Breast cancer prevention strategies

When you hear health messages about cancer or any disease do you find yourself filtering it out?  If you do, this next sentence might cause you to stop reading, but please continue because there's a point I'm hoping to make. At the time of writing this, statistics say that one out of eight women will get breast cancer in their lifetime (American Cancer Society). Are you still reading? That's good, because the purpose of sharing that statistic was to illustrate that even though we frequently hear these kinds of health messages, we don't always feel connected to them. 

Perhaps you might be thinking as I did when hearing those numbers, wow, that sounds like a lot, but I'm not going to be the one.  Unfortunately, this kind of thinking often translates into inaction. Statistical health data, although sometimes shocking and troubling, may not be meaningful enough to inspire change for some of us.

If you find that you aren't motivated by statistics, you're not alone. Evidence suggests that health messages which highlight health consequences and the numbers of people who get disease aren't as effective as was once thought.

What can be more successful in motivating change in health behaviors are messages that focus on causes and solutions for disease (McKenzie).

Obviously there is no clear solution to breast cancer at this point in time. However, there is a great deal of data available that is linking lifestyle factors with increased risk.

There may be no sure way to prevent breast cancer yet. However, this doesn't mean we're powerless. Our best prevention strategy is to take steps to reduce our risk factors as much as possible. So, let's take a closer look at the modifiable risk factors.  In other words, the things we can do to lower the probability of  becoming one out of eight women who will get breast cancer.


A few Prevention Strategies

• Excercise- Enough said.
• Avoid weight gain and obesity - Exercise and healthy nutrition are the keys. According to the National Cancer Institute (NCI), a gain in body mass index (BMI) may substantially increase a women's risk for breast cancer, especially after menopause.The NCI states, " In a recent analysis, women who reported a gain in BMI of five points  or more between age 20 and postmenopausal age (ages 55-74) had nearly twice the risk of developing postmenopausal breast cancer compared to women who maintained their BMI during the same time period." You can read more about BMI in this post here.
• Eat plenty of fruits and vegetables - Preferably organic.  Organically grown produce lowers exposure to pesticides which can effect hormone levels, particularly estrogen dominance.
• Have your vitamin D levels checked -  A low level of Vitamin D is linked to increased risk for breast cancer. 
• Reduce chronic inflammation - I've blogged about this very important element of cancer prevention here, but simply put, if our immune system is preoccupied and overwhelmed responding to environmental and food stressors, it's possible that it can miss the angiogenesis of a sneaky cancer cell. 

Here's some additional information about eating "nutritarian" from Dr. Fuhrman's informative website which explains how to support our wellness with healthy nutrition. The foods we eat can either support or oppose our bodies. Experts now agree that there are even so-called power foods that do an especially good job of restoring our bodies. 

  

So, rather than tuning out messages about disease, consider the strategies that you can incorporate into your lifestyle that will help prevent illness from starting in the first place - because "an ounce of prevention is worth a pound of cure."

Sources
http://www.cancer.org/acs/groups/content/@nho/documents/document/f861009final90809pdf.pdf
McKenzie, J. An Introduction to Community Health, 5th ed.
http://www.cdc.gov/healthyweight/assessing/bmi/
NCI - http://benchmarks.cancer.gov/2010/04/gain-in-body-mass-index-increases-postmenopausal-breast-cancer-risk/
Breast Cancer.org http://www.breastcancer.org/symptoms/understand_bc/statistics
Breast Cancer.org http://www.breastcancer.org/risk/factors/low_vit_d

Breast Cancer Awareness Month: Seeing red over pink!

image of pink lit White House from CBC News

It's that time of year when I see red, even though October is all about the color pink. That's because it's Breast Cancer Awareness Month. Here in the states it's referred to as National Breast Cancer Awareness Month (NBCAM), and even the White House is wearing pink! This whole pink thing is really getting old and frankly, since going through my own breast cancer experience, I find I'm actually angered by it all. Now that I've gotten that off of my, er, dare I say, chest - I'll get straight to the issue. How could a positive thing like raising awareness about cancer rouse me to anger?

Well, before I tackle that question, I want to be clear that this isn't going to be a post bashing America, or medical experts, researchers, charities or any others that have made a positive difference in the diagnosis and treatment of breast cancer or any cancer. My family and I have personally benefited from these things, and I am especially grateful for early detection. My hope is that this post will provide some food for thought.

Experts agree that an increased awareness about a disease may encourage a person to receive medical screening that can lead to early detection (6). Obviously, this is a good thing. But after more than 25 years of raising awareness, is NBCAM actually impacting the early diagnosis of breast cancer? A recent study published in the Journal of Health Economics researched this question and they found the answer is no, not any more (1). So, if NBCAM is no longer effectively raising public awareness about breast cancer or encouraging early detection via screening, than why is it we are seeing more pink than ever? I believe it's because breast cancer has turned into a profit generating industry, and I'm not alone in this thinking.

Profiteering of breast cancer? -
What ever happened to the thinking that:

"An ounce of prevention is worth a pound of cure." Benjamin Franklin 

Benjamin Franklin's quote holds true for those of us health seekers doing our best to prevent disease. But how does this resonate with, for example, a pharmaceutical company, whose bottom line is to make a profit? Let's face it, there's just not much money to be made in preventing breast cancer, or any cancer for that matter. Consider the primary breast cancer treatments to date: slash, burn and poison, otherwise known as surgery, radiation and chemotherapy. In a previous post I discussed an instance where a pharmaceutical company that produced a chemotherapy drug also made a bovine growth hormone being used in dairy cows. This hormone has been linked to an increased risk of breast cancer (5). But, hey, we've got a drug for that.

Whose interests are being served here? This is just one sad example of how some corporations have turned breast cancer into a profitable industry. Breast Cancer Action explains it this way:

 "The cancer industry consists of corporations, organizations, and agencies that diminish or mask the extent of the cancer problem, fail to protect our health, or divert attention away from the importance of finding and working to prevent the disease. This includes drug companies that, in addition to profiting from cancer treatment drugs, sometimes produce toxic chemicals that may be contributing to the high rates of cancer in this country and increasing rates throughout the world. It also includes the polluting industries that continue to release substances that are known or suspected to be dangerous to our health, and the public relations firms and public agencies that protect these polluters. The cancer industry includes organizations like the American Cancer Society that downplay the risk of cancer from pesticides and other environmental factors, and that historically have refused to take a stand on environmental regulation. " (3). 

More to NBCAM than meets the eye?-
So what does National Breast Cancer Awareness Month (NBCAM) have to do with this? Well, let's see. According to Wiki, NBCAM "is an annual international health campaign organized by major breast cancer charities every October to increase awareness of the disease and to raise funds for research into its cause, prevention, diagnosis, treatment and cure. The campaign also offers information and support to those affected by breast cancer. As well as providing a platform for breast cancer charities to raise awareness of their work and of the disease, BCAM is also a prime opportunity to remind women to be breast aware for earlier detection." This sounds great doesn't it?

Well, if we look a little deeper, we find that NBCAM was formed by Imperial Chemical Industries, the creator of Tamoxifen, a breast cancer treatment drug. In the 90's, Imperial Chemical Industries spun off Zeneca Group. Then Zeneca merged with Astra and became Astra Zeneca, which formed a non profit arm that is known today as AstraZeneca Healthcare Foundation, one of the largest financial contributors to NBCAM.  Astra Zeneca also created and markets Arimidex, another breast cancer treatment drug. CancerCares was also involved in the formation of NBCAM. A look at their donors reveals several pharmaceutical companies as well. So, what message would you want to spread if you were a drug manufacturer financially invested in breast cancer treatment medications? Probably not prevention.

I do want to acknowledge again that cancer treatment drugs are not bad. I'm just saying that it's a fact that pharmaceutical companies spend a lot of money on the research and development of new drugs. Forbes  published an article earlier this year that puts the dollar amount between a high of $12 billion and a low of $55 million (4). Considering the magnitude of expense to produce a drug, pharmaceutical companies must be under an enormous amount of pressure to deliver a drug that will generate revenue and for that they need a disease to treat. As I said earlier, there's no profit in prevention.  

Pink washing -
This brings me to what has come to be known as the "pink washing" of breast cancer. You can read more about this here. The term "pink washer" has been used to describe a company "that purports to care about breast cancer by promoting a pink-ribboned product, but manufactures products that are linked to the disease" (Breast Cancer Action) (2). The point is non-profit organizations accepting donations from companies that stand to gain from their philanthropy seems to represent a conflict of interest to me. It's no wonder that little focus is being placed on breast cancer prevention! It's much more profitable for these powerful industries to keep the emphasis on looking for the so-called "cure", which is really just another word for drug treatment.

Awareness, screening and a cure are NOT prevention -
Let's face it,  awareness, screening and early detection is a means to find disease, not prevent it. A cure is defined as the "restoration of health; recovery from disease" (7). Primary prevention of disease is about avoiding or reducing the risk factors for disease. After over 25 years of seeing pink, I think it's safe to say we are aware of breast cancer. I can't help but wonder where we would be now if that focus had been directed toward the prevention of breast cancer.

Well, we can't go back, but we can take action going forward! Let's think before we let our emotions be swayed by all things pink. Let's do some due diligence when donating to a charity.  Where does our money go?  How much of what is spent on that pink colored item will go toward breast cancer prevention research? What chemicals are in my pink marketed cosmetics or foods that my be adversely affecting my body? What's my elected official's stance on this topic? Let's tell those in government how we feel about these issues. Going forward we can shift the focus from awareness to prevention, because the only way we can be cancer free is by preventing cancer from occurring in the first place! 

GO TO: http://org2.democracyinaction.org/o/6098/p/dia/action/public/?action_KEY=11729

Resources

(1) Health awareness campaigns and diagnosis rates: Evidence from National Breast Cancer Awareness Month

Grant D. Jacobsena, Kathryn H. Jacobsen, Journal of Health Economics http://www.sciencedirect.com/science/article/pii/S016762961000144X

(2) Breast Cancer Action, http://bcaction.org/

(3) Breast Cancer Action, 

(4) Forbes - http://www.forbes.com/sites/matthewherper/2012/02/10/the-truly-staggering-cost-of-inventing-new-drugs/2/

(5) Breast Cancer Fund - http://www.breastcancerfund.org/clear-science/chemicals-glossary/bovine-growth-hormone.html

(6) Planning Implementing and Evaluating Health Promotion Programs, James McKenzie, et al, 4th ed., Pearson, 2005.

(7) The Free Dictionary http://www.thefreedictionary.com/cure

The pinkwashing and profitizing of breast cancer

It's that wonderful time of year again, and I'm not talking about the upcoming joyous holiday season. Please forgive my sarcasm, but the reason for my less than mirthful attitude about October is because it's officially National Breast Cancer Awareness Month.  I have come to prefer Breast Cancer Action's more accurate designation of National Breast Cancer Industry Month.  

I've shared my feelings about this month-long marketing extravaganza in a previous post, along with a little background on the origin and history of pink ribbons and breast cancer.  You can read more about that here.  Unfortunately, not much has changed in the world of pinkwashing since I wrote that post a year ago. In fact, it appears things are getting worse.

First, however, the good news is that our awareness of this practice is increasing. This is evidenced by the creation of a new word to describe the phenomenon, i.e. pinkwashing. The term comes from a mash up of the words pink - the color of the ribbon used to commemorate breast cancer, and whitewashing - which means to gloss over or cover up vices or scandals (1).  The Urban Dictionary defines pinkwashing as "the use of breast cancer by corporate marketers in which companies promote their products with claims to donate a percentage of proceeds to the cause" (2). In the spirit of creating new words, let's throw in "profitizing" while we're at it because that's exactly the action that is occurring in what has become the industry known as breast cancer.

Now the bad news. Sadly, it's no longer uncommon for corporations to put profits before the welfare of people. However, things have gone from strange to bizarre considering the fact that joining the long line of companies marketing their products under the pink ribbon is the queen of breast cancer charities - the Susan G. Komen Breast Cancer Foundation.  Evidently, the Komen Foundation has enlisted a company to manufacture a fragrance for them called Promise Me (4).  The slogan listed on the ShopKomen webpage reads, "purchase with purpose to end breast cancer forever" (4).  Have you ever wondered how much of the purchase price of a product that is marketed as "pink" actually goes toward the noble mission to "end breast cancer forever"? At ShopKomen it's 25% (5) (see the small print at bottom of the Komen webpage).

Now, if you're reading this blog you are probably clued in to the fact that the beauty industry is unregulated and as a result most beauty care products, including fragrances, contain chemicals that are proven to be unhealthy. Can you believe that the safety testing of personal care products is left up to the manufacturers? You read that correctly! According to the Environmental Working Group, they police themselves. So, considering this revelation, it will probably come as no surprise to learn that the original Komen Promise fragrance contained at least 2 chemical toxins (8):
• Galaxolide – a synthetic musk that works as a hormone or endocrine disruptor and has been detected in blood, breast milk, and even newborns.
• Toluene – a potent neurotoxicant linked to a variety of demonstrated negative health effects and is widely known as one of the toxic trio. Toluene is banned by the International Fragrance Association.

HELLO!! Endocrine disrupting chemicals are linked to cancer (6). This is outrageous and appalling to me. The Susan G. Komen Foundation is an organization whose mission is to "eradicate breast cancer as a life-threatening disease by advancing research, education, screening, and treatment" (3), yet they are marketing and selling a product containing chemicals that are suspected cancer causing agents.

That's why at this wonderful time of year, when everything is awash in pink, it is especially important to "think before you pink." This phrase, coined by Breast Cancer Action, suggests we ask the following questions before we generously support a charity or buy a pink ribbon product (9):

1. Where does the money raised by pink ribbon products go?
2. How much money goes towards breast cancer programs and services?
3. How are the funds being raised? For example, is it through the sale of cosmetics that contain potential cancer causing chemicals?
4. What types of programs are being supported? Is the money being used to conduct research to understand the causes of breast cancer, or in support of the prevention of the disease?

Check out the video below and please spread the word. Let's join together to let those who are choosing to profit from this disease that we won't be pinkwashed anymore!

Sources
(1) Wikipedia - definition of whitewashing - http://en.wikipedia.org/wiki/Whitewash_%28censorship%29
(2) Urban Dictionary - pinkwashing - http://www.urbandictionary.com/define.php?term=pinkwashing
(3) Susan G. Komen Breast Cancer Foundation - http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1508105/ 
(4) Shop Komen - http://www.shopkomen.com/cart.php?m=product_detail&p=1687
(5) Shop Komen homepage - http://www.shopkomen.com/
(6) http://www.ewg.org/skindeep/2011/04/13/why-this-matters/
(7) Endocrine Society - http://www.endo-society.org/journals/scientificstatements/upload/edc_scientific_statement.pdf
(8) Breast Cancer Action - Think before you pink - https://org2.democracyinaction.org/o/6098/p/salsa/web/thank_you_page/public/thankYou.sjs?thank_you_page_KEY=1654
(9) http://bcaction.org/our-take-on-breast-cancer/politics-of-breast-cancer/the-cancer-industry/#anchor2 
 

Eating for healing: the restorative power of food

It's been a year since a doctor gave me the life altering news that I had a disease. If, at this point you're thinking well I'm not sick, so this post doesn't pertain to me.  Please, consider reading on. Eating for healing isn't just for those dealing with illness. This lifestyle is for everyone who wants to support their body as it copes with disease, or attempts to deal with the daily assaults of living.  This may sound a bit dramatic, but our bodies really are in a state of constant warfare against environmental toxins, aging and disease. Doesn't it seem prudent to give the body a hand with some nutritional weaponry?

                                    Photo by Anna Pelzer on Unsplash

Eating for healing may not be a magic bullet, but research is showing that food and medicine are not distinctly separate domains (1).  This wisdom has been known by some cultures for centuries. In Western society, the trend away from botanical medicines began when two chemists took an herbal analgesic called salicylic acid and synthesized the synthetic drug Aspirin from it (2).  The pharmaceutical industry was born from this progress and has resulted in the ability to entirely or partly replicate many medicinal botanicals.

What are medicinal botanicals?
The University of Minnesota Life Science Foundation defines them as "plants (or substances that come from plants) that are used to treat or prevent disease" (3). To underscore the importance of botanicals in the treatment of disease,  the Biotechnology Center for Agriculture and Environment at Rutgers University states that "natural products continue to make the most dramatic impact in the area of cancer" (2).  This is because "a primary advantage of botanicals is their complex composition consisting of collections of related compounds having multiple activities that interact for a greater total activity" (2). In other words, synthetic compounds just aren't able to replicate what nature provides.


Plant foods as medicine
The European Botanical Forum has a compiled a very comprehensive and informative Compendium of Botanicals that have been reported to contain substances that may be of health concern when used in food or food supplements found here. Also of note, is their discussion of the role of plant food nutrients, as well as the plants' secondary metabolites and their effects on our health.  The following is a quote from their discussion of understanding the benefits to our health of botanicals:

"In seeking to achieve optimum nutrition, for many years attention has been focused on nutrients because their lack in the diet leads to deficiencies with characteristic clinical symptoms. However, the role of other food components in achieving optimal health is now better understood. Most of these food components are from plants which are rich in bioactive secondary metabolites. These are substances produced by the plant in adaptation to local environmental conditions, which, for example in the Mediterranean area, are often pro-oxidative. This requires an adaptive response from the botanical, producing protective bioactive compounds such as polyphenolic molecules. This is particularly relevant for human health because the intake of these plants results in the transfer of those protective compounds to the human organism."

Simply put, research is now beginning to understand that the interactions that occur between plants and their environment result in substances that can have a profound impact on the health of those of us who eat these plants. The researchers from Rutgers articulate this concept in another way:  "Plants must maintain and protect themselves through diverse arrays of complex natural products that they make from the inorganic components of air, soil and water because they lack the flight response. ...Plants can live hundreds of years without succumbing to diseases or predation.  It should come to no surprise that some of the compounds that have enabled plants to survive may also be used to maintain the health and well-being of humans" (2). Wow! This could give an additional meaning to Kermit the Frog's lament of "It's not that easy being green."

Seriously though, my purpose in sharing the above was to underscore the dire importance of including plant foods in your diet.  Having said that, eating for healing is not just about consuming a few more servings of fruits and vegetables a day, although this is definitely a good thing to do for your health. Let's take a closer look at a few of the nutritional strategies that were recommended to me. 


Options for nutritional paths to healing -
First, I'd like to share that when I began considering disease treatment plans, I sought the expertise of many qualified resources. What I'm sharing is the advice of these experts, and it has proven invaluable to me in determining the best course of action for me. Having a team of physicians that will consider and support your desire to choose the best treatment for you is priceless.  If you are dealing with an illness and struggling to navigate through the standard practice of care maze, I encourage you to pursue finding these experts.  They do exist!

My journey led me to an outstanding oncologist and functional medicine doctor who recommended the Comprehensive Elimination Diet, which is discussed in more detail here. In addition, this physician felt it was important to incorporate detoxification measures into my lifestyle (more about this in the post here). Another physician suggested I try the Anti-Inflammatory Diet.  Dr. Andrew Weil also has some excellent info on this program here. I have discovered that many components of these diet strategies overlap and compliment each other. Ultimately, what I found most productive for me was to pick certain components of these diets and combine them into an amalgamation that has become my lifestyle.

I'm ecstatic to say that the results speak for themselves. My annual follow up with the radiologist was so positive it prompted him to ask me about my treatment plan! I've also shared in previous posts that since my husband joined me on my eating for healing journey he has lost over 40 pounds, is healthier and feels better than he has in years. Clearly for us, making the decision to eat for healing has been positively life transforming! So, on to the bottom line. 

 
Key components of eating for healing
Here are the strategies that I feel are critical, along with their supporting elements. It's important to note that the components share many common elements. 

1. Eliminate or limit foods that can cause chronic inflammation
2. Aid the body in detoxification and support liver function
3. Increase foods that have healing properties
• Eat a colorful variety of plant foods - Serving recommendations can be found at the Centers for Disease Control (CDC) Fruits and Veggies Matter website here and you can also read more in my blog post about this found here and here.  
• When possible eat organic foods because pesticides and herbicides actually thwart the production of phenolics. As mentioned above, phenolics are chemicals that act as a plant's natural defense and they also happen to be good for our health. Read more here.
• Limit or avoid foods made with refined grains, like white bread and pasta and eat more whole grains. For now, I have made the choice to restrict wheat because I wanted to make more room in my diet for the nutritional benefits of other grains that I wasn't eating because of my love of wheat.  Ancient grains like farro, quinoa and amaranth, for example, are a few that I'm eating now. The important take away here, is that you want to avoid refined white flour and foods containing this flour because the refining removes much of the grains nutritional benefits, as well as negatively effecting insulin.  More about whole grains here and on insulin below.
• Avoid prepackaged, processed and refined foods. Always choose whole foods.
• Eat low glycemic index foods. This prevents a rapid rise in insulin which can contribute to infllammation in the body.  Check out this website for more info on the glycemic index (GI) of foods. A good rule of thumb: Foods with more fiber usually have a lower GI.
• Liberally use spices that have anti-inflammatory properties. Examples: ginger, turmeric and curry.
• I avoid dairy to reduce risk of inflammation, especially from non-organic sources (lactose intolerance runs in my family), but I do eat some organically produced goat dairy products. 
• Drink plenty of filtered water. 
• Get more Omega 3 in your diet. Western diets are much higher in Omega 6 fats. Research suggests that a 1:1 ratio of Omega 3 to Omega 6 is healthier (5).  Supplement with a quality fish oil and eat more food sources of Omega 3 fats. For example walnuts, ground flax seeds or flax seed oil. Read more about fats here and here.  
• Eliminate partially hydrogenated oils. Check food labels for trans fats and avoid fried foods.
• Reduce saturated fats by cutting back on red meat and full-fat dairy foods.

The University of Michigan's Healing Foods Pyramid is a great visual representation of many of the elements just discussed. You can view the full sized, printable version here.

University of Michigan's Healing Foods Pyramid

The journey back to health and a "new normal" has been a long, winding and rather bumpy road, but as it is with many of life's passages, it has led to greater wisdom and strength. It's important to stress that what I discerned to be the best course of treatment for me does not suggest it is the only path to take. My choice is not better or more correct than any other treatment options.  Only you, along with the assistance of your health care provider, can decide what is best for you. Healthy or otherwise, our bodies can always use the nutritional support that eating for healing provides.

The next post will outline a weekly menu with meal suggestions to get you started.  In the meantime, I encourage you to begin by implementing one of the dietary strategies mentioned above each week, or perhaps you're ready to dive right in and try the Elimination Diet, the Anti-Inflammatory Diet, or the Healing Foods Plan. Go for it! You have nothing to lose, except maybe a few unwanted pounds, and you might even find you have gained renewed health. 

Sources
(1) Pieroni, A., Price, L., Eating and Healing: Traditional Food as Medicine, Haworth Press, 2006.
(2) Barbara Schmidt, David M. Ribnicky, Alexander Poulev, Sithes Logendra, William T. Cefalu, Ilya Raskin, A natural history of botanical therapeutics. Science Direct. - http://mss3.libraries.rutgers.edu/dlr/TMP/rutgers-lib_24171-PDF-1.pdf 
(3) University of Minnesota Center of Spirituality and Healing - http://www.takingcharge.csh.umn.edu/explore-healing-practices/botanical-medicine-0
(4) European Botanical Forum - Benefits of Botanical Foods -http://www.botanicalforum.eu/uploads/Fact%20File%203.pdf 
(5) http://www.ncbi.nlm.nih.gov/pubmed/12442909
Wikipedia - secondary metabolites - http://en.wikipedia.org/wiki/Secondary_metabolite
Wikipedia - bioactive-  http://en.wikipedia.org/wiki/Bioactive
Wikipedia - polyphenol antioxidant - http://en.wikipedia.org/wiki/Polyphenol_antioxidant
Functional Medicine - http://www.functionalmedicine.org/content_management/files/ifm_Comp_Elim_Diet_091503.pdf
Dr. Weil - http://www.drweil.com/drw/u/PAG00361/anti-inflammatory-food-pyramid.html

Chemical body burden: Are you toxic?

As the Britney song goes, "Don't you know that you're toxic?" Given that the belt I purchased on sale recently contained lead, these lyrics could be prophetic. I just might be toxic! Of course, the toxic love Britney sings about isn't to be taken lightly. Thankfully, we usually have the option to walk away from a toxic relationship. I wish the same could be said about the toxins in our environment.

Toxins in our environment-

How did we get here? Warning labels attached to accessories? You would think that the past experiences of public safety concerns due to chemical risks would have brought about a change in practice. For example, toys, jewelry, accessories, clothing, furniture, crafts, foodware and office supplies have been recalled because they were found to contain dangerous levels of heavy metals, usually lead and/or cadmium. Evidently, if we are warned about something containing a toxic substance, that somehow makes it OK to be sold. 

I know, "caveat emptor" and all that. Given that you're reading this it's probably safe to say that you're concerned about your health and all that influences it. So, when we choose our purchases we try to consider their impact on us and our environment. I could simply choose to buy a different belt.  One that doesn't contain lead. But how would I know which belt doesn't contain a toxic substance given that this warning label isn't required by every state government? How are we to ascertain whether something we are purchasing contains a toxic substance known to cause harm to our health and well being?

Toxins in our bodies: biomonitoring and body burden-

An even bigger question for me is how many of these toxic substances are we exposed to in our environment, and what are the cumulative health risks, if any? In the bigger scheme of health hazards, wearing a belt that may expose me to a low dose of  lead might seem relatively benign. However, when you combine that particular exposure with the multitude of other toxins we encounter daily, the health risks increase and we end up with something scientists call the body burden (1).

According to the Environmental Working Group (EWG), body burden is the total amount of of toxic chemicals that have built up over time in our bodies (1). "Scientists estimate that everyone alive today carries within her or his body at least 700 contaminants, most of which have not been well studied" (3). To my horror I learned that the presence of toxic chemicals is found even in fetuses (2)(3). Evidently, pregnant mothers unintentionally pass toxins on to their babies through the placenta. According to the EWG, "358 industrial chemicals, pesticides and pollutants [were found] in the cord blood of American infants" (6). One expert calls this the state of being born "pre-polluted" (4).

The knowledge of body burden is available because scientists are now better able to measure and track the levels of chemicals present in us through blood, urine, breast milk and hair specimens. This process is called biomonitoring. According to Commonweal Breast Cancer Fund, biomonitoring is an important process for monitoring public health because it indicates "trends of exposure, identifies highly exposed communities and helps in setting priorities for legislative and regulatory action" (10). You can find one overview of some of the chemicals currently being biomonitored here, as well as the CDC's 4th Report on Human Exposure to Environmental Chemicals here. Interestingly, biomonitoring is also being used to watch wildlife that inhabit chemically contaminated environments like toxic waste dump sites. Scientists find that biomonitoring these animals serves as a "front line indicator of pollutant levels and potential health impacts" (7). You can read more about this here at the National Institute of Environmental Health Sciences.

Chemical regulation - Innocent until proven guilty-

When it comes to the chemical industry and our government's regulation of it, it appears their thinking is that chemicals are innocent until proven guilty. Historically speaking, it hasn't been until recent times that chemicals and their link to ill health effects have come under closer scrutiny. Back in the 1970's, the US Environmental Protection Agency (EPA) began to regulate a limited number of chemicals, mostly pesticides, under the Toxic Substance Control Act (TSCA). In 1992, the TSCA was amended to include a Lead Exposure Reduction Provision.

Toxins and health effects-

The health problems resulting from lead exposure are documented and well-known, with children being the most adversely effected. It took years, but health advocates pushed for tighter regulation of lead. As a result unleaded gas, paint and plumbing components are now the norm (5). However, as is evidenced by the warning label attached to my belt, lead is still finding its way into our lives. The lead example highlights what is broken with the current laws: 1) poor control of the import of goods made in countries that still allow the use of toxic substances and 2) current regulations are outdated.

The TSCA was enacted before the current scientific findings that show even small levels of chemical exposure, which were once considered harmless, actually do cause detrimental health effects. In addition, there are now hundreds of new chemicals that have been created since the TSCA went into effect. These chemicals aren't being regulated. Also, the present regulation of chemicals tends to focus on the effect that just one chemical has on our health and not the effects of total body burden. Given the past negative history of, for example, lead, one would expect that the government would choose to err on the side of caution and at least restrict the use of newer chemicals until more is known about their effects on us. Sadly, this just isn't the case. This wait and see attitude is like playing a game of chemical roulette. 

Since this post is focusing on what we can do to limit our body burden, I won't go into a lot of detail about the ill health effects of toxins.  Suffice to say, current scientific evidence clearly shows increased risk for birth defects, as in genetic mutations, reproductive issues, and cancers (3). These risks, combined with the fact that babies are being born pre-polluted is compelling enough to take at least a little protective action.

How are we exposed? The biggest chemical culprits-

One of the biggest areas of our exposure comes from the consumer products we use. Government health authorities have identified the following chemicals as being "human carcinogens, serious neurotoxins or well-established hormone disrupters" (4), so it would seem prudent to try to limit our exposure to these (click on each if you want to learn more):

• Brominated flame retardants
• pesticides
• the Teflon chemical PFOA
• the Scotchgard chemical PFOS
• BPA
• lead
• cadmium
• mercury
• perchlorate
• dioxins
• furans

Several other areas of exposure include the air we breathe, the water we drink and the foods we eat. If you've just thrown your hands up in surrender, I share your frustration. However, the situation isn't hopeless.  We may not be able to avoid toxins, but there are things we can do to reduce our level of exposure. Checking to see what your body burden currently is might seem like a logical place to begin.  However, at this point experts are saying that individual biomonitoring is difficult to use for specifically assessing how relevant your individual results are to your actual risk for disease. So, where do we begin?

What we can do to limit our body burden:

1. Let our government officials know that:
• we find the current regulation of chemicals unacceptable.  Public outcry was exactly what prompted the chemical DDT to be banned. The EWG states that "Proper environmental regulation does work to reduce people's chemical burdens" (8). The Toxic Substances Control Act must be amended to at least require that the complete health and safety data on chemicals be known and disclosed to the public. No more innocent until proven guilty. Dangerous chemicals should be phased out and safer alternatives assured.
• we desire community biomonitoring programs. The Centers for Disease Control (CDC) has been conducting biomonitoring for the past 30 years and several states are also biomonitoring for a small number of specific toxins only. One example is the program in Pennsylvania that tracks blood lead levels (9). You can read more about this at the CDC site here. However, more wide-spread biomonitoring of the chemicals experts have linked to increased risk for disease needs to be conducted in communities.
2. Support "watch dog" organizations that advocate for us by keeping an eye on the largely unregulated chemical industry, like the Environmental Working Group,  The Natural Resources Defense Council, or the Children's Environmental Health Network.
3.  Filter your water.
4. Buy organic foods if possible, especially if you have young children. If this isn't an affordable option, try to focus on buying organic products that make the most difference.  EWG has a handy list of the most pesticide laden produce here and it's also available as a free Iphone app.
5. Know what's in your personal care products and household cleaners and what chemicals to avoid. The list above gives you a good head start. Try to use natural products. You can read more about the natural personal care products at Skin Deep here and the household cleaning products here.
6. Know what kind of plastics are safer and avoid plastic baby bottles, water bottles, toys, teethers and  pacifiers and canned foods whose cans are lined with BPA. Avoid microwaving foods in plastic containers.
7. Throw away aluminum cookware and pans with non-stick coated surface. 
8. Avoid fabrics treated with flame retardants, wrinkle relaxers or stain repellents and limit use of fabric softeners and air fresheners.
9. Use low VOC (volatile organic compounds) paints whenever possible.
10. Try not to use chemical pesticides on your lawn, pets or in your home and take your shoes off before you walk in the house.

The evidence linking toxins to deteriorating health is mounting and seems compelling. The good news is that by becoming educated about the situation we can take steps to decrease our chemical body burden. While making these changes in our lifestyle are important to reducing our chemical exposure, it is critical that we also push for improved government and industry standards regulating chemicals.

As for the lead belt that prompted this post, it went back to the store, along with a letter to the company letting them know how I feel about their sale of a lead laced accessory! I like a bargain, but with this purchase I got more than I bargained for!    


Sources
(1) Environmental Working Group (EWG) http://www.ewg.org/news/proof-burden 
(2) Biomonitoring http://www.cdc.gov/biomonitoring/
(3) Chemical Body Burden http://www.chemicalbodyburden.org/whatisbb.htm
http://frwebgate.access.gpo.gov/cgi-bin/usc.cgi?ACTION=RETRIEVE&FILE=$$xa$$busc15.wais&start=9720137&SIZE=4204&TYPE=TEXT
Environmental Protection Agency (EPA) http://www.epa.gov/lead/pubs/titleten.html
(4) EWG http://www.ewg.org/minoritycordblood/pressrelease
(5) EWG http://www.oregon.gov/DHS/ph/lead/docs/introhealtheffectsmedicalprovider.pdf?ga=t  
(6) EWG http://www.ewg.org/files/2009-Minority-Cord-Blood-Report.pdf
(7) National Institute of Environmental Health Sciences - http://www.niehs.nih.gov/research/supported/srp/products/products2_s3_s1.cfm 
(8) EWG http://www.ewg.org/news/proof-burden
(9) Centers for Disease Control (CDC) - http://www.cdc.gov/nceh/tracking/trackbiomon.htm

The not so rosy side of breast cancer pink ribbons

National Breast Cancer Awareness month celebrates its 26th anniversary this year, and pink seems to be everywhere. Even football players are wearing pink. Have you ever wondered how this campaign began and what impact it is actually having on the prevention of breast cancer? Personally, I didn't give it much thought, that is until I was diagnosed with breast cancer. Before then, I rather naively assumed that anything pink was linked to a benevolent organization that was supporting the critical research needed to prevent the disease. That's why it came as a total surprise to realize that when it comes to the pink movement it seems there's a whole lot of gray.

Before I get to the gray, here's a brief history of the pink. Back in 1985, National Breast Cancer Awareness Month (NBCAM) was organized through the sponsorship of Astra Zeneca, a pharmaceutical company, the American Academy of Family Physicians, a medical society, and CancerCare, Inc., a non-profit. More on this later, suffice to say for now that their purpose in forming NBCAM was to "promote breast cancer awareness, share information on the disease and provide greater access to screening services." NBCAM's initial week long event spawned what is now an internationally recognized month devoted to breast cancer awareness.

On to the story of how breast cancer awareness became wrapped up in a pink ribbon. In the early 1990's, activist Charlotte Haley was inspired by the yellow ribbons tied on trees to honor American soldiers. She decided to make peach ribbons in her home and distribute them in an effort to raise public awareness about the National Cancer Institute's small percentage (5%) of their then $1.8 billion budget going towards cancer prevention.  Her efforts caught the attention of Estee Lauder and Self Magazine executives. They contacted Charlotte about joining her efforts.  She refused saying they were "too commercial". The attorneys at Self Magazine suggested that the color of the ribbon be changed in order for Self to use the concept. That's when the pink ribbon began to be associated with breast cancer, and shortly after Avon began their breast cancer cause related marketing campaign. 

Now, there is absolutely nothing wrong with pink ribbons, or raising money for cancer research, or providing greater access to mammography for the under or uninsured. When done altruistically, these are extraordinary  things. What is disconcerting is when pink ribbons are used to boost a company's profits or image under the guise of philanthropy. Unfortunately, it seems that breast cancer has become big business. It's because of those seeking to profit from breast cancer that some critics of NBCAM are now referring to it as "BCAM SCAM", or Breast Cancer Industry Awareness Month.  But how is it that such a noble and worthy cause has come to be viewed by some as a scam? To answer this question, a little research, along with some open minded consideration, is required.

When it comes to the public's health, the primary goals of health officials are prevention, intervention and eradication of disease, with prevention being preferable to intervention (McKenzie). For example, "immunizing to prevent a disease is preferable to taking an antibiotic to cure one" (McKenzie). Case in point, the human papillomavirus (HPV) vaccine and cervical cancer. Yet, when we look at the pink ribbon message, it focuses not on prevention, but detection and cure. Wait a minute. If prevention is preferable, why is the push for detection and cure? Because the detection and treatment of breast cancer has become a multi-billion dollar industry. Simply stated, prevention just isn't as profitable.

Skeptical? Perhaps a closer look at NBCAM might provide additional insight. Their organization was formed by Imperial Chemical Industries, the creator of Tamoxifen, a breast cancer treatment drug. In the 90's, Imperial Chemical Industries spun off Zeneca Group. Then Zeneca merged with Astra and became Astra Zeneca, which formed a non profit arm that is known today as AstraZeneca Healthcare Foundation, one of the largest financial contributors to NBCAM.  Astra Zeneca also created and markets Arimidex, another breast cancer treatment drug. CancerCares was also involved in the formation of NBCAM. A look at their donors reveals several pharmaceutical companies as well. So, what message would you want to spread if you were a drug manufacturer financially invested in breast cancer treatment medications? Probably not prevention. Might this explain NBCAM's focus on awareness and detection? To be clear, I'm in no way suggesting that awareness, screening and early detection of breast cancer is negative. The point is non-profit organizations accepting donations from companies that stand to gain from their philanthropy seems to represent a conflict of interest.

The pink campaign isn't only effected by conflicts of interest. There are also the companies that profit from linking their products to the breast cancer cause. At first glance this may seem altruistic, but sometimes things aren't always as transparent as they seem. For example, 12 years ago Yoplait began a pink ribbon campaign called Save Lids to Save Lives. A portion of the proceeds from the sale of their yogurt are donated for breast cancer research. The conflict resulted from their yogurt being made with milk from cows that were given a synthetic growth hormone, called rBGH. This chemical has been linked to breast cancer and is banned from use in many countries. You can read more about the topic here, and Oregon Physicians for Social Responsibility has an interesting video discussing rBGH and milk found here or click on the Videos tab in this blog.

The term "pinkwasher" has been used to describe a company "that purports to care about breast cancer by promoting a pink-ribboned product, but manufactures products that are linked to the disease" (Breast Cancer Action). When you consider that Yoplait was both contributing to and profiting from breast cancer, one could say they were successful at "pinkwashing." Thankfully, because of pressure brought about by health activist groups, like Breast Cancer Action and their "Put a Lid on It" campaign, as well as concerned consumers, to their credit as of 2008 Yoplait has stopped using rBGH milk in their yogurt.

The above is just one example of pink ribbon profiteering. Breast Cancer Action has some great information on their Think Before You Pink site to help guide consumers when purchasing "pink" products. They suggest asking the following questions:

1. How much money from your purchase actually goes toward breast cancer?
2. What is the maximum amount that will be donated? Sometimes contributions are capped at a certain amount. 
3. How are the funds being raised? 
4. To what breast cancer organization does the money go, and what types of programs does it support?
5. What is the company doing to assure that its products are not actually contributing to the breast cancer epidemic? 

You can find a more detailed discussion of these points here.

In a recent post I mentioned my support of the Love/Army of Women, a non-profit foundation dedicated to stopping breast cancer before it starts.  At first inspection I felt this group represented something that I feel is of critical importance - the need for more research into the prevention of breast cancer. However, after closer scrutiny I realized that this group is funded through a grant from Avon. This cosmetics company uses a number of chemicals in their products that have been linked to cancer through standard laboratory feeding tests done on mice and rats by the National Toxicology Program. Their study results have been published and accepted by the International Agency for Research on Cancer. A perfect example of the importance of the need to "think before I pink."

A final thought. On my last visit to the doctor she mentioned that Tamoxifen is now being recommended as a breast cancer prevention treatment for women who are considered to be at high risk for developing the disease. I was hoping that more breast cancer prevention research would be focused on how to reduce our exposure to cancer causing agents, such as the above-mentioned chemicals. Sadly, this doesn't appear to be a research priority, but it's not that surprising.  All things considered, I suppose drugs would be the first line of defense offered for prevention, if the pharmaceutical and chemical companies are underwriting a great deal of the research being conducted in the area of cancer prevention. Evidently there isn't anything completely transparent when it comes to this issue. One thing is for certain, pink looked a whole lot rosier before I took off my rose-colored glasses.

Sources
McKenzie, J., et.al., An Introduction to Community Health, 5th Ed., Jones & Bartlett, MA, 2005
http://www.nbcam.org/newsroom_nbcam_facts.cfm
http://bcaction.org/index.php?page=newsletter-88d
http://www.safe2use.com/drsherman/life/15.htm
http://www.cancercare.org/about_us/
http://www.cancercare.org/about_us/annual_reports/2009/donors.php
http://globalrace.info-komen.org/site/PageNavigator/hq_gr_learn_FAQ_2010
http://en.wikipedia.org/wiki/Imperial_Chemical_Industries#History
http://www.cancer.gov/cancertopics/factsheet/Risk/HPV
http://www.ajcn.org/cgi/content/full/86/3/878S
Lancet - Circulating concentrations of insulin like growth factor 1 and risk of breast cancer -  http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2897%2910384-1/abstract
Potential public health impacts of the use of recombinant bovine somatotropin in dairy production - http://www.consumersunion.org/food/bgh-codex.htm
Breast Cancer Action - http://thinkbeforeyoupink.org/?page_id=10
http://ntp.niehs.nih.gov/

Breast cancer jeopardy: cause vs. cure

Image from Memphis Flyer

Would you like to play a game called Breast Cancer Jeopardy? I'm going to assume a very firm and collective NO answer to this question. Unfortunately, the reality is regardless of whether or not we want to play, we are in the game. This is because when it comes to risks for breast cancer (BC), there are some we simply cannot avoid.

For example, if you're a woman who is aging, than you're playing breast cancer jeopardy because these are  the 2 biggest risk factors for breast cancer. Here are other risks both in and out of our control:

• Being over 40 years old
• Having genetic links, or family members with breast, prostate or ovarian cancer
• Having high breast density on a mammogram
• Never having children
• Having your first child after age 35
• Going through menopause after age 55
• Being exposed to radiation, or having frequent x-rays in youth
• Overweight after menopause or weight gain as an adult
• Used or are using hormone replacement therapy

All of these up our stakes in the BC jeopardy game. Yet, even with all the information we have about the known risk factors, 80% of women in America who get breast cancer have no other risks besides being a woman.  According to the Dr. Susan Love Research Foundation, "more than 4 billion dollars has been spent on breast cancer research over the past 25 years". Yet, we still have no idea what causes this disease.  To date, doctors and researchers have focused most of their attention on curing breast cancer. Personally, I would rather not have gotten the disease in the first place!

Now, please don't get me wrong. It's wonderful that the focus on finding a cure has led to great strides in detecting and treating breast cancer. However, it seems to me to make more sense to turn our attention to what is causing breast cancer and stopping it before it starts. An ounce of prevention is worth a pound of cure, right?

A recent example of the medical community turning their research focus toward the cause and prevention of a disease is cervical cancer.  Through their study of women, researchers discovered that the disease was caused by a virus. Fortunately, a similar approach is being taken by some researchers, who are now looking into determining the causes of breast cancer and ultimately figuring out how to eradicate it once and for all. One of these research organizations is the Love/Avon Army of Women (AOW). Their goal is to enlist one million women (men are welcome too) to participate in breast cancer research studies aimed at determining the causes of breast cancer - and how to prevent it. They are doing this by connecting breast cancer researchers via the internet with men and women willing to participate in a variety of research studies which are prevention based, not necessarily clinical trials.

Signing up for the Army of Women doesn't mean you're signing up for a study. You are just signing up to be added to the AOW database. Then you'll be able to hear about studies being conducted in your area in which you can choose to participate. All ethnicities, all ages (18 and older), healthy women, women with cancer, and women who are survivors can participate, depending on the study.

There is NO COST to join and NO DONATIONS are being solicited. All that's needed is your willingness to be informed about studies. Than you decide if you want to participate and which type of study commitment best fits you. Studies require a variety of things, anywhere from answering an online questionnaire to being asked for a blood sample. It's totally your choice and entirely up to you. So far, there haven't been any opportunities in my area that I have qualified for, but I'm continually updated and can choose what works for me.

Need more info? Check out the AOW website here and also look for their monthly webinars presented by the healthcare experts doing research studies on understanding the causes of breast cancer.
Let's increase our odds of winning the breast cancer jeopardy game by joining together to help encourage, support and maybe even participate in research for the cause of breast cancer.  A world without this disease is in our hands. When it comes to breast cancer, prevention really is the breast, I mean best medicine!


Sources
http://www.cancer.org/Cancer/BreastCancer/DetailedGuide/breast-cancer-risk-factors
Dr. Susan Love Research Foundation
Avon/Army of Women
http://clinicaltrials.gov/ct2/info/understand

Breast cancer prevention strategies

National Cancer Institute

When you hear health messages about cancer or any disease do you find yourself filtering it out? Well, if you do than this next sentence might cause you to stop reading, but please continue because there's a point I'm hoping to make. 1 out of 7-8 women will get breast cancer in their lifetime (American Cancer Society). Are you still reading? That's good, because the purpose of sharing that statistic was to illustrate that even though we frequently hear these kinds of health messages, we don't always feel connected to them. Perhaps you might be thinking as I did when hearing those numbers, wow, that sounds like a lot, but I'm not going to be the one.  Unfortunately, this kind of thinking often translates into inaction. Statistical health data, although sometimes shocking and troubling, may not be meaningful enough to inspire change for some of us.

If you find that you aren't motivated by statistics, you're not alone. Evidence suggests that health messages which highlight health consequences and the numbers of people who get disease aren't as effective as was once thought. What can be more successful in motivating change in health behaviors are messages that focus on causes and solutions for disease (McKenzie).

Obviously there is no clear solution to breast cancer at this point in time. However, there is a great deal of data available that is linking lifestyle factors with increased risk. This suggests that our best prevention strategy is to take steps to reduce our risk factors as much as possible. So, let's take a closer look at the modifiable risk factors -  in other words, the things we can do to lower the probability of  becoming one of the seven or eight women who will get breast cancer.

Prevention Strategies-

• Avoid weight gain and obesity - According to the National Cancer Institute (NCI), a gain in body mass index (BMI) may substantially increase a women's risk for breast cancer, especially after menopause.The NCI states, " In a recent analysis, women who reported a gain in BMI of five points [equivalent to about 30 pounds] or more between age 20 and postmenopausal age (ages 55-74) had nearly twice the risk of developing postmenopausal breast cancer compared to women who maintained their BMI during the same time period."  (You can read more about BMI in this post and more on this study here).  Interestingly, women who had never used hormone replacement therapy had the strongest association between breast cancer and BMI increases. It's also worth noting that regardless of a woman's starting BMI, if it went up 5 points the risk increased also.  This means that even if a woman's BMI is in the normal range to start with, a 30 pound weight gain during her lifetime doubles the breast cancer risk.
• Avoid hormone replacement therapy (HRT) - The study results of the Women's Health Initiative trial  showed that women taking hormones after menopause had more breast cancer than the women who took a placebo. Not only was increased cancer a risk, according to the Center for Science in the Public Interest, women taking estrogen plus progestin hormones were "29% more likely to have a heart attack, 41% more likely to have a stroke, twice as likely to have a blood clot and 47% more likely to show a marked drop on tests of memory and other mental abililties." Yikes! If avoiding HRT isn't an option, the Mayo Clinic suggests using the lowest dose possible and to shoot for short term use.
• Watch your diet, particularly the fats consumed - This will help with the first prevention strategy mentioned: avoid weight gain and obesity. The Mayo Clinic recommends limiting fat intake to "less than 35 percent of your daily calories" and also restricting "foods high in saturated fat." The findings from the Women's Intervention Nutrition (WIN) Study further suggests a diet consisting of  "lower proportions of saturated fats and higher proportions of polyunsaturated fats." If you want more details on dietary fat you can read more here and more specific details about the omega fats (polyunsaturated fats) here. 
• Get moving - Along with good nutrition, being more physically active will also help control weight gain. In addition, research from a recent study published in the American Journal of Clinical Nutrition on the relationship between BMI, physical activity and a woman's sex hormones showed that "low physical activity is linked with higher amounts of estrogens which is in turn linked with a higher risk of breast cancer."  So, how much physical activity should you aim for? According to the NCI, "existing evidence shows a decreasing risk of breast cancer as the frequency and duration of physical activity increase. Most studies suggest that 30 to 60 minutes per day of moderate- to high-intensity physical activity is associated with a reduction in breast cancer risk." 
• Limit alcohol consumption - Even though red wine has received a lot of good press with regard to heart health lately, it doesn't appear to be beneficial for reducing breast cancer, nor does drinking any alcoholic beverage. On the contrary, according to the Million Women Study which tracked over a million women for 7 years, "each daily alcoholic drink raised the risk of postmenopausal breast cancer by 12%." This is considered a modest, but significant increase in risk, especially when combined with additional risk factors. Another reason to limit alcohol is because calories contained in alcoholic beverages can be a factor in raising the daily amount of calories consumed, and therefore contribute to weight gain. 

If thinking about tackling the prevention strategies discussed above has you feeling overwhelmed, consider beginning with the most important step first - maintain or get to a healthy weight. This isn't just a positive step to take for breast cancer prevention, it's good for your overall health. There are many great resources on the internet to help you take action, just make sure they are credible sources. Also, make sure to talk these strategies over with your health care professional.

Making healthy choices is within reach when we have the information we need and the motivation to put the information into practice. Having knowledge of the known risk factors for breast cancer, as well as a corresponding plan of attack can be more empowering than a vague threat of becoming a negative health statistic. I know now that becoming a breast cancer statistic is a very real possibility. So it's important to take action sooner rather than later. 

Sources
http://www.cancer.org/acs/groups/content/@nho/documents/document/f861009final90809pdf.pdf
McKenzie, J. An Introduction to Community Health, 5th ed.
http://www.cdc.gov/healthyweight/assessing/bmi/
NCI - http://benchmarks.cancer.gov/2010/04/gain-in-body-mass-index-increases-postmenopausal-breast-cancer-risk/
Center for Science in the Public Interest, Nutrition Action Newsletter
http://www.mayoclinic.com/health/breast-cancer-prevention/WO00091
http://www.ajcn.org/cgi/content/full/86/3/878S
http://www.ajcn.org/cgi/content/abstract/86/3/817S
http://www.cancer.gov/cancertopics/factsheet/prevention/physicalactivity
http://www.millionwomenstudy.org/introduction/
http://mason.gmu.edu/~montecin/web-eval-sites.htm

Breast cancer risk indicators

Wouldn't it be great if doctors had a way to determine our individual risk factors for breast cancer? Then armed with this knowledge we could take specific steps or treatments to prevent the disease? Now you might be thinking, well, there's the mammogram, which has become the gold standard for breast cancer screening. There's also the breast MRI and ultrasound, and let's not forget the clinical or self breast exam. As important and useful as these tools are, they are not about the prevention of breast cancer. The focus of these tests is on detection not prevention, and these are two totally different things.

The National Cancer Institute (NCI) defines cancer prevention as an "action taken to lower the chance of getting cancer". When it comes to disease, prevention really is the best cure. Yet, compared to screening information, not much discussion about prevention is offered to women. 

There are three approaches to disease prevention one can take: reducing risk factors, increasing protective factors or doing both.  Risk factors are defined as anything that increases the chances of getting a disease. Protective factors are anything that helps to reduce the chances of getting a disease. Some risk factors for disease can be avoided and others cannot. For example, tobacco smoking, poor nutrition or lack of exercise can be changed, but a genetic tendency toward cancer cannot. Reducing risk factors and increasing protective factors can help lower the risk of getting cancer, but this doesn't guarantee you won't ever get it either. 

What are the risk factors for breast cancer? According to the NCI, studies have shown the following risk factors:

• Age
• Personal history of breast cancer
• Family history of breast cancer
• Certain breast changes
• Genetic alterations
• Menstrual history
• Race/ethnicity
• Radiation therapy to the chest
• Breast density
• DES (diethylstilbestrol) exposure
• Reproductive history
• Hormone use
• Obesity after menopause
• Physical inactivity
• Alcoholic beverage intake

The good news is that "most women who have these risk factors do not get breast cancer" (NCI). If you're interested in learning more about each of the risk factors listed above you can view more detailed information here. The National Cancer Institute also has an excellent resource called the Breast Cancer Risk Assessment Tool which you can access here. This tool helps estimate a woman's individual risk of developing invasive breast cancer. The NCI points out that no risk assessment tool is 100% accurate and that the tool does have limitations, but it is useful for providing insight into the factors that increase each individual woman's risk for breast cancer. Armed with this knowledge, it can then provide a jumping off point for discussion of an action plan for breast cancer prevention with a health care provider.

If you're considering a breast cancer prevention action plan, experts suggest beginning with specific lifestyle changes to increase the protective factors against developing breast cancer. There are several nutrition and exercise steps you can take, such as limiting alcohol, staying physically active, maintaining a healthy weight, watching the type of fat consumed in your diet (see previous post on understanding the omegas) and eating a diet that is rich in fruits and vegetables. Also, other lifestyle changes like limiting chemical exposure and avoiding antibiotics and hormones found in food can be protective as well (Mayo Clinic and Linus Pauling Institute).

Many of the posts in this blog are focused on providing more information about each of these protective factors against cancer. I believe that when it comes to our health, knowledge is power. It's easy for medical misinformation to result. For example, a news story might have misinterpreted the findings from a research study, or the story that is reported may be a small portion of the bigger picture. In addition to confusing information, medical terminology, data and statistics can often seem overwhelming and frightening.

Rather than living in the shadow of fear that can be created by misinformation and technicality, we can attempt to become empowered by educating ourselves. We can learn more about our own health, beginning with knowing our own realistic level of breast cancer risk. Armed with this knowledge, we can then talk to our medical professional about ways to reduce the risk factors and increase the protective factors that are within our control.  That old saying really is true - an ounce of prevention is worth a pound of cure.



Sources
National Cancer Institute -
Breast Cancer Risk Assessment: http://www.cancer.gov/bcrisktool/
Mammogram: http://www.cancer.gov/cancertopics/factsheet/Detection/mammograms
MRI and ultrasound: http://www.cancer.gov/cancertopics/factsheet/Detection/breast-cancer
Risk factors: http://understandingrisk.cancer.gov/a_breast/01.cfm
Science Daily - http://www.sciencedaily.com/releases/2010/04/100421102338.htm
http://www.cancer.org/Cancer/BreastCancer/DetailedGuide/breast-cancer-detection

DCIS Diagnosis? At least get a second opinion.

Image via Wikipedia

When it comes to your health, YOU are your own best advocate. I recently found this out the hard way. In January of this year I went in for a routine mammogram that turned out to be anything but routine.  My doctor did a biopsy and sent it off to a pathologist. His diagnosis: ductal carcinoma in situ or DCIS.

What is DCIS? It's a type of early stage breast cancer located in the milk duct(s). In situ, I learned, is Latin for "in place". In the world of cancer this is a good thing because it means that the cancer cells are contained within the breast's milk duct, and haven't broken out and infiltrated to other areas. The Wikipedia image above illustrates the type, placement and progression of cells from normal to invasive breast cancer.

DCIS has become one of the most commonly diagnosed breast cancers.  It is also sometimes referred to as Stage Zero. To add to the confusion, some doctors don't consider DCIS cancer at all. Yet, the treatments for DCIS are typically the same as those for early stage invasive cancers. Most doctors I spoke with used the terminology ductal carcinoma in situ. Whatever it's called, when you hear you have cancer it rocks your world.

After my doctor called to report the pathology diagnosis of DCIS, I started thinking about how my life had been completely altered by one individual's assessment of my biopsy. It occurred to me that everything hinged on that pathology report. After the initial shock wore off, I found myself in a state of denial. However, in my case denial turned out to be a good thing because it motivated me to get a second opinion.

I'm fortunate to live near a university hospital and several large medical centers with expert physicians. Still, I decided to seek a second opinion from a pathologist outside of  my area. I learned that it's not uncommon for local patholgoists to support each others diagnoses.  As a result, it's important to get a second opinion from a pathologist who is at least associated with a different hospital. I chose the expertise of  Dr. Michael Lagios, an independent pathologist located in California who is experienced in the pathology of  DCIS. His diagnosis differed from that of the first pathologist. Now, I felt I needed a third opinion to break the stalemate so to speak.

My third opinion came from a group of doctors affiliated with a local hospital, but not from the same hospital as the first pathology report. They all agreed that mine was a tricky case, but that's where their agreement ended. They were split in their diagnoses.  My case was then presented to a tumor conference.  Ask your  doctor if they attend these sessions which are usually held monthly. At the very least, it is important that they are discussing your case with other experts. The consensus of the tumor conference was that they leaned more toward the second pathologist's opinion.

Needless to say, trying to get a diagnosis was a very frustrating, time consuming and emotional journey, but for me it was absolutely necessary! I realized that sometimes doctors really don't have all the answers. I was fortunate. My radiology oncologist, Dr. Mark A. Engleman, didn't scorn or dismiss me. He didn't diminish my need for a third opinion.  He supported me and encouraged me to be my own health advocate. He recognized the importance of getting the most precise diagnosis possible BEFORE he started radiation treatment. Not all doctors feel comfortable when put in this position. I can't say enough about his care and professionalism.

I'm still not sure I feel I've received an absolutely definitive diagnosis. One thing I do know for certain. When it comes to DCIS pathology there is sometimes a gray area. It isn't always a clear cut, black or white situation. Unfortunately in my case the uncertain diagnosis has made decision making about treatments more challenging. The up side is because I sought these additional expert opinions I feel I can make a more informed evaluation and decision regarding treatments. This approach worked for me. Having said that, I'm still working toward feeling okay with the uncertainty surrounding my diagnosis and the treatment decisions I made.

The Dallas Morning News ran a New York Times article this week that hit a nerve for me. Stephanie Saul's  article discusses the difficulties of diagnosing DCIS and she shares one woman's compelling journey from misdiagnosis to treatment in the video below. Sadly, the woman in the article lost a quarter of her breast and later learned she didn't have cancer. Perhaps if she had sought a second opinion, she might have been spared that trauma and loss. If I can share one thing I've learned from my experience it's this - when it comes to DCIS, or really any diagnosis, it's important to be your own health advocate and consider a second opinion.

 




Sources
http://www.wisegeek.com/what-is-a-pathologist.htm
http://www.wikipedia.com
 http://www.dcis.info/second-opinion.html

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