One in four Americans takes blood pressure-lowering drugs, and some of these drugs may double a woman's risk for breast cancer when taken for many years.
Whether or not to undergo mammography is a personal choice, and women must be given accurate information about the risks and benefits of mammograms in order to make an informed decision.
Despite the abundance of scientific evidence demonstrating the benefits of whole soy foods, many people have been scared off from healthful foods like edamame by the anti-soy propaganda (lacking responsible scientific integrity) that continues to float around the internet.
It is true that the nutrient-depleted isolated soy in protein powders and processed foods is likely problematic. And of course, I recommend steering clear of genetically modified soy, as its safety, phytochemical value, and environmental impact remain questionable.
However, research has shown overwhelmingly that whole and minimally processed soy foods (like edamame, tofu and tempeh) provide meaningful health benefits. The presence of isoflavones, a class of phytoestrogen, has sparked much of the controversy around soy. There were concerns that these plant estrogens could potentially promote hormonal cancers, such as breast and prostate cancers; however, those fears were unfounded. I have previously discussed the large body of evidence that convincingly suggests that whole and minimally processed soy foods protect against breast cancer. In addition, a 2009 meta-analysis of studies on soy and prostate cancer found that higher soy intake was associated with a 26% reduction in risk.1 In addition, it appears that isoflavones have a number of anti-cancer effects that are unrelated to their ability to bind the estrogen receptor. Accordingly, soy foods are not only associated with decreased risk of hormonal cancers, but also lung, stomach, and colorectal cancers.2-4 (For further discussion of soy foods and health, see the May 2012 member teleconference.)
An article posted by John Robbins seeks to finally put the soy misinformation to rest. He provides a balanced review of the available information, addressing all the common concerns about soy, from cancer and osteoporosis risk to protein digestibility and mineral absorption.
Soy is not a magic pill or a poison; it is simply a bean.
One can’t argue with the data – the associations between minimally processed soy intake and reduced risk of cancers has been reported over and over again. There is no real controversy here. However, one still should not eat lots of soy products, to the exclusion of other valuable foods. Variety is crucial for obtaining diversity in protective phytochemicals, and a variety of beans are health promoting, along with many other foods. So use good judgment, avoid processed foods, GMO foods and eat a variety of whole natural plant foods including beans such as black beans, chickpeas, lentils and enjoy some edamame, tofu and tempeh as well.
Image credit - Flickr: cl_03
1. Hwang YW, Kim SY, Jee SH, et al: Soy food consumption and risk of prostate cancer: a meta-analysis of observational studies. Nutr Cancer 2009;61:598-606.
2. Yang WS, Va P, Wong MY, et al: Soy intake is associated with lower lung cancer risk: results from a meta-analysis of epidemiologic studies. Am J Clin Nutr 2011;94:1575-1583.
3. Kim J, Kang M, Lee JS, et al: Fermented and non-fermented soy food consumption and gastric cancer in Japanese and Korean populations: a meta-analysis of observational studies. Cancer Sci 2011;102:231-244.
4. Yan L, Spitznagel EL, Bosland MC: Soy consumption and colorectal cancer risk in humans: a meta-analysis. Cancer Epidemiol Biomarkers Prev 2010;19:148-158.
Angelina Jolie’s choice to undergo a preventive double mastectomy because of a family history of breast cancer and a mutation in the BRCA1 gene has made news and raised important questions. Complex medical decisions like these are personal must be made on an individual basis. The appearance of this story and subsequent debate in the global media, however, brings up critical issues about the relative contributions of genetics and lifestyle to breast cancer risk. Also it begs the question, if you are indeed genetically susceptible to breast cancer, can you reduce this risk through nutrition?
The BRCA1 and BRCA2 genes are tumor suppressors.1 Having one of several known mutations in one of these genes is known to impair their function and produce a predisposition for breast cancer and several other cancers. There are mutations in other genes that also increase risk; however the majority of hereditary breast cancer cases are attributed to BRCA1 and BRCA2 mutations. These mutations produce a substantial increase in breast cancer risk. About 12 percent of women in the general population will develop breast cancer throughout their lifetimes, but about 60 percent of women who carry a BRCA mutation will develop breast cancer;2 women with a family history and a BRCA mutation could have a risk of breast cancer as high as 87 percent.3 This is frightening, but keep in mind that most breast cancers are not due to these mutations. The percentage of breast cancer cases that are due to BRCA1 mutations is estimated at 3.5-6.2 percent and 2.1-3.4 percent for BRCA2 mutations.3
Breast cancer is a complex disease with many contributing factors. Even those with a genetic issue can dramatically reduce their risk of breast cancer and other cancers through strong dietary decisions. Natural plant foods contain a huge quantity and variety of phytochemicals, micronutrients with a variety of anti-cancer effects: anti-estrogenic, anti-proliferative, pro-apoptotic, anti-angiogenic, antioxidant and anti-inflammatory effects. All of these different functions act synergistically to prevent the development of cancers, regardless of a person’s genotype.
For example, studies have demonstrated that vegetable and fruit consumption or an overall healthful diet is associated with decreased breast cancer risk, even in carriers of BRCA mutations.6,7 The fact that not every woman who has these mutations gets breast cancer suggests that environmental factors can have a preventive effect. An important study demonstrated that higher cruciferous vegetable intake cut risk in half for women with a breast cancer-associated genetic mutation.8,9 This significant reduction in risk was only from the green vegetables at modest intake, it was not the the entire Nutritarian diet – a diet consisting primarily of nutrient-rich foods - designed to maximize protection with all the anti-cancer foods present simultaneously. So even with heightened genetic risk, healthful foods are significantly protective. Since several populations around the world 25 years ago had only about one-tenth of the breast cancer rates that we had in the U.S.,10-12 it is clear that even in the context of increased genetic risk, diet and lifestyle trump genetics.
Regardless of family history, genetic mutation, or even double mastectomy, a Nutritarian diet is essential for reducing cancer risk.
A Nutritarian diet consists of the following key foods referred to as G-BOMBS (Greens, Beans, Onions, Mushrooms, Berries, Seeds). Unfortunately because every cancer prevention study focuses only on one variable, not the synergistic benefits that add up from the entire Nutritarian lifestyle: isothiocyanates from cruciferous vegetables13, organosulfur compounds from onions and garlic, aromatase inhibitors from mushrooms, flavonoids from berries, lignans from flax, chia and sesame seeds, angiogenesis inhibitors from beans, anti-estrogenic effects of fiber, plus the protective effects of exercise have yet to be calculated. That said, each of these factors has been shown to be powerfully protective; for example, one interesting study on lignans followed women for up to 10 years and found a 71 percent reduced risk of breast cancer mortality in women with the highest lignan intake.14 This demonstrates dramatic anti-cancer potential from the Nutritarian approach, because this study was performed on women late in life who already had a diagnosis of breast cancer, and their lignan intake was only minimal. In other words, even more significant protection can be assumed when these changes are much more significant and started earlier in life before breast cancer occurs.
An important point this news story has brought up is empowerment, and I want to emphasize that when faced with simple, every day choices – what to have for breakfast, lunch and dinner – all women have the power to achieve substantial protection against breast cancer. Many women can’t afford to get genetic testing, or a preventive mastectomy if they are positive for a mutation, but all women can’t afford NOT to eat a Nutritarian diet for their hearts, their brains, their breasts and their peace of mind.
1. Fan S, Meng Q, Auborn K, et al: BRCA1 and BRCA2 as molecular targets for phytochemicals indole-3-carbinol and genistein in breast and prostate cancer cells. Br J Cancer 2006;94:407-426.
2. BRCA1 and BRCA2: Cancer Risk and Genetic Testing. National Cancer Institute. http://www.cancer.gov/cancertopics/factsheet/Risk/BRCA. Accessed
3. Robson ME: Clinical considerations in the management of individuals at risk for hereditary breast and ovarian cancer. Cancer Control 2002;9:457-465.
4. Bosviel R, Durif J, Dechelotte P, et al: Epigenetic modulation of BRCA1 and BRCA2 gene expression by equol in breast cancer cell lines. Br J Nutr 2012;108:1187-1193.
5. Fustier P, Le Corre L, Chalabi N, et al: Resveratrol increases BRCA1 and BRCA2 mRNA expression in breast tumour cell lines. Br J Cancer 2003;89:168-172.
6. Ghadirian P, Narod S, Fafard E, et al: Breast cancer risk in relation to the joint effect of BRCA mutations and diet diversity. Breast Cancer Res Treat 2009;117:417-422.
7. Nkondjock A, Ghadirian P: Diet quality and BRCA-associated breast cancer risk. Breast Cancer Res Treat 2007;103:361-369.
8. Lee SA, Fowke JH, Lu W, et al: Cruciferous vegetables, the GSTP1 Ile105Val genetic polymorphism, and breast cancer risk. Am J Clin Nutr 2008;87:753-760.
9. Huang MY, Wang YH, Chen FM, et al: Multiple Genetic Polymorphisms of GSTP1 313AG, MDR1 3435CC, and MTHFR 677CC highly correlated with early relapse of breast cancer patients in Taiwan. Ann Surg Oncol 2008;15:872-880.
10. International Agency for Research on Cancer, World Health Organization. CI5plus: Cancer Incidence in Five Continents Annual Dataset [http://ci5.iarc.fr/CI5plus/ci5plus.htm]
11. Ahn YO, Park BJ, Yoo KY, et al: Incidence estimation of female breast cancer among Koreans. J Korean Med Sci 1994;9:328-334.
12. Bah E, Hall AJ, Inskip HM: The first 2 years of the Gambian National Cancer Registry. Br J Cancer 1990;62:647-650.
13. Liu X, Lv K: Cruciferous vegetables intake is inversely associated with risk of breast cancer: A meta-analysis. Breast 2012.
14. McCann SE, Thompson LU, Nie J, et al: Dietary lignan intakes in relation to survival among women with breast cancer: the Western New York Exposures and Breast Cancer (WEB) Study. Breast Cancer Res Treat 2010;122:229-235.
What are the foods you think of when you hear the word “fiber”? Although most people probably think of whole grains, all plant foods are rich in fiber. In fact, beans contain more fiber than whole grains, and vegetables and fruits (and some seeds) contain comparable amounts – here are a few examples:
- 1 cup cooked quinoa – 5 grams fiber
- 1 cup cooked brown rice – 4 grams fiber
- 1 cup cooked kidney beans – 11 grams fiber
- 1 cup cooked broccoli – 6 grams fiber
- 1 cup blueberries – 4 grams fiber
- 1 tablespoon chia seeds – 6 grams fiber
Fiber, by definition, is resistant to digestion in the human small intestine. This means that during the digestive process, fiber arrives at the large intestine still intact. Fiber takes up space in the stomach but does not provide absorbable calories, which makes meals feel more satiating and promotes weight loss. In the colon, fiber adds bulk and accelerates movement, factors that are beneficial for colon health. Soluble fiber (primarily from legumes and oats) is effective at removing cholesterol via the digestive tract, resulting in lower blood cholesterol levels. Some types of fiber are fermented by intestinal bacteria. The fermentation products, such as butyrate, have anti-cancer effects in the colon and also serve as energy sources for colonic cells. Fermentable fiber also acts as a prebiotic in the colon, promoting the growth of beneficial bacteria. Fiber intake is associated with a multitude of health benefits, including healthy blood pressure levels and reduced risk of diabetes, heart disease and some cancers.1, 2
Fiber and breast cancer
A recent analysis of 10 scientific studies found that higher fiber intake is associated with lower risk of breast cancer.3 How does fiber impact one’s risk of breast cancer?
First and foremost, since animal products, refined grains, sugars and oils contain little or no fiber, fiber intake is a marker for greater intake of natural plant foods, many of which are known to have a variety of anti-cancer phytochemicals. Some breast cancer protective substances that have already been discovered include isothiocyanates from cruciferous vegetables4, organosulfur compounds from onions and garlic, aromatase inhibitors from mushrooms, flavonoids from berries, lignans from flax, chia and sesame seeds, and inositol pentakisphosphate (an angiogenesis inhibitor) from beans.
Does fiber itself have some potentially breast cancer protective actions?
High-fiber foods help to slow emptying of the stomach and absorption of sugars, which decreases the after-meal elevation in glucose. This is meaningful because elevated glucose levels lead to elevated insulin levels, which can send pro-cancer growth signals in the body, for example via insulin-like growth factor 1 (IGF-1). As such, high dietary glycemic index and glycemic load (characteristic of refined grains and processed foods) are associated with an increase in breast cancer risk.5-7 Accordingly, a study on Korean women found that higher white rice intake was associated with higher breast cancer risk.8
Increased exposure to estrogen is known to increase breast cancer risk.9-11 A woman may be exposed to estrogen via her ovaries’ own production, estrogen production by excess fat tissue, or environmental sources such as endocrine-disrupting chemicals (like BPA). Fiber can reduce circulating estrogen levels, thereby reducing breast cancer risk, because it helps to remove excess estrogen from the body via the digestive tract. Fiber binds up estrogen in the digestive tract, accelerates its removal, and prevents it from being reabsorbed into the body.12-14 In addition, soluble fiber (as shown with prunes and flaxseed) seems to alter estrogen metabolism such that a less dangerous form of estrogen is produced, whereas insoluble fiber (wheat bran) did not have the same effect.15,16 For this reason, beans, oats, chia seeds and flaxseeds may provide some extra protection due to their high soluble fiber content.
One notable case-control study looked specifically at different sources of fiber to determine the associations between vegetable fiber, fruit fiber, and grain fiber with breast cancer. Interestingly, when fiber was split up by source, only fruit fiber and vegetable fiber decreased risk; there was a 52% risk reduction for high intake of vegetable fiber, and a 46% risk reduction for fruit fiber. In contrast, there was no association between grain fiber and breast cancer risk.17 A new study, published in February 2013 came to a similar conclusion when analyzing the association between fiber subtypes and breast cancer risk. This study was part of the larger European Prospective Investigation into Cancer and Nutrition (EPIC) study of over 300,000 women; they found that among the fiber subtypes, only vegetable fiber was linked to decreased risk.18
Fiber itself has some breast cancer-protective properties, like limiting glycemic effects of foods and assisting in estrogen removal, but we get optimal protection when we focus on foods that are both rich in fiber and rich in phytochemicals. G-BOMBS contain numerous anti-cancer phytochemicals, and and greens, mushrooms, and flax and chia seeds in particular contain anti-estrogenic substances in addition to fiber, making them more effective breast cancer fighters than whole grains.
Image credit: Flickr - Muffet
1. Higdon J, Drake VJ: Fiber. In An Evidence-based Approach to Phytochemicals and Other Dietary Factors New York: Thieme; 2013: 133-148
2. Carbohydrates. In Nutritional Sciences: From Fundamentals to Food. Edited by McGuire M, Beerman KA; 2013
3. Dong JY, He K, Wang P, et al: Dietary fiber intake and risk of breast cancer: a meta-analysis of prospective cohort studies. Am J Clin Nutr 2011.
4. Liu X, Lv K: Cruciferous vegetables intake is inversely associated with risk of breast cancer: A meta-analysis. Breast 2012.
5. Dong JY, Qin LQ: Dietary glycemic index, glycemic load, and risk of breast cancer: meta-analysis of prospective cohort studies. Breast Cancer Res Treat 2011, 126:287-294.
6. Romieu I, Ferrari P, Rinaldi S, et al: Dietary glycemic index and glycemic load and breast cancer risk in the European Prospective Investigation into Cancer and Nutrition (EPIC). Am J Clin Nutr 2012, 96:345-355.
7. Sieri S, Pala V, Brighenti F, et al: High glycemic diet and breast cancer occurrence in the Italian EPIC cohort. Nutrition, metabolism, and cardiovascular diseases : NMCD 2012.
8. Yun SH, Kim K, Nam SJ, et al: The association of carbohydrate intake, glycemic load, glycemic index, and selected rice foods with breast cancer risk: a case-control study in South Korea. Asia Pac J Clin Nutr 2010, 19:383-392.
9. Hankinson SE, Eliassen AH: Endogenous estrogen, testosterone and progesterone levels in relation to breast cancer risk. J Steroid Biochem Mol Biol 2007, 106:24-30.
10. Pike MC, Pearce CL, Wu AH: Prevention of cancers of the breast, endometrium and ovary. Oncogene 2004, 23:6379-6391.
11. Bernstein L, Ross RK: Endogenous hormones and breast cancer risk. Epidemiol Rev 1993, 15:48-65.
12. Aubertin-Leheudre M, Gorbach S, Woods M, et al: Fat/fiber intakes and sex hormones in healthy premenopausal women in USA. J Steroid Biochem Mol Biol 2008, 112:32-39.
13. Aubertin-Leheudre M, Hamalainen E, Adlercreutz H: Diets and hormonal levels in postmenopausal women with or without breast cancer. Nutr Cancer 2011, 63:514-524.
14. Goldin BR, Adlercreutz H, Gorbach SL, et al: Estrogen excretion patterns and plasma levels in vegetarian and omnivorous women. N Engl J Med 1982, 307:1542-1547.
15. Haggans CJ, Travelli EJ, Thomas W, et al: The effect of flaxseed and wheat bran consumption on urinary estrogen metabolites in premenopausal women. Cancer Epidemiol Biomarkers Prev 2000, 9:719-725.
16. Kasim-Karakas SE, Almario RU, Gregory L, et al: Effects of prune consumption on the ratio of 2-hydroxyestrone to 16alpha-hydroxyestrone. Am J Clin Nutr 2002, 76:1422-1427.
17. Zhang CX, Ho SC, Cheng SZ, et al: Effect of dietary fiber intake on breast cancer risk according to estrogen and progesterone receptor status. Eur J Clin Nutr 2011, 65:929-936.
18. Ferrari P, Rinaldi S, Jenab M, et al: Dietary fiber intake and risk of hormonal receptor-defined breast cancer in the European Prospective Investigation into Cancer and Nutrition study1,2. Am J Clin Nutr 2013, 97:344-353.
October is Breast Cancer Awareness Month; this October, what women need to be aware of is that they are not powerless against breast cancer. Mammograms for ‘early detection’ are not the only defense and do not even offer significant benefits. The scientific evidence shows that women do have the power to protect themselves against breast cancer with powerful preventive lifestyle measures. Staying slim and active, focusing on healthful natural foods, and avoiding the disease-causing foods of the Standard American diet are strategies women can use to win the war on breast cancer.
Most importantly, we must unleash the immune system’s special forces: G-BOMBS!
As I describe in my book Super Immunity, G-BOMBS (Greens, Beans, Onions, Mushrooms, Berries and Seeds) are the foods with the most powerful immune-boosting and anti-cancer effects. These foods help to prevent the cancerous transformation of normal cells, and keep the body armed and ready to attack any pre-cancerous or cancerous cells that may arise.
G – Greens
Green vegetables (the cruciferous family in particular) contain compounds with anti-cancer compounds and substances that protect blood vessels; they also promote healthy vision and reduce diabetes risk.1-3 Cruciferous vegetable phytochemicals inhibit a wide range of cancer-promoting cellular processes, including angiogenesis; the angiogenesis inhibitors found in in cruciferous vegetables prevent new blood vessel growth, which is needed for tumor growth and fat tissue growth.4-7 Eating cruciferous vegetables regularly is associated with decreased risk of breast cancer and has even been shown to increase survival in women after being diagnosed with breast cancer.
B - Beans
Beans are unique foods because of their very high levels of fiber and resistant starch; carbohydrates that are not broken down by digestive enzymes. The fiber and resistant starch in beans reduce total the number of calories absorbed from beans,8,9 reduce cholesterol levels, and are converted by healthy gut bacteria into many substances that protect against colon cancer. Eating fiber-rich beans regularly dramatically lowers colon cancer risk, and a recent analysis of 10 scientific studies has shown that the higher your fiber intake, the lower your risk of breast cancer.10-15
O – Onions
Onions, leeks, garlic, shallots, chives, and scallions not only lend great flavor to meals, they have beneficial effects on the cardiovascular and immune systems, as well as anti-diabetic and anti-cancer effects.16-19 These vegetables are known for their characteristic (and eye-irritating) organosulfur compounds, which slow tumor growth and kill cancer cells – eating onions and garlic frequently is associated with reduced risk of digestive cancers.20,21 These vegetables also contain high concentrations of anti-inflammatory flavonoid antioxidants that contribute to their anti-cancer properties.16,22-24
M - Mushrooms
In one recent Chinese study, women who ate at least 10 grams of fresh mushrooms each day (which equates to about one button mushroom per day) had a 64% decreased risk of breast cancer!25 All types of mushrooms all have anti-cancer properties.26-32 Plus, mushrooms are unique in that they contain aromatase inhibitors – compounds that can block the production of estrogen. Aromatase inhibitors are thought to be largely responsible for the preventive effects of mushrooms against breast cancer. Even the most commonly eaten mushrooms (white, cremini, and Portobello) have high anti-aromatase activity.25,33,34 Mushrooms also contain powerful angiogenesis inhibitors.31,35,36 Keep in mind that mushrooms should only be eaten cooked: several raw culinary mushrooms contain a potentially carcinogenic substance called agaritine, and cooking mushrooms significantly reduces their agaritine content.37,38
B – Berries (and Pomegranate)
Berries’ plentiful antioxidant content helps to reduce blood pressure and inflammation, prevent DNA damage that leads to cancer, protect the brain against oxidative damage and stimulate the body’s own antioxidant enzymes.39-44 Berries and pomegranate are anti-angiogenic foods, and have anti-inflammatory effects that may protect against cancer and other chronic diseases.45-51 Pomegranate (similar to mushrooms) is one of the few foods that contain natural aromatase inhibitors – substances that inhibit the production of estrogen, which can reduce breast cancer risk.52
S - Seeds
Nuts and seeds are healthy fat sources that increase the absorption of nutrients in vegetables in addition to supplying their own spectrum of micronutrients including plant sterols (which help to reduce cholesterol), minerals, and antioxidants. Some seeds – sesame and flax in particular – are rich in lignans, plant estrogens that protect against breast cancer; in one fascinating study, women were given flaxseeds daily after being diagnosed with breast cancer, and reduced growth and increased death of their tumor cells was found after just 4-5 weeks.53
Instead of Breast Cancer Awareness Month, make it Breast Cancer Prevention Month! Eat your G-BOMBS every day!
Image credit: Building Blocks Show (Flickr)
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2. Higdon J, Delage B, Williams D, et al. Cruciferous vegetables and human cancer risk: epidemiologic evidence and mechanistic basis. Pharmacol Res 2007;55:224-236.
3. Stringham JM, Bovier ER, Wong JC, et al. The influence of dietary lutein and zeaxanthin on visual performance. J Food Sci 2010;75:R24-29.
4. Cavell BE, Syed Alwi SS, Donlevy A, et al. Anti-angiogenic effects of dietary isothiocyanates: mechanisms of action and implications for human health. Biochem Pharmacol 2011;81:327-336.
5. Kunimasa K, Kobayashi T, Kaji K, et al. Antiangiogenic effects of indole-3-carbinol and 3,3'-diindolylmethane are associated with their differential regulation of ERK1/2 and Akt in tube-forming HUVEC. The Journal of nutrition 2010;140:1-6.
6. Davis R, Singh KP, Kurzrock R, et al. Sulforaphane inhibits angiogenesis through activation of FOXO transcription factors. Oncol Rep 2009;22:1473-1478.
7. Kumar A, D'Souza SS, Tickoo S, et al. Antiangiogenic and proapoptotic activities of allyl isothiocyanate inhibit ascites tumor growth in vivo. Integrative cancer therapies 2009;8:75-87.
8. Bednar GE, Patil AR, Murray SM, et al. Starch and fiber fractions in selected food and feed ingredients affect their small intestinal digestibility and fermentability and their large bowel fermentability in vitro in a canine model. J Nutr 2001;131:276-286.
9. Muir JG, O'Dea K. Measurement of resistant starch: factors affecting the amount of starch escaping digestion in vitro. Am J Clin Nutr 1992;56:123-127.
10. Hamer HM, Jonkers D, Venema K, et al. Review article: the role of butyrate on colonic function. Aliment Pharmacol Ther 2008;27:104-119.
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12. Bazzano LA, Thompson AM, Tees MT, et al. Non-soy legume consumption lowers cholesterol levels: a meta-analysis of randomized controlled trials. Nutrition, metabolism, and cardiovascular diseases : NMCD 2011;21:94-103.
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20. Zhou Y, Zhuang W, Hu W, et al. Consumption of large amounts of Allium vegetables reduces risk for gastric cancer in a meta-analysis. Gastroenterology 2011;141:80-89.
21. Pierini R, Gee JM, Belshaw NJ, et al. Flavonoids and intestinal cancers. Br J Nutr 2008;99 E Suppl 1:ES53-59.
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23. Miyamoto S, Yasui Y, Ohigashi H, et al. Dietary flavonoids suppress azoxymethane-induced colonic preneoplastic lesions in male C57BL/KsJ-db/db mice. Chem Biol Interact 2010;183:276-283.
24. Shan BE, Wang MX, Li RQ. Quercetin inhibit human SW480 colon cancer growth in association with inhibition of cyclin D1 and survivin expression through Wnt/beta-catenin signaling pathway. Cancer Invest 2009;27:604-612.
25. Zhang M, Huang J, Xie X, et al. Dietary intakes of mushrooms and green tea combine to reduce the risk of breast cancer in Chinese women. Int J Cancer 2009;124:1404-1408.
26. Martin KR, Brophy SK. Commonly consumed and specialty dietary mushrooms reduce cellular proliferation in MCF-7 human breast cancer cells. Exp Biol Med 2010;235:1306-1314.
27. Fang N, Li Q, Yu S, et al. Inhibition of growth and induction of apoptosis in human cancer cell lines by an ethyl acetate fraction from shiitake mushrooms. J Altern Complement Med 2006;12:125-132.
28. Ng ML, Yap AT. Inhibition of human colon carcinoma development by lentinan from shiitake mushrooms (Lentinus edodes). J Altern Complement Med 2002;8:581-589.
29. Adams LS, Phung S, Wu X, et al. White button mushroom (Agaricus bisporus) exhibits antiproliferative and proapoptotic properties and inhibits prostate tumor growth in athymic mice. Nutr Cancer 2008;60:744-756.
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43. Cassidy A, O'Reilly EJ, Kay C, et al. Habitual intake of flavonoid subclasses and incident hypertension in adults. The American journal of clinical nutrition 2011;93:338-347.
44. Devore EE, Kang JH, Breteler MM, et al. Dietary intakes of berries and flavonoids in relation to cognitive decline. Ann Neurol 2012.
45. Roy S, Khanna S, Alessio HM, et al. Anti-angiogenic property of edible berries. Free Radic Res 2002;36:1023-1031.
46. Khan N, Afaq F, Kweon MH, et al. Oral consumption of pomegranate fruit extract inhibits growth and progression of primary lung tumors in mice. Cancer Res 2007;67:3475-3482.
47. Toi M, Bando H, Ramachandran C, et al. Preliminary studies on the anti-angiogenic potential of pomegranate fractions in vitro and in vivo. Angiogenesis 2003;6:121-128.
48. Sartippour MR, Seeram NP, Rao JY, et al. Ellagitannin-rich pomegranate extract inhibits angiogenesis in prostate cancer in vitro and in vivo. Int J Oncol 2008;32:475-480.
49. Panchal SK, Ward L, Brown L. Ellagic acid attenuates high-carbohydrate, high-fat diet-induced metabolic syndrome in rats. Eur J Nutr 2012.
50. Edirisinghe I, Banaszewski K, Cappozzo J, et al. Strawberry anthocyanin and its association with postprandial inflammation and insulin. Br J Nutr 2011;106:913-922.
51. Adams LS, Seeram NP, Aggarwal BB, et al. Pomegranate juice, total pomegranate ellagitannins, and punicalagin suppress inflammatory cell signaling in colon cancer cells. Journal of Agricultural and Food Chemis ry 2006;54:980-985.
52. Adams LS, Zhang Y, Seeram NP, et al. Pomegranate ellagitannin-derived compounds exhibit antiproliferative and antiaromatase activity in breast cancer cells in vitro. Cancer Prev Res (Phila) 2010;3:108-113.
53. Thompson LU, Chen JM, Li T, et al. Dietary flaxseed alters tumor biological markers in postmenopausal breast cancer. Clin Cancer Res 2005;11:3828-3835.
At the recent American Association for Cancer Research annual meeting, new evidence highlighted the importance of cruciferous vegetables for breast cancer protection
The cruciferous vegetable family:
|Broccoli rabe||Kale||Turnip greens|
|Brussels sprouts||Mustard greens|
The cruciferous family is unique among vegetables because of their glucosinolate content – glucosinolates give cruciferous vegetables their characteristic spicy or bitter tastes; when the plant cell walls are broken by blending, chopping, or chewing, an enzyme called myrosinase converts glucosinolates to isothiocyanates (ITCs) – compounds with potent anti-cancer effects, including:1
- Anti-inflammatory effects – ITCs have been found to decrease the secretion of inflammatory molecules.
- Anti-angiogenic effects – isothiocyanates can inhibit the development of new blood vessels to limit tumor growth.
- Detoxification of carcinogens – Some carcinogens must be converted to their active form before they can bind DNA to cause carcinogenic changes – isothiocyanates can block this transformation.
- Preventing DNA damage – Isothiocyanates also increase the production of our body’s natural detoxification enzymes, which protect DNA against damage from carcinogens and free radicals.
- Stopping cell division in cells whose DNA has been damaged
- Promoting programmed cell death in cancerous cells
- Anti-estrogenic activity – Exposure to estrogen is known to increase breast cancer risk; estrogens can alter gene expression, promoting cell proliferation breast tissue. ITCs have been shown to inhibit the expression of estrogen-responsive genes.
- Shifting hormone metabolism – Eating cruciferous vegetables regularly helps the body to shift hormone metabolism, reducing the cancer-promoting potency of estrogen and other hormones.
Eating cruciferous vegetables produces measurable isothiocyanates in breast tissue2, and observational studies show that women who eat more cruciferous vegetables are less likely to be diagnosed with breast cancer: In a recent Chinese study, women who regularly ate one serving per day of cruciferous vegetables had a 50% reduced risk of breast cancer.3 A 17% decrease in breast cancer risk was found in a European study for consuming cruciferous vegetables at least once a week.4
What about women who already have cancer? Is it too late for cruciferous vegetables to improve their prognosis?
We know that childhood and adolescence are the most crucial timesfor environmental stimuli to affect breast cancer risk, but changes made during adulthood and even after diagnosis still have the potential to create positive changes in the body.
The new study kept track of cruciferous vegetable intake in Chinese women with breast cancer for the first 3 years after diagnosis, and followed the women for a total of 5 years. They found dose-response effects – this means that the more cruciferous vegetables women ate, the less likely they were to experience breast cancer recurrence or die from breast cancer. When the women were grouped into four quartiles of cruciferous vegetable consumption, in the highest quartile had a 62% decrease in risk of death and 35% reduced risk of recurrence compared to the lowest quartile.5
This new data supports a previous report from the Women’s Healthy Eating and Living (WHEL) study. Breast cancer survivors who reported higher than median cruciferous vegetable intake and were in the top third of total vegetable intake had a 52% reduced risk of recurrence – especially powerful since the average intakes were quite low – 3.1 and 0.5 servings/day of total and cruciferous vegetables, respectively.6
Don’t forget: cruciferous vegetables must be chopped, crushed, or chewed well for maximum benefit!
The myrosinase enzyme is physically separated from the glucosinolates in the intact vegetables, but when the plant cells are broken, the chemical reaction can occur and ITCs can be formed. The more you chop before cooking (or chew if you are eating the vegetables raw), the better. Some ITC benefit may be lost with boiling or steaming, so we get the maximum benefit from eating cruciferous vegetables raw – however, gut bacteria also have the myrosinase enzyme, so additional ITC production may occur in cooked cruciferous vegetables after we eat them. Also, we can increase ITC production from cooked cruciferous vegetables by having some shredded raw cruciferous vegetables such as cabbage, kale, collards or arugula in a salad in the same meal to supply the myrosinase enzyme, which the body can use during the digestive process.
1. Higdon J, Delage B, Williams D, et al. Cruciferous vegetables and human cancer risk: epidemiologic evidence and mechanistic basis. Pharmacol Res 2007;55:224-236.
2. Cornblatt BS, Ye L, Dinkova-Kostova AT, et al. Preclinical and clinical evaluation of sulforaphane for chemoprevention in the breast. Carcinogenesis 2007;28:1485-1490.
3. Zhang CX, Ho SC, Chen YM, et al. Greater vegetable and fruit intake is associated with a lower risk of breast cancer among Chinese women. Int J Cancer 2009;125:181-188.
4. Bosetti C, Filomeno M, Riso P, et al. Cruciferous vegetables and cancer risk in a network of case-control studies. Ann Oncol 2012.
5. Nechuta SJ, Lu W, Cai H, et al: Cruciferous Vegetable Intake After Diagnosis of Breast Cancer and Survival: a Report From the Shanghai Breast Cancer Survival Study. Abstract #LB-322. In Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4. Chicago, Il; 2012.
6. Thomson CA, Rock CL, Thompson PA, et al. Vegetable intake is associated with reduced breast cancer recurrence in tamoxifen users: a secondary analysis from the Women's Healthy Eating and Living Study. Breast Cancer Res Treat 2011;125:519-527.
The Women’s Healthy Eating and Living (WHEL) Study was a randomized controlled trial that was designed to test whether adhering to a diet high in vegetables, fruits, and fiber would reduce the risk of recurrence in breast cancer survivors. The study was conducted from 1995-2006, and the subjects were 3,088 women who had been treated for early stage breast cancer. Women were either in a control group or an intervention group.
The daily dietary goals given for the intervention group in the WHEL study were as follows:
- 5 servings of vegetables
- 16 ounces of vegetable juice
- 3 servings of fruit
- 30 g of fiber
- 15-20% of calories from fat.1
The overall results of the WHEL study were published in 2007 and were disappointing. Women in the intervention group on average increased their vegetable intake by 65%, their fruit intake by 25%, and their fiber intake by 30%; they also decreased their energy percentage from fat by 13%. However, there were no significant differences in the number of breast cancer recurrences or deaths between the control and intervention groups.2
Why did this intervention fail?
There were likely many contributing factors. This dietary intervention was started after the women had already been diagnosed and treated for breast cancer; after eating the Standard American Diet for decades and developing cancer; moderate dietary improvements at that point may be too late to prevent recurrence. The dietary advice was likely not specific enough or rigorous enough to have a significant effect. For example, vegetables with breast cancer preventive properties, such as cruciferous vegetables and mushrooms, were not emphasized over starchy vegetables – women were simply advised to eat 5 servings of vegetables daily. Plus, 75% of the women were already consuming 5 servings of vegetables daily before being randomized to control or intervention groups. 2
Women were not instructed to eat less of anything except fat or to decrease their caloric intake – so it is unsurprising that there was no significant change in body weight in the intervention group. 2 This is an important issue, since excess weight is strongly linked to breast cancer risk.3-7 Plus, these women were also consuming significant amounts of animal protein, which increases cancer risk by increasing IGF-1. 8-11
Another potential issue was the advice to reduce percentage of calories from fat, but no advice on limiting refined carbohydrates. Advising women to decrease their calories from fat without direction on what to replace those calories with likely resulted in the women choosing more pasta, rice, white potatoes, bread, and low fat processed foods. These women received no guidance on limiting refined carbohydrates, which is an important point here. Refined carbohydrates are higher in glycemic index and contain less fiber and more starch compared to natural carbohydrate foods. High dietary glycemic index is known to be associated with increased breast cancer risk.12 In contrast, consuming high-fiber foods increases the excretion of estrogen and decreases breast cancer risk.13-15 Now, new research coming out of the original WHEL data suggests that starch intake may play a role in breast cancer risk as well.
Starch intake and breast cancer recurrence
In new research presented at the San Antonio Breast Cancer Symposium in December, data from the WHEL Study were re-analyzed with respect to changes in carbohydrate intake. Women from both the control and intervention groups were included in the analysis.
The subjects were arranged into four groups based on how much their starch intake changed over the first year of the study: in the group who had the greatest decreases in starch intake, the likelihood of recurrence was 9.7%; in the group with the greatest increases in starch intake the likelihood of recurrence was 14.2%.16,17 The women who increased their starch intake were at greater risk of recurrence.
Although this particular study did not investigate specific foods, we know that white rice, white flour products, and white potatoes are some of the highest starch foods – these are also low nutrient, high glycemic foods and staples in the Standard American Diet. Breast cancer survivors and all women who want to prevent breast cancer must focus on protective foods (GOMBBS) such as mushrooms, green vegetables, beans, and onions; and avoid low-nutrient disease-causing foods, like refined starches and sugars, animal products, and oils. Too often, researchers do not study dietary patterns with the best anti-cancer potential.
1. Pierce JP, Faerber S, Wright FA, et al: A randomized trial of the effect of a plant-based dietary pattern on additional breast cancer events and survival: the Women's Healthy Eating and Living (WHEL) Study. Control Clin Trials 2002;23:728-756.
2. Pierce JP, Natarajan L, Caan BJ, et al: Influence of a diet very high in vegetables, fruit, and fiber and low in fat on prognosis following treatment for breast cancer: the Women's Healthy Eating and Living (WHEL) randomized trial. JAMA 2007;298:289-298.
3. American Institute for Cancer Research. New Estimate: Excess Body Fat Alone Causes over 100,000 Cancers in US Each Year [http://www.aicr.org/site/News2/153571380?abbr=pr_&page=NewsArticle&id=17333&news_iv_ctrl=1102]
4. Trentham-Dietz A, Newcomb PA, Storer BE, et al: Body size and risk of breast cancer. Am J Epidemiol 1997;145:1011-1019.
5. Ballard-Barbash R, Schatzkin A, Taylor PR, et al: Association of change in body mass with breast cancer. Cancer Res 1990;50:2152-2155.
6. Vrieling A, Buck K, Kaaks R, et al: Adult weight gain in relation to breast cancer risk by estrogen and progesterone receptor status: a meta-analysis. Breast Cancer Res Treat 2010;123:641-649.
7. Parker ED, Folsom AR: Intentional weight loss and incidence of obesity-related cancers: the Iowa Women's Health Study. Int J Obes Relat Metab Disord 2003;27:1447-1452.
8. Rinaldi S, Peeters PH, Berrino F, et al: IGF-I, IGFBP-3 and breast cancer risk in women: The European Prospective Investigation into Cancer and Nutrition (EPIC). Endocr Relat Cancer 2006;13:593-605.
9. Hankinson SE, Willett WC, Colditz GA, et al: Circulating concentrations of insulin-like growth factor-I and risk of breast cancer. Lancet 1998;351:1393-1396.
10. Sugumar A, Liu YC, Xia Q, et al: Insulin-like growth factor (IGF)-I and IGF-binding protein 3 and the risk of premenopausal breast cancer: a meta-analysis of literature. Int J Cancer 2004;111:293-297.
11. Shi R, Yu H, McLarty J, et al: IGF-I and breast cancer: a meta-analysis. Int J Cancer 2004;111:418-423.
12. Dong JY, Qin LQ: Dietary glycemic index, glycemic load, and risk of breast cancer: meta-analysis of prospective cohort studies. Breast Cancer Res Treat 2011;126:287-294.
13. Goldin BR, Adlercreutz H, Gorbach SL, et al: Estrogen excretion patterns and plasma levels in vegetarian and omnivorous women. N Engl J Med 1982;307:1542-1547.
14. Zhou Y, Zhuang W, Hu W, et al: Consumption of large amounts of Allium vegetables reduces risk for gastric cancer in a meta-analysis. Gastroenterology 2011;141:80-89.
15. Park Y, Brinton LA, Subar AF, et al: Dietary fiber intake and risk of breast cancer in postmenopausal women: the National Institutes of Health-AARP Diet and Health Study. Am J Clin Nutr 2009;90:664-671.
16. Emond JA, Patterson RE, Pierce JP: Change in Carbohydrate Intake and Breast Cancer Prognosis. In San Antonio Breast Cancer Symposium, vol. Presentation #P3-09-01; 2011.
17. Starch Intake May Influence Risk for Breast Cancer Recurrence. 2011. AACR in the News. http://www.aacr.org/home/public--media/aacr-in-the-news.aspx?d=2654. Accessed December 29, 2011.
What are lignans?
Plant lignans are one of the four classes of phytoestrogens (isoflavones, lignans, stilbenes, coumestans), phenolic compounds that are structurally similar to the main mammalian estrogen, estradiol.1 Plant lignans are modified by bacteria in the human digestive tract into enteroligans. It is important to recognize the role of healthy bacteria in this process, because antibiotics can destroy beneficial bacteria in the gut resulting in long-term reduction in enteroligans.2 Eating commercial meats exposes us to antibiotics, as does the overuse and inappropriate prescribing by physicians.
Which foods are good sources of plant lignans?
Flaxseeds are the richest source of plant lignans, having about 8 times the lignan content of sesame seeds [note that flaxseed oil does not contain lignans – they bind to the fiber]. The other plant foods on the list have about one-tenth or less the amount of lignans as sesame seeds per serving.2,3 Chia seeds are also a rich source of lignans, however the exact amount is still debatable, so that number will be made available at a later date.
• Flaxseeds (85.5 mg/ounce)
• Sesame seeds (11.2 mg/ounce)4
• Kale (curly; 1.6 mg/cup)
• Broccoli (1.2 mg/cup)
Anti-cancer effects of lignans
Enterolignans are structurally similar to estrogen and can bind to estrogen receptors – this capability allows lignans to either have weak estrogenic activity or block the actions of estrogen in the body. For this reason, plant lignans are classified as phytoestrogens, and there has been much interest in the potential contribution of lignan-rich foods to reduced risk of hormone-related cancers.2,5 Enterolignans inhibits aromatase6 and estradiol production in general, lowering serum estrogen levels.7 Plant lignans also increase concentration of sex hormone binding globulin, which blunts the effects of estrogens.8-10 These benefits were documented when 48 postmenopausal women consumed 7.5 g/day of ground flax seeds for 6 weeks, then 15 g for 6 weeks – and significant decreases in estradiol, estrone, and testosterone were noted with a bigger decrease in overweight and obese women.11
In a mouse model, a flaxseed diet (5%, 10%) shows dose-dependent inhibition of breast tumor growth.12 Human trials also confirmed similar beneficial effects. A double-blinded, randomized controlled trial of dietary flaxseed demonstrated dramatic protection. Women ate either a control muffin with no flax seeds imbedded or 25g flax-containing muffin starting at time of diagnosis of breast cancer for just 32-39 days until surgery. Tumor tissue analyzed at diagnosis and surgery demonstrated surprising benefits even in this short timeframe. There was a significant apoptosis (tumor cell death) and reduced cell proliferation in the flaxseed group in just the one month.13 Likewise women eating more flaxseeds with a documented higher serum enterolactone were found to have a 42% reduced risk of death from postmenopausal breast cancer and a dramatic (40 percent) reduction in all causes of death.14,15 Flaxseeds are clearly super foods; even with a mediocre diet they offer powerful protection against certain types of breast cancer. Another interesting study on flax followed women for up to 10 years and found a 51% reduced risk of all-cause mortality and a 71% reduced risk of breast cancer mortality. The intake of dried beans was also associated with a 39% reduced risk of all-cause mortality.16 Endometrial and ovarian cancer have not been as extensively studied, but the few studies that have been conducted suggest a protective effect.2,17
Bottom line; don’t forget to take your ground flax seeds (or chia seeds) every day. I sometimes forget too, but reviewing the science encourages me to remember. When used in conjunction with dietary exposure to greens, onions, mushrooms and beans, dramatic reductions in the risk of breast cancer are possible.
My newest book, Super Immunity, addresses my full nutritional program to win the war against breast cancer.
1. Mense SM, Hei TK, Ganju RK, et al: Phytoestrogens and breast cancer prevention: possible mechanisms of action. Environ Health Perspect 2008;116:426-433.
2. Higdon J: Lignans. In An Evidence-Based Approach to Dietary Phytochemicals. New York: Thieme; 2006: 155-161
3. Milder IE, Arts IC, van de Putte B, et al: Lignan contents of Dutch plant foods: a database including lariciresinol, pinoresinol, secoisolariciresinol and matairesinol. Br J Nutr 2005;93:393-402.
4. Coulman KD, Liu Z, Hum WQ, et al: Whole sesame seed is as rich a source of mammalian lignan precursors as whole flaxseed. Nutr Cancer 2005;52:156-165.
5. Adlercreutz H: Lignans and human health. Crit Rev Clin Lab Sci 2007;44:483-525.
6. Adlercreutz H, Bannwart C, Wahala K, et al: Inhibition of human aromatase by mammalian lignans and isoflavonoid phytoestrogens. J Steroid Biochem Mol Biol 1993;44:147-153.
7. Brooks JD, Thompson LU: Mammalian lignans and genistein decrease the activities of aromatase and 17beta-hydroxysteroid dehydrogenase in MCF-7 cells. J Steroid Biochem Mol Biol 2005;94:461-467.
8. Adlercreutz H, Mousavi Y, Clark J, et al: Dietary phytoestrogens and cancer: in vitro and in vivo studies. J Steroid Biochem Mol Biol 1992;41:331-337.
9. Adlercreutz H, Hockerstedt K, Bannwart C, et al: Effect of dietary components, including lignans and phytoestrogens, on enterohepatic circulation and liver metabolism of estrogens and on sex hormone binding globulin (SHBG). J Steroid Biochem 1987;27:1135-1144.
10. Low YL, Dunning AM, Dowsett M, et al: Phytoestrogen exposure is associated with circulating sex hormone levels in postmenopausal women and interact with ESR1 and NR1I2 gene variants. Cancer Epidemiol Biomarkers Prev 2007;16:1009-1016.
11. Sturgeon SR, Heersink JL, Volpe SL, et al: Effect of dietary flaxseed on serum levels of estrogens and androgens in postmenopausal women. Nutr Cancer 2008;60:612-618.
12. Chen J, Power KA, Mann J, et al: Flaxseed alone or in combination with tamoxifen inhibits MCF-7 breast tumor growth in ovariectomized athymic mice with high circulating levels of estrogen. Exp Biol Med (Maywood) 2007;232:1071-1080.
13. Thompson LU, Chen JM, Li T, et al: Dietary flaxseed alters tumor biological markers in postmenopausal breast cancer. Clin Cancer Res 2005;11:3828-3835.
14. Buck K, Vrieling A, Zaineddin AK, et al: Serum enterolactone and prognosis of postmenopausal breast cancer. J Clin Oncol 2011;29:3730-3738.
15. Buck K, Zaineddin AK, Vrieling A, et al: Estimated enterolignans, lignan-rich foods, and fibre in relation to survival after postmenopausal breast cancer. Br J Cancer 2011;105:1151-1157.
16. McCann SE, Thompson LU, Nie J, et al: Dietary lignan intakes in relation to survival among women with breast cancer: the Western New York Exposures and Breast Cancer (WEB) Study. Breast Cancer Res Treat 2010;122:229-235.
17. Bandera EV, King M, Chandran U, et al: Phytoestrogen consumption from foods and supplements and epithelial ovarian cancer risk: a population-based case control study. BMC Womens Health 2011;11:40.
Why Awareness? Is there anyone out there who has never heard of Breast Cancer? Do you want to know why it wasn’t called Breast Cancer Prevention Month? I’ll tell you why, because its purpose is not to help women by preventing breast cancer; it is all about money.
It is obvious this pink product promotion kick is all about promoting mammograms so radiologists can make more money. They need plenty of awareness to counter all the recent research from large studies showing that mammograms aren’t too effective.1-3
If preventing human suffering and saving women's lives were the overriding purpose then promoting how to reduce the risk of developing breast cancer would be front and center as the main objective. Women should be getting notified of the scientific evidence that has accumulated in recent years that can enable women to avoid breast cancer. There are powerful protective steps women need to be aware of, such as:
- Stay slim
- Eat lots of green vegetables, onions, and mushrooms daily.
- Do not eat mass factory farmed dairy products, especially those given rBGH
- Stay away from fast foods and insulin promoting refined foods such as white flour and sweets.
- Do not eat mass factory farmed meats given antibiotics and growth promoting hormones.
Consider: these cancer non-profits are affiliated with drug companies and mammogram machine companies. They are also supported by companies such as Omaha Steaks, Pretzel Crisps, Boar’s Head Meats, General Mills, and ACH Foods (which makes margarine and cooking oils for fast food restaurants). They have no interest in preventing cancer, only treating it. The search for the magic “cure” for breast cancer is just another belief system with no reality behind it. I wish you a long life waiting for this to happen - that women can eat fast food, pasta, doughnuts, and bagels with cream cheese every day and then take a magic pill and not get cancer. Never gonna happen. The whole purpose of buying pink and raising money is to actually increase the amount of women with the diagnosis of cancer so they can be tested and treated, making more money for this billion dollar industry.
Hysterical wasn’t it that Southern Cancer Fried Chicken was selling pink buckets of the cancer-causing (junk food fried) chicken to raise money for breast cancer awareness? A skull and crossbones on the chicken bucket would have made more sense than a pink ribbon, but what do I know? I am sure next year we will see a pink Big Mac with a ribbon around it, and we will be encouraged to drink Pepsi for breast cancer awareness. I say let’s have some pink-ribboned cigarettes, and whiskey in pink bottles, too. I wonder if the cocaine pushers will get in on the act. Why not? Maybe even we can get the lawn service technicians that spray toxic weed killer on the neighbor’s lawn to dress in pink.
Let me tell you something, a cure is not coming soon. You’d better hedge your bets and eat right.
1. Gotzsche PC, Nielsen M: Screening for breast cancer with mammography. Cochrane Database Syst Rev 2009:CD001877.
2. Wright CJ, Mueller CB: Screening mammography and public health policy: the need for perspective. Lancet 1995;346:29-32.
3. Esserman L, Shieh Y, Thompson I: Rethinking Screening for Breast Cancer and Prostate Cancer. JAMA: The Journal of the American Medical Association 2009;302:1685-1692.
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