November 15, 2012

Virender Sodhi, MD(Ayurved),ND

Breast cancer is the most frequently diagnosed cancer in women in the U.S. It is the second most frequent cause of cancer death (41,000 deaths per year) 1. According to National Cancer institute, a woman’s lifetime risk of developing cancer is 1 in 8. In 2007, the latest year for which updated statistics are available, the U.S. incidence rate for female breast cancer was approximately 125 new cases diagnosed for every 100,000 women in the population and the mortality rate was approximately 23 deaths for every 100,000 women. The breast cancer death rate in the United States has been declining steadily since 1989-1990, when it peaked at a rate of 33 deaths for every 100,000 women. The fall in breast cancer deaths is mainly due to stopping of hormone replacement therapy in post-menopausal females.

Breast cancer is of two types: Ductal i.e. carcinoma in the cells that line the ducts (tubes that carry milk to the nipple) of breast or Lobular i.e. cancer of the lobules (glands where milk is formed) of breast. About 80% of invasive carcinomas are ductal carcinomas; 8% to 15% are infiltrating lobular carcinomas 1

According to Ayurveda, unbalanced physiology (doshas) –> leads to faulty inherent intelligence –> leading to malfunctioning of genes and gene behavior leading to diseases like cancer. We all make cancer cells every day but our immune system is very sharp and not only recognizes the bad faulty cells but also sends its own army to destroy it. That is why balance at mental, emotional, physical and spiritual health is very important part of healing.

Who gets it? Risk factors for Breast Cancer

  • Age:Risk increases with age. More than half the risk increases after the age 60. One third risk occurs after age 75y. The average age of breast cancer in general population is 62 years1, 3.
  • Family history: Women who have an especially strong family history, e.g., two or more first-degree relatives (a mother, daughter, or sister) with breast or ovarian cancer, particularly before menopause carry a greater than 50 percent chance of developing breast cancer. This represents an approximately five- to 10-fold increase in a woman’s baseline risk of developing breast cancer3.
  • Genetics: In 1994, the first gene associated with breast cancer — BRCA1 (for BReast CAncer1) was identified on chromosome 17. A year later, a second gene associated with breast cancer — BRCA2 — was discovered on chromosome 13. When individuals carry a mutated form of either BRCA1 or BRCA2, they have an increased risk of developing breast or ovarian cancer at some point in their lives. Children of parents with a BRCA1 or BRCA2 mutation have a 50 percent chance of inheriting the gene mutation.
  • Ashkenazi Jews and Breast Cancer In 1995 and 1996, studies of DNA samples revealed that Ashkenazi (Eastern European) Jews are 10 times more likely to have mutations in BRCA1 and BRCA 2 genes than the general population. Approximately 2.65 percent of the Ashkenazi Jewish population has a mutation in these genes, while only 0.2 percent of the general population carries these mutations. However, despite the relatively high prevalence of these genetic mutations in Ashkenazi Jews, only seven percent of breast cancers in Ashkenazi women are caused by alterations in BRCA1 and BRCA2. Interestingly Brazilian Ashkenazi women carrying similar gene have no extra risk of developing breast cancer than the rest of the population. Is this nutrition, exercise, sunshine, weight consciousness or social structure which does not create extra cancer in these females? Lot of time I hear this from my patients that I have faulty gene for this and this disease. But genes are under control of environment which you can modify with your thought process, nutrition, exercise and stress reduction. Not all hereditary breast cancers are caused by BRCA1 and BRCA2. In fact, researchers now believe that at least half of hereditary breast cancers are not linked to these genes. Scientists also now think that there are many genes, each accounting for a small fraction of breast cancers.
  • Gender: < 1% of all breast cancer cases occur in men1.
  • Dense breast: Data has shown that women with high density of breasts on mammogram; breast biopsy that revealed proliferative abnormality; and those who have undergone high dose radiation therapy to chest region have an increased risk of breast cancer3. Making you think that if yearly mammography is good preventive tool or not.
  • Menstrual history: Early menarche and late menopause have greater risk for breast cancer1,3. The longer the woman exposed to estrogen, the greater the risk of developing breast cancer. Making you think if birth control pills which is being given to our young girls like candies, has something to do with increased breast cancer incidents.
  • Pregnancy and breast feeding: Late first pregnancy (> 30 years) and never been pregnant (nulliparity) increases risk of breast cancer.
  • Hormone replacement therapy (HRT): Women health initiative study published in 2004, showed that females who took Prempro, which is a combination of estrone, estradiol and progestin (a synthetic progesterone like hormone), between the ages of 50 to 79, had 26% increased risk of developing breast cancer, 29% increased risk of heart attack, 41% increased risk of strokes and double the risk of developing clots. To translate this data in real life situation, for every 100,000 females there was 80 more deaths due to breast cancer, 70 more heart attacks, 80 more strokes and 80 more blood clots in lungs. After stopping the use of Prempro there have been a sharp fall in the breast cancer, heart attacks, strokes and lung clots; whereas, the use of bio-identical hormone therapy does not show any increase of these diseases compared to non-users.
  • Alcohol:Alcohol intake increases risk of breast cancer in females. One glass of wine a day may not provide protection to heart in case of females. One of the explanations is that alcohol makes more estrogen, and the second is that females may be lacking enzymes which degrade alcohol, creating more free radicals. Recently scientist found protein CYP2E1, which is found more in females and it leads to more free radical damage. According to the study published last year on November 1, 2011 by Dr.Wendy. Y.Chen at Harvard, who studied more than 100,000 females for 28 years, found a very clear link in females who were drinking 3-6 glass of wine/week. This is ½ to 1 glass of wine per day, there was 15% increase in breast cancer. In females who were drinking 30 glasses of wine/ week had 51% increased risk of developing breast cancer. And it did not matter what kind of alcohol you consumed.
  • Weight: obese women are more likely to get breast cancer after menopause. Fat manufactures more hormones and also store more toxins like pesticides, insecticides and others.
  • Presence of other cancers: presence of cancers other than breast cancer also increases the risk of developing breast cancer.
  • Diet and lifestyle: eating high fat diet and low physical activity is associated with higher risk of getting breast cancer.
  • Socioeconomic status: women of high socioeconomic status are more likely to develop breast cancer may be due to alcohol, smoking or stress.
  • Ethnicity: black women are more likely than Asian women to develop breast cancer before age 40, while white women are more likely than Asian to develop breast cancer at the age of 40 and older.
  • Smoking: increases the risk for breast cancer.
  • Mood: bad mood, bad life incidence and work load increases chances of breast cancer4.
  • Wearing bra with steel rings and sleeping with bra5 increases the chances of breast cancer. Breast is one of the biggest lymph gland and it needs to have exercise to drain.
  • Factors which can reduce the risk of breast cancer:

    • Breast feeding for at the least 12 months.
    • Oophorectomy (removal of ovaries) before age 35y however, it puts them at higher risk for more common disease such as coronary heart disease and osteoporosis.
    • Increased physical activity.
    • Avoiding adult weight gain and maintaining a healthy weight reduces postmenopausal breast cancer risk.
    • Very limited amount of alcohol consumption.
    • Sleeping without bra.
    • Eat 7-8 servings of vegetables. If you cut vegetable and put that in one 8 ounce cup, that is one serving. Cooked will be 3-4 cups per day.
    • Eat 1-2 handful of different nuts, like almond, walnuts, pecans, pistachios, pumpkin seeds, brazil nuts, macadamia, hemp seeds etc. These nuts and seeds should be raw, unroasted and unsalted. Soaking overnight in water is good practice to activate enzymes in these seeds.
    • Take 1-2 tablespoon of chia seeds and Flax seeds per day. Research has shown that consuming soy and soy products1, lignans rich foods like flax seeds can benefit postmenopausal women and even women who are at high risk for breast cancer. Add soya and other bean products 1-2 servings per day.
    • Eat 2-3 seasonal fruits per day. Research has shown that Pomegranate juice and its components inhibit metastatic processes in breast cancer cells18. Strawberries ( organic) fruit carry preventive and therapeutic properties toward breast cancer19
    • Avoid fried food, sugar, red meat and extra calories. Eating less calories certainly helps not to grow cancer cells at all. Best way of eating less calories is to eat lots of vegetables.
    • Avoid emotional pitfalls: anger, hatred, jealousy, low self –esteem and self- hatred. Go for counseling to address deep-seated grief, anger, and resentment.
    • Avoid environmental exposure to chemicals, pesticides, solvents, emissions, industrial wastes.
    • Go for brisk walk for 45 min per day in open air.
    • Do t’ai chi, yoga and meditation every day.
    • Breast massage (Stanya shodhana)- using breast massage oil, coconut oil, castor oil or olive oil helps to immobilize the accumulated toxins and helps breast detoxification.
    • Do Panch Karma detoxification treatments to detoxify your body.

    Ayurvedic Herbal treatment:

    Ayurvedic herbs which have anti-cancer activity are:

    • Tumeric8, 9,
    • Amla10,
    • Ashwagandha11,
    • Boswellia12,
    • Nigella sativa13,
    • Rhubarb root,
    • Triphla and many more14.

    Prevention is better than cure:

    Death is eminent, we all die one day. One should not be afraid of death. To enjoy the full fruits of life, eat healthy organic foods, more on the vegetarian side, with little animal protein, exercise regularly; do self breast examination; stay happy, enjoy every moment of life, go for yoga and meditation to balance ups and downs of life, take good care of oneself and finally keep positive attitude. Life is sacred, you have the owner’s manual in your hand to prevent breast cancer or many other diseases.

    References

    1. http://www.mdconsult.com/das/pdxmd/body/374910223-3/1369793055?type=med&eid=9-u1.0-_1_mt_1014646
    2. http://www.cancer.gov/cancertopics/factsheet/cancer-advances-in-focus/breast
    3. http://www.uptodate.com/contents/risk-factors-for-breast-cancer-beyond-the-basics?source=see_link
    4. Zhang AQ, Xia JH, Wang Q, Li WP, Xu J, Chen ZY, Yang JM. [Risk factors of breast cancer in women in Guangdong and the countermeasures]. Nan Fang Yi Ke Da Xue Xue Bao. 2009 Jul;29(7):1451-3. Chinese. PubMed PMID: 19620080.
    5. Yao XY, Ni SS, Zhou J, Hu HY, Li LL, Wan F, Wang YK, Chen YD. [A case-control study on risk factors of female breast cancer in Zhejiang province]. Zhejiang Da Xue Xue Bao Yi Xue Ban. 2012 Sep;41(5):512-8. Chinese.
    6. http://www.health2us.com/bra.htm
    7. http://www.namaskarhealing.com/files/namaskarhealing/files/articles/Breast_Cancer.pdf
    8. Chang CC, Fu CF, Yang WT, Chen TY, Hsu YC. The cellular uptake and cytotoxic effect of curcuminoids on breast cancer cells. Taiwan J Obstet Gynecol. 2012 Sep;51(3):368-74. doi: 10.1016/j.tjog.2012.07.009. PubMed PMID: 23040919
    9. Sun XD, Liu XE, Huang DS. Curcumin induces apoptosis of triple-negative breast cancer cells by inhibition of EGFR expression. Mol Med Report. 2012 Dec;6(6):1267-70. doi: 10.3892/mmr.2012.1103. Epub 2012 Sep 26. PubMed PMID: 23023821.
    10. Ngamkitidechakul C, Jaijoy K, Hansakul P, Soonthornchareonnon N, Sireeratawong S. Antitumour effects of Phyllanthus emblica L.: induction of cancer cell apoptosis and inhibition of in vivo tumour promotion and in vitro invasion of human cancer cells. Phytother Res. 2010 Sep;24(9):1405-13. PubMed PMID: 20812284
    11. Llanos GG, Araujo LM, Jiménez IA, Moujir LM, Bazzocchi IL. Withaferin A-related steroids from Withania aristata exhibit potent antiproliferative activity by inducing apoptosis in human tumor cells. Eur J Med Chem. 2012 Aug;54:499-511. Epub 2012 Jun 1. PubMed PMID: 22705001.
    12. Suhail MM, Wu W, Cao A, Mondalek FG, Fung KM, Shih PT, Fang YT, Woolley C,Young G, Lin HK. Boswellia sacra essential oil induces tumor cell-specific apoptosis and suppresses tumor aggressiveness in cultured human breast cancer cells. BMC Complement Altern Med. 2011 Dec 15;11:129. PubMed PMID: 22171782;PubMed Central PMCID: PMC3258268
    13. Sutton KM, Doucette CD, Hoskin DW. NADPH quinone oxidoreductase 1 mediatesbreast cancer cell resistance to thymoquinone-induced apoptosis. Biochem Biophys Res Commun. 2012 Sep 28;426(3):421-6. doi: 10.1016/j.bbrc.2012.08.111. Epub 2012 Aug 30. PubMed PMID: 22960073.
    14. Chang CY, Chan HL, Lin HY, Way TD, Kao MC, Song MZ, Lin YJ, Lin CW. Rheininduces apoptosis in human breast cancer cells. Evid Based Complement AlternatMed. 2012;2012:952504. Epub 2011 Oct 5. PubMed PMID: 22007260; PubMed Central PMCID: PMC3189565.
    15. Zaineddin AK, Buck K, Vrieling A, Heinz J, Flesch-Janys D, Linseisen J,Chang-Claude J. The association between dietary lignans, phytoestrogen-rich foods, and fiber intake and postmenopausal breast cancer risk: a German case-control study. Nutr Cancer. 2012;64(5):652-65. Epub 2012 May 16. PubMed PMID: 22591208.
    16. Magee PJ, Rowland I. Soy products in the management of breast cancer. Curr Opin Clin Nutr Metab Care. 2012 Nov;15(6):586-91. doi: 10.1097/MCO.0b013e328359156f. PubMed PMID: 23075937.
    17. Jeffs E, Wiseman T. Randomised controlled trial to determine the benefit of daily home-based exercise in addition to self-care in the management of breast cancer-related lymphoedema: a feasibility study. Support Care Cancer. 2012 Oct
    18. [Epub ahead of print] PubMed PMID: 23073712
    19. Pomegranate juice and specific components inhibit cell and molecular processes critical for metastasis of breast cancer. http://www.ncbi.nlm.nih.gov/pubmed/23065001
    20. Extracts of Strawberry Fruits Induce Intrinsic Pathway of Apoptosis in Breast Cancer Cells and Inhibits Tumor Progression in Mice http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0047021