I believe that this natural supplement is one of the most important immune boosters available today, and I particularly recommend it as a preventative measure for women at risk for breast cancer. (For more information, read AHCC: The Medical Breakthrough in Natural Immunotherapy [Basic Health Publications, 2010] by Fred Pescatore, M.D.)
MULTIVITAMINS AND BREAST CANCER RISK
While a study from Sweden made headlines in 2010 when it reported a link between taking multivitamins and breast cancer, several holes have since been poked in this research.44 (Here’s just one inconsistency: the data showed that risk was less in women who took supplements daily compared to those who took their vitamins fewer than seven times a week.) Other larger studies show no such effect, and the Nurses’ Health Study showed that among women who drank more than one alcoholic drink a day, taking multivitamins reduced breast cancer risk.45
For overall good health, including breast health, I recommend taking a good multivitamin daily—in part because the antioxidants contained in them (as well as in fresh foods) help to quell cellular inflammation. Chronic cellular inflammation in women diagnosed with breast cancer may also increase the chances of cancer recurring, according to a 2009 study published in the Journal of Clinical Oncology. Researchers found that elevated levels of C-reactive protein (CRP), which is a marker for cellular inflammation, even when present as long as seven years after the women were successfully treated for early-stage breast cancer, were associated with reduced survival rates.46
~ MODERATE ALCOHOL CONSUMPTION. Many studies have linked the consumption of alcohol with increased risk for breast cancer, with the latest research showing that alcohol use is more strongly associated with hormone-sensitive breast cancers than hormone insensitive cancers.47 The risk increases with the amount of alcohol consumed. In the Nurses’ Health Study, for example, researchers found that the risk of breast cancer in women who had one or more drinks per day was 60 percent higher than the risk in women who did not drink.48 In addition, a 2009 study by researchers at the Fred Hutchinson Cancer Research Center in Seattle who looked at breast cancer survivors showed that those who consumed an average of one drink per day had a 90 percent increased risk of cancer recurring in their other breast.49 Part of the alcohol-breast cancer connection is due to alcohol’s effect on the liver’s ability to process estrogen effectively.
For women who are taking oral estrogen replacement therapy, the risk of drinking alcohol may be even higher. In one study, women on oral estrogen and synthetic progestin replacement who drank the equivalent of half a glass of wine experienced an increase of 327 percent in blood estradiol levels, a rise that didn’t happen in women not on oral hormone therapy. Significant rises in estradiol were noted within ten minutes after drinking the alcohol.50 In the Nurses’ Health Study participants this was prevented in those women whose average intake of folic acid was at least 600 mcg per day. (I recommend 800 mcg per day for everyone.) Alcohol is a known inhibitor of folic acid, and folic acid is required for DNA repair mechanisms. High folic acid intake may therefore prevent some of the gene mutations that lead to cancer.51
Another part of the alcohol–breast cancer link is that women too often use alcohol as a way to stay out of touch with the painful feelings of sorrow, anger, and pining for love and relationship that may be associated with increased risk for disease in the fourth chakra organs.
~ DON’T SMOKE. A study published in the Journal of the American Medical Association in 1996 noted that a flawed enzyme present in millions of Americans (in half all white women and in an even larger number of those of Middle Eastern descent) may raise the risk of breast cancer in women who smoke. Of those with the flawed enzyme, heavy smokers who had reached menopause had about four times the risk of breast cancer as nonsmokers. Postmenopausal women who had the flaw and who had smoked any amount at or before age sixteen also ran a similar risk, which supports the theory that exposure to certain toxic substances adversely changes the way DNA gets expressed during the stages of life when breast tissue is developing.52 The researchers from the 2009 Fred Hutchinson Cancer Research Center study mentioned above also found that breast cancer survivors who were current smokers had a 120 percent increased risk of developing a second breast cancer.
Smoking, like alcohol consumption, also tends to shut down the energy of the fourth emotional center, rendering us numb to the situations we’re in and less capable of doing anything to change them for the better.
~ EXERCISE REGULARLY. As many studies have shown, regular exercise decreases the risk of breast cancer considerably, along with all its other well-documented benefits.53 This is because it normalizes insulin and blood sugar levels and also tends to decrease excess body fat, all of which keep estrogen levels normal. A New England Journal of Medicine study showed that women who exercise for about one hour four times per week reduce their breast cancer risk by at least 37 percent.54 The same study showed that in women who exercised the same amount but whose body mass index was less than 22.8, the risk of breast cancer is cut by 72 percent! You don’t need to do strenuous exercise to get this benefit. Walking, gardening, and dancing will all do fine. And it’s never too late to start. According to the National Institutes of Health–American Association of Retired Persons Diet and Health Study, published in 2009, postmenopausal women who maintain a regular exercise program of moderate to vigorous intensity reduced their breast cancer risk even if they did not exercise in the past.55
~ GET ENOUGH SLEEP. Women who consistently sleep nine hours or more a night have less than one-third the risk of breast tumors compared with those who get seven or eight hours of sleep nightly, according to a 2005 Finnish study of more than 12,000 women.56 Several recent studies have shown that exposure to light late at night may increase the risk of breast cancer. The reason is that nighttime light (if it’s bright) interrupts the production of the hormone melatonin.57 Harvard researcher Eva Schernhammer, M.D., Dr. P.H., showed that women with above-average melatonin concentrations are less likely to develop breast cancer.58 (Dr. Schernhammer’s previous research found that female night-shift workers have about a 50 percent greater risk of developing breast cancer than other working women.)59 So be sure to get plenty of sleep in a dark room every night. (Using a night-light, if it is dim, is not associated with higher risk.) I personally always sleep with an eye pillow filled with flaxseed and scented with lavender. This is not only deeply relaxing, it also keeps out ambient light.
BREAST CANCER SCREENING
Most women have been taught that regular mammograms and breast self-exams are the key to breast health. And there is indeed heartening evidence that the mortality rate for breast cancer is decreasing. What isn’t clear, however, is whether this decrease in mortality is simply because we’re now diagnosing more pre-cancers that would never have resulted in death in the first place. It is generally accepted that the recent drop in breast cancer incidence itself is secondary to the decrease in the use of Premarin and Provera (or Prempro) following the termination of the Women’s Health Initiative in 2002.60
Though screening may be an important part of early detection, keep in mind that mammograms, breast exams, sonograms, and MRIs do not actually prevent breast cancer. At best, they diagnose it at an earlier and presumably more treatable stage. This has been the basis of the conventional approach to breast cancer for the past thirty years or so. Unfortunately, this approach is not nearly as clear-cut as we once thought it was. I’m also concerned that the massive national campaigns aimed at getting women to have regular mammograms have taught an entire generation that breast cancer screening is synonymous with creating breast health. Participating in disease screening is no substitute for learning and practicing the preventive, health-building thoughts and behaviors that can transform us.
Every perimenopausal woman needs to know about the limitations of screening and take responsibility for creating healthy breast cells daily by nurturing herself with healthy food and supplements, avoiding excessive alcohol, stopping smoking, and
engaging in mutually satisfying relationships.
The Pros and Cons of Early Detection
The idea that breast cancer can be cured by early detection and prompt treatment rests on the belief that all breast cancers grow at the same rate. They don’t. Some cancers grow rapidly and others slowly, which is one of the reasons why just about every one of us has heard about or knows a woman whose regular mammogram screening was normal but who was diagnosed with breast cancer several months later. One possible explanation for this is that mammography screening is far more likely to detect slow-growing, nonaggressive tumors than the kinds of cancers those women had. A study conducted at Yale–New Haven Hospital of all the women who received their first treatment for breast cancer in 1988, for example, showed that those women whose cancers were detected via mammography screening alone had an excellent prognosis, not just because of early detection, but because the cancers so detected were relatively slow-growing or even dormant, thus requiring minimal therapy. Many of the women, for example, had a condition known as ductal carcinoma in situ (DCIS), a type of breast pathology that can often remain completely dormant for a woman’s entire life.
In fact, autopsy studies of women who died of other causes, such as accidents, have shown that 40 percent have some degree of DCIS in their breasts.61 Other studies have confirmed that the incidence of DCIS has increased more than fourfold since 1980; this type of cancer now accounts for a quarter of all cancers detected by mammogram. The main reason for this dramatic increase is the widespread use of mammographic screening. Gilbert Welch, M.D., a researcher at Dartmouth-Hitchcock Medical Center and author of the mustread book Should I Be Tested for Cancer? Maybe Not and Here’s Why (University of California Press, 2004), puts the dilemma well when he writes, “Our ability to detect subtle forms of breast cancer is a two-edged sword. On the one hand, it offers the hope of preventing some cases of advanced breast cancer through early detection and treatment. On the other hand, it fosters increased worry and labels more women as having disease, many of whom would never develop invasive cancer.”62
Some striking new research adds additional weight to Welch’s findings. A study published in the November 2008 edition of Archives of Internal Medicine indicates that that some breast cancers regress on their own, without any treatment.63 This important study followed more than 200,000 Norwegian women between the ages of fifty and sixty-four over two consecutive six-year periods. Half received regular, periodic breast exams or regular mammograms, while the others had no regular breast cancer screenings. The study reported that those women receiving regular screenings had 22 percent more incidents of breast cancer. The researchers (as well as another team of doctors who did not take part in the study but who did analyze the data) concluded that the women who didn’t have regular breast cancer screenings probably had the same number of occurrences of breast cancer, but that their bodies had somehow corrected the abnormalities on their own. This makes complete sense given that our bodies routinely produce abnormal cells that are then destroyed by our immune systems before becoming a problem.
Because of just such evidence, the American Cancer Society has now shifted its position about cancer screening, admitting that early detection—especially for breast (and prostate) screening—has been overstated. For every one hundred women who are told they have breast cancer, for example, as many as thirty have cancers that are so slow-growing that they are unlikely to be life-threatening.64 “The health professions have played a role in oversimplifying and creating the stage for confusion,” Barnett S. Kramer, M.D., associate director for disease prevention at the National Institutes of Health, told the New York Times in 2009. “It’s important to be clear to the public about what we know and be honest about what we don’t know.”65
Still, for the moment, major medical organizations such as the American Cancer Society and the American College of Obstetricians and Gynecologists continue to support the regular use of mammography for women starting in their forties. The American College of Radiology was so opposed to the change that it even went so far as to ask the task force to reverse their recommendation! Some medical groups, however, including the National Cancer Institute, announced they would reevaluate their guidelines. I, for one, applauded the new guidelines, knowing full well the limitations of mammography and the fact that mammograms have consequences that are far from benign.
The DCIS Dilemma
DCIS, or what is now erroneously being called Stage 0 breast cancer, presents a real dilemma for women and doctors alike. Although our increasingly sensitive technology keeps improving our ability to detect early forms of breast cancer, our understanding of what to do with this knowledge is lagging behind. What is clear is that in the majority of women DCIS does not go on to become invasive cancer. Recall the fact that in autopsy studies, 40 percent of healthy women in their forties who died in accidents were found to have evidence of DCIS. The fact is that 98 percent of the time, DCIS doesn’t spread—and women don’t die from it, which means that only minimal treatment (if any) is necessary. Yet many women with DCIS are told that they have breast cancer and are then subjected to very aggressive treatment: surgery (often mastectomy), sometimes followed by radiation, tamoxifen, or both. Because conventional screening modalities cannot identify which types of DCIS or which women are likely to progress, doctors feel obligated to treat everyone as though they are cancers waiting to happen. Given the fear of breast cancer, many women with DCIS understandably decide to be treated. The Yale investigators in the study above, for example, noted that of the thirty-one women with DCIS in their study, all of whom survived without recurrence, fully 48 percent underwent mastectomies. The authors noted, “Since none of these patients had cancer death or recurrence, regardless of the extensiveness of treatment, the need for aggressive forms of therapy might be reconsidered.”66 That’s one of the understatements of the decade. The high rate of DCIS that is picked up on mammograms may also be a factor in the much-celebrated reduction in breast cancer mortality that we’ve seen over the past twenty years; the women so diagnosed would not have died in any case. They’d die with their so-called disease, not from it.
Breast-Screening Concerns
Several years ago I gave a lecture in California to a group that included physicians, allied health care professionals, and others interested in a more holistic approach to health. I presented the data on mammograms and DCIS and suggested that women may want this information when making decisions about if, when, and how often to have mammograms. I was dismayed by the reaction.
In the ladies’ room during a break, women from the audience were confused and upset. They deeply believed in mammograms and felt safe when they had them. I had introduced doubt. I couldn’t help wondering if, by telling the truth about the diagnosis and treatment questions raised by our improved technology, I had inadvertently broken my Hippocratic oath: “First, do no harm.” But I decided that confusion is often the first step on the road to clarity and personal power. If a period of uncertainty and questioning was required for these women to rely more on their inner wisdom, then I figured that over the long haul I’d done more good than harm. After all, there is nothing benign about surgery, radiation, and drug therapy, with all their well-known side effects, when they aren’t absolutely necessary.
When I came back from the ladies’ room I was met onstage by an infuriated radiologist who ran a breast-screening center. “You’re dangerous. Do you know that?” he spat at me. “I cannot believe that you’re telling women this stuff. I am so disappointed in you. You’re putting women’s lives at risk.” He wasn’t interested in the scientific reasons for my statements, and it was clear to me that we weren’t about to have a balanced discussion about the mammogram issue. His mind was made up. Then and there I learned directly and painfully that when it comes to breasts and mammograms, emotions run very high, and this has nothing to do with science.
In January 1997, the National Institutes of Health convened a panel of prestigious experts who spent six week
s reviewing more than a hundred scientific papers and hearing thirty-two oral presentations on this issue. When they concluded that there wasn’t enough evidence to recommend routine mammography screening for all women ages forty to fifty, they, too, were met with vicious attacks.67 In an editorial on the subject, which also included a reply to one radiologist’s particularly vehement objections, Kenneth Prager, M.D., the chair of the Ethics Committee at Columbia-Presbyterian Medical Center in New York, wrote, “Could it be that the radiologist who vilified the panel’s conclusion has not only the welfare of women in mind but radiologists’ own wallets, in view of the millions that would be spent in the wake of an official recommendation for all women in their forties to undergo mammography?”68 Nothing much has changed over the past fourteen years. When the latest mammogram guidelines calling for a reduction in mammography for women in their forties was published in 2009, there was the same hue and cry. So much for science.
I have long agreed with Cornelia Baines, professor emerita at the University of Toronto and former deputy director of the Canadian National Breast Screening Study, who wrote in 2005, “I remain convinced that the current enthusiasm for screening is based more on fear, false hope, and ‘greed’ than on evidence.”69
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