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Breast Cancer 26 July 2009

The risk of breast cancer increases dramatically as women age as seen by research published by Simone in the 2004 edition of the journal Cancer and Nutrition:

By age 25: 1 in 19608
By age 30: 1 in 2525
By age 35: 1 in 622
By age 40: 1 in 217
By age 45: 1 in 93
By age 50: 1 in 50
By age 55: 1 in 33
By age 60: 1 in 24
By age 65: 1 in 17
By age 70: 1 in 14
By age 75: 1 in 11
By age 80: 1 in 10
By age 85: 1 in 9
Ever: 1 in 8

It is important to remember that by the time a breast cancer is detectable on a mammogram, it has been present for at least 8 years. Early detection then is just that- early detection. It’s not prevention. Prevention involves not allowing the breast cancer cells to grown in the first place. We are all full of cancer cells. The key to preventing cancer is not providing those cells an environment conducive to growth and maximising the bodies ability to kill those cells quickly. Studies have shown that only 20-30% of breast cancer is inherited and that the other 70-80% is avoidable.

In order to prevent breast cancer, follow these simple steps:

Step 1: Maintain the Alkaline Design of the Body.

See acid:alkaline balance.

Step 2: Understand Oestrogen

Oestrogen does not cause cancer. If it did, every 18 year old woman with high levels of oestrogen would have breast cancer. The damage is done by unbalanced oestrogens, synthetic oestrogen and oestrogens forced down abnormal metabolic pathways.

Every woman actually has three different types of oestrogen- oestrone (10%), oestradiol (10%) and oestriol (80%). Oestrone and oestradiol increase the risk of breast cancer. Oestriol is the weakest of the 3 oestrogens, is not metabolised to dangerous metabolites and reduces the risk of breast cancer. That’s why a woman’s natural balance of oestrogen is 80% oestriol.

Every woman should have the levels of all 3 oestrogens measured. This can easily be done on a 24 hour urine by specialised laboratories (PathLab in Melbourne provides this test in Australia). The oestrogen quotient (OQ) can then be calculated:

OQ= oestriol/oestrone + oestradiol.

The OQ is a very powerful predictor of breast cancer. The lower the OQ, the higher the risk of breast cancer. If your OQ is less than 1.2, you should follow the rest of the steps in this newsletter to increase your OQ, especially progesterone (see step 5) and iodine (see step 6) which increase the levels of oestriol compared to oestrone and oestradiol.

What if you are menopausal and deficient in oestrogen? Oestrogen is an invaluable hormone with many beneficial effects on a woman’s health. In women who do require oestrogen supplementation -1) have symptoms of oestrogen deficiency, 2) have low oestrogen levels on testing and 3) a trial of treatment with progesterone and herbs has not helped), supplementing with just oestradiol decreases the OQ and increases the risk of breast cancer. If you need oestrogen replacement, then make sure you get the 24 hr urine assessment. Knowing the levels of all 3 oestrogens will allow you to personalize your hormone restoration using natural bioidentical hormones in the correct ratio for you. For example, some women may be deficient in all 3 oestrogens and can be prescribed Triest which contains all 3 oestrogens in the 10/10/80 ratio. Some women may be deficient in just oestradiol and oestriol and would be better on Biest which just contains these oestrogens. There are also some women who are only deficient in oestriol and do best on oestriol cream. Although the weakest of the oestrogens, most women can control menopausal symptoms on oestriol alone without major side effects. You can see how problems can occur if these levels are not checked and a woman just low in oestriol is prescribed pharmaceutical oestradiol. You can see what that will do to the OQ and therefore her risk of breast cancer.

Caveats: Women with a past history of breast cancer should probably avoid all types of oestrogen replacement. Oestrogen replacement should never be given without also giving bioidentical progesterone.

Step 3: Know How You Metabolise Oestrogen

All 3 oestrogens are metabolised to 3 different metabolites – 2 OH, 4 OH and 16 OH oestrone. These metabolites are further metbolised by methylation to harmless metabolites which are excreted in the urine. 2 OH oestrone lowers the risk of breast cancer, 4 OH and 16 OH oestrone increase the risk of breast cancer by causing mutations in DNA. A study published in the November 2000 edition of the journal Epidemiology reviewed 10000 women and found that they were much less likely to develop breast cancer if they had high levels of 2 OH oestrone.

Oestrone and oestradiol are primarily metabolised to 16 OH oestrone. The higher your level of the 16 OH metabolite, the higher your risk of breast cancer. The lower the level, the lower the risk. Oestriol is not metabolised to 4 OH or 16 OH oestrone.

The 24 hour urine test for oestrogen can also measure the levels of these metabolites. The lowest risk of breast cancer is associated with a 2 OH/ 16 OH ratio (Oestrogen Metabolite Index, OMI) of 2 or higher. An OMI > 2 has been shown to decrease the risk of breast cancer by 30%. One study showed the OMI was the most predictive factor of breast cancer in post menopausal women.

OMI can be increased by avoiding drugs like cimetidine which decrease 2 OH and increase 16 OH, eating cruciferous vegetables (see step 3) and supplementing with Indole-3-Carbinol (I3C) or Diindolemethane (DIM).

4 OH oestrone is the least prevalent metabolite but increases the risk of breast cancer the most. It does this by increasing free radical levels. Ensuring adequate levels of antioxidants minimises the risk of 4 OH oestrone. Alpha lipoic acid, curcumin, vitamin C, green tea and selenium can reduce levels. Progesterone decreases the metabolism of oestrogen to 4 OH oestrone. Cruciferous vegetables and DIM have also been shown to reduce 4OH oestrone levels.

If the methoxy metabolites are low (suggesting deficient methylation pathways) then folate, vitamin B12 and trimethylglycine can be used to correct them. This is of added importance because there is evidence that low levels of the methylated oestrogens are associated with an increased risk of atherosclerosis and fibroids because of the deficient methylation pathways. Foods which are rich in methyl donors include green leafy vegetables, legumes, berries and nuts.

Increasing research on the methyl metabolite of 20H oestradiol (2-methoxyestradiol) is showing that it has powerful anticancer properties itself. This is why it is so crucial to get the oestrogen metabolites tested and make sure that the levels of this metabolite are optimised. Studies have shown that 2-methoxyestradiol inhibits the growth of both breast and prostate cancer cells by causing them to self-destruct (a process known as apoptosis). It has also been shown to inhibit the formation of new blood vessels which cancer cells require to grow and to inhibit the spread of cancer metastases.

Step 4: Consume More Carrots, Broccoli. Soy and Flax Seeds

Broccoli is a member of the cruciferous vegetable family. Others include bok choy, brussel sprouts (even I can’t eat them), cabbage and cauliflower. Countries with a high level of cruciferous vegetable consumption have a low incidence of breast cancer. These vegetables contain I3C. This compound is converted by stomach acid into DIM. I3C and DIM increase the OMI (by increasing the 2 OH oestrone metabolite and decreasing the 16 OH metabolite) and block cancer causing chemicals from attaching to the oestrogen receptors of the breast.

Beta-carotene is an antioxidant in orange-yellow vegetables. Women with low levels of beta-carotene have double the risk of breast cancer compared to women with high levels.

Soy is a selective oestrogen receptor modulator which means soy has the beneficial effects of oestrogen but without its potentially damaging effects. A study published in the May 1991 edition of the Lancet found that women with the highest consumption of soy had low risk of breast cancer. Another large study of nearly 22000 women published in the June 2003 edition of the Journal of the National Cancer Institute found a 54% reduction in risk in women consuming high levels of soy. Similar results have been found for endometrial and prostate cancers.

Flax seeds contain lignans which protect against cancer by:
• Favourably altering oestrogen metabolism
• Inhibiting new blood vessel information (which is crucial for rapid cancer cell growth)
• Inducing cancer cells to self destruct

A study published in the September 2004 edition of the International Journal of Cancer found that premenopausal women with the highest lignan intake had a 43% reduced risk of breast cancer.

Step 5: Supplement With I3C or DIM.

If eating more cruciferous vegetables doesn’t work or is too hard, I3C and DIM supplements are available. There is some controversy over which one is the best. I3C does not appear to be active until converted into metabolites (DIM is one). Many people do not metabolise I3C well, especially those with low stomach acid. There is also some concern that one of the I3C metabolites may increase the dangerous 4 OH oestrone metabolite. All things considered, DIM (starting at 75 mg daily) is probably the best option. This can be increased to 150 mg if the OMI does not increase above 2 after 6 months.

Step 6: Progesterone

Most women over the age of 35 have a relative deficiency in progesterone. Progesterone counteracts the cell growth stimulating effects of oestrogen on the breast. It also reduces the conversion of oestrogen to the dangerous 4 OH oestrone metabolite. One study has shown that women deficient in progesterone are 5 times more likely to get breast cancer than women with normal levels of progesterone. Furthermore, the women with a progesterone deficiency had a 10 times greater chance of death from all types of cancer.

Serum progesterone levels at the time of breast cancer surgery also influence survival rates. Women with normal levels of progesterone at the time of surgery had significantly better survival rates at 18 years than women with low levels.

If measured levels are low (it can be measured on the 24 hour urine assessment), supplementation is best done with bioidentical progesterone cream. Progesterone has the added benefit of increasing bone density and improving thyroid function. For more information, see Progesterone.

Step 7: Ensure You are not Iodine Deficient

Ensuring adequate iodine intake is the foremost example of using a natural substance to promote health and healing in the body. It seems that iodine triggers the death of cells which are abnormal or those which are at the end of their life cycle. Long-term iodine deficiency is a risk factor for hypothyroidism, malignant thyroid cancer, fibrocystic breast disease, breast cancer, prostate cancer, endometrial cancer and ovarian cancer. Iodine and thyroid hormone together may act as a team to protect us against abnormal cell development, carcinogens and the spread of cancer cells.

Cancer-causing chemicals have been present in the environment since the beginning of time. Iodine and thyroid hormone both have a protective role against these chemicals. Iodine in tissues provides an inhospitable environment for cancer cells to grow. It neutralises carcinogens, removes abnormal cells, kills viruses and neutralises toxins from microorganisms. Unfortunately because of epidemic iodine deficiency, the thyroid gland traps all of our dietary iodine and there isn’t any left for this important function in other tissues.

Iodine is necessary for the development and maintenance of normal breast architecture. It appears that iodine deficiency is a risk factor for both breast cancer and fibrocystic breast disease. Animals that are maintained in an iodine deficient state develop breast cancer, especially if they are given oestrogen.

Iodine also helps convert oestrone and its dangerous metabolite 16-alpha-hydroxyoestrone to oestriol, the anti-carcinogenic oestrogen.

Step 8: Ensure You are not Hypothyroid

Once cancer has developed, it invades connective tissue and then spreads to other tissues (metastasises).Thyroid hormone seems to be the earliest system designed to cope with these threats. Thyroid hormone gives strength and cohesion to connective tissue. If thyroid hormone levels are low, connective tissue is weak and cancer spreads more easily.

Some researchers have found that hypothyroidism is much more common in women with breast cancer while others have found the use of thyroid hormones may increase the risk of breast cancer. Why the disparity? Shouldn’t the correction of hypothyroidism which causes poor immune function protect against breast cancer? The answer is that thyroid hormones increase the bodies need for iodine. If an iodine deficiency in the body is not corrected first, the thyroid gland will steal iodine from the breasts. The Japanese who consume large amounts of iodine have very low levels of fibrocystic breast disease, breast cancer, endometrial cancer, ovarian cancer and prostate cancer.

Step 9: Take a Pharmaceutical Grade Fish Oil Supplement

In one study, breast tissue from 73 breast cancer patients and 74 women without breast cancer was analysed for fatty acid content. The cancer cases had high levels of omega-6 fatty acids and low levels of omega-3 fatty acids. Higher levels of omega-3’s appeared to be protective. In a similar study, women with the highest ratio of omega-3 to omega-6 in their breast tissue had a 67% lower risk of breast cancer than women who had the lowest ratios. In a population based study, premenopausal women with a high intake of omega-3 fatty acids had a significantly lower risk of breast cancer than those with the lowest intake.

Omega-3’s have been shown to induce cancer cell destruction (apoptosis). They also have a role after treatment for breast cancer. After analysis of all the research, reviewers concluded that “it is reasonable to consume omega-3 fatty acids in an effort to slow or stop the growth of metastatic cancer cells, increase the longevity of cancer patients and improve their quality of life.”

Step 10: Normalise Melatonin Levels

Several studies have shown that blind women have a low risk of breast cancer because they have high melatonin levels. Melatonin is our sleep hormone produced from our pineal glands when it is dark. Melatonin is one of the most powerful antioxidants known. After the age of 40, levels of melatonin begin to drop. There are also studies showing that women who don’t sleep between 1-2 am (when we make most of our melatonin) have an increased risk of breast cancer. To increase melatonin levels:

• walnuts are a great source of natural melatonin
• make sure where you sleep is very dark
• try and be asleep by 2300 hrs
• over the age of 40, small amounts of melatonin can be supplemented preferably after a saliva test confirms you are low.

Step 11: Minimise Environmental Toxins

Many of the chemicals in our environment have oestrogenic effects and are known as xenoestrogens. They are stored in breast tissue, react with oestrogen receptors and stimulate cell proliferation, including any cancer cells that might be present. Laboratory rats given dioxin in very small amounts always develop breast cancer. Dioxin is used to make plastics and pesticides. It is released into the environment and gets concentrated in meat, dairy, fish, soil and water.

PCB’s in plastic and pesticides like the organochlorines have also been associated with breast cancer. One study showed that breast cancer was 400% higher in women with the highest levels of organochlorines in their breasts. Organochlorines increase the formation of the dangerous 4 OH and 16 OH oestrones.

To minimise the intake of these chemicals:

• Try and use organic meats, fruits and vegetables as much as possible
• Avoid using pesticides and herbicides in or around your house. Look for safe natural alternatives. Another study showed that children living in houses where the lawn was routinely spayed with herbicides had a 600% higher risk of childhood leukaemia.
• Minimise the use of plastic wrap and plastic bottles. Never microwave anything in plastic.
• Consume more broccoli (see step 3).

Step 12: Detoxify

There are lots of benefits to living in this time period. The price we pay is our daily, unavoidable exposure to environmental toxins. As well as minimising our exposure, it is prudent to take steps to continuously detoxify our bodies of these chemicals.

Step 13: Optimise Vitamin B12 and Folate Levels

Studies have shown that low levels of vitamin B12 are a risk factor for breast cancer. The normal ranges of vitamin B12 in the blood are very wide and not of much use. A better indicator of your B12 levels is the homocysteine level. Homocysteine is a breakdown product of the amino acid methionine. It is in turn metabolised by vitamin B12 and folic acid. Levels greater than 9 umol/l are associated with an increased risk of heart disease and cancer. Elevated levels indicate a functional deficiency in B12 and folate. If your level is greater than 9 umol/l, find a supplement with at least 400mcg of folate and 400 mcg of B12.

Step 14: Get Some Sun

A review in the February 2006 edition of the American Journal of Public Health states that improved vitamin D status could significantly cut the risk of colon, breast, ovarian and prostate cancer. A review in the October 2005 edition of the Journal of Steroid Biochemistry found that consuming 1000 IU or more of vitamin D/day cut the risk of colon cancer in half.

The Association of Cancer Councils of Australia has recently acknowledged the importance of Vitamin D with a move away from advising to avoid sun exposure: “A balance is required between avoiding an increase in the risk of skin cancer and achieving enough ultraviolet radiation exposure to achieve adequate vitamin D levels.”

So try and get at least 30 minutes of sunshine per day at times of low UV light levels. Get your vitamin D levels checked occasionally. If your levels are less than 100 nmol/l, take vitamin D 1000 IU as a supplement.

Step 15: Avoid TFA’s, Refined Sugar, Grain Fed Red Meat and HRT

Trans-fatty acids (TFA’s) are present in polyunsaturated oil that has been heated, oils from seeds that are not cold pressed, margarine and oils that have been modified (“hydrogenated”) to give foods a longer shelf life. Trans-fatty acids have been shown to increase the risk of both heart disease and breast cancer. Everyone should be reducing their intake of omega 6 fatty acids and increasing the intake of omega-3 fatty acids (fish and flax) and omega-9 fatty acids (extra virgin olive oil). Try and avoid frying with any oil but if you have to, organic coconut oil is the safest.

Refined sugar and other refined carbohydrates (like white flour) cause a rapid spike in insulin. Persistent high levels of insulin leads to weight gain and increased oestrogen production. Meanwhile, the high levels of insulin impair the ability of the ovaries to ovulate and therefore progesterone levels are low. So eventually you have the worst combination of all for increasing your breast cancer risk- insulin resistance, high oestrogen levels and low progesterone levels.

A study published in the April 2007 edition of the British Journal of Cancer found that women who ate a lot of red meat had an increased risk of breast cancer. A study published in the July 2007 edition of the journal Cancer, Epidemiology, Biomarkers and Prevention found that postmenopausal women in China who ate a Western-style diet (including beef, pork and desserts) were 60% more likely to develop breast cancer than those eating a diet based on vegetables and soy. The researchers concluded that ‘consuming more plant-derived protein, phytonutrients and omega-3 fatty acids in place of meat, high fat dairy and sugary foods is a good way to cut back on the foods that have been shown to increase breast cancer risk.”

In 2002, the Journal of the American Medical Association published the Woman’s Health Initiative which showed that women on hormone replacement therapy with Premarin and Medroxyprogesterone had an increased risk of breast cancer. Premarin is pharmaceutical oestrogen derived from horse urine (containing some oestrogens completely foreign to women). Medroxyprogesterone is a drug derived from petrochemicals which is meant to simulate the effects of a woman’s natural progesterone (but doesn’t). Traditional HRT is usually prescribed orally. When a hormone is taken orally, it is metabolised by the liver before it is distributed to the rest of the body. This is why nature didn’t put any endocrine organs in the gastrointestinal tract. Hormones applied to the skin get distributed to the rest of the body before they are eventually metabolised by the liver. This means that it is oestrogen which binds to the receptors in the breast, not the dangerous metabolites.

There are some pharmaceutical oestrogen patches but unfortunately they contain mainly oestradiol.

Step 16: Maintain Good Bowel Health.

Health begins in the colon. If your bowel is sick, it’s impossible to be healthy. We should be consuming enough fiber from vegetables to be having at least 1 (preferably 2) bowel motions a day. Oestrogen metabolites are excreted in the stool. The longer they sit there, the more they get reabsorbed.

Tips for good bowel health:

• Consume a predominantly plant (fruit and vegetables) based diet. The Nurses Health Study also showed that premenopausal women who ate 5 or more servings of fruit and vegetables per day had a lower risk of breast cancer than those who ate fewer than 2.
• If you have any bowel symptoms, make sure you are not gluten intolerant by asking your doctor for a check of your gluten antibody levels
• Avoiding the unnecessary use of antibiotics which destroy the good bowel bacteria

Step 17: Exercise

There is good evidence that walking for 3 hours a week can reduce the risk of breast cancer by 25%. Walking for 3-8 hours per week reduces the risk by 50%.

Step 18: Have Fun

Have fun, don’t worry about things too much and live your life.

Click here to read the text of a television interview with Dr Greg Emerson and the risk of breast cancer with frequent antibiotic use.

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