Disease Proof : Breast Cancer

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Prevent Breast Cancer at Every Age

Posted on May 30, 2006 by Gerald Pugliese

Wall Street Journal health journalist Tara Parker-Pope reports preventing breast cancer is not just a grown-up issue:

A growing body of evidence shows that a woman's risk for breast cancer may be determined far earlier in life. Cellular changes that can lead to cancer likely begin in childhood when breast tissue is just beginning to develop.

So while strategies like diet, exercise and -- for high-risk women -- prevention drugs like Tamoxifen may help stave off breast cancer in midlife, scientists are also beginning to look at prevention efforts for young girls. What's increasingly clear is that the health decisions parents make for their daughter in preschool, adolescence and the late teen years have the potential to dramatically alter her risk for breast cancer as she becomes a woman.

Parker-Pope explains childhood exercise is an import factor in cancer prevention:

Encourage exercise at a young age. Exercise early in life appears to lower a girl's hormone levels, and potentially delay the onset of her first period. The average age of first period today is about 12, but some girls start periods as early as nine or 10. Girls who don't get their periods until the age of 13 or 14 have a lower lifetime risk for breast cancer.

Exercise before puberty lowers body fat and also damps down hormone production by the pituitary gland, keeping hormone levels low longer and thereby delaying menstruation. "It's important to start things young," says Anne McTiernan, director of the Prevention Center at the Fred Hutchinson Cancer Center in Seattle and author of the book "Breast Fitness." Dr. McTiernan suggests an hour of daily exercise for girls, including recess and gym class.

Parker-Pope goes on to point out the importence of a healthy diet in young girls' lives:

Limit Junk Food. Some research suggests that diet early in life and into adolescence can influence breast-cancer risk. In February, a Harvard study suggested a child's preschool diet could affect breast-cancer risk. Women who frequently ate french fries in preschool had a 27% higher risk for breast cancer as adults.
Modest reductions in fat intake during puberty can lower levels of hormones in a girl's body. Girls who eat diets higher in fiber appear to get their first period later. Some evidence suggests that increasing soy in the teen diet can also lower long-term breast cancer risk. Even though the data on adolescent diet and breast-cancer risk are mixed, it makes sense to encourage girls to eat fruits and vegetables and avoid unhealthy fats.

In The Wall Street Journal, the connection between healthy practices at a young age, and cancer later in life is news, and they should be saluted for being among the first major media outlets to really make the connection. Dr. Fuhrman looked at a lot of the same research in researching his book Disease Proof Your Child last year. The connection between childhood diet and exercise, early menstruation, and cancer is a major theme of his book, which has an entire chapter on the causes of cancer and other illnesses.

In this excerpt, Dr. Fuhrman explains the trademarks of the standard American Diet (SAD) contribute to earlier puberty in girls, which heightens lifetime risk of breast cancer:

The average age of onset of menstruation in the nineteenth century was seventeen, whereas in the last fifty years in Western industrialized countries, such as the United States, the average age of onset of menstruation is twelve. The over-nutrition and heightened exposure to animal products, oil, and saturated fats2 earlier in life induces a rapid earlier growth and an earlier puberty. Earlier age of puberty increases one's lifetime exposure to estrogens and is associated with a higher incidence of breast cancer years later.

Cohort studies, which follow two groups of children over time, have shown that the higher consumption of produce and protein-rich plant foods such as beans and nuts is associated with a later menarche, and the higher consumption of protein-rich animal foods�-meats and diary�-is associated with an earlier menarche and increased occurrence of adult breast cancer.3

Hopefully this is just the beginning of word starting to spread to parents that what they feed their young children can have a big effect on lifelong health.

Tags: Breast Cancer, Healthy Parenting

Re-Examining Chemotherapy for Breast Cancer

Posted on May 12, 2006 by Gerald Pugliese

When people think cancer they inevitably think chemotherapy. For some patients the link is so strong that they request chemotherapy even if their doctor doesn't recommend it. But The New York Times claims more and more doctors are questioning the role of chemotherapy in treating breast cancer. Gina Kolata reports:

Today, national guidelines call for giving chemotherapy to almost all of the nearly 200,000 women a year whose illness is diagnosed as breast cancer. In the new approach, chemotherapy would be mostly for the 30 percent of women whose breast cancer is not fueled by estrogen.

So far the data are tantalizing, but the evidence is very new and still in flux. And even if some women with hormone-dependent tumors can skip chemotherapy, no one can yet say for sure which women they might be. Some doctors have already cut back on chemotherapy, but the advice a woman gets often depends on which doctor she sees.

It hasn't yet inspired wholesale changes in treatment.

"It's a slightly uncomfortable time," said Dr. Eric P. Winer, who directs the breast oncology center at the Dana-Farber Cancer Institute in Boston. "Some of us feel like we have enough information to start backing off on chemotherapy in selected patients, and others are less convinced."

Among the less convinced is Dr. John H. Glick, director of the Abramson Cancer Center of the University of Pennsylvania. Dr. Glick tells his patients about the new data but does not suggest they skip chemotherapy. After all, he notes, the national guidelines were based on results from large randomized clinical trials. And the recent data indicating that some women can skip chemotherapy are based on an after-the-fact analysis of selected clinical trials.

"We're in an era where evidence-based medicine should govern practice," Dr. Glick said.

For years Dr. Fuhrman has insisted chemotherapy isn't the sun, the moon, and the stars in breast cancer treatment. He explains in a previous post entitled Diet, Chemotherapy, and the Truth: How to Win the War on Cancer:

Chemotherapy has contributed to the progress made against cancer deaths from fast-growing cancers, such as leukemia, lymphoma, testicular cancer, and childhood cancers such as osteogenic sarcoma. But for the major cancers affecting most adult Americans, chemotherapy adds less than one year of disease-free life to those treated�

Does Chemotherapy Work?
Let's see how effective chemotherapy actually is with a few common cancers.

A meta-analysis of chemotherapy for postmenopausal, estrogen receptor-positive women (the largest group of women with breast cancer) pooled the six largest studies to get the most accurate data on survival and complications. Here is what researchers concluded about the group treated with standard chemotherapy: "No significant survival benefit was observed."1
In non-small cell lung cancer (the most common type), the 5- year survival is only about 10 percent. In stage 4, when the cancer has spread to distant sites, the 5-year survival is only 1.6 percent. After looking at multiple studies, it appears that treatment generally results in a very slight improved survival rate at 1 year, but this advantage disappeared at 30 months of follow-up.2
Even in small cell lung cancer where chemotherapy has proven effectiveness in life extension, the benefit adds only a few months of life, not years. And during this time the patient can experience serious�even life threatening�side effects from the treatment.

No doubt this uncertainty among doctors further complicates an already difficult situation. Dr. Fuhrman provides some advice for those confronting cancer:

Every patient has to make her own decision. But if I were a woman with postmenopausal breast cancer, I would opt for surgery, without radiation and without chemotherapy, and would then pursue an aggressive nutritional protocol. I also would include antiestrogens if the tumor histology showed it to be estrogen receptor-positive.