October is Breast Cancer Awareness month. As many as 1 in 8 women will develop breast cancer throughout their life. It is the most common type of female cancer. Breast health is paramount, and it’s important that we understand the highlights of prevention, screening, and risks. The preventive approach to breast health is much like the holistic approach to overall wellness. Here are some things I recommend.
Prevention
- Eat a whole foods plant-based diet. A new study presented at the American Society for Nutrition in 2022 looked at the dietary intake of over 65,000 postmenopausal women and determined that a diet rich in vegetables, fruits, whole grains, and nuts reduced their risk of breast cancer by 14%. Those partaking in a diet where refined grains, fruit juices, potatoes, and processed plant foods were staples had a 20% higher risk of breast cancer of all types.
- Use extra virgin olive oil (EVOO). EVOO has an abundance of antioxidants and anti-inflammatory properties. Many studies show its positive impact on heart disease and stroke, but there are links between the consumption of EVOO and not only reduced risk of breast cancer, but also prevention of relapse!
- Take fish oil as a supplement. Studies show taking fish oil may both decrease your risk of getting breast cancer and improve survival. Fish oil contains omega 3 fatty acids, which are anti-inflammatory. Inflammation over time can damage DNA and lead to cancer. The Standard American Diet has a higher ratio of pro-inflammatory omega 6 fatty acids, and an increase in omega 3’s will provide a more favorable ratio, ultimately decreasing inflammation.
- Limit alcohol intake. Moderate alcohol consumption has been linked to a 30-50% risk of breast cancer.
- Breastfeed if you are a new mother. Breastfeeding lowers risk of pre- and post-menopausal cancers. Don’t stress if you can’t. Stress may slightly increase the risk of breast cancer! (Remember that inflammation we talked about?)
A Note About Hormone Replacement Therapy (HRT)
Regarding the use of hormone replacement therapy, it’s important to note that the largest study to date that looked at hormone replacement in women has been called into question by many physicians in the integrative wellness and anti-aging space. This study, called The Women’s Health Initiative, showed an increase in breast cancer with the use of hormone replacement therapy. However, the study used a synthetic form of hormones, was done on women who had overall poor health, and started therapy approximately 10 years after the menopause. A comprehensive discussion regarding the use of hormone replacement should be undertaken with your provider to truly understand the risks and benefits.
Screening Options
Note: This is a discussion of screening for women with an average risk of getting breast cancer. Women who have a high risk (family history of cancer or genetic mutations) need to discuss options individually with your physician. Also, screening means checking for cancers BEFORE there are any breast symptoms. ALL BREAST SYMPTOMS, PARTICULARLY BREAST LUMPS, REQUIRE EVALUATION.
The most common screening tools for the average risk patient are 2D & 3D mammography, which use a low-energy X-ray. 2D mammography provides the least amount of radiation of the mammographies, but also increases the chance that the woman gets called back for further views. 3D mammography limits the call-backs because it scans the breast holistically, so the risk of having to come back for extra views is lower. However, the radiation is higher. The sensitivity (meaning the detection of cancer when there is one) in 3D mammography is as good or better than 2D, and in particular, improves detection in women who have dense, fibrous breasts. Some places will do both 2D and 3D mammography together.
The second screening option is thermography, which uses a thermal camera to capture and create an image by using infrared radiation emitted from the body.
Ultimately, it is best to talk with your doctor about which screening option is right for you, as well as to understand your risk level and prevention strategies. Together, you and your doctor can assess the best approaches for your body that you feel most comfortable with. Below is a breakdown of some of the pros and cons of mammography and thermography.
Mammography
Pros:
- 2D mammograms correctly identify about 87% of women who have breast cancer.
- Mammograms are covered by most insurance companies.
Cons:
- Mammography may have a lead-time bias for average-risk individuals (no history of breast cancer in family or genetic mutations), which is the phenomenon where early diagnosis of a disease falsely makes it look like people are surviving longer. This means the screening may find a cancer earlier than the cancer would have been diagnosed because of symptoms, but the earlier diagnosis does nothing to change the course of the disease.
- Mammograms expose the patient to radiation.
- Mammography compresses the breast in an X-ray machine, which is uncomfortable.
- Mammography finds a lot of breast pathology (not cancer) that causes patients to worry. An over-diagnosis or uncertain diagnosis can lead to anxiety and decreased productivity, as anyone who has had an abnormal mammogram that turned out to be benign can attest to!
Thermography
Pros:
- Thermography can detect cancer earlier than mammography because it utilizes a heat sensor that picks up new blood vessel formation (which new cancer needs to grow).
- Thermography is non-invasive; the patient simply stands in front of a machine that scans them for temperature changes in their breast.
Cons:
- Thermography is typically not covered by insurance.
- Thermography can miss DCIS (ductal carcinoma in situ, or the presence of abnormal cells inside a milk duct), a different form of breast pathology that is considered the earliest form of breast cancer, but is rarely invasive. There is some controversy amongst physicians about how to treat DCIS when it is found.
Risk Levels and Making a Decision
Depending on your risk level (average or high), your doctor can help you determine the best choice for screening. Age plays a role as well. Generally, older women are at a higher risk for developing breast cancer than younger women. Most breast cancers are diagnosed after age 50. This is why many national organizations recommend women get screened at a specific age, generally at 40 or later, but each has a different protocol and screening recommendation, so once again, your doctor is your best resource in determining the right time for you to do a screening. Prioritize steps for prevention and understand your risk level and options for screening. For optimal breast health, take the best care you can of your overall health!