What Is Known About Breast Cancer Recurrence
Healthy Steps: Breast Cancer Recurrence Prevention—First Steps
Healthy Steps: Breast Cancer Recurrence Prevention—Full Program
Breast Cancer Detection
From Dr. Deborah's Desk
You had been doing everything right, and you still got breast cancer – how many times have we heard that story? Too many, that’s for sure.
Traversing the complex world of cancer diagnosis and treatment – surgery, radiation, chemotherapy and hormonal therapy options – is truly challenging. When the dust settles, it’s time to step back and also take a careful look at everything you do to keep yourself healthy. Can anything be improved so that you don’t face a breast cancer recurrence?
For my mother, breast cancer recurrence happened 19 years after her mastectomy, taking the form of shortness of breath, due to cancer spreading to her lungs. For many others, it is the awareness of another cancer in breast tissue, considered a local recurrence. A cancer recurrence may be local, regional or distant.
A local recurrence may be of the same cancer initially diagnosed, or could turn out to be a completely different kind of breast cancer. One of my patients is currently about twenty years out two breast cancer diagnoses, a year apart, opposite sides and different pathologies. I’m not sure she’s done everything I would recommend at this point, but I do know that she has kept a healthy level of vitamin D throughout those decades.
A regional recurrence involves the lymph nodes near to the site of the original cancer, and a distant recurrence has traveled to some other part of the body, most commonly the bones, liver, or lungs.
The treatment received after an initial diagnosis of breast cancer is intended to kill any cancer cells – surgery for the removal of the tumor, and chemotherapy, radiation or hormone therapy to deal with cells outside the tumor. No treatment is perfectly effective, so it is possible that certain cancer cells present at the time of diagnosis are able to hide out and survive the treatment chosen. Consultation with a wise and trusted oncologist will help a woman to sort through the maze of talk shows, well-meaning relatives, and even perfect strangers, all with a success story that must be shared with you – definitely one of the most challenging parts of dealing with breast cancer. In addition to conventional treatment and surveillance options, there is much a woman can do to lessen her own risks of recurrent breast cancer.
At the time of initial diagnosis and treatment, certain key factors might increase a woman’s chance of recurrent breast cancer. The more advanced the cancer at the time of diagnosis, the more likely it is to have lymph node involvement, a larger size, both of which are unfavorable. Additionally, the cancers considered more aggressive (inflammatory breast cancer, and cancer in women under 35) are more likely to recur. As with any cancer, a surgery that fails to completely remove the tumor, as determined by a report that all the margins of the excised tumor were clear of cancer, is also a recurrence hazard. Cancers that are negative for hormone markers or the HER2 gene (triple negative breast cancer) may have an increased risk of recurrence, although newer treatments show some promise in that area.
Everything mentioned in the above paragraph are factors over which a woman has no choice or control. On the other hand, there are certain lifestyle factors which can be modified and thus deserve particular consideration for secondary prevention even more than for primary prevention. Following a breast cancer diagnosis, a woman has the opportunity to review all the conventional and well-known risk factors that can be modified to reduce cancer risk. Additionally, certain other more individualized steps can be taken to mitigate risk.
We can take primary prevention a step farther when we know we are at particular risk for breast cancer. Primary prevention steps which might seem extreme – such as reduced alcohol intake for someone who enjoys a couple glasses of wine – might be reasonable to re-consider when the stakes are higher. Other individual prevention measures become more important depending on each woman’s history and habits.
Additionally, we can take the step of “avoiding toxins” a bit further and consider the importance and the options for “detoxification.” Many environmental toxins – hormone mimickers and others - have been identified as particular risky for breast cancer, yet of course not everyone gets breast cancer. One determining factor might be how well one woman clears toxins from her body. For instance, in the controversy surrounding now-banned PCB’s, it has been noted that several types of PCB are found in much higher blood levels in women with breast cancer when compared to healthy, age-matched controls. PCB’s are of different sorts, so some act like estrogens, others are estrogen antagonists, and a third type affects the working of enzyme systems. PCB’s are unfortunately still found in the environment and in people’s bodies.
The body’s detoxification procedures are complex, but some of them are at easy reach to understand. The liver metabolizes toxins through two pathways, both of which must work at compatible levels to be effective. We can monitor the effectiveness of liver metabolic pathways and supplement as needed to support different stages of liver metabolism. Additionally, we can investigate pathways used for the specific metabolism of estrogen, the methylation and detoxification pathways individualized through genetic testing.
Finally, we know a little bit about the maintenance and growth of cancer cells, and might consider some dietary and exercise manipulations that specifically correspond with our most up-to-date information.
For the greatest risk reduction with the fewest steps, follow these three recommendations.
- Go all organic. Organic food is the best choice for what goes in your body; choose organic body care and home care products for what touches your skin and is inhaled through your nose.
- Nourish yourself. Gift yourself with daily restorative time (walk, yoga, meet with friends) and make sure you get 8 hours of good sleep in a dark room. (More info below!)
- Maintain Vitamin D levels at 60-85 ng/mL, checking twice a year, and supplementing with Pure Encapsulations Vitamin D3.
A comprehensive cancer secondary prevention program involves many areas in which action steps can be taken, gradually or all at once. Start by following DrDeborahMD's basic nutrition and healthy lifestyle guidelines, with the following modifications:
Foods to Enjoy
- Protein and fat that is real and organic. By "real" I mean eggs from pasture-raised chickens, and milk and meat from grass-fed and grass-finished meats.
- Cruciferous vegetables. As mentioned before, three or more servings of cabbage a week are associated with reduced incidence of breast cancer, partially for their general health and partially for their ability to detoxify estrogen. For women who have had breast cancer, I recommend finding a practitioner who can help you investigate your body's own resources for estrogen metabolism and supplement as necessary.
- Iodine-rich foods. Seaweed and seafood, such as Wild Alaskan Salmon, are the best sources: eat twice weekly.
- Folate-rich foods. Liver and dark leafy greens (romaine lettuce to collard greens). See Recipe for Liver Pate.
- Healthy fats particularly important for cancer prevention are omega-3's in fish oil or cod liver oil, which effectively slow down tumor growth in estrogen-sensitive cancers such as breast-, prostate- and colon cancers. Also the healthy fats in butter and yolks should be enjoyed.
Foods to avoid
- Sweets, especially sugars. Cancer loves sugar and requires it to grow. Track insulin levels and keep them low.
- Inflammatory foods. Are you still using canola/soy/cottonseed/grapeseed/sunflower seed oil? Industrial seed and vegetable oils are inflammatory for everyone and have been associated with breast cancer risk. Be careful in restaurants: choose grilled or poached meats, as most sauteed options are fried in unhealthy oils.
- Food allergens. If you have systemic or local inflammation, it's worth a trial of food eliminations and gut healing to see if a particular food allergy has been the cause. I'd suggest starting with the elimination of gluten, and just to make sure the elimination works well: eliminate all grains for 6 weeks. Read about food elimination here.
- Alcohol. As described elsewhere on this website, alcohol's relationship to breast cancer is complex and probably individual. Consider whether you are ready for permanent abstention (certainly the safest route), or limited indulgence (1 glass of alcohol, once a week).
- Vitamin D3. For preventing recurrence, I recommend keeping D levels at 60-85 ng/mL, which usually requires supplementation to achieve. Pure Encapsulations Vitamin D3, in liquid or capsule form, is an ideal supplement, usually at a dose of 5000 i.u. (see package for details) daily to normalize and maintain levels. Take with food.
- Omega 3 fatty acids, Barlean's Omega Swirl is a good choice: 1 Tbsp or 1000 mg daily.
- Thorne Research Melaton-5. Past the age of 50, or if you have a history of night work or sleep difficulties, it's wise to supplement with melatonin, even on a regular basis, to reduce breast cancer risk. Although technically a hormone, taking oral melatonin, up to 5 mg at bedtime does not suppress your own body's production, according to at least one study, and that is probably the best hormone. If you don't sleep great, supplementation at higher levels may be necessary both to achieve sleep (worthy in its own right) and maintain adequate to high levels of melatonin. Start with 0.5 mg, taken 1-5 hours before bed. Increase to 1 mg, then 5 mg, by the same protocol. Continue to increase by 5 mg increments, and most importantly: look for some other reason why you are not sleeping well. As a particular area of personal interest (the least cause for excitement seems to my body a reason to stay up all night), I have written many posts on this site about solutions for sleep problems!
- CoQ10 has a sweet spot. Women are at risk with either very low or very high levels. Optimal dosing would be with Ubiquinol 100 mg, 1-2 times daily.
- Take methylated vitamin support as needed. Our bodies are designed to be very wise at detoxifying both external chemicals and the waste products of our own physiology. There are some genetic "glitches" that impair our detoxification abilities, the best known example being mutations in the MTHFR gene. If you have one or more mutations in MTHFR, you will benefit from taking methylated B vitamins (Methyl B12, Methyl Folate and Pyridoxal-5-Phosphate for vitamin B6). If however, you have some other mutations, you must be careful with methylation, proceeding gradually.
Cancer Prevention Lifestyle:
- Issues to investigate with your health care provider include: vitamin D levels, iodine supplementation, estrogen metabolism, methylation, insulin levels and levels of inflammation. Chronic inflammation can increase your vulnerability to the spread of wayward metastatic cells, allowing regrowth of the primary tumor, metastases, or even entirely new malignancies.
- Don't smoke.
- Sleep regular night hours in a dark room. Avoid shift work if possible that keeps you awake at night and depletes your natural melatonin levels. Multiple studies confirm the importance of 7 or more hours of sleep a night, and recent evidence suggests that any light that brightens your room lessens the healthy effect of sleeping in the dark. If it is impossible for you to darken your room totally, an eye mask would be helpful.
- Enjoy the sun. Sun exposure is the best way to get vitamin D. Enjoy sun and avoid burning.
- Nourish yourself with restorative activity. Whether it be a walk with friends, a bit of yoga, or meditation, a daily practice that enables you to manage stress effectively has been document in at least one study to enhance immune responsiveness.
- Exercise. Three times a week, exercise strenuously enough to make conversation difficult for 20-30 minutes, is the simplest advice.
- Iodine. Population evidence (low cancer incidence in Japan) suggests that optimal iodine levels are cancer-protective. Iodine levels are tested by a single urine test, and levels should be over 150 mcg/L to be optimal. Iodine supplementation is best discussed with a knowledgeable health care practitioner. Particularly if you have Hashimoto's thyroiditis, caution is necessary for optimal iodine supplementation.
- Avoid obesity. Keep your waist circumference less than half your height, and see if you can return to your youthful weight. The Weight Loss Eating Plan is an excellent diet for reducing cancer risk, including breast cancer.
- Cook meat gently. Charred meat contains carcinogenic compounds: bake, roast, or steam. If you are going to cook over high temperatures, marinade the meat for at least 2 hours before cooking.
- Plastics and body care products are toxic with estrogen analogues, avoid them. When you must use plastic water bottles, choose BPA free ones, and look for organic skin care products.
- Conventional hormone therapy. Postmenopausal hormone therapy with conventional drugs such as Premarin and Provera clearly raise the risk of breast cancer. It is likely that birth control pills might increase the risk also. Treatment with bio-identical hormone therapy might have a favorable or negligible impact on breast cancer risk.
- Lower your insulin levels. Elevated insulin levels, such as those seen in women with type 2 diabetes, are associated with increased risk: cancers seem to be well-fed by sugar, ushered into the cell by insulin. If your insulin levels are high, or if you have been told you are diabetic, or pre-diabetic, follow a healthy, low-carbohydrate lifestyle as described here to reduce your risk of breast cancer and to heal from diabetes.
Add thermography to the surveillance protocol recommended by your oncologist and surgeon. Thermography offers great promise at offering earlier
My suggestions for reducing breast cancer risk are only the current synthesis of the most significant findings about breast health. Sign up for my newsletter, where I always give breast cancer news a place of importance as it becomes available. I am always curious about new findings and particular proven actions women can take to augment their health.
Although the list of possible changes may seem long and daunting, none of them is harder than what a cancer survivor has already been through! Take them one at a time, and prioritize based on your individual situation, you can do it.