Breast Cancer

Overview: Breast Cancer

• Cancer encompasses a wide variety of diseases that have uncon-trolled growth of abnormal cells in common. Each cancer has a unique set of genetic and environmental factors that encourage this abnormal response in the body.

• Genetic vulnerability is coupled with environmental factors (epigenetics) that give rise to conditions favorable to cancer growth.

• Breast cancer involves this interplay of genes with environmental fac tors (such as food choices, exercise, lifestyle, and estrogen exposures) and environmental toxins (such as radiation and pesticides). Integrative medicine emphasizes personal empowerment to make lifestyle choices that can help prevent cancer from occurring and slow its growth once it has occurred or prevent recurrence.

• Many factors may not be in our control, but many lifestyle choices are. These same healthy choices also limit the development of other chronic illnesses, such as heart disease, diabetes, obesity, and hyperlipidemia.

Important points to consider

• Exercise, weight loss, cruciferous vegetables, and lignan-rich flaxseed can improve the 2-hydroxyestrone/16-hydroxyestrone ratio, reducing the stimulatory effect on breast tissue.

• Soy isoflavones in supplements may be avoided, given concerns in mice; but soy foods do not appear to be contraindicated and indeed seem to be valuable in reducing risk of breast cancer, recurrence, and mortality.

• One head of cabbage contains approximately 1200mg of indole-3-carbinol. Eating of one third of a head of cabbage daily would equal the common supplemental dose of 400mg daily and offer the other synergistic properties of the whole plant.

• Tamoxifen is used in premenopausal women; aromatase inhibitors (anastrozole) are more effective in postmenopausal women. Use of tamoxifen in stage 0 breast cancer is controversial, and benefits of treatment may not outweigh risks.

Prevention Prescription

• Eat primarily a plant-based diet rich in cruciferous vegetables (broccoli, cauliflower, Brussel sprouts, cabbage, and kale). Eat one or two servings of cruciferous vegetables daily.

• Follow an antiinflammatory and Mediterranean diet. This diet avoids saturated fat in dairy and meats, it has no trans fats and includes increased amounts of omega 3 fatty acids (ocean fish, walnuts, soybeans, greens, flaxseed meal). See Chapter 86, The Antiinflammatory Diet.

• Avoid processed foods. Organic foods are not contaminated with pesticides and herbicides. Many organic meats, poultry, and produce can be purchased from local farms or farmers' markets.

• Fatty fish such as herring, mackerd, tuna, salmon, and sardines have high levels of omega-3 fatty acids. Minimize your eating of albacore tuna, shark, swordfish, king mackerel, and tile fish because they can have higher levels of contamination with mercury.

• You may want to take omega-3 supplements that are detoxified. Fish, however, is an excellent protein source. Eat fish often (three times per week or less) or take fish od supplements daily. (If you eat fish high in omega-3 content, do not take your fish odd supplements that day)

• Do not skip meals. If breakfast is a problem, try protein-fortified smoothies in the morning. Whey protein powder is best, and if you are lactose intolerant, buy whey protein powder without lactose.

• Drink lots of water, filtered if possible. Bring it with you everywhere (reuse water bottles). Flavor it with lime or lemon (or cucumber, orange, or any other natural flavor you like),

• Drink green tea, two or three cups a day Moderate alcohol intake if you drink alcohol (no more than one serving per day for women). Do not drink it at all if it makes you feel not well.

• Mushrooms contribute to a healthy diet, especially adding medicinal mushrooms (Le, maitake, shiitake, reishi, turkey tail) as food or supplement. Eat one to three servings of soy food daily. Avoid soy (isoflavone) supplements.

• Eat one or two tablespoons of flaxseed meal dولني Vitamin D can be obtained from adequate sun exposure or a supplement. For most people, 2000 units/day will maintain adequate levels. I recommend determination of a 23-hydroxyvitamin D level in winter to anes for adequate intake. Maintain healthy weight with a BMI of less than 30 and ideally 25 (not overweight).

• Avoid smoking and passive tobacco exposure. Exercise for 30 to 60 minutes at least 5 days a week (more than 3 hours per week is recommended) Combine aerobic activity such as walking with a resistance or ce or strength training program two or three times a week.

• Nordic walking sticka can increase the overall conditioning of walking while improving posture, balance, and core strengthening. Yoga, tai chỉ, with the benefit of relaxation and exercise. Do exercise that is enjoyable to you.

  and qi gong are meditative movement Optimize sleep at night.

• Melatonin can be added if sleeping difficulties are occurring, starting at 3 mg before bed. Sleep in a darkened room at regular hours to unproved sleep quality.

• Do not sleep with a television on in the bedroom Maintain spiritual practices that give meaning and relaxation to your life. Maintain a strong support network with family and friends.

• Consider testing for a 2-hydroxyestrone/16-hydroxyestrone ratio, and consider interventions to improve the ratio in favor of weak estrogens. (See the Appendix for laboratories that offer this testing)

• Minimize use of estrogen replacement medication. For menopausal symptoms, consider nonhormonal measures first. Attend to self-care every day. Make healthy lifestyle choices a part of your routine.

Integrative therapeutics review

Nutrition

• The Mediterranean diet can lower the risk of breast cancer and other chronic health conditions, such as heart disease, diabetes, and obesity. This diet is high in omega-3 and omega-3 fatty acids, add five to nine servings of fruit and vegetables per day.

• Cruciferous vegetables are beneficial in a healthy diet to decrease cancer risk.

• In general, antioxidants are preferably obtained in food rather than in supplements. Three cups of green tea per day can decrease breast cancer risk.

• Soy foods in moderation are safe and protective for breast cancer. One to three servings of soy

  foods daily are recommended. Avoid isolated isoflavone supplements.

• Flaxseed meal can lower breast cancer risk.

• Avoid excessive alcohol intake. Drink no more than one alcoholic beverage daily.

• Weight control and gradual weight loss if the patient is obese or very overweight can reduce risk of breast cancer. Weight loss can be achieved with regular exercise, portion control, and eating more fruits and vegetables and fewer calorie-dense foods.

• Vitamin D in supplement form when adequate sun exposure is not available is important for bone health, anticancer effect, immunity, and muscle health. Higher levels of vitamin D are associated with decreased risk of breast cancer.

• Monitor levels of 25-hydroxyvitamin D in the winter to ensure adequate intake of vitamin D. Medicinal mushrooms have many potential beneficial effects during cancer treatment and can be part of a healthy diet.

Medication

• Avoid prolonged HRT of both estrogen and progesterone.

• Nonhormonal therapies for postmenopausal symptoms of hot flashes can be effective. These include regular exercise, medications, and acupuncture.

• Tamoxifen is commonly used for ER tumors for 5 years after treatment to prevent recurrence. The dose is 20 mg daily. Aromatase inhibitors (anastrozole, exemestane, letrozole) are used in postmenopausal treatment. of breast cancer to prevent recurrence.

Exercise

• Exercising more than 3 hours per week can decrease cancer risk.

Lifestyle

• Sleep is important in decreasing cancer risk. Melatonin is implicated in this mechanism of reduced cancer cell proliferation when melatonin levels are high. Supplemental melatonin can help improve circadian rhythms and quality of sleep. The dose is 1 to 3 mg at bedtime. Up to 20 mg has been used.

• Psychological interventions can be helpful in cancer care. Those most helpful are psychoeducation and psychotherapy conducted by a psychotherapist individually.

• Mindfulness-based stress reduction programs can enhance well-being and coping and decrease anxiety during and after treatment.

Key Web Sources

• www.lmj.com/cgi/content-nw/full/3372-3

• http://www.cancer.gov/heriskt/Default.asps

• http://www.cancer.org/Cancer/Breast Cancer/indexasSourceSiteld-null

• ww5.komen.org

• www.integrativeonc.ong

• www.bcrecovery.org

• http://www.comcer.gov/cancertopics/cam

• http://www.cancer.gov/cam!

• http://ods.od.nih.gov/research/pubmed_dirtary_supplement_subset.aspx

• http://www.msk. org/cancer-care/integrative-medicine/about-herbs-botanical