Promoting Breast Health
Stephen Holt, MD
HRT and Breast Cancer
Recent statistics on the occurrence of breast cancer in the nation are depressing. Added to this situation is the shocking recent report in the UK medical journal “The Lancet” published on August 9, 2003. This report indicates that conventional hormone- replacement therapy (HRT) increases the occurrence of breast cancer. This recent finding comes from the research collaborators who are running the “Million Women Study” which is designed to provide information about HRT use, disease occurrence and lifestyle. The researchers report that the use of HRT by women aged 50 to 64 years in the United Kingdom over the past 10 years has resulted in 20,000 extra cases of breast cancer. The terrible news is that the current use of HRT is clearly associated with an increased occurrence of fatal breast cancer and that this risk is particularly high for HRT which combines estrogens and progestagens (synthetic progesterone).
Breast Cancer Prevention
While the current bad news focuses on breast cancer occurrence in mature women taking HRT, the increasing occurrence of breast cancer in young women is alarming. Therefore, many women and their health care practitioners are seeking effective disease prevention programs. Certainly, adverse lifestyle and poor diet are involved in the breast cancer epidemic. While some authorities have suggested that poor diet could account for about one-half of all breast cancers, there are few large-scale studies to define dietary components that will protect against breast cancer. In contrast, much investment has been made in studying breast cancer prevention using drugs, such as tamoxifen. Tamoxifen has potentially serious side effects, including the development of cancer itself. Clearly, there is an urgent need to place new order in the priorities of research for breast cancer prevention.
The Role of Estrogen
The biggest focus of research in breast cancer attempts to characterize the effects of the female hormone estrogen on breast cancer development and outcomes. Although estrogen can be a woman’s best friend, it can act sometimes like a woman’s enemy. Mature females can be quite desperate in their attempts to escape the unpleasant symptoms of the period around the menopause. Such symptoms include hot flashes, lack of psychological well-being, mood change, sleeplessness, vaginal dryness, etc. While quite distressing, these symptoms are time-limited and the greatest significance of the menopause is the onslaught of cardiovascular disease, osteoporosis and age-related cancer. The occurrence of these diseases increases following the cessation of periods in a mature woman.
HRT: More Risks Than Rewards
There was a time when HRT was seen as not only a way of melting unpleasant symptoms of the menopause, but it was also viewed as a healthy way to prevent age-related diseases. However, HRT seems to come with more risks than rewards. Added to the alarming increased risk of breast cancer with HRT are the reports of the association of HRT with risks of coronary heart disease, stroke, increased tendency to blood clotting and cancer of the womb. There appear to be no options to avoid these demonstrated risks of HRT. To add to the bad news is a study published in the New England Journal of Medicine on August 7, 2003 that shows that HRT is not preventive against coronary heart disease. In fact, the New England Journal of Medicine study implies that the risk of heart attack increases 81 percent during the first year of use of conventional hormone-replacement therapy.
Breast Cancer Prevention
While most breast cancer occurs in women following the menopause, prevention should begin early in life. It is never too late or too early to engage in a lifestyle and nutritional program to prevent breast cancer. These natural ways to prevent breast cancer may be effective even in preventing recurrence of breast cancer. My recommendations are listed below in Table 1.
Improve lifestyle Exercise, avoidance of substance abuse and stress-reduction techniques
Weight control Weight gain in early adulthood can cause an increased risk of breast cancer which is only apparent later in life. Weight loss and weight control must occur with a global health initiative.
Reduce refined sugar intake Simple sugars in the diet cause high blood glucose which is linked to the development of insulin resistance, obesity and other factors that cause the metabolic syndrome (Syndrome X). Syndrome X causes menstrual irregularity and polycystic ovaries and high blood insulin levels are associated with cancer.
Specific dietary interventions Increase omega 3 fatty acid intake (fish oil) and keep a balance between omega 6 and omega 3 fatty acid intake. Add liberal amounts of dietary fiber, especially soluble fiber which helps with weight control and general health. Eat fruits and vegetables which are a good source of antioxidants.
Consider dietary supplements Powerful antioxidants e.g. ellagic acid, green tea, turmeric, Vitamin C, etc. Consider nutritional factors that may combat Syndrome X. Add fish oil and fiber supplements. Antioxidants that are found in berry powders and cruciferous vegetables are very valuable
Think carefully about avoiding chemical
estrogens Discuss the risks and benefits of HRT with your physician. Consider viable, simple, gentle and natural ways of dealing with menopause e.g. soy isoflavones, black cohosh, etc.
Natural Ways to a Healthy Menopause
There are several pathways to approach menopause in a natural way. It has shown in scientific studies that women with a positive attitude and good lifestyle have less symptoms and adverse events while going through the early postmenopause. Several researchers have suggested that certain herbs and botanicals may be viable alternatives to conventional HRT for helping with troublesome symptoms associated with the menopause.
Soy isoflavones have been shown in certain studies to reduce hot flashes and they help build bones. In addition, soy isoflavones have been described as having certain anti-cancer benefits by virtue of their ability to block estrogen receptors (an adaptogenic role) and exert antiangiogenic and antioxidant effects. Soy isoflavones are sometimes referred to as “phytoestrogens”, but their actions have more to do with other benefits, in addition to any effect they have on estrogen. Standardized extracts of black cohosh have been shown to have value in reducing symptoms due to the menopause and other herbals or botanicals have been shown to exert benefits in the support of healthy menstrual function and the postmenopause. These natural substances include black cohosh (Cimicifuga racemosa, standardized for triterpene glycosides 2mg), soy isoflavones (40% extract), red clover (8% extract), L-Theanin, evening primrose oil (60%), Dong Quai (Angelica sinensis, 1% extract) chasteberry (Vitex agnus castus, 0.5% extract) and Gingko Biloba extract (24% gingkoflavonglycosides and 6% terpene lactones).
New, evidence-based, dietary supplements have been developed for menopause and healthy menstrual function and the benefits of the ingredients within these supplements have been quite well defined in recent scientific publications in major medical journals (Kronenberg F and Fugh-Berman A, Annals of Internal Medicine, Vol 137 No 10, November 2002) For further information on herbs and botanicals.