Breast Cancer Prevention

1. Breast Cancer Prevention Dr. Jake Psenka, ND Naturopathic Family Care 13832 N. 32nd Street #126 Phoenix, Arizona 85032 www.4wecare.com 602-493-2273

2. What Are Risk Factors Risk factors are lifestyle or personal traits that increase the risk of developing cancer. Decreasing the risk factors decreases the chance of disease.

3. Established Risk Factors • Family History: especially in your mother, sister, or daughter(s). • Age: the older you are the higher your risk. • Never having borne a child. • Having your first child after 30 years old. • Early onset of menarche • A history of benign breast diseases

4. Other Risk Factors • Hormone replacement after menopause. • Chemical Exposure • Poor dietary choices • Lack of exercise • Heavy metal exposure

5. Possible Risk Factors • Decreased melatonin • Pesticide exposure

6. Brest Cancer Family History Researchers estimate that only 5-27% of breast cancer cases are a result of genetics. In the majority of those cases the genes involved are: • BRCA1 • BRCA2

7. BRCA1 and BRCA2 BRCA stands for BReast CAncer. These are the two most common genetic mutations associated with breast cancer. Women inheriting these mutations have a 40-85% lifetime risk of developing breast cancer, as well as an increased risk of ovarian cancer.

8. BRCA1 and BRCA2 Researchers at the National Institutes of Health recently completed a study that offers a more complete understanding of these mutations in the US population. This study looked at 2300 multi-ethnic women ages 35-64, some with breast cancer and some without.

9. BRCA1 and BRCA2 The study found the following: • BRCA1 mutations were more common in white women with breast cancer than African-American women. • Women with Jewish ancestry had a substantially higher incidence of the BRCA1 mutation compared to non-Jewish women. • African-American women are more likely to carry the BRCA2 mutation. • Not every woman who carries one of the genes will get cancer.

10. BRCA1 and BRCA2 • The real significance of the study was it’s ability to identify key predictors of whether a woman with breast cancer will carry the BRCA1 or BRCA2 mutations. • This information is important because it can predict those women who will benefit from genetic testing, increased breast cancer screening, and other measures aimed at early detection, treatment, and prevention.

11. BRCA1 and BRCA2 The most predictive factors for the BRCA1 mutation are: • Jewish ancestry • Family history of ovarian cancer • Family history of breast cancer before the age of 45

12. BRCA1 and BRCA2 • The only predictive factor for the BRCA2 mutation is early onset in the patient (before age 45) in the patient herself or early onset of breast cancer in mother, sisters, grandmothers, or aunts.

13. Genetic Testing Genetic testing can be performed by submitting a small blood sample to a laboratory for analysis. Remember, testing positive for the BRCA1 or BRCA2 genes does not automatically mean a cancer diagnosis. Just having the gene doesn’t mean that it will be expressed.

14. Age • Risk increases with age.  Age is the biggest risk factor. In other words, all women have some risk. Hence the need to promote awareness and take steps for prevention.  • About 18% of breast cancer diagnoses are among women in their 40s, while about 77% of women with breast cancer are older than 50 when they are diagnosed.

15. Children • Women who have had no children or who had their first child after age 30 have a slightly higher breast cancer risk. Having multiple pregnancies and becoming pregnant at an early age reduces breast cancer risk. Women who have breast fed their children also have a decreased risk.

16. Early Menarche • Women who started menstruating at an early age (before age 12) or who went through menopause at a late age (after age 55) have a slightly higher risk of breast cancer.

17. Benign Breast Diseases Having a history of non-cancerous breast disease increases breast cancer risk. Examples include: • Lobular carcinoma in situ. • Fibrocystic changes • Inflamed breast tissue

18. Post Menopausal Hormone Replacement Therapy A study in the July 2006 issue of the Archives of Internal Medicine concluded: “Women using estrogen and testosterone therapies have a significantly increased risk of invasive breast cancer.”

19. Post Menopausal Hormone Replacement Therapy Another study reported in the cancer edition of BioMed Central stated: “The relatively feasible lifestyle changes of discontinuing EPRT use, reducing alcohol consumption, increasing physical activity, and lengthening breastfeeding duration could lower population breast cancer incidence substantially.” EPRT = Estrogen/progestin ReplacementTherapy

20. Post Menopausal Hormone Replacement Therapy The International Journal of Cancer reported in August of 2006 that: “Higher serum concentrations of estrogens were associated with increased breast cancer risk in postmenopausal women.”

21. Effect of HRT Increased breast cancer risk associated with testosterone may be because enzymes in breast tissue convert testosterone to estradiol, an estrogen-like hormone that could contribute to the development of breast cancer. Higher levels of testosterone alone have also been linked to increased breast-cancer risk in postmenopausal women.

22. Checking Your Estrogen Levels There are a variety of ways to have your hormonal status evaluated. The most accurate measures are done via blood, urine, or saliva samples. Not all women will have similar circulating levels of estrogens, even if they are the same age, race, etc. This concept is called “Biochemical Individuality.”

23. Checking Your Estrogen Levels Researchers at Rockefeller University have found that the body metabolizes estrogens into several different metabolites that can impact cancer development. One metabolite, 2-hydroxyestrone (2-OHE1), tends to inhibit cancer growth. Another, 16-a-hydroxyestrone (16-a-OHE1), actually encourages tumor development. A woman’s "biochemical individuality" determines which of these metabolites predominates. Studies have shown that measuring the ratio of these two metabolites provides an important indication of risk for future development of estrogen-sensitive cancers. The studies also show that this risk is modifiable!

24. Identifying Hormone Status If you are over 40, and especially if you have a family history of breast cancer, it’s a good idea to have your estrogen levels checked. Most laboratories offer blood testing for estrogen, progesterone, and testosterone. Although some are better than others.

25. Chemical Exposure and Breast Cancer Risk Animal cancer bioassays conducted by the National Toxicology Program indicate more than 40 chemicals can induce mammary tumors, and most of these are still in production. How much exposure is too much? • Nobody Knows. What are all the chemicals that can have a negative effect? • Nobody Knows.

26. Chemicals that Cause Cancer Xenoestrogens- These are synthetic agents that mimic the action of estrogens. Chronic exposure to xenoestrogens may be partially responsible for the world-wide increase in breast cancer. Xenoestrogens are found in pesticides, fuels, plastics, detergents, and prescription drugs.

27. Xenoestrogens Bisphenol-A (BPA): one of the most pervasive chemicals in modern life. Used to make polycarbonate plastic. Diethylstilbestrol (DES): Drug prescribed to prevent miscarriges. Banned in 1971after causing breast cancer in daughters. Polyvinyl Chloride (PVC): Used in plastic products such as food packaging, medical products, appliances, cars, toys, credit cards, and rainwear. Dieldrin: Pesticide, banned in 1987. House Hold Products: Cleaners, solvents, and pesticides.

28. Solvents Solvents are a class of chemicals that are used to dissolve other substances. Elevated rates of breast cancer have been found in women with exposure to: • Electronics Manufacturing • Fabricated Metals • Lumber • Furniture • Textiles • Clothing Industry

29. Aromatic Amines Are a class of chemicals found in the plastic and chemical industries, in air and water pollution, diesel exhaust, tobacco smoke, and in grilled meats and fish. One type, o-toluidine, is known to cause mammary tumors in animal studies.

30. Know the Facts State of the Evidence Report http://www.bcaction.org/PDF/StateofEvidence.pdf

31. Diet and Breast Cancer It’s been estimated that diet contributes to up to 80% of cancers of the colon, prostate, and breast. Diet also negatively affects the risk factors of other cancers such as pancreatic, lung, stomach, and esophagus.

32. Saturated Fat Intake Elevated saturated fat intake is associated with higher breast cancer risk. • Diet during puberty influences sex hormone levels, possibly breast cancer risk. Journal of the National Cancer Institute. January 2003. The study found that girls who had a modest reduction in fat intake had significant lower rates of sex hormones including estradiol, estrone, and testosterone. • The European Prospective Investigation into Cancer and Nutrition (EPIC) Public Health and Nutrition. February 2006 This study found that a daily intake of 35 grams of saturated fat doubles the risk of breast cancer compared to women with a daily intake of 10 grams or less. This study had over 500,000 participants.

33. Not all fats are bad • International Journal of Cancer March 2002 Data based on fatty acids levels in breast adipose tissue suggest a protective effect of n-3 fatty acids on breast cancer risk and support the hypothesis that the balance between n-3 and n-6 fatty acids plays a role in breast cancer. The best ratio is 3:1 omega-6 to omega-3 fatty acids. The typical western diet is about 15:1.

34. Sources of Omega 3 and 6 Fatty Acids • Omega-3: Flax Seed, Walnuts, Chinook Salmon, Scallops, Cauliflower, Cabbage, Sesame seeds. • Omega-6: Safflower oil, sunflower oil, hemp oil, wheat germ oil, evening primrose oil.

35. Other Dietary Risk Factors • Alcohol: 2-5 drinks per day increase risk 1.5 times over that of women who don’t drink. • Excessive Red Meat Intake: Increased inflammation, source of carcinogenic substances ie. heterocyclic amines. • Excess Sugar/Calories: Sugar intake is a strong risk factor that contributes to higher breast cancer rates, particularly in older women. Sugar containing foods cause and increase in insulin and insulin-like growth factor- which can promote cancer growth. Annals of Oncology, February, 2006.

36. Exercise The positive effects of exercise cannot be overstated. Regular physical activity can impact the body in a variety of ways, and there are several hypothesized biological mechanisms for the physical activity--cancer association. These mechanisms include changes in hormone levels, reduced percentage of body fat, enhancement of the immune system, and alteration in free radical damage by scavenger systems.

37. Quick Review- What Do We Know? • We know that women who have elevated hormone levels can have a 2-3-fold increased risk of cancer.Exercise can decrease hormone levels. • We know that elevated saturated fat intake, and an increased body fat content can double breast cancer risk. Exercise can decrease body fat. • We know that a decreased immune system is a risk factor for cancer, we also know that it is a big problem for people undergoing cancer therapy. Exercise stimulates the immune system. 4. We know that chronic exposure to free radicals can increase cancer risk. Exercise can help to neutralize free radicals.

38. Journal of the National Cancer Institute, Sept. 1994 “Our results suggest that implementation of regular physical exercise programs as a critical component of a healthy lifestyle should be a high priority for adolescent and adult women.”

39. How Much Exercise? The available data indicate that 30-60 minutes per day of moderate-to-vigorous physical activity is needed to be protective against breast cancers.

40. Heavy Metal Exposure The documented effects of heavy metals: • Depletion of immune system activity. • Disruption of the haematopoiteic system. • Accumulation in breast cancer tissue. • Increased breast cancer risk. • Increased cardiovascular risk.

41. What are heavy metals? Metallic chemicals like cadmium, arsenic, copper, mercury and zinc that can be harmful pollutants when they enter soil and water. These chemicals are put into animal feed to help make animals grow faster. Heavy metals are present in human and animal waste and can enter the environment if waste is released without being treated. Animal waste is never treated to remove heavy metals. Once in the environment, heavy metals are almost impossible to get rid of because they do not decompose.

42. Sources of Heavy Metal Exposure Water Food (animals and plants) Make-up and Cosmetics Air pollution Smoking

43. Assessing Heavy Metal Loads The best way to determine your heavy metal exposure is through a timed urinary collection. To correctly assess exposure over long periods of time it is necessary to use a provoking agent such as EDTA, DMPS, or DMSA. These chemicals are called “chelators,” and they “claw” onto heavy metals and promote their excretion.

44. Removing Heavy Metals Chelation: Using chelators either IV, orally, or as suppositories. Sweating: Saunas can be used- the skin is the largest eliminative organ in the body Detoxification: Targeted supplementation, diet, exercise, IR heart.

45. Melatonin Melatonin is a natural hormone that is found in nearly all living creatures. Melatonin is the hormone that regulates our sleep cycle. Additionally, melatonin levels can stimulate the immune system, and act as an antioxidant.

46. The Melatonin Hypothesis Melatonin synthesis can be modulated by sleep cycle and exposure to artificial lighting. The hypothesis is that with decreased melatonin in our bodies we may be increasing our cancer risk through increased stress, decreasing the effectiveness of the immune system, and increased anti-oxidant burden. Increased melatonin levels have even been shown to decrease breast cancer growth.

47. Pesticide Exposure Pesticide exposure is recognized as an important environmental risk factor associated with cancer development. Maternal exposure to pesticides can have harmful effect on the fetus. It is important to take steps to decrease exposure and bodily burden.

48. Minimizing Pesticides The best way to avoid pesticides is to eat organic foods. It’s important to wash your produce thoroughly- the best way is to fill up your sink with water and then add 1 cup hydrogen peroxide. Add your produce and allow to soak for 15 minutes. Rinse and eat. This will help to eliminate waxes, pesticides, and any micro-organisms may be on your foods.

49. Removing Pesticides/Residues A good detoxification program that targets fat tissues, as well as stimulation of the detoxification processes liver can help to move these chemicals out of the body.

50. Stopping Breast Cancer Remember that roughly 85% of breast cancer cases are due to environmental and dietary causes. Making some simple lifestyle changes can have a profound impact on the prevalence of breast cancer.