Articles

Breast Cancer

Introduction

Breast cancer is a physically and emotionally traumatizing disease. Unfortunately, the incidence of breast cancer has been increasing steadily for decades. In 1972 when President Nixon declared our national war on cancer, a woman’s lifetime risk of developing breast cancer was 1 in 20. Today breast cancer rates have escalated to the point where women’s lifetime risk of developing breast cancer is 1 in 8. In the year 2002, the American Cancer Society estimates that nearly 203,500 women will be diagnosed with breast cancer and approximately 39,600 women will die from it. This means that approximately every two and a half minutes a woman in the United States is diagnosed with breast cancer and that approximately every thirteen minutes, a woman dies from this disease. Breast cancer has become the second largest cause of cancer death in women, after lung cancer, and the leading cause of death for women between the ages of 35 and 54.

Malignant Breast Tumors

One of the most common ways to classify breast cancer is according to the type of cells where the cancer originates, such as the lobule, duct, or connective tissue. Each breast has 15 to 20 sections called lobes, each of which contain many smaller sections called lobules. The lobes and lobules are connected by a network of thin tubes called ducts. Ductal cancer is the most common type of breast cancer, accounting for 85-90% of cases. (1) Lobular cancer occurs in 10-12% of cases. Inflammatory breast cancer is an uncommon form of the disease, in which the breast becomes warm, red, swollen, and inflamed.

Tumor Grade

Each type of breast cancer can be examined for its degree of "differentiation," which classifies the cancer according to how different its cells are from normal cells. This varies from well differentiated to poorly differentiated. Well differentiated cells are very similar to the cells of origin. On the other hand, poorly differentiated cells have bizarre appearances, retaining only a few characteristics of the original normal cells. This description of tumor differentiation is referred to as tumor "grade." Low-grade malignancies are well differentiated, while high-grade indicates poor differentiation. Determination of tumor grade is meaningful because this is highly related to the degree of aggressiveness of the cancers and to patient survival, with high-grade cancers usually carrying the worst prognoses.

Carcinoma In situ

Ductal breast malignancies are divided into two categories, pre-invasive (have not invaded surrounding tissues) and invasive. Pre-invasive ductal cancer is called intraductal carcinoma in situ (Latin for "in position"). This is a very early stage of breast cancer, which is so small that it can never be diagnosed on breast examination. Mammography is the only diagnostic method that can detect this in situ stage. In modern mammography centers, ductal carcinoma in situ (DCIS) composes 25% of all breast cancers detected by screening mammography. (2) In DCIS, the ductal cancer cells remain within the ducts, with no sign of outside tissue invasion. If DCIS is not treated surgically, it frequently evolves into invasive ductal carcinoma. (3) It is believed that all invasive ductal cancers began as noninvasive forms.

Lobular carcinoma in situ

Invasive lobular carcinomas only account for about 10% of all breast cancers and they tend to be somewhat less aggressive than invasive ductal carcinomas. Unlike invasive ductal carcinomas, it is now believed that lobular carcinoma in situ (LCIS) is not a precursor of invasive lobular carcinoma. The confusion exists because LCIS, while it has the word carcinoma in its name, does not behave like a cancerous condition. It does not grow, form masses, transform into invasive cancer, or metastasize. Therefore, it does not represent a true malignancy. In addition, LCIS cannot be diagnosed by a breast exam or mammogram. It is only diagnosed by accident when a breast biopsy is performed for another reason. LCIS represents a risk 7 to 12 times that of the general population for subsequent invasive cancer. (4)

Uncommon Breast Malignancies

Other types of breast malignancies occur less frequently. The first category is connective tissue breast cancers, which are referred to as breast sarcomas. Next are metastases, which are malignancies that have spread to the breast from a cancer in another part of the body. While spread of a cancer to other sites from the primary site is a common occurrence in many types of cancer, metastatic tumors rarely spread to the breasts from another primary site.

Metastasized Breast Cancer

Breast cancer is able to spread or metastasize to distant sites by two mechanisms; through the blood vessels or via the lymphatic ductal system. If a tumor invades the lymph ducts, it travels to the armpit (axilla) where the migrating tumor cells are caught in the filtering processes of the lymph nodes, which causes the nodes to enlarge. This can make the lymph nodes feel like firm lumps. From these initial nodes, cancer cells can continue to spread through this ductal system to other parts of the body.

Clinical Staging

Clinical staging is another way to rate and compare disease activity. Each stage from 0 through IV represents an incremental worsening of the overall disease prognosis. Staging is important when picking subjects to participate in clinical settings because it verifies that researchers have the same number of women at each stage of the disease in both the experimental group and in the untreated placebo controls. This ensures that patients in both groups have cancers that are approximately at the same level of development. Clinical staging is determined by considering the size of the tumor (T), the status of the nearby lymph nodes (N), and the existence of distance metastasis (M). (5)

Statistic

American Cancer Society Facts, 2000-2006.

An estimated 212,920 new cases of invasive breast cancer will be diagnosed in women during 2006. (6) In addition to invasive breast cancer, 61,980 new cases of breast carcinoma in situ are expected to occur among women during 2006. (7) An estimated 40,970 women will die from breast cancer in 2006. (8) Over 75% of women who are diagnosed with breast cancer are age 50 or older. Men can get breast cancer, although this is very rare. An estimated 1,720 new cases will be diagnosed in men during 2006. An estimated 460 men will die from breast cancer in 2006. About 5-10% of all breast cancers are inherited. Children can inherit an altered breast cancer susceptibility gene from either their mother or father. Most women—about 80%—who get breast cancer do not have a sister or mother who has breast cancer. Excluding skin cancer, breast cancer is the most common cancer in women. Although the lifetime risk of breast cancer is 1 in 8, the chances of getting breast cancer by age 50 are 1 in 54. By age 60 the chances are 1 in 23. In the 1990's, the breast cancer death rate declined by the largest amount in over 65 years. Heart disease, not breast cancer, is the leading killer of women. Women under the age of 40 account for only 5% of breast cancer cases. Nearly 97% of women who are diagnosed with breast cancer at an early stage survive for more than 5 years.

Signs and Symptoms

[span class=alert]The following list does not insure the presence of this health condition. Please see the text and your healthcare professional for more information.[/span]

The primary sign or symptom associated with breast cancer is finding a breast lump. In a survey of post-mastectomy women, the first sign or symptom of breast cancer was identified by the patient herself 80% of the time. In 19% of cases, the first signs were picked up by health professionals. An unexpected finding was that pain was the first symptom noted by 13 percent of the women. (9)

General

    Asymptomatic Finding a breast lump upon routine self-examination Possible presence of pain or tenderness in breast Biopsy with pathologic confirmation following radiographic evaluation noting the presence of a foreign mass

Treatment Options

Conventional

There are four primary types of treatment for breast cancer, which include:

    surgery (lumpectomy, partial mastectomy, radical mastectomy) radiation therapy (using high-dose x-rays to kill cancer cells) chemotherapy (numerous forms of cytotoxic drugs are used to kill cancer cells) hormonal therapy (using anti-estrogen drugs or surgically removing the ovaries)

Estrogen Receptors

The cells of many breast cancers have a chemical "socket" or receptor for estrogen on their surface. The presence of this receptor is usually determined by the pathologist during an examination of the biopsy tissue. Roughly 50 to 70% of breast cancers have estrogen receptors and are referred to as being estrogen receptor positive (ER+). Breast cancer cells that lack estrogen receptors are called estrogen receptor negative (ER-). ER+ breast cancers are stimulated by the presence of estrogen more than ER- breast cancers.

Cutting off the estrogen supple to ER+ breast tumors often stops or substantially slows down their growth rate. This is important because two-thirds of patients with ER+ tumors respond to hormonal therapy, compared to less than 10% with ER-. (10) Therefore, being estrogen receptor positive provides a substantially better prognostic outcome than ER- status.

Anti-estrogen medications:

Tamoxifen appears to act by binding to estrogen receptor sites on cells. It has been used for over 20 years to treat estrogen receptor positive breast cancer and is probably the most commonly prescribed anticancer medication in the world.

Selective estrogen receptor modulators (SERM 2), such as raloxifene, have been developed for the prevention of osteoporosis. Preliminary studies with raloxifen revealed that the breast cancer rate was also reduced by more than 50% without any concomitant increase in endometrial cancer. The search for a SERM 3, and beyond, may lead to the development of drugs that have the beneficial effects of estrogen while preventing breast cancer and osteoporosis. (11)

Additional therapies:

Bone marrow transplant is a procedure that is sometimes attempted when a woman becomes resistant to chemotherapy. This procedure involves taking a sample of a patient’s bone marrow and freezing it. After the patient has undergone extremely high doses of chemotherapy, which destroys the bone marrow, the bone marrow cells are injected back into the patient, in the hopes that they will stimulate the production of healthy new cells.

Peripheral blood stem cell transplant. The patient's blood is passed through a machine that removes the stem cells (immature cells from which all blood cells develop) and then returns the blood back to the patient. This procedure is called leukapheresis and usually takes 3 or 4 hours to complete. The stem cells are treated with drugs to kill any cancer cells and then frozen until they are transplanted back to the patient. This procedure may be done alone or with an autologous bone marrow transplant.

Early Detection:

Women are encouraged to adhere to the following guidelines regarding the early detection of breast cancer. These include (a) annual physical breast exam by a physician, (b) annual mammography for women over 40 years of age according to the prescribed guidelines, and (c) monthly breast self-examination (BSE). When a woman does all three of these things, she's doing everything she can to insure early detection of breast cancer.

Risk factors:

The risk factors for breast cancer can be divided into two categories, uncontrollable and controllable. The major uncontrollable risk factors are related to issues involving gender and a woman’s menstrual, reproductive, and family history.

GENDER: Most breast cancers (over 99%) occur in women. Recent statistics from the American Cancer Association indicate that approximately 1,400 men are diagnosed with breast cancer annually and 400 men die from breast cancer. (12)

AGE: The longer a woman lives, the more likely she is to develop breast cancer.

FAMILY HISTORY: A gene defect is suspected when two or more first-degree relatives have developed premenopausal breast cancer. The term first-degree refers to parents, siblings, or children. If a woman has a first-degree relative with premenopausal breast cancer, her risk is 6 to 7 times greater than those with no such family history. Postmenopausal breast cancer is not thought to be due to defective genes. Having a single blood relative with breast cancer has very little relative risk, perhaps only 1.5 times greater.

DEFECTIVE GENES: It is estimated that breast cancer caused by gene defects is estimated to account for only 5 to 10% of all breast cancer cases. Studies show that from 5 to 10% of all breast cancer cases are linked to mutations in either BRCA1 and BRCA2 genes. (13) If a woman has inherited a mutated gene from either parent, she is more likely to develop breast cancer. According to the American Cancer Society, about 50%-60% of women with these inherited gene mutations will develop breast cancer by the age of 70.

EARLY ONSET OF MENSTRUATION: Women who begin menstruating before the age of twelve have a much greater risk of developing breast cancer compared to a woman who began menstruating at age 13 or older. (14)

LATE MENOPAUSE: Women who experience menopause after the age of fifty have double the breast cancer risk of women with earlier menopause. (15)

LATE CHILDBEARING: A woman who gives birth to her fist child after age 30 has a four times greater risk of breast cancer than one who has her first child before the age of 18. Women who never bear children have an even greater risk. (16)

The controllable risk factors for breast cancer, such as diet, nutrition, exercise, alcohol consumption, etc. are discussed in the lifestyle section of this monograph.

Nutritional Supplementation


Vitamin E

Vitamin E, although best known as a potent antioxidant, has been shown to have other functions that are unrelated to its antioxidant activity. Recent studies indicate that vitamin E may inhibit the growth of smooth muscle cells and also cancer cells. In both breast and prostate cell cancer lines, analysis of high-molecular-weight DNA revealed extensive fragmentation, indicating apoptosis of all cell lines supplemented with vitamin E. The results of these studies suggest that vitamin E provides a general inhibition of cell proliferation with breast and prostate cancer cells. (17)


Selenium

It has been suggested that selenium levels in the blood might be used as a noninvasive diagnostic parameter in clinical assessment of malignant breast disease. The results of one study revealed that women with breast cancer had blood selenium levels ranging from 41-58 micrograms/l, whereas the selenium levels in healthy women subjects ranged from 73-89 micrograms/l. (18) However, numerous other studies suggest that selenium intake later in life is not likely to be an important factor in the etiology of breast cancer.


Coenzyme Q10 (CO-Q10)

Coenzyme Q10 was part of the therapy in the previously mentioned nutritional/antioxidant protocol with women who were “high-risk" breast cancer patients. Six of the 32 women in that trial obtained partial tumor regression. In one of those 6 women, the dosage of CoQ10 was increased to 390 mg. One month later, her tumor was no longer palpable and at the end of a second month of high-dose coenzyme Q10 therapy, a mammogram confirmed the absence of tumor. Based on this initial success, another woman who had a verified residual tumor remaining in the tumor bed following non-radical surgery began treatment with 300 mg. CoQ10 daily. Three months later the woman’s clinical condition was excellent and examination revealed the complete absence of residual tumor tissue. The authors of this trial made the following concluding statement, “The bioenergetic activity of CoQ10, expressed as hematological or immunological activity, may be the dominant but not the sole molecular mechanism causing the regression of breast cancer." (19)


Lycopene, Lutein

Carotenoids: One study reported reduced breast cancer risks in women with higher intakes of foods containing the following carotenoids: beta-cryptoxanthin, lycopene, lutein, and zeaxanthin. It is suggested that these nutraceutical agents may provide a protective effect against breast cancer. (20)


Melatonin

Melatonin is a hormone that is secreted from the pineal gland in the brain. Melatonin is the "sleep trigger," the substance that regulates our sleep/wake cycles. However, recent research also indicates that melatonin is also an important antioxidant. (21) Studies report that melatonin is capable of inhibiting the in vitro growth of breast cancer cells, which suggests that it may be useful in the prevention of breast cancer. (22)

Breast cancer is one of numerous types of cancer that have been shown to be associated with reduced circulating levels of melatonin. (23) Two factors that are known to suppress melatonin levels are electromagnetic fields and increased exposure to light at night. Because some studies have reported that melatonin suppresses mammary cancer in rats and blocks estrogen-induced proliferation of human breast cancer cells in vitro, it is suggested that reduced melatonin production increases the risk of breast cancer. In a recent (1999) review of the scientific literature on these topics, the authors made the following statement, “Based on the published data, it is currently unclear if electromagnetic fields and electric light exposure are significant risk factors for breast cancer, but further study appears warranted. Given the ubiquitous nature of EMF and artificial light exposure along with the high incidence of breast cancer, even a small risk would have a substantial public health impact." (24) Some studies have also indicated that melatonin enhances the effects of tamoxifen therapy in women who are being treated for breast cancer. (25)


Antioxidant Nutrients

Antioxidant nutrients help support the immune system especially when the body is under stress. Although the following research highlights individual antioxidant nutrients, it should be stressed that it is not advisable to take large amounts of one or two antioxidants while excluding the rest. For optimal protection, a nutritional supplement program should include multiple antioxidants. The primary antioxidants are vitamins A, C, E, beta-carotene, selenium, coenzyme Q10, and lipoic acid.

In the following 18-month study, 32 women with breast cancer were put on a nutritional protocol consisting of high dose antioxidants and accessory nutrients. The women were between 32 and 81 years of age and classified "high risk" because of tumor spread to the lymph nodes in the axilla. The nutritional protocol, which was added to the normal surgical and therapeutic treatments for breast cancer, consisted of a combination of the following antioxidants. Vitamin C, 2,850mg; vitamin E, 2,500 IU; beta-carotene, 32.5 IU; selenium, 387 mcg, plus secondary vitamins and minerals, essential fatty acids (1.2 gm gamma linolenic acid and 3.5 gm n-3 fatty acids) and coenzyme Q10, (90 mg per day). Biochemical markers, clinical condition, tumor spread, quality of life parameters and survival were followed during the 18-month trial. Compliance was excellent. The main observations were: none of the patients died during the study period (the expected number was four); none of the patients showed signs of further distant metastases; quality of life was improved (no weight loss, reduced use of painkillers); and six patients showed apparent partial remission. (26)


Selenium, Iodine

There is some evidence linking iodine and selenium to breast cancer prevention. Seaweed is a popular dietary component in Japan and a rich source of both of these essential elements. A group of scientists hypothesize that this dietary preference may be associated with the low incidence of benign and malignant breast disease in Japanese women. Studies in animals and humans suggest that iodine administration is therapeutically effective in the treatment of both iodine-deficient goiter and benign pathological breast tissue. In addition to iodine’s role in thyroid hormones, utilized in the production of anti-proliferative iodolipids in the thyroid. These compounds may also help regulate cellular proliferation in tissues beyond the thyroid gland. It appears that selenium and iodine act synergistically since the mono-deiodinase enzymes are selenium-dependent and are involved in thyroid hormone regulation. It explains how selenium levels may affect both thyroid hormone activity and iodine availability. These authors suggest that iodine and selenium may play a preventive role in breast cancer, but additional retrospective and prospective studies are needed to confirm this hypothesis. (27)


Folic Acid

Results from the 88,818 women who participated in the Nurses’ Health Study started in 1980 with 16 years of followup revealed that folic acid levels are not associated with breast cancer. However, women who drink a moderate amount of alcohol (15 grams/day) have a greater risk of developing breast cancer if they have low levels of folic acid. (28) Numerous categories of drugs have been reported to deplete folic acid levels, and therefore may increase a woman’s breast cancer risk. The categories of drugs that deplete folic acid include antacids, antibiotics, anticonvulsants, anti-inflammatory drugs, potassium-sparing diuretics, bile acid sequestrants, estrogen-containing medications, and anti-ulcer medications. (29)


Soy Isoflavones

In cultures where soy products are consumed in abundance, women’s health problems, certain cancers, and cardiovascular disease are reported to be less prevalent. (30) Increasing the dietary intake of soy products increases the intake of phytoestrogens, which weakly mimic the effects of endogenous estrogens. Soy isoflavones (genistein and daidzein) are rich in phytoestrogens and are thought to reduce menopausal symptoms, support bone mineralization, and decrease the risk of certain cancers. (31) , (32) , (33) , (34)

Epidemiological studies have noted that soy consumption is associated with a lowered risk of cancers, including breast cancer. (35) Evidence in support for these claims has come from studies with cultured human breast cancer cells (36) and animal models of breast cancer. (37) , (38) Researchers concluded that in the case of breast cancer risk, the beneficial effects of soy and soy isoflavones occur prior to and during puberty by accelerating the rate of differentiation of the epithelial cells of the breast. (39)

More study is warranted before recommending isoflavones for estrogen positive breast cancer because it has been reported that the soy isoflavone genistein stimulates the growth of estrogen-dependent breast cancer cells in vivo in a dose-dependent manner. (40) , (41) Genistein has also negated the inhibitory activity of tamoxifen in women with certain estrogen positive breast tumors. (42) Thus, women with estrogen positive breast cancer or who are on tamoxifen should limit their intake of isoflavones until more is known about the effects of phytoestrogens on breast tumors in this patient population.


Flaxseed

Flaxseed is a rich source of plant lignans, particularly secoisolariciresinol and matairesinol, which are then converted to mammalian lignans enterodiol, enterolactone. (43) They are similar in structure to endogenous sex steroid hormones, possessing estrogenic and possibly antiestrogenic activity thus altering hormone metabolism and possibly a subsequent cancer risk. (44) , (45) , (46)

A study completed in premenopausal women has indicated that flaxseed may be chemoprotective by altering estrogen metabolism and increasing the urinary excretion ratio of its metabolites, 2-hydroxyestrogen:16alpha-hydroxyestrone, which has served as a biomarker for breast cancer. 2-hydroxyestrogen may also have breast cancer protective effects due to its slight estrogen effect and possible antiestrogen activity. (47) One study involving greater than 280 women noted a substantial reduction in breast-cancer risk among women with a high intake (as measured by urinary excretion) of the lignan enterolactone. (48) Flaxseed and its lignan secoisolariciresinol diglycoside have reduced plasma insulin-like growth factor I (IGF-I) levels. Increased concentrations of IGF-1 are associated with an increased risk of breast cancer. This reduction in plasma IGF-I may indicate another mechanism for the anticancer effect of flaxseed and secoisolariciresinol diglycoside. (49) Other studies, mainly using animal models have demonstrated inhibited growth and delayed progression of mammary tumors. (50) , (51)

Herbal Supplementation


Arabinoxylane

Arabinoxylane is a polysaccharide dietary fiber formula from the outer shell of rice bran (hemicellulose B) that has been enzymatically modified with hyphomycetes mycelia from three different medicinal mushrooms: Shiitake, Kawaratake and Suehirotake. This enzymatically altered arabinoxylane is studied and marketed as MGN-3 and has potential as immune system support for cancer patients. (52) Several reports noted the ability of the proprietary arabinoxylane extract to improve immunity. Arabinoxylane has been reported to significantly improve the induction of Natural Killer (NK) cell activity both in vitro and in vivo and may actually continue to improve NK activity up to 6 months after cessation of therapy. (53) , (54) Arabinoxylane has also been reported to: increase tumor necrosis factor-a (TNF-a) production and increase interferon-g (IFN-g) synthesis by peripheral blood mononuclear cells in vitro. (55)


Shiitake Mushroom

Shiitake mycelia has been reported to be immunomodulating in the following ways: (1) Activation of macrophages, promoting recognition of antigens and information transmission to the T-helper cells, increasing rate of phagocytosis. (2) Increase and reinforce interleukin-1 production, thereby activating the T-helper cells. (3) Promotes the mitosis and proliferation of B-lymphocytes. (4) Increases antibody production. (56) , (57)

Shiitake has been reported to increase lymphokine-activated killer (LAK) cell activity in vitro. (58) Treatment with shiitake mycelia preparation increased the LAK cell concentration by 50%, and reduced the dose of recombinant interleukin 2 (rIL-2) by 50%. This data suggests that shiitake preparations can be used as bio-regulators in LAK cell therapy in tumor treatment. Lentinan (b-1-3-glucan), has been reported to increase host immune responses, with effectiveness for the patients with advanced or recurrent stomach or colo- rectal cancer in combination with chemotherapeutic agents such as mitomycin. Lentinan has been administered as an agent for supportive therapy in patients with advanced breast carcinoma with effectiveness. (59) The b-1,3-glucan (lentinan) reversed tumor growth when injected in mice. It acts by stimulating the immune system, rather than by direct action on the tumor. (60) Lentinan activates the alternative complement pathway, stimulating the macrophages, thus inhibiting tumor growth. It also may activate interleukin-1 secretion, which helps trigger T lymphocytes. Shiitake is also believed to stimulate interferon production. Shiitake significantly inhibited the toxic immunosuppressive effects of cancer drugs such as cyclocy-tidine, when taken with them. Lentinan restores impaired enzyme activity of X-proline-dipeptidyl-aminopeptidase in the serum of mice with tumors. Because of its large molecular size, lentinan may not be absorbed efficiently when taken orally, but studies report enough is absorbed to elicit a positive pharmacological response.

Recently, aqueous shitake extracts have been reported to decrease IL-1 production and apoptosis in human neutrophils in vitro, as measured by ELISA and flow cytometry (61) The extract was further separated into high and low molecular weight components, and it was found that the low molecular weight component retained the activity of the whole extract. This further suggests that the active substance is a novel compound distinct from lentinan, the well-studied high molecular weight anti-tumor agent found in shiitake.


Larch Arabinogalactan

Arabinogalactans are a class of long, densely branched polysaccharides of the 3,6-beta-D-galactan type with molecular weights ranging from 10,000-120,0002. Because of the immune-enhancing properties, larch arabinogalactan (LA) is receiving increased attention as a clinically useful immunomodulating agent, making it potentially useful as an adjunct to more traditional cancer treatment options. LA is reported to enhance immunity by various methods. Studies report that LA stimulates natural killer cell cytotoxicity, enhances other functional aspects of the immune system, and inhibits the metastasis of tumor cells to the liver. (62)


Green Tea

Green tea reportedly has antioxidant properties (63) and the ability to protect against oxidative damage of red blood cells. (64) Antioxidants protect cells and tissues against oxidative damage and injury. (65) Green tea’s antioxidant effects seem to be dependent upon the polyphenol (catechin) fraction. (66) , (67) It is important to note that the addition of milk to any tea may significantly lower the antioxidant potential. (68)

Inhibitory effects of green tea on carcinogenesis have been investigated in laboratory studies using (-)epigallocatechin gallate (EGCG) or crude green tea extract. (69) Further, EGCG has been reported to inhibit the growth of cancer cells, lung metastasis in an animal model and urokinase activity. (70) , (71) Investigators have reported that increased consumption of green tea was associated with decreased numbers of axillary lymph node metastases among pre-menopausal women with stage I and II breast cancer and with increased expression of progesterone and estrogen receptors among postmenopausal women. (72) , (73) Claims have been made that increased consumption of green tea prior to clinical cancer onset may be associated with improved prognosis of stage I and II breast cancer. This association may be related to a modifying effect of green tea on the clinical characteristics of the cancer. (74)

Green tea and its major polyphenolics have been studied to determine if they prevent chemically induced tumors in a variety of experimental animal models. (75) , (76) The exact mechanism(s) of any anticarcinogenic activity remains to be found, but green tea polyphenolics are claimed antimutagenic, anticarcinogenic, antioxidant and antipromotional effects, including inhibition of Phase I and induction of Phase II enzymes.

The oral administration of green tea reportedly enhanced the inhibitory effects of doxorubicin on tumor growth 2.5-fold. (77) The doxorubicin concentration in the tumor was increased by the combination of green tea with doxorubicin. In contrast, the increase in doxorubicin concentration was not observed in normal tissues after green tea combination. (78) Green tea has also been reported to increase the tumor inhibiting effects of Adriamycin (doxorubicin). (79) Green tea’s potent antioxidant properties have been reported to be effective in reducing normal tissue damage from chemotherapy. (80) Green tea has also been reported to inhibit UVR-induced skin carcinogenesis. (81)


Astragalus

Experiments have reported that astragalus promotes regeneration of cells in the bronchi after viral infection. The polysaccharides contained in astragalus relate to the improvement in natural killer (NK) cells and T-cell function, as well as interferon production by the immune system. (82) Studies have reported that administration of astragalus for 1 month increased phagocytosis by spleen cells, decreased T-suppressor cell function and improved T-killer cell function. (83) Astragalus enhances the effects of interferon and may act not only to improve resistance to colds but decrease the duration of a cold. (84) Due to a belief that it inhibits bone marrow depression, astragalus has been studied in patients with AIDS and cancer. (85) , (86) Astragalus is claimed to protect against cellular damage in the liver, (87) , (88) help with oxygenation of the heart and cerebrovascular tissue and improve stamina and endurance. (89) , (90)


Cordyceps

Cordyceps is a unique black mushroom that extracts nutrients from and grows only on a caterpillar found in the high altitudes of Tibet and China. Cordyceps has been reported to have anticancer effects by decreasing proliferation and differentiation of cancerous cells and has immunomodulatory effects. (91) , (92) , (93) Cordyceps has been used for decreasing the renal toxicity of aminoglycosides and cyclosporine (94) , (95) and in individuals with chronic renal failure. (96) Kidney protection is claimed to be due to: protecting tubular cell sodium pump activity; attenuating tubular cell lysosome overfunction stimulated by phagocytosis of aminoglycoside; and decreasing tubular cell lipoperoxidation in response to toxic injury. (97) Cordyceps was also reported to protect stem cells and red blood cells during chemotherapy and radiation. (98)

Acupuncture & Acupressure

Wang used acupuncture to treat pain in late stages of mammary cancer. After surgery, the patients suffered pain that migrated subcutaneously all over the body, resulting in frequent (occurring every 15-30 minutes) splitting headaches, and waist pain that made it difficult for the patients to move and sleepless nights. The acupuncture treatment treated the following acupoints: Bai Hui (Du 20), Tai Yang (Extra 2), Feng Chi (GB 20), Shen Shu (UB 23), Zhi Shi (UB 52), Wei Zhong (UB 40), Tai Xi (K 3), etc. The following needle stimulation techniques were employed: 1) lifting and tonification method for Bai Hui, 2) reduction method for Tai Yang and Feng Chi, 3) tonification method for Shen Shu, Zhi Shi, and Tai Xi, and 4) the uniform reinforcing-reducing method for Wei Zhong. After three needling sessions, nighttime headache incidences were reduced from more than 20 to 5, allowing short bouts of sleep. (99)

Aromatherapy

Aromatherapy in Breast Cancer

The primary use of aromatherapy or essential oil therapy in breast cancer would be to relieve stress, promote a sense of well-being and thereby improve quality of life for the patient. A study of an aromatherapy service at a cancer support center demonstrated that the use of essential oils in cancer therapy may not only relieve stress, but may also assist in controlling some symptoms. (100)

For relieving stress and promoting a sense of well-being, aromatherapy may be used in the bath, with massage or inhaled using a diffuser or by applying the oil to a tissue. The following oils are useful for promoting a positive sense of well being and for reducing stress.

    Lavender (Lavendula augustifolia) Cedarwood (Juniperus mexicana scheide)
  • Geranium (pelargonium graveolen)
  • Bergamot (Citrus bergamia)
  • Vertiver (Vetivera zizanoides)
  • Cypress (Cupressus sempervirens)

Other oils that might be useful to relieve the stress of the physical body due to disease treatments would include:

    Rosemary (Rosemarinus officinalis) Marjoram (Origanum Marjorana) Fennel (Foeniculum vulgare) Lavender (Lavendula augustifolia) Thyme (Thymus Vulgaris)

Caution: Essential oils should not be used during pregnancy or lactation except under the guidance of a trained aromatherapist or healthcare practitioner.

Traditional Chinese Medicine

Breast Cancer

Extensive information regarding the treatment of this health condition using Traditional Chinese Medicine is available through the link above.

Diet & Lifestyle

Lifestyle: The following lifestyle factors are important for women who want to reduce their risk of developing breast cancer. However, this information is also very important for women who have already been diagnosed with breast cancer, because the factors discussed below can alter hormone activity, boost the immune system, and increase women’s chances for successful remission and long-term survival.

Diet: Numerous dietary factors affect a woman’s risk of breast cancer. These include the following:

Dietary Fat: Many, but not all, epidemiological studies on breast cancer have reported that high fat-consuming societies have higher rates of cancer. Research indicates that dietary fat, especially consumption of polyunsaturated fat, tends to promote mammary tumorigenesis. (101) It has been suggested that the level of dietary fat consumption that represents the lowest risk to breast cancer is in the range of 15 to 20% of calories. (102)

However, it is also important to understand the significance of "good" fats and "bad" fats. Experimental evidence from animal and human trials indicate that excess omega-6 fats and oils increase the risk of cancers of the breast, prostate and colon whereas omega-3 fats and oils seem to be cancer-protective. Studies also indicate that high consumption of omega-6 polyunsaturated fatty acids (PUFAs) stimulates several stages in the development of mammary and colon cancer. In contrast, members of the omega-3 family of fatty acids seem to provide protection against these cancers by affecting the activity of enzymes and proteins that influence intracellular signalling and, ultimately, cell proliferation. (103) Rather than trying to eliminate fats, the emphasis should be on ingesting optimal amounts of the right kind of fats. In general, most people in the U.S. consume too much of the omega-6 fats (corn, safflower, sunflower oils) and not enough of the omega-3 fats. The best sources for omega-3 fats are flaxseed oil (1 tablespoonful daily) and fish oil capsules containing eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA).

Fiber fights cancer. A high fiber diet acts to decrease the amount of estrogen in a woman’s body. Estrogens circulating in the blood pass through the liver, where they are bound into biologically inactive compounds. These inactive estrogen complexes are then passed via the bile into the intestines for excretion. Women consuming diets higher in fiber have increased fecal excretion, which corresponds to a higher fecal excretion of estrogen and a lower risk to breast cancer. (104)

Research suggests that the amount of fiber in the diet affects the activity of intestinal bacteria, which in turn affects the amount of estrogen that gets reabsorbed. The intestinal bacteria that proliferate in meat-eating women are more capable of freeing up the previously bound estrogen, which increases estrogen levels and a woman’s risk of breast cancer. (105)

Sugar The results of a study that evaluated food consumption statistics from 21 countries found a strong association between sugar consumption and breast cancer in postmenopausal women. The fact that women with adult onset diabetes have a higher incidence of breast cancer supports the sugar/breast cancer hypothesis. (106)

Toxins in our food and water as well as environmental exposures represent a serious increased risk to breast cancer. Some of the worst offenders are the chemicals that belong to a class of compounds known as organochlorines. These are fat-soluble compounds that that get stored in fatty tissue, and a woman’s breast tissue is a prime storage site for these toxins. Research revealed that women with higher blood levels of DDE, which is a metabolite of DDT, have up to a four times greater risk of developing breast cancer. (107) Research funded by the World Health Organization and published in 1976 revealed that DDT and other pesticides were found in very high concentrations in the tumors of women with breast cancer. (108)

In a paper titled "Organochlorine Contamination of Breast Milk," the authors state that over 95% of all the toxic chemicals ingested in the American diet come from meat, fish, eggs, and dairy products. (109) This is one of the main reasons why many people feel it is important to purchase and eat organically grown foods, which have not been exposed to the pesticides, insecticides, and herbicides used in commercial farming.

Alcohol consumption can increase circulating estrogen levels and increase a woman’s risk of developing breast cancer. The results of one study revealed that regular consumption of 30 grams of alcohol per day, which is equivalent to approximately two average drinks, increased levels of estrogen excreted in the urine. (110) In the Nurses Health Study, researchers followed 89,538 women between the ages of 34 and 59 for a number of years. The results revealed that women who consumed between 3 and 9 drinks per week were 30% more likely to develop breast cancer. (111)

In a comprehensive review of the scientific literature, Dr. Lynn Rosenberg stated that the association between alcohol and breast cancer is real, although rather weak. (112) Another literature review reported that 5 out of 6 epidemiological studies have found a positive correlation between alcohol consumption and increased risk for breast cancer. In the same review in which 28 case-controlled studies were examined, 18 of the studies reported a positive association between alcohol consumption and breast cancer whereas 10 studies did not. (113)

Exercise: Regular exercise lowers circulating levels of estrogen and reduces a woman’s risk of developing breast cancer. A study published in the September 21, 1994 issue of the Journal of the National Cancer Institute reported that regular exercise resulted in a substantial reduction of a premenopausal woman’s risk of developing breast cancer. (114) In another study, Dr. Rose Frisch at the Harvard School of Public Health examined the occurrence of breast cancer among female college athletes compared to non-athletes. The data was gathered from 5,398 women (2,622 former college athletes and 2,776 non-athletes) who were alumnae from eight different collages from 1925 to 1981. The women non-athletes had an 86% greater occurrence of breast cancer than the women who had been athletes. (115) These studies indicate that regular physical exercise is one of the most important modifiable risk factors for breast cancer.

It is important to emphasize to women that even moderate levels of regular exercise can provide substantial reduction in the future risk of breast cancer. This is especially true for adolescent girls. When regular exercise programs are started in adolescence, even moderate levels of regular physical activity will produce beneficial changes in menstrual cycle patterns and female hormones, which significantly lower the risk of breast cancer later in life. (116) , (117)

Clinical Lab Assessment

Some of the following laboratory testing can provide information necessary for diagnosis and treatment. In addition, the tests listed may also give insight to functional metabolism and functional nutrient status in the body.

Estradiol

Estradiol and Progesterone Receptors: Both of these hormones may create an environment in which certain breast cancers can grow more prolifically. Knowing if a certain cancer grows in the presence of a specific hormone enables potentially more successful treatment.

Fatty Acids

Dietary polyunsaturated fatty acids (PUFA) are primarily composed of omega 3 and omega 6 fatty acids. PUFA are vital in the production of eicosanoids – components involved in regulating inflammatory response, blood vessel leakage, lipid accumulation, immune cell response and optimal control of virtually every body tissue. (118) PUFA's appear to significantly interfere with proliferation of breast cancer cells. (119)

Carcinogenic Antigen 15-3 (CA 15-3)

This marker detects the antigens from breast carcinoma and though not specific enough to be used in screening, correlates with tumor progression.

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