Oct. 30. 2019
Health Conditions
McKel Kooienga, MS, RDN, LDN

McKel Kooienga, MS, RDN, LDN

Dietitian, Founder and CEO

Chances are you know someone who’s dealing with breast cancer and unfortunately, that’s not surprising.

Breast cancer is the most common cancer diagnosis for women worldwide, accounting for 1/4 of all cancers diagnosed (1). October is breast cancer awareness month so I’d like to take some time to share information that’s easy to understand from how it’s diagnosed, how nutrition and lifestyle play a role, and more.

Lindsay here, one of the nutrition editors at Nutrition Stripped. As a Dietitian, I practiced for years in one of the nation’s top cancer centers. In working with women (and men) with breast cancer I was consistently surprised at the facts and figures surrounding this all too common disease.

An Ounce of Prevention

There are a number of factors that contribute to the development of cancer. Through research, we know many lifestyle factors impact breast cancer including the food we eat, physical activity, stress levels, sleep and even things like cleaning chemicals, personal care products, and food packaging.

While breast cancer is a common health challenge for sure, there is a lot you can do to minimize your risk. One of the first and most important steps is to brush up on the facts about breast cancer, especially how to prevent and early detection.

What is Breast Cancer?

Breast cancer occurs when damaged cells in the breast start to grow out of control and start to invade other tissues. Most breast cancers occur in the milk ducts of the breast – these are known as ductal cancers.

Lobular cancers are the second most common type of breast cancer and they start in the glands of the breast that make milk. Sometimes, cancer can start in other tissues of the breast but this is less common.

Cancer is known as metastatic if it moves outside of its original location. Breast cancer moves to other tissues through blood or the lymphatic system – most commonly to the bones, lungs, liver, and brain (2).

Defining Breast Cancer Type

Defining breast cancer type helps clinicians understand the best way to approach the disease. It is generally defined using a number of factors. These include:

  • Where cancer originated
  • How fast it’s growing and if it spread outside the breast
  • If it’s responsive to hormones like estrogen or progesterone
  • When the cancer was diagnosed relative to life stage (before or after menopause)
  • Certain genetic features of the cancer

This information is taken into account to determine the specific type and stage of the cancer.

Cancer Staging

The cancer staging system is an official and consistent method of classifying the type and size of cancer and if it has spread to other parts of the body. The stage will also help determine the course of treatment. The stage of the cancer is determined by tests that may include biopsies, scans, X-rays, and physical exams.

There are 4 cancer stages and 1 precancerous stage (3). In general, the higher the stage the worse the prognosis.

  • Stage 0: Abnormal cells identified but cancer not present. This is known as carcinoma in situ.
  • Stage 1: Small cancer (tumor) that has not spread.
  • Stages 2-3: Larger cancers (tumors) that may have spread to nearby lymph nodes but not to other parts of the body.
  • Stage Four: Cancer that has spread to other parts of the body, known as metastatic or advanced cancer.

Breast cancer is further classified by how it reacts to the hormones progesterone and estrogen and the cancer cell’s genetic makeup.

Stage 0 Breast Cancer

Ductal Carcinoma In Situ (DCIS) is a condition where the abnormal cells are confined to the milk ducts and have not spread. This is known as stage 0 breast cancer. From 1983-2003 there was a 500% increase in the diagnosis of DCIS, mostly related to the use of mammograms (4). Each year in the US about  50,000 women are diagnosed with DCIS and anywhere from 14-53% of those will turn into true breast cancer.

There is some disagreement within the medical community over the treatment of DCIS due to the fact that it is not officially cancer. In fact, even physicians vary with how they talk about DCIS – some refer to it as cancer while others do not (5).

How Common Is Breast Cancer?

Breast cancer is a common health issue in the United States and around the world. It is the second most frequently diagnosed cancer globally, accounting for 25% of all cancers (6). To put this in perspective, think of 8 women you know – statistically speaking one of them will develop the disease in her lifetime (7).

Advancements in prevention, detection, and treatment mean there are also many survivors – in the US alone there are 3.5 million!

Risk Factors for Breast Cancer

As with most common health conditions, some risk factors are controllable and others are not. It is important to focus on those that are within your control rather than those that cannot be changed.

Non-Modifiable Risk Factors

  1. Being female: Breast cancer largely affects women. However, men can develop breast cancer but, it’s much less common.
  2. A personal or family history of breast cancer: If you have a history of breast cancer or a relative your risk is higher than someone who does not.
  3. How long you’ve had a period: Starting periods at age 12 or earlier (aka early menarche) or ending periods at age 55 or later (aka late menopause) both increase your risk.
  4. Gene mutations: BRCA1 and BRCA2 are the most well-known gene mutations that increase the risk of breast cancer. Cancer is not inevitable with these gene mutations but they do increase risk quite a bit. The average risk of developing breast cancer for women is about 12% during their lifetime, for women with the BRCA gene mutations it is around 70% (8).
  5. Radiation exposure: Radiation treatments to the chest area, especially in a child or young adulthood, increases your risk.

Modifiable Risk Factors

Truth be told, many of the women and men I’ve worked with are surprised to learn there are so many risk factors that can be controlled. The choices we make daily, to work out, to eat healthily, to enjoy or skip the nightly glass of wine – all impact our health. There is often so much buzz about weight and appearance in the wellness space, the message of making lifestyle choices to feel good and prevent disease gets lost.

So what factors do we have control over?

  1. Carrying extra body fat: Being overweight or obese increases your risk. Extra fat tissue produces the hormone estrogen, a big factor in developing some types of breast cancer.
  2. Drinking alcohol: Regular consumption of alcohol increases risk. Risk starts to increase with 3 drinks or more per week.
  3. Pregnancy and breastfeeding: Breastfeeding is not just good for baby, its good for mom too! Being pregnant and breastfeeding decreases your risk. On the flip side never being pregnant and/or not breastfeeding increases risk. This topic is borderline as sometimes this is within your control and sometimes it is not.
  4. Hormone therapy after menopause: Taking supplemental hormones after menopause increases your risk. An example of this is using estrogen cream or patch to boost low levels of hormones. This is often a difficult decision for women as supplemental hormones can also have a positive impact on other aspects of health and quality of life.
  5. Physical activity and exercise: Regular activity including both moderate and vigorous exercise reduces your risk. It is really important to note that the relationship here is considered a dose-response relationship meaning the more active you are the lower your risk of breast cancer (9).

Detection & Diagnosis

There are many methods of breast cancer diagnosis and detection. Despite advances in technology-based screening, most women find their cancer through self-detection. Survivors report finding their cancer most often through a self-breast exam or by accident (10).

Some other detection methods include:

  • Mammogram: A mammogram is simply an Xray of the breast. The American Cancer Society recommends mammograms for women age 45 and older.
  • Ultrasound: An ultrasound uses sound waves to create detailed images of structures within the body. Ultrasound helps to get more information on suspicious tissue that may be cancerous.
  • Office breast exam: A physician or an advanced practice provider such as a Certified Nurse Practitioner or a Physician’s Assistant will complete an office breast exam to check for abnormalities.
  • Magnetic Resonance Imaging (MRI): An MRI is another method of taking pictures of the breast tissue

A sample of any suspicious tissue (also known as a biopsy) undergoes analysis in a lab. If the cells are cancerous, the lab may also determine the type of cancer, if it is fast or slow-growing and if it is responsive to hormones. This information helps direct the treatment of cancer.

Treatment for Breast Cancer

Standard Therapies

Treatment for breast cancer depends largely on the specific type of cancer and the individual. Ideally, treatment plans take shape with a comprehensive medical care team and the individual with cancer. Traditional treatment may include:

  • Surgery
  • Chemotherapy
  • Immunotherapy
  • Radiation
  • Hormone therapy

Complementary and Alternative Therapies

Complementary and alternative therapies are also available and have been studied. Therapies where research shows a benefit include (11, 12):

  • Yoga
  • Meditation
  • Acupressure and electroacupuncture
  • Music therapy
  • Exercise
  • Nutrition

In my practice, I’ve found that individuals who work to stay active and connected with their bodies through exercise, yoga, meditation, and eating well, feel better during and after their treatment.

Sticking to somewhat of a routine and making self-care a priority also provides a small bit of control in an otherwise uncontrollable situation. The routine can be comforting and what’s more, many of these methods help with symptom management and surgical recovery.

Breast Cancer and Lifestyle

The role of lifestyle factors such as nutrition and exercise have been studied extensively relative to breast cancer prevention, treatment, and survivorship. What you eat and how much you move your body matters!

Nutrition

The overall pattern of your diet plays a larger role in cancer risk than eating or avoiding any particular food or food group. In general, plant-based diets, rich in whole, minimally processed foods reduce cancer risk. Such diets are high in fiber, vitamins, minerals, and phytonutrients (beneficial plant compounds).

Obesity and excess body fat increase the risk of breast cancer. So eating enough but not too much and balancing eating with activity are both important.

Soy

Soy can be a controversial topic due to its containing compounds that are similar to estrogen. However, research shows that populations who include whole soy foods regularly have lower rates of hormone-sensitive cancers like breast and prostate. For women who have had breast cancer, soy may help reduce the risk of cancer coming back (13).

Flaxseed

Flaxseed has been shown to reduce the risk of breast cancer in both pre and post-menopausal women. Furthermore, for women with cancer, human studies show flaxseed can actually shrink tumors and can enhance hormone therapy drugs commonly prescribed following treatment for breast cancer (14).

Grind flaxseed in a handheld blender or coffee grinder to enjoy all of the benefits. Given the prevalence of breast cancer and the preventive benefits of flax, it makes sense to work to include it regularly in the diet. It can easily be mixed into smoothies, sprinkled on salads or baked into bread.

Adding flax is one of the recommendations I make first in my practice when it comes to cancer prevention. The research on the health benefits of flax, particularly its anti-cancer benefits, is strong. It is versatile, can be added to many dishes, and quite frankly – it is an easy place to start. Often, one positive change can lead to others and it’s much easier to add something than it is to avoid something.

Cruciferous Vegetables

Cruciferous vegetables such as broccoli, cauliflower, and cabbage may aid in the prevention of breast cancer, especially for women who have not gone through menopause. One study found women who at larger amounts of vegetables in this family had lower rates of breast cancer (15)

Exercise

Regular exercise and daily physical activity lower the risk of heart disease, all causes of death and many types of cancer – including breast. After diagnosis, exercise can improve quality of life and prevent recurrence (16).

The best health benefits come with a lifestyle of staying regularly active, not a hard workout here and there. So, it’s important to do something enjoyable so you can maintain consistency. If you’re short on time, try to squeeze in a quick routine you can do at home.

Sleep

Sleep is the time the body repairs itself. Without sleep, the immune and other vital bodily systems don’t work as well. So it’s not surprising that shorter sleep duration increases the risk of breast cancer. According to a recent study, women who slept 6 or fewer hours per night had the largest increase in risk (17).

Hands down this is the area I’ve found most difficult in working with individuals with breast cancer. Typically busy women who are juggling many responsibilities and unfortunately, life doesn’t stop when you get cancer. I’ve found that getting up early and/or staying up late is how all the balls stay in the air.

It can be difficult to make sleep priority, but the evidence is clear – quality sleep is required for good health. My recommendation is to think of inadequate sleep like smoking or driving without your seat belt on. These are behaviors that are harmful to our health and yet lack of sleep doesn’t seem to carry the same weight when it comes to taking care of ourselves.

Stress

Studies have shown mixed results when investigating the relationship between stress and breast cancer (18). However, chronic stress and stress hormones aid in cancer progression in general. Stress hormones impair the activity of the immune system and as a result, it can’t do its job of finding and killing cancer cells as well. Even chemotherapy can be less effective when the stress response is chronically activated (19).

Stress management is vital to good health including the prevention of cancer. Personal stress management practices like nature walks, exercise, and meditation all aid in reducing stress hormones and promoting health.

Time for Action – The Big 5

Now that you’re well versed in how common breast cancer is and the role that early detection and lifestyle factors can play, its time to take action. Here is what you can do today:

  1. Talk to your doctor about appropriate screening for your age and personal medical history. This may include self-exams, office exams, and mammograms.
  2. Eat mostly whole foods, plant-based diet. Incorporate superfoods like ground flax and cruciferous vegetables regularly throughout the week.
  3. Stay active and exercise. Notice how I separated those two out? Thirty minutes at the gym does not undo 8 hours sitting in the office. Make an effort to be both active throughout your day and work in some dedicated heart-pumping exercise.
  4. Stay on top of stress with regular meditation, nature walks, plain old quiet time or whatever gets you zen mode – for me, its puzzles!
  5. Get your zzz’s. Set your phone to remind you when you need to get in bed so you can hit the 8-hour mark of quality sleep. It may help to develop a nighttime routine to get you ready for bed.

What Are You Taking Home?

Breast cancer facts can be surprising. What lifestyle changes are you going to make as a result of your learning? Share it with the NS community in the comments below or on social with #nutritionstripped.