Seven of eight breast cancer patients have no
family history
of the disease.
There is no sure way to prevent breast cancer.
Dr. Bodai, Can a Woman
Prevent Breast Cancer?
Not yet! But one of the biggest myths about breast cancer is that we have no control over it. Women can and should take charge of their health. Talk to your health care provider about any questions or concerns you have, get a second opinion if you still have more questions. Get active! There are also positive lifestyle choices you can make that help support good breast health and may lower your risk of getting breast cancer.
- Most importantly– do all steps of your breast screening program (monthly breast self-exams, annual clinical exams, annual mammograms starting age 40).
- Eat a low-fat, high fruit and vegetable diet.
- Maintain a healthy weight.
- Exercise regularly. Just recently, the Journal of the American Medical Association reinforced the value of regular exercise.
- Limit the amount of alcohol.
- Don’t smoke.
- Also, breast feed your baby. Research has shown that it may lower your risk.
Beyond these important self-help measures, there are also some promising research initiatives that are especially important for women with high risk.
An extremely important clinical trial (the STAR trial) tested two drugs that have been shown to dramatically lower the risk of breast cancer in women believed to be at high risk of developing the disease.
Some women with a strong family history of breast cancer may also consider the option of prophylactic (preventive) mastectomy– removing their healthy breasts when there is no sign of cancer– in an effort to reduce the risk of the disease. The physical, emotional and psychological impacts of such a decision are significant.
A number of researchers are also focusing on specific vitamins and minerals that– when consumed in high doses– appear to have a cancer-preventive effect. Other researchers are developing “cancer vaccines” that may have the same revolutionary success as the polio vaccines of yesterday and the measles vaccines of today.
While cancer cannot be “prevented,” your risk for the disease or its recurrence may well be minimized. Significant risk reduction is an achievable goal. Risk reduction is certainly within your personal capability. Researchers are doing their part and making remarkable strides. So can you!
Ernie Bodai, M.D.
Regular Exercise
Clinical studies have shown that regular exercise– even 30 minutes, 2 to 3 times a week– can lower estrogen levels. (Estrogen has been linked to breast cancer risk.) In addition, fat cells store estrogen, so the less fat you carry, the less estrogen you store– and the less potential stimulation of breast cancer cells.
Even women who are at especially high risk for breast cancer due to genetic mutations in the BRCA1 or BRCA2 genes may be able to delay or forestall the onset of breast cancer if they exercise and maintain a healthy lifestyle during their adolescent and young adult years.
Overall, studies have found that women who exercise consistently in the years leading up to menopause can cut their breast cancer risk by as much as 35 percent. However, even when increased physical activity is begun later in life, a woman’s risk can be cut by as much as 20 percent. What’s more, the activity needs not be strenuous but it should be done consistently, such as taking a brisk, 30-minute walk five times a week.
Some researchers believe that as many as one-third of all breast cancer cases could be related to lack of exercise and a poor diet– highly preventable risk factors! And yet almost two-thirds of American adults remain inactive, despite the long list of well-known health benefits.
Excerpt from Part 1 of Ernie Bodai, M.D., “I Flunked My Mammogram!”
Vitamin D
More and more studies have shown that vitamin D may have helpful effects on some types of cancer, including cancers of the colon, prostate, and breast. Vitamin D is obtained through skin exposure to ultraviolet (UV) radiation and through diet, particularly products fortified with vitamin D such as milk and cereals, and supplements. But many Americans do not get enough vitamin D.
The current national recommended levels of intake of vitamin D (400 to 800 IU per day) may not be enough to meet needs, especially among those with little sun exposure, the elderly and people with dark skin. More research is needed to define the best levels of intake and blood levels of vitamin D for cancer risk reduction, and it is likely that 2000 IU per day may be optimal.
Other studies are linking vitamin D and calcium to a significant reduction in the risk of breast cancer. While the research is ongoing, initial benefits appear limited to younger, pre-menopausal women, with the link strongest for the most aggressive tumors. No statistically significant benefits have been seen after menopause.
One final word about vitamin D. A recent study suggests it may also lower the potential of breast cancer to spread (metastasize).
Excerpt from Part 1 of Ernie Bodai, M.D., “I Flunked My Mammogram!”
Other Vitamins and Minerals
Most vitamin and mineral supplements are not harmful if taken in appropriate doses– and many may certainly have some benefit. Your body uses certain nutrients in vegetables and fruits to protect against damage to tissues that happens constantly as a result of normal metabolism (oxidation). Because such damage is linked with increased cancer risk, the so-called antioxidant nutrients are thought to protect against cancer. Antioxidants include vitamin C, vitamin E, carotenoids and many other phytochemicals (chemicals from plants). A good example of such phytochemicals includes Pycnogenol, a pine bark extract. (For further information visit www.pycnogenol.com)
There is real concern that excessive doses of many supplements could, in fact, be harmful. For example, vitamin A has been linked to an increased risk of
stomach cancer. Some supplements may skew the results of laboratory tests. Others may alter bleeding times– an important consideration if you are about to undergo surgery. Be sure to disclose to your physician any supplements that you are taking on a regular basis.
In the meantime, the U.S. Department of Agriculture has published the results of a major study identifying natural foods that have strong antioxidant (cancer-fighting) properties. In addition to confirming the well-publicized high antioxidant ranking of foods such as cranberries and blueberries, the researchers found that artichokes, beans, Russet potatoes, pecans and even cinnamon are all excellent sources of antioxidants.
Excerpt from Part 1 of Ernie Bodai, M.D., “I Flunked My Mammogram!”
The STAR Trial:
Important for Women with High Risk for the Disease
A large clinical trial was launched by the National Cancer Institute in 1999 to see which of two major breast cancer drugs– Tamoxifen or Raloxifene– might work better to reduce the incidence of breast cancer, or possibly prevent the disease. The Study of Tamoxifen and Raloxifene (STAR), enrolled almost 20,000 postmenopausal women (women who have gone through menopause) who are at high risk for the disease. It took place at more than 500 medical centers across the United States, Canada and Puerto Rico.
Initial results from the STAR trial have found that Raloxifene is as effective as Tamoxifen in reducing breast cancer risk. Both drugs reduced the risk of developing invasive breast cancer by about 50 percent. In addition, women who were assigned to take Raloxifene daily and who were followed for an average of about four years, had 36 percent fewer uterine cancers and 29 percent fewer blood clots than the women who were assigned to take Tamoxifen.
While both of these drugs show exceptional promise as breast cancer “preventives,” they do have side effects.
Those experienced most often by women include hot flashes and other menopausal symptoms.
Women taking Tamoxifen were found to have an increased chance of developing three relatively rare conditions: endometrial cancer (cancer of the lining of the uterus), pulmonary embolism (blood clots in the lung), and deep vein thrombosis (blood clots in a major leg vein). Although women taking Raloxifene in clinical trials also demonstrated an increased chance of developing a pulmonary embolism or deep vein thrombosis, the drug did not increase the risk of endometrial cancer.
Importantly, a number of recent studies have found that Tamoxifen may have a limited time period for its positive benefits. Researchers have found that taking Tamoxifen for ten years was no better than taking it for five years. In fact, some studies have suggested that after five years, Tamoxifen can actually begin acting like estrogen rather than blocking its effects.
Dr. Bodai does not think that Tamoxifen and Raloxifene will be the “magic pills” for preventing breast cancer, but they may have a dramatic impact on reducing the risk for many women.
Excerpt from Part 1 of Ernie Bodai, M.D., “I Flunked My Mammogram!”
Prophylactic Mastectomy
Prophylactic (“preventive”) mastectomy involves the removal of one or both healthy breasts when there is no sign of cancer. The procedure is a major operation that is usually followed by immediate (simultaneous) breast reconstruction. It is a drastic alternative undertaken by women who consider themselves to be at very high risk for the disease.
While prophylactic bilateral mastectomy (removing both breasts) appears to be effective, it remains extremely controversial. Women who are high risk and are considering the procedure are usually given at least two other options: very careful monitoring (which most women choose), and “chemoprevention” with Tamoxifen.
(Keep in mind that if breast cancer is caught early, it is highly curable. Careful monitoring, therefore, is an acceptable alternative.)
Prophylactic mastectomy is clearly both a major medical decision and a highly emotional one. Yet among those women who decide to undergo the procedure, most do not appear to have subsequent regrets. They viewed their risk for breast cancer as extremely life-threatening and made their decision accordingly, and comfortably. Breast cancer patients with BRCA mutations are twice as likely as non-carriers to opt for double mastectomy to reduce the risk of cancer in the opposite breast.
A study by researchers at the Mayo Clinic in Rochester, Minnesota, found that 70 percent of women who had a bilateral (both breasts) prophylactic mastectomy were
satisfied with their decision. Two-thirds of them would likely choose to have the procedure again. Three-quarters of the women said that they are now less concerned about developing breast cancer.
Another study found that women at high risk of getting breast cancer who undergo preventive double mastectomies suffer minimal psychological and physical distress as a result. Two-thirds said the surgery had no impact on their sexual functioning. Almost half reported no change in self-image, while 28 percent reported an improved self-image after surgery.
Similarly, 83 percent of women who had one breast removed because of cancer and then chose to have the other breast removed to reduce their risk of developing a second breast cancer were satisfied with their decision more than 10 years after their surgery.
But does it work? Does prophylactic mastectomy actually prevent breast cancer? It apparently does. A study by the University of Pennsylvania found that bilateral prophylactic mastectomy can reduce breast cancer risk by more than 90 percent in women with BRCA1 and BRCA2 genetic mutations, and may be even more effective when performed concurrently with or following oophorectomy (removal of the ovaries). But it is still not foolproof, and the personal, physical and emotional tradeoffs are significant. It is a decision that requires careful and prolonged consideration.
Excerpt from Part 1 of Ernie Bodai, M.D., “I Flunked My Mammogram!”
Cancer Vaccines
Some pioneering cancer researchers are currently working to develop vaccines that will encourage the body’s immune system to recognize cancer cells, just as traditional vaccines for mumps and measles target those infectious diseases.
Vaccines work by exposing your body’s immune system to a weakened version of the specific disease. This then stimulates your immune system to produce cells called antibodies to fight the unwelcome invaders. Once your body has produced antibodies for a specific disease, it can remember how to recognize the disease in the future. In terms of cancer, these antibodies may destroy any cancer cells that develop, or at least slow their growth.
A small, but significant study, has shown that an effective vaccine against breast cancer is, in fact, on the horizon. NeuVax© is in further study, to evaluate its effectiveness. Soon vaccinations against breast cancer may be readily available.
The manufacture of vaccines against specific cancers is a very promising avenue of cancer research. Such vaccines could be used either as preventive treatments to stop people from actually getting cancer, or could be used together with traditional cancer-fighting treatments (surgery, radiation, chemotherapy) to target existing or recurrent tumors.
For example, a University of Pennsylvania study is evaluating the effectiveness of a telomerase peptide as a possible vaccine against breast cancer. The study will measure potential tumor cell shrinkage in patients after an immune response has been triggered to an antigen– the telomerase peptide– that is found in more than 90 percent of breast cancer tumors.
While the practical use of vaccines to prevent and treat cancer may still be years away, dramatic advances in our understanding of the human genetic code could move that timetable up significantly.
Excerpt from Part 1 of Ernie Bodai, M.D., “I Flunked My Mammogram!”
