Michael Schachter MD FACAMIn many ways, breast cancer in women is quite analogous to prostate cancer in men. As with prostate cancer, my views on the optimal management of patients with the disease differs markely from that of the conventional medical establishment. Breast cancer is a much feared, growing menace that needs attention.
My plan is to outline some important facts about breast cancer in terms of incidence, mortality, risk factors and possible causes. This discussion will imply something about what can be done both by the individual and our society to help tame this menace. I will then discuss the general conventional management of breast cancer, which generally involves surgery and/or radiation and/or chemotherapy and/or hormonal or anti-hormonal treatment. Following this, I’ll discuss alternative treatments for breast cancer, both as adjuncts to conventional treatment and as a replacement in some cases.
I hope that you women in the audience who have not been afflicted with breast cancer will learn some very practical things that you can do to help reduce your risk of developing this disease. For those of you who have had a bout with breast cancer or are currently suffering from it, I hope to provide you with some information that you haven’t heard to help improve your chances of long term survival, as well as improve your quality of life.
Breast cancer is the most frequently occurring cancer in women, just as prostate cancer is the most frequently occurring cancer in men. It is the second leading cause of cancer death in women behind lung cancer, just as prostate cancer is the second leading cause of cancer death in men behind lung cancer. The American Cancer Society estimates that in 1995, 182,000 women will be diagnosed with breast cancer and 46,000 women will die from it. One in eight women will be diagnosed with breast cancer during their lifetimes compared to one in twenty women in 1950. The five-year survival rate of women with breast cancer is virtually identical to what it was 30 years ago, implying that in spite of all the hype about early detection and the great advances in the conventional treatment of breast cancer with radiation and chemotherapy, there has really been no significant improvement in treatment.
Staging of Breast Cancer
The staging of breast cancer is important in terms of predicting the prognosis (that is, the course of the disease) and from a conventional medicine point of view, the best conventional approach to a particular patient’s breast cancer. The staging of breast cancer involves the size of the cancer in the breast, whether or not it has spread or metastasized to regional lymph nodes and whether or not it has metastasized to distant organs, such as the liver, lungs, bones or brain.
A stage 0 breast cancer is one that is limited to the topmost cell layer and the five-year survival is about 90%. A stage 1 breast cancer a cancer that is less than 2 centimeters (about an inch) in diameter with no evidence of spread to the lymph nodes or distant organs. The five-year survival for stage 1 is about 85%. In a stage 2 breast cancer, the cancer is 2 to 5 centimeters in diameter or the tumor is less than 2 cm, but there is a spread of the cancer to the lymph nodes under the arm. The overall 5-year survival for stage 2 is about 60%. However, the larger the tumor and the more lymph nodes involved, the worse the prognosis. In stage 3, the cancer is more than 5 cm in diameter or the lymph nodes that are involved are fixed to either themselves or to other tissue, such as the skin or muscles. The 5-year survival for stage 3 is about 40%. Finally, stage 4 breast cancer involves either a cancer that is fixed to the chest wall or overlying skin, has metastases to lymph nodes above the collarbone, or has distant metastases to distant organs, such as the liver, lungs, bones or brain. The 5-year survival for these patients is less than 10%.
Other observed variables may be helpful in establishing the probable prognosis for a breast cancer. The microscopic appearance of the cancer in terms of the degree of bizarre structures of the cancer cells, whether or not there appears to be evidence of lymphatic or blood vessel invasion and whether or not the cancer cells have a significant amount of hormone receptors (mostly estrogen) on their surfaces. In general, the more bizarre the cells and the more involvement of the lymphatics or blood vessels, the worse the prognosis. The presence of estrogen receptors, on the other hand, bodes for a better prognosis.
Stages I and II and possibly stage III will usually be treated with some form of surgery, followed by radiation and/or chemotherapy. Stage IV will usually be treated with palliative radiation and with chemotherapy. Tamoxifen, a drug considered to be an anti-estrogen is usually ordered when positive estrogen receptors are present.
Known Risk Factors for Breast Cancer
Women whose menstrual periods start when they are relatively young have an increased risk for the development of breast cancer as do women who have a late menopause. This suggests that a woman who has a longer exposure to female sex hormones during her lifetime will be at risk and that estrogen, the female sex hormone that stimulates cell growth may play a role in the formation of breast cancer. Women who have no children and women who have children, but do not breast feed have an increased risk. This suggests that other hormones, such as the other female sex hormone, progesterone, may have a protective effect.
Other known and accepted risk factors include: (1) an increased alcohol intake, (2) a diet which is high in fat content, (3) being overweight, (4) a family history of breast cancer, and (5) past irradiation of the chest with high doses of x-rays. Fat tissue can make estrogen, so that heavier women tend to have higher estrogen levels. Alcohol stimulates the production of estrogen. In summary, most of the risk factors seem to be associated with increased lifetime exposure to estrogens, decreased lifetime exposure to progesterone or both.
This leads us to a discussion about the relationship between the two classes of female sex hormones–estrogen and progesterone, which tend to balance each other in the woman. Excessive estrogen or progesterone deficiency or a combination of both may lead to a condition known as estrogen dominance. Symptoms of estrogen dominance include: water retention or edema, breast swelling, fibrocystic breasts, premenstrual mood swings and depression, loss of sexual drive, heavy or irregular menses, uterine fibroids, craving for sweets and fat deposition in the hips and thighs. Estrogen is metabolized in the body to a variety of substances. Two of them have been termed the “good” and “bad” estrogens. The “bad” estrogen, 16-alpha-hydroxy-estrone, favors the development of breast cancer. Certain chemicals seem to stimulate the pathway to form this estrogen.
Recent research indicates that certain chemicals that are foreign to the body may behave like estrogens. These substances are called xenoestrogens as the term “xeno” means foreign. Xenoestrogens mimic estrogen’s action. Some xenoestrogens can reduce estrogens effects. These varieties, which are rapidly degraded in the body, usually occur in plant foods, such as soy products, cauliflower and brocolli. These xenoestrogens protect against the development of breast cancer. Other xenoestrogens, typically synthetic ones, appear to amplify the effects of estrogen and may play a major role in the development of breast cancer.
Role of Synthetic Chemicals in Development of Breast Cancer
We are living in the petrochemical era. The petrochemical era was born in the 1940’s as a result of technological advances in the procurement of oil and the manufacture of its products. In 1940, one billion pounds of synthetic chemicals were manufactured. By 1950, the amount had increased to 50 billion pounds and by the late 1980’s, 500 billion pounds of synthetic chemicals were being produced annually. Many of these compounds are toxic, mutagenic,and carcinogenic. The majority have not been adequately tested for toxicity, let alone for their environmental and ecologic effects. Approximately 600 chemicals have been shown to be carcinogenic in well-designed, controlled and validated animal experiments. Within the scientific community, the overwhelming consensus is that chemicals carcinogenic to animals will also be carcinogenic for humans. In large scale epidemiologic human studies, approximately 25 chemicals have been proven to be carcinogenic. For each of these 25 chemicals, animal research had established carcinogenicity between one and three decades earlier. The epidemiologic studies are all the more significant when it is considered how relatively insensitive epidemiologic studies are establishing the carcinogenicity of chemicals.
Some of these chemicals, such as certain pesticides, fuels, and plastics function as xenoestrogens. They may do so in various ways. Some enhance the production of the so-called bad estrogens. Others bind to estrogen receptors, inducing them to issue unneeded signals to increase cellular growth. Xenoestrogens may enter the body through animal fat because they tend to accumulate in fatty tissues and are concentrated as you go up the food chain. During the past 15 years, experiments reveal that several xenoestrogens cause breast tumors in animals. Xenoestrogens tend to be synergistic in their effects, so that a mixture of tiny amounts of many chemicals may have dire effects. At Mt.Sinai in NYC, Dr.Mary Wolff found the levels of DDE to be higher in 58 women who developed breast cancer compared to those who did not. At Laval University in Canada, 41 women who had estrogen-responsive breast cancers had higher concentrations of DDE and PCBs.
Finally, in a 1990 study of breast cancer and pesticides in Israel, a strong relationship between the two was shown; in the 1970’s, Israeli women had one of the highest breast cancer mortality rates in the world. But, in the 10 years that followed a 1976 ban on several organochlorine-type pesticides, the incidence of breast cancer declined 20%, while it increased in other industrialized nations. Prior to the ban, some dairy products had pesticide residues as high as 500% above U.S. levels and residues in human breast milk were 800 times the level measured in the breast milk of American women.
Role of the Lymphatic System in Removing Toxins from Body
It is the job of the lymphatic system of the body to help drain toxic substances from tissues and poor lymphatic drainage may play a role in breast cancer formation. The lymphatic system is a specialized part of the circulatory system that functions as a central component of the immune system. It consists of fluid called lymph, derived from blood and tissue fluid. The lymph moves through lymph vessels called lymphatics back into the bloodstream. Lymph contains cell debris, nutrients, waste products from the cells, hormones, toxins and many other substances. It is the microenvironment of the cells. Lymph flow is dependent upon muscle contraction that massages the outside of the lymphatic vessels, respiration, which pulls the lymph along each time we inhale, pressure from the pulsation of arteries, changes in posture and passive compression of soft tissues. It is very sensitive to constricting external pressure which can impede its flow.
Over 85 percent of the lymph fluid flowing from the breast drains to the armpit lymph nodes. Most of the rest drains to the nodes along the breast bone. Bras and other external tight clothing can impede flow. The nature of the bra, the tightness, and the length of time worn, will all influence the degree of blockage of lymphatic drainage.Thus, wearing a bra might contribute to the development of breast cancer as a result of cutting off lymphatic drainage, so that toxic chemicals are trapped in the breast. This idea has been popularized recently by Sydney Ross Singer, Ph.D., with the publication of his book Dressed to Kill: The Link between Bras and Breast Cancer by Avery Press. In this book he describes an epidemiologic study that he carried out which shows a strong link. This study is similar to the early studies that showed a relationship between smoking and lung cancer. Women who wore bras more than 12 hours daily had a nineteen times greater chance of developing breast cancer than those who wore a bra less than 12 hours daily. Women who never wore bras seemed to have an even greater protection. So, the take home message to women is to wear bras as little as possible and when wearing them try to choose one that is least constricting.
Dietary Measures to Help Prevent Breast Cancer
As mentioned previously, the accumulation of synthetic chemicals, such as pesticides, plays a role in the development of breast cancer. Thus avoiding these synthetic chemicals in food, water, and the air would be wise. Whenever possible, organically grown foods, which do not contain pesticides, should be eaten. Water should be pure and not contain pesticides, chlorine, fluoride and other synthetic chemicals. Many spring waters are fine. Otherwise, water should be purified, as many urban and suburban water supplies cannot be trusted. Many filters remove chemicals and chlorine, but if the water is fluoridated, a reverse osmosis type of water purifier is necessary to remove the fluoride.
Some xenoestrogens found in some fruits, vegetable and other whole foods are actually protective with regard to breast cancer. Many natural chemicals in foods are beneficial. Vitamins and minerals, as well as accessory food factors, can be helpful in many ways. Much of the damage and mutations that occur in breast tissue cells are mediated by highly reactive chemicals called free radicals, which form as a result of poorly controlled oxidation reactions. To help prevent this damage the body contains certain anti-oxidant proteins, such as SOD or superoxide dismutase, which help to neutralize oxidatively induced free radicals. The two types of SOD require three minerals–zinc, copper and manganese– to function properly. Thus deficiencies of any one of these minerals may predispose to oxidation damage with resulting increased risk of breast cancer.
Certain vitamins, such as A, E, and C also function as anti-oxidants and deficiencies of any one may increase breast cancer risks. Many other nutrients in food appear to have protective actions. The flavones and carotenoids are two classes of nutrients found in food that offer a great deal of protection. To help ensure against deficiencies, whole fresh foods should be used as much as possible–fruits, vegetables, nuts, seeds, whole grains and some animal products in proper balance should be eaten. Processed, highly refined foods containing white sugar and starch should be avoided as much as possible. Excessive fatty foods should be avoided. Foods containing hydrogenated fats should be completely avoided.
Keep in mind that anything that I recommend for the prevention of breast cancer also applies to any person suffering from breast cancer. This position differs somewhat from that of many conventional physicians and cancer organizations. Their position often acknowledges the importance of diet and lifestyle in preventing cancer. However, once a person has cancer, diet and lifestyle are often ignored with total emphasis being placed on the destructive elements of cancer treatment, including surgery, radiation and chemotherapy. I believe that no matter what conventional treatment a breast cancer patient has or doesn’t have, diet and lifestyle factors should be emphasized. Attention to diet and lifestyle will help to reduce toxic side effects of conventional treatment, promote faster healing and improve the results.
Any activity which will help to remove accumulated toxins in the breasts will help to reduce the chances of developing breast cancer. Thus, studies show that aerobic exercise is associated with reduced cancer risk, as the exercise will promote lymphatic drainage and sweating will help to remove toxins from the tissues. Although I am not aware of any direct studies showing a reduction of breast cancer risk with a detoxification program using saunas and certain nutrients, as is done with the Hubbard method of detoxification, I do know that this procedure has been clearly shown to reduce pesticides and other toxic substances in the bloodstream and in fat tissues. Since high levels of these toxic chemicals increase the risk of breast cancer, reducing them with this detoxification method should reduce breast cancer risk.
Nutritional Supplements for Preventing and Treating Breast Cancer
Oral supplements may be used in both breast cancer prevention and treatment programs. These may include vitamins, minerals, enzymes, essential fatty acids, herbs, amino acids, accessory food factors and special therapeutic foods. As mentioned earlierwhen discussing food, the anti-oxidant vitamins A, C and E are important. Large doses of each may be used as long as the person is monitored closely, especially for possible vitamin A toxicity. Most cancer patients will do well with high levels of vitamin C in the 10 gram per day range, spread out over the day. Lower doses can be used for prevention. Severe gas or diarrhea are reasons to cut back on the dosage. Vitamin D plays a role in cancer prevention and should be supplemented unless the patient has sufficient exposure to sunlight.
Maryon Stewart
Jim Strohecker
Daniel Redwood DC