulating out there states that your diet doesn’t impact breast health, which is completely bananas and wrong. What you put into your body influences estrogen levels, inflammation, blood vessel formation, cellular function, and destructive free radicals, to name a few cancer-related processes. What’s more, the core genetic mutation within a cancer cell cross-talks with hundreds of other genes, turning them on or off to suit the cancer’s survival instincts. Cancer growth isn’t the handiwork of a single gene; it’s the product of a network of genes. A human study in men with prostate cancer proved that by using only diet and healthy lifestyle interventions, the cross-talking chatter got turned down in 453 bad genes, and turned up in forty-eight good ones.6 Oh yes, nutrition matters, you can bet your life on it. I’ve devoted the next two chapters to foods that work to enhance breast health or flat-out destroy it, but a few phony food rules come up so often that I’d like to take a moment to slam them down.
First up, wake up to coffee. A lot of the women I meet believe that coffee causes breast cancer, but absolutely no link exists between your sacred cup of joe and breast cancer.7 In fact, mounting evidence suggests that coffee might actually have a preventive effect.8 That being said, the caffeine in coffee isn’t always a plus for your breasts, as it can increase breast pain and breast cysts, particularly in young women with fibrocystic breast changes—but that’s not cancer. So if your breasts don’t hurt, it doesn’t hurt your breasts to love a latte.
And speaking of lattes, the idea that dairy causes breast cancer is unproven. Evidence from more than forty case-control studies and twelve cohort studies does not support an association between dairy product consumption and breast cancer risk.9 It sounds intuitive to say that the presence of hormones, growth factors, fat, antibiotics, and chemical contaminants often found in dairy would lead to a proliferation of cancer cells, especially hormonally sensitive breast cancer cells, but the evidence contradicts our intuition. That being said, dairy is a major source of saturated fat, so you must be mindful of how fat influences your risk, which we discuss in chapter 4.
At first blush, the evidence seems to point toward the fact that no causative link exists between the consumption of red meat, white meat, total meat, or fish and breast cancer.10 Hit the brakes and screech to a skidding stop! Ladies, it took my writing this book to live inside the hundred-plus confusing and contradictory breast/meat studies and really figure it out. Meat is so toxic to your breasts that even the slightest consumption of it nullifies a measurable difference between “high” and “low” meat consumers. Only when you compare zero/zippo meat consumption to any meat consumption might you arrive at the truth. Minimize meat. See you in chapter 4 to understand why.
Finally, I hear from a lot of my most nutrition-savvy patients that acidic foods alter the body’s pH balance to the extent that it could cause breast cancer. But here’s the thing: your body tightly regulates your blood pH to be 7.35 to 7.45 no matter what you eat, and even minor changes to this range would cause severe symptoms and life-threatening illness. According to the American Institute for Cancer Research, this myth clashes with everything science teaches about the chemistry of the human body. There isn’t much wiggle room, since a pH outside of 6.8 to 7.8 equals certain death. And don’t be fooled by test kits said to rate your body’s acidity through urine. If you check the pH of your urine, and it’s not a perfect 7.35, that’s because your body constantly fine tunes excess acid or base to maintain proper blood pH balance, and it does so by excreting the excess in your urine.
That said, it’s true that cancer cells flourish in acidic microenvironments.11 However, it’s the cancer itself that creates the acid it bathes in, so consuming low pH foods doesn’t provide a happy place for cancer; cancer doesn’t even need you for that.12 Besides, stomach juices are pure acid at pH 1.5 to 3.5. Your alkaline water slides down the esophagus and splashes right into an acidic bath; it will not change your body’s pH, and it will not neutralize a cancer cell’s acidic little world. I will say that the foods (nuts and veggies) you would consume in a (futile) effort to change your pH to more alkaline actually pack a massive punch to cancer cells via high antioxidant levels, DNA–damage control, and immune system support, but it’s not from making you alkaline.
BOGUS LIFESTYLE BELIEFS
We’ll dive into the lifestyle changes that matter most in chapter 5, but I’d like to first clear the decks on certain popular myths so you don’t think I’m skipping these.
Let’s talk bras. They don’t start or stimulate breast cancer, thankfully, because we need their unwavering support. Underwire bras, tight bras, sleeping in a bra, or wearing a bra more than twelve hours a day has no connection to risk. I’ve heard the claims, and initially they seem so plausible that one might believe they have a basis in fact. I repeatedly hear two schools of thought. One involves stating that tight bras compress the lymphatic system of the breast, which leads to toxins building up within the breast tissue itself, deleteriously altering the cells. This has no grounding in breast anatomy or physiology. We treat breast lymphedema (a blockage of lymphatic fluids within the breast that infrequently occurs after cancer surgery and radiation) with, among other strategies, breast compression.13 The other smart-sounding hypothesis proposes that the underwire itself conducts environmental electromagnetic fields (EMFs). As you will read in a minute, even if this antenna theory were true, EMFs don’t cause breast cancer.
A 2014 study compared bra-wearing habits between postmenopausal women with and without invasive breast cancer. Researchers found that details such as cup size, underwire presence, age first beginning to wear bras, and average hours worn were not associated with an increased risk of breast cancer.14 So, ladies, whatever you feel is appropriate in terms of chest support, I support you.
Next up: antiperspirants and deodorant. You can officially slow your search for the ultimate natural substitute because no scientific evidence backs the claim that antiperspirants or deodorants cause breast cancer due to toxin buildup or aluminum exposure or parabens.15 As a reminder, antiperspirants block the pores with astringents such as aluminum chlorohydrate so that they can’t release sweat, thereby preventing bacterial buildup and odor. On the other hand, deodorants don’t prevent sweating but rather neutralize the smell of excess bacteria by combining fragrances that mask odor with propylene glycol that creates an environment where bacteria can’t grow.
One cancer-linking theory purports that pore-plugging aluminum compounds absorbed near the breast contain estrogen-like activity.16 As we will review later, estrogens feed and fuel the majority of breast cancer cells. Therefore, the presence of estrogen-behaving compounds might increase the division of cancer cells. A second study suggests that aluminum itself directly negatively affects breast tissue cells.17 But a 2014 systematic review of peer-reviewed literature regarding these two potential health risks posed by aluminum concluded that no such relationships exist.18
Maybe it’s not the aluminum? One publication found traces of a preservative called parabens inside a tiny sample of twenty breast cancer tumors.19 As “endocrine disrupters,” parabens demonstrate weak estrogen-like properties, but the study in question made no cause-and-effect connection between parabens and breast cancer, nor did it conclusively identify how they got there in the first place. Parabens have even been found inside tumors when women don’t use underarm products at all.20 Besides, the dose of parabens required to initiate a mutation in a human breast would be much higher than that absorbed through the application of a stick or spray. Additionally, most brands no longer use parabens, but if you’re still worried about this, choose a product that specifically says paraben-free on the packaging.
Another widely circulating rumor claims that antiperspirant prevents you from sweating out toxins, which can then accumulate in the lymph nodes and cause breast cancer. To draw conclusions that wipe the sweat off our concerned brows (and pits), we need epidemiologic studies that compare two groups of people who are alike except for one deodorant factor. Luckily we have a few. In 2002, researchers at the Fred Hutchinson Cancer Research Center in Seattle conducted an epidemiologic study to address the sweat issue and other antiperspirant-related toxicity theories. They compared 1,600 women with and without breast cancer and found no link between breast cancer and antiperspirants, with or without shaving.21 A similar but smaller Iraqi study of 104 women with and without breast cancer also showed no link.22
The only published epidemiologic study with a competing point of view observed 437 Chicago-area breast cancer survivors and divided them according to underarm habits.23 The author found that women who used antiperspirant/deodorant earlier in life and more frequently and with underarm shaving were statistically more likely to develop breast cancer at an earlier age. He theorized that aluminum salt substances found in these products entered the lymphatic system through nicks in the skin caused by shaving. However, this study did not demonstrate a conclusive link between underarm hygiene habits and breast cancer. Furthermore, a major study no-no existed: the omission of a control group of women without breast cancer. The studies with the most research cred always have a control group. And one more thing: girls who use deodorant and shave earlier than others probably went through puberty sooner. Strong evidence shows that the earlier periods start (menarche), the higher the breast cancer risk.