In Honour of Breast Cancer Awareness Month

At doctorOctober marks breast cancer awareness month.  Excluding skin cancer, breast cancer is the most commonly diagnosed cancer in women in North America and the Canadian Cancer Society estimates that as many as 1 in 8 women will be diagnosed in their lifetime.

We see many patients with breast cancer at the CCNM Integrative Cancer Centre and offer whole-person, holistic support for those undergoing treatment, as well as those in recovery.

In honour of breast cancer awareness month we’ve compiled some important information we think every woman should know about the disease.

 Non-modifiable risk factors we can’t change:

  • Being a woman
    • The strongest risk factor for breast cancer, with more than 99% of newly diagnosed breast cancers occurring in women
  • Age
    • The risk of breast cancer increases with age, with 2/3rds of invasive breast cancers occurring above the age of 55
  • Family history
    • Those with one first-degree female relative (sister, mother, daughter) with breast cancer have double the risk of being diagnosed themselves, and the risk is 5 times higher than average if there are two first-degree relatives that have been diagnosed
    • Mutations in genes such as the BRCA1 or BRCA2 may account for up to 10% of all breast cancers, however having a BRCA mutation does not always lead to breast cancer
  • Personal history
    • Being previously diagnosed with breast cancer infers a 3-4 times increased risk to develop a new cancer in a different part of the same breast or in the other breast
  • Race/ethnicity
    • Caucasian women are at an increased risk to develop breast cancer over African-American, Hispanic and Asian women. African-American women are more likely to develop aggressive and advanced-stage breast cancer and are often diagnosed at a younger age

Although the above non-modifiable risk factors exist, diet and lifestyle remain within our control, and it is important to know that women can decrease their overall risk of developing breast cancer by making some lifestyle changes.

 Modifiable risk factors we can influence:

  • Being overweight
    • Elevated BMI increases the risk of being diagnosed with breast cancer
  • Pregnancy history
    • Pregnancy reduces the total number of lifetime menstrual cycles, decreasing hormonal exposure and the risk of breast cancer with each full-term pregnancy
  • Menstrual History
    • Reaching menarche before 12 years of age and menopause over the age of 55 also increases risk
  • Alcohol
    • Compared to non-drinkers, women who consume 3 alcoholic drinks a week have a 15% increased risk of breast cancer
  • Dense breasts
    • Dense breast tissue may make it more difficult to detect early stage breast cancer on screening mammography
  • Lack of exercise
    • Those who exercise regularly for 4-7 hours per week have a lower risk of breast cancer
  • Smoking
    • Smoking has been linked to a higher risk of breast cancer in young, premenopausal women
  • Vitamin D levels
    • Research has suggested that women with low levels of vitamin D have a higher risk of developing breast cancer
  • Shift work
    • Women working at night have a higher risk of developing breast cancer compared to those working during the day, which may be linked to low melatonin levels
  • Exposure to ionizing radiation
    • Radiation to the chest, neck and armpit areas puts women at an increased risk of developing breast cancer

In addition to the above, there may be other factors that increase the risk of developing breast cancer.  These can be discussed with us at the CCNM Integrative Cancer Centre and include poor blood sugar regulation, exposure to xenoestrogens (man-made estrogen’s), hormone replacement therapy, oral contraceptives, breast implants and stress.

Screening Guidelines:

  • Guidelines for screening vary between Canadian provinces, making it important to be familiar with the guidelines in the jurisdiction where you are practicing.
  • Breast cancer screening guidelines for Ontario can be found here
  • In Ontario, women ages 50-74 with average risk are to be screened every other year with mammography
  • Based on the screening guidelines, patients with known risk factors will begin screening earlier than those with average risk. It should be noted that mammography is not a perfect test as they may detect false positives that can cause unnecessary treatment (4). Mammograms may also miss some cancers (4).

Conventional Care:

  • The stage of the cancer at diagnosis will determine conventional care, which can include surgery, chemotherapy and radiation therapy.
  • Surgery options include lumpectomy, partial mastectomy, total mastectomy, modified radical mastectomy and radical mastectomy.
  • In Canada the first-line chemotherapy regimens include (5):
    • FEC-D (fluorouracil, epirubicin, and cyclophosphamide followed by docetaxel)
    • Dose-dense AC-T (Adriamycin, cyclophosphamide, followed by docetaxel or paclitaxel)
    • TC (taxotere/docetaxel and cyclophosphamide)
  • If you undergo breast-conserving surgery (lumpectomy or partial mastectomy) you may be offered radiation therapy as well.
  • In addition, if your cancer was hormone receptor positive, you will be offered hormone therapy to reduce any circulating estrogen and progesterone in your body.

Naturopathic Support for Breast Cancer:

  • There are various natural supports for breast cancer that can support quality of life during and after treatment
  • It is important that that the foundations of health – nutrition, sleep and exercise – are all supported during treatment, as this can improve outcomes, but also in the recovery and prevention stage, in order to help keep you cancer-free.
  • Some well-researched natural therapies to consider include:
    • Vitamin D
      • Improving vitamin D status should be considered if you are deficient at the time of diagnosis. A study has shown improved survival rates in patients who had optimal vitamin D levels compared to those with chronic deficiency (9).  Maintaining optimal vitamin D status at diagnosis is important for improving the survival rates of breast cancer patients (9).
    • Melatonin
      • Melatonin has antioxidant and immune properties that work to inhibit the growth of breast cancer cells (6). Melatonin has been studied and shown to improve sleep parameters among breast cancer survivors and improvement in depressive symptoms for breast cancer patients undergoing surgery (7,8).
    • These are general recommendations however for case specifics and dosing consider consulting with a naturopathic doctor who is a Fellow of the American Board of Naturopathic Oncology (FABNO).
      • NDs who are board certified in naturopathic oncology, holding the FABNO designation, have additional, focused training in combining conventional cancer treatment with safe and evidence-based natural therapies.
      • Both Dr. Dan Lander, ND and Dr. Elise Hoffman, ND, at the CCNM Integrative Cancer Centre have attained their FABNO designation.

Author: Catherine Multari

My hope is that this blog will give women a basic understanding of the risk factors, screening guidelines and naturopathic approach to breast cancer. I am a 4th year naturopathic medical intern at the CCNM Integrative Cancer Centre in Toronto, Ontario (ccnmicc.ca).  If you would like to book an appointment to discuss your breast health, please call 416-498-9678.

Resources:

1) Breast Cancer Society, www.breastcancer.org

2) Canadian Cancer Society, www.cancer.ca

3) Centers for Disease Control and Prevention, https://www.cdc.gov/cancer/breast/basic_info/risk_factors.htm

4) Cancer Care Ontario- Breast Cancer Screening, https://www.cancercareontario.ca/en/types-of-cancer/breast-cancer/screening

5) BC Cancer- Chemotherapy Protocols, http://www.bccancer.bc.ca/health-professionals/clinical-resources/chemotherapy-protocols

6) https://www.ncbi.nlm.nih.gov/pubmed/25876649

7) https://www.ncbi.nlm.nih.gov/pubmed/24718775

8) https://www.ncbi.nlm.nih.gov/pubmed/24756186

9) https://www.ncbi.nlm.nih.gov/pubmed/25824788