Breasts: An Owner’s Manual: Every Woman’s Guide to Reducing Cancer Risk, Making Treatment Choices and Optimising Outcomes

Breasts: An Owner’s Manual: Every Woman’s Guide to Reducing Cancer Risk, Making Treatment Choices and Optimising Outcomes Kristi Funk A revolutionary and definitive new approach to preventing breast cancer, from Board-certified world authority on breast health Dr. Kristi Funk, co-founder of the renowned Pink Lotus Breast Centre, and surgeon to Angelina Jolie and Sheryl Crow.Breasts: An Owner’s Manual is a straight-talking, myth and misconception-busting, strategy-filled guide to breast health. Sharing the latest on lifestyle choices that impact your risk factor including food, supplements, hormones and exercise, Dr. Funk demonstrates that you are so much more in control of whether or not you get breast cancer than you could ever dare to think.In fact, unless you carry a genetic mutation associated with breast cancer, the choices you make in your-day-to-day life trumps genetics and family history when it comes to breast cancer risk, every time.Including a unique long-term risk reduction plan for every woman based on her needs, as well as the latest on diagnosis and treatment for women living with and surviving breast cancer, and with a heartfelt Foreword from longtime patient Sheryl Crow, this is a book with a life-saving message for the 1 in 8 women, at the time of writing, who are set to be diagnosed in their lifetime. About the Author (#ulink_c1bfdf94-fcb0-592d-884f-fa22f6cc7571) Dr. KRISTI FUNK, board-certified breast cancer surgeon and cofounder of the Pink Lotus Breast Center, is an expert in minimally invasive diagnostic and treatment methods for all types of breast disease. She has helped thousands of women through breast treatment, including well-known celebrities such as Angelina Jolie and Sheryl Crow, who have turned to her for her surgical expertise. After graduating with distinction from Stanford University in 1991, Dr. Funk received her medical degree from the UC Davis School of Medicine. Following her surgical residency at Virginia Mason Medical Center in Seattle, Washington, she completed a surgical breast fellowship at Cedars-Sinai Medical Center in Los Angeles, where she then excelled as a surgeon and breast center director for seven years. In 2009, Dr. Funk, alongside her entrepreneurial husband, Andy Funk, opened the Pink Lotus Breast Center in Beverly Hills. The Pink Lotus Breast Center fuses state-of-the-art screening, genetic testing, diagnosis, and treatment with preventive strategies and holistic, compassionate care. Dr. Funk is also the founding ambassador of the Pink Lotus Foundation, whose mission is to provide low-income, uninsured, and underinsured women free access to breast cancer screening and care. When not appearing as a breast expert and TV personality in hundreds of television segments, documentaries, news articles, and stories, Dr. Funk enjoys Half Ironman triathlon races, vegan cooking, and card games. She resides with Andy and their three sons in Santa Monica, a peaceful suburb of Los Angeles. Copyright (#ulink_ab8ae230-e814-5268-97f5-9600ba3890cf) An imprint of HarperCollins Publishers Ltd 1 London Bridge Street London SE1 9GF First published in Great Britain by HQ in 2018 Copyright © Kristi Funk 2018 Kristi Funk asserts the moral right to be identified as the author of this work. A catalogue record for this book is available from the British Library. This novel is entirely a work of fiction. The names, characters and incidents portrayed in it are the work of the author’s imagination. Any resemblance to actual persons, living or dead, events or localities is entirely coincidental. All rights reserved under International and Pan-American Copyright Conventions. By payment of the required fees, you have been granted the non-exclusive, non-transferable right to access and read the text of this e-book on-screen. No part of this text may be reproduced, transmitted, downloaded, decompiled, reverse engineered, or stored in or introduced into any information storage and retrieval system, in any form or by any means, whether electronic or mechanical, now known or hereinafter invented, without the express written permission of HarperCollins. Ebook Edition © June 2018 ISBN: 9780008271398 Praise for Breasts: An Owner’s Manual (#ulink_de929ac2-56fa-5240-9461-96fcd11ea82b) “I love this book! In Breasts: An Owner’s Manual, Dr. Kristi Funk’s evidence-based advice will have you kicking breast cancer—and all of life’s major killers—to the curb.” —MICHAEL GREGER, MD, FACLM Founder, Nutritionfacts.org New York Times Bestselling Author “Dr. Funk writes Breasts: An Owner’s Manual just like she talks: with conviction, passion, and a laser focus on you.” —DR. MEHMET OZ Host, The Dr. Oz Show Professor of Surgery, New York Presbyterian Columbia University Director, Integrative Medicine Center, Columbia University Medical Center New York Times Bestselling Author “Breasts: An Owner’s Manual is an empowering guide to the latest life-saving information. It has everything you need for protecting and improving your health, tackling medical questions, planning health-supporting meals, and breaking through the myths that could hold you back, all in an easy-to-read format.” —NEAL D. BARNARD, MD, FACC Adjunct Associate Professor of Medicine, George Washington University School of Medicine President, Physicians Committee for Responsible Medicine New York Times Bestselling Author “Dr. Funk has written an incredibly detailed and carefully documented book on the very complex topics of breast health and breast cancer. She lays out a clear plan for breast health, cancer prevention, and, in reality, a lifestyle that we all could use to improve our health. Presented in an easily approachable manner, Breasts: An Owner’s Manual does not spare the science (in fact, it really ladles it on), but Dr. Funk makes the science readable in a conversational style that both calms and empowers the reader (exactly how I imagine she talks with her patients!). As she writes in the introduction, ‘Knowledge is power, and power replaces fear with confidence and joy, which motivates you to implement changes’—words that all patients (and all of us) can take to heart, making positive changes and taking control of our futures!” —PETER D. BEITSCH, MD, FACS Director, Dallas Breast Center Past President, American Society of Breast Surgeons “Dr. Funk uses scientific facts, complex theories, and clinical experience to artfully compose and communicate pearls of advice that are actionable and sensible. Breasts: An Owner’s Manual will become an indispensable and valued guide for women looking to optimize health and minimize breast illness.” —DEBU TRIPATHY, MD Professor and Chair, Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center Editor-in-Chief, CURE Magazine “In Breasts: An Owner’s Manual, I can hear Dr. Funk’s straight-talking, witty voice as she debunks breast myths, simplifies complex choices, and inspires you to become your healthiest self. An important read for anyone looking to take charge of their health.” —TRAVIS STORK, MD Host, The Doctors Emergency Medicine Physician “Breasts: An Owner’s Manual not only provides a clear path to breast health, but a road that leads straight to your healthiest self. As someone who has faced breast cancer, I suggest you follow it.” —ROBIN ROBERTS Coanchor, Good Morning America “Dr. Kristi Funk distills the complex topic of cancer causation and promotion down to practical, actionable advice and cutting-edge nutritional science. Breasts: An Owner’s Manual will become a cherished, life-saving manual shared among all generations of women throughout the world, for both breast health and breast illness. There’s simply no guide like it—and it’s so compelling to read!” —CAROLYN “BO” ALDIG? President and Founder, Prevent Cancer Foundation “Breasts: An Owner’s Manual is highly readable, informative, and practical. Dr. Funk is a trustworthy and knowledgeable source of information. If you’re searching for the comprehensive book on breast health, look no further.” —MIKE DOW, PSYD Psychotherapist New York Times Bestselling Author “I believe that Breasts: An Owner’s Manual will change and save lives and serve as a gateway for many women to enter into a total health transformation: physical, mental, and spiritual. It is a comprehensive how-to, go-to book addressing the lifestyle issues of anyone with breasts. Somehow Dr. Funk has been able to neatly dissect, define, and package this explosive information. You now hold in your hands knowledge of revolutionary proportions. The light of this manual chases away the darkness that can be associated with breast health. Now sit back and enjoy the ride.” —BEVERLY “BAM” CRAWFORD, DD Chancellor, Bible Enrichment Fellowship International Church “We all have (or had) breasts, but who has ever told us how to care for them? What should you eat, not eat, do, not do—and what about all those risk factors over which you have no control? There are so many mixed messages about screening and even about what to do after you’ve been diagnosed. In Breasts: An Owner’s Manual, Dr. Funk helps you sift through all the confusion as though you’re having coffee with a dear friend—a friend who just happens to know a lot about breast health and illness! So grab a cup and turn the page.” —LISA LING TV Journalist Producer and Host of This Is Life with Lisa Ling To the women and girls all over this wonderful world who have—or had—breasts. Contents Cover (#u8e02fce5-c719-5890-98e6-b81275f1e09d) About the Author (#ulink_4905ddb9-a4dd-5c58-834a-ca8f72e7b85e) Title Page (#udb3f86b0-a52d-54fb-b884-ae56897400f4) Copyright (#ulink_c3e1c33f-47e5-5768-b7c7-4e575a9fb6c9) Praise (#ulink_c0e090f8-9813-54a3-86f6-1122143477ec) Dedication (#ude1e8e10-1e7b-507c-855a-976edce2b6d1) Foreword by Sheryl Crow (#ulink_a144b263-60a6-525d-b345-d76d51771d44) Author’s Note (#ulink_98d877a8-74f5-5022-b58e-3adfa9639267) Introduction (#ulink_f08721be-91fa-522f-87f4-23ce8f5c53bf) PART 1: Breast Health Basics (#ulink_30c6c67a-b53d-56d5-abe8-5292e962860d) Chapter 1: Breast Care ABCs (#ulink_5df3a05a-bccb-53b6-8b60-98f752578f8d) Chapter 2: Debunking Breast Cancer Myths (#ulink_9e505303-dbb9-5612-9d9b-36e725fe98ff) PART 2: Reducing Cancer Risk (#ulink_062e5392-fd81-5f9b-b3d3-bffb184fadcb) Chapter 3: Eat This (#ulink_c6086a3f-d58c-5784-96ea-3b7c39c37178) Chapter 4: Don’t Eat That (#litres_trial_promo) Chapter 5: Beyond Food: What You Should Do (#litres_trial_promo) PART 3: Learn Your Personal Risk Factors and Control What You Can (#litres_trial_promo) Chapter 6: Uncontrollable Risk Factors: Do You Have Them? (#litres_trial_promo) Chapter 7: Medications and Operations to Consider (#litres_trial_promo) PART 4: Making Medical Choices and Living with Risk (#litres_trial_promo) Chapter 8: Breast Cancer Screening and Detection (#litres_trial_promo) Chapter 9: Cancer Happens: A Newly Diagnosed Starter Kit (#litres_trial_promo) Chapter 10: Now What? Life After Diagnosis and Treatment (#litres_trial_promo) Acknowledgments (#litres_trial_promo) Appendix: Acronyms and Abbreviations (#litres_trial_promo) Notes (#litres_trial_promo) Index (#litres_trial_promo) About the Publisher (#litres_trial_promo) Foreword (#ulink_3599333d-41ad-50f9-b15a-4ce020bae670) I’m embarrassed to say that when I first walked into my appointment with Dr. Kristi Funk, I wanted to turn around and leave. I thought, There’s no way this young woman whose beauty rivals Jessica Simpson’s can be the doctor I’ve heard so much about from my gynecologist and my internist as being someone who is widely known for her dedication and expertise to breast surgery. Boy, was I wrong! And furthermore, that appointment was one of the big blessings to come from my cancer experience. Not only was she then—and remains now—one of the finest breast surgeons a woman could have, but she also has been an inspiration and a friend to me ever since I walked into her office. It was February 2006, and I was due to have my yearly mammogram. This one seemed to be more of a nuisance than ones in the past, because my engagement had just fallen apart five days before and I really didn’t want to be bothered with something I knew would be a waste of time. I was healthy and extremely fit, having spent the better part of the previous three years riding my bicycle up the sides of mountains—and I had no family history of breast cancer. I licked my wounds and went ahead and got it over with. A few days after my mammogram, my gynecologist called me and suggested that I have two biopsies just to answer any questions that had shown up on the film, rather than waiting the recommended six months to view the areas again. She advised me to see Kristi Funk, who performed surgery a few days later. I went through the painful process of a wire-localized open surgical biopsy and went home to resume the business of getting on with life. Four days later, I went in for my postoperative appointment with Dr. Funk. I will never forget the look on Kristi’s face when she told me that, although the odds of my having invasive cancer had been extremely minimal, mine was invasive, and I would need additional treatments. It was a blow of the first degree to someone who, until that point, had had complete and total control over every aspect of her life, or so I thought. And it seemed a blow to Kristi as well. Now that I know Dr. Funk as I do, I believe each time she has had to deliver the outcome of a cancer screening that renders a malignant diagnosis, it has felt like a blow to her. I got through my treatment uneventfully and went about rebuilding my life, personally and physically. Cancer was a game changer in the best and hardest of ways. I had to learn to put myself first, and I had to challenge what it means in a woman’s life to always nurture others but never to allow anyone to nurture her. I had to learn to say no and to be okay with not everyone liking or respecting me. I had to learn how symbolic breasts truly are and to accept that reality. Accepting these truths seemed to be the lesson in the cancer experience for me—and from what I have heard from the countless women I have met in the most random of places who come up to me and share their cancer experiences, there is a lesson in it for everyone. Additionally, cancer changed my behavior; I had to learn about self-care and quality of living through nutrition and alleviating stress. After some time passed, Kristi and her husband, Andy, and I met about their dream of opening a place that offered a “one-stop shop” where breast cancer screening, diagnosis, and treatment happened seamlessly and comfortably under one roof. I was all in. Their dream would eventually become Pink Lotus, including the free care they provide to underserved women via the Pink Lotus Foundation. The Pink Lotus Breast Center would offer the first contrast-enhanced digital mammograms in North America, combining Western medicine with complementary and alternative medicine, nutrition, psychology, physical therapy, genetics, and innovative technologies — and offering women holistic, whole-body view of health and wellness. Over the years, I have learned so much about how to live a healthier life through diet and exercise and meditation. I wince every time I hear from someone I know or someone who is distantly connected that they’ve been diagnosed with breast cancer or cancer in general. The 1 out of 8 statistic seems to hold on, but we are learning more about prevention, and until there is a cure . . . well, early detection is a great help, but prevention is the greatest hope for us all. Over a decade later, I remain grateful to Kristi for continuing to be driven to learn more about how to outsmart this insidious disease. Whether you live with or without breasts, there is so much to know and so many things one can do. Navigating it all can become confusing, especially with all the contradictory advice out there. Dr. Funk’s book is a gift to women everywhere looking for answers to breast issues and to health in general. Kristi shares what she learns in the hopes that eventually she will be out of a job as a breast cancer surgeon! —Sheryl Crow Author’s Note (#ulink_61c5ebb8-696f-58cc-8d6f-f758e63b2985) My mom was thirty-six years old and had five children under the age of fourteen (I was two) in December 1971. She was in peak fitness as a competitive A-level tennis player who swam daily when she suffered a stroke and inexplicably fell into a coma that lasted three weeks. The UCLA doctors told my father on multiple occasions not to leave for home that night, for she would surely die by morning. A priest administered the sacrament of last rites, which I believe made heaven take notice: Oh heck no, we aren’t ready for that ornery MaryAnn; give her another fifty-plus. So she woke up! (If you ever meet me—and I hope you do—ask me how she woke up.) My mom remained in rehab for a year before returning home, relearning how to speak and how to walk, since she would never move her right side again (hemiparesis). All of my parents’ “friends” disappeared and my dad downsized the house, but his love for her never diminished; in fact, it grew. To this day, in their late eighties, he defends her fiercely and assists her tenderly. How could you not cherish a warrior who stared down death and won—without speaking a word? That’s where I come from, and that’s what I offer you. I possess the dogged determination and tenacity of my mother, mixed with the empathy and compassion of my father. So when you fling excuses and hopelessness at me, I will whack you with a reality check. And when you come to me scared and broken, I will hug you until you’re whole again. After my relationship with God, I only really care about two things in this life: loving family and killing cancer. You picked up this book. You’re family now, so let’s get going. Introduction (#ulink_f423b3ce-565c-5901-a75a-8aab9c3b4396) From the age of four, I wanted to be an actress. (Ha! You thought I was going to say I always wanted to be a doctor, didn’t you?) I performed in every school play, beginning with Sleeping Beauty in the second grade and continuing all the way through college, when I starred as Oedipus in an all-female production. Yet Hollywood was never my endgame. I actually pictured myself helping children heal from illness, using drama and imaginative play to explore the feelings and fears brought on by sickness. Cut to my sophomore year as a psychology major at Stanford University, when I experienced an epiphany that would both change my course and guide it to this day. In the midst of studying for a neuropsychology final, painstakingly trying to memorize which neurotransmitters in the brain led to which functions of the body, I experienced an unmistakable and repetitive “interrupting thought” that made my own neurotransmitters buzz. It came from God. You’re going to be a doctor, it said. Whoa. Okay, that was interesting. Incorrect, but interesting. You see, my female role models married young, and all I wanted was to raise a family and work as a drama therapist. I traveled to Africa a week later on a summer missionary trip that had been planned for months. When I saw firsthand the health challenges that millions of men, women, and children face, my life’s purpose snapped into shape—and not in the form of theater or therapy. I felt newly inspired to care for people in the one way that matters most to them—by helping them maintain the very vessel that carries them around all day: their bodies. Disease robs far too many people of joy, replacing hope with chronic illness and death. It isn’t right. As I sat cross-legged in a dung hut, balancing potatoes on my head to make the tribal kids laugh, I decided to do something with my life to try to stop the killer of joy: I heeded God’s voice and resolved to become a doctor. I went to medical school, did my residency in general surgery, and then completed a surgical breast fellowship at Cedars-Sinai Medical Center. I stayed on to become the director of patient education at their breast center, where I gave a number of community and physician lectures. Most women don’t want to hear about cancer unless they have it and need to make some decisions, so rather than bore them to tears with medical jargon, I challenged my audiences by discussing attention-grabbing studies that would incite them to alter their behavior. I delved into risk reduction and discovered all sorts of lifestyle game changers. I loved the work, and patients responded like crazy. I couldn’t wait to get to the office to spend all day examining and educating women, operating with curative intent, and becoming creative when a diagnosis or cosmetic issue became challenging. Everything I did back then and continue to do today—helping women boost their health, reduce their breast cancer risk, make sense of a diagnosis, or find their way after treatment—inspired the book you’re reading now. A MULTILAYERED PROBLEM Whether perky or droopy, full or flat, for two organs perched front and center on half the population’s chests, it is pretty crazy that breast health remains rather mysterious to many breast owners. Most women don’t know much about their breasts, what their purposes are, and how to keep them healthy so the rest of their bodies can thrive. Everyone knows that breasts can grow cancer, which is the number-one killer of women ages twenty to fifty-nine, yet there’s never been a solid and informed conversation about how to reduce our risk factors for this disease and why certain precautions might help. Any breast health conversation needs to focus on two problems: numbers and knowledge. First and foremost, breast cancer is a pandemic concern, and the numbers sure prove it. In the United States alone, 1 in 8 women will be diagnosed with breast cancer at some point in their lives. Every year, we identify 1.7 million new breast cancer cases worldwide, with over 300,000 in the US. Interestingly, incidence rates vary fourfold across the globe, ranging from 27 per 100,000 in Middle Africa and Eastern Asia, to 93 in the US, to 112 in Belgium, and it’s not the weather that accounts for these global disparities. If this freaks you out, you’re not alone. Based on my experience as a board-certified breast cancer surgeon who has helped tens of thousands of women navigate breast health issues, I know for a fact that we have the power to reduce our breast cancer risk in achievable and dramatic ways. Enter our second big problem with breast cancer awareness: erroneous public perception. Most women believe that family history and genetics determine who gets breast cancer, but for most people, they don’t. Inherited mutations, like BRCA, only cause 5 to 10 percent of breast cancer; in fact, 87 percent of women diagnosed with breast cancer do not have a single first-degree relative with breast cancer. I’ll give you a minute to pick your jaw up off the floor. For the last thirty years, the medical community has not corrected the false notions held by the majority of breast cancer survivors who attribute their breast cancer entirely to family history, environmental factors, stress, or fate—all factors predominantly not under their direct control. Yet research tells us that if, before reaching menopause, women embrace a lifestyle that prioritizes exercise, not smoking, not drinking alcohol, and a diet shifted away from meat and dairy toward whole food, plant-based eating, their odds of getting breast cancer are slashed in half. And for older women, risk drops by 80 percent. That’s right. You have the opportunity to impact the way you behave toward your breasts and how your breasts respond to that behavior. Rigorous science and firsthand experience in the trenches back up everything I know to be true about breast cancer risk reduction and care. The women I treat are exactly like you. They share your concerns about any new mammogram finding, pain, lump, itch, or discharge. They want to know if there’s anything new under the sun that they can do to ward off this disease. Most of the patients who heed my diet, lifestyle, and medical advice come away from our conversations feeling empowered and relieved, gaining clarity over “the right thing to do.” Depending on the changes they make, women might also notice that their fibrocystic lumps and pain disappear, their obesity or diabetes improves, or they find themselves cancer-free year after year. I must mention here that having an unhealthy lifestyle doesn’t guarantee a future breast cancer diagnosis; similarly, we can never know with certainty that lifestyle choices caused the cancer you might have already had. Moreover, even women following an ideal lifestyle get breast cancer (although not as frequently, as we shall repeatedly see), and boy, are they upset. “I did everything right!” That being said, the changes I’m about to suggest in this book don’t just serve your breasts well. Oh no, ladies. They also yield lower cholesterol, better triglycerides, perfect blood pressure, fewer heart attacks, a leaner body, less diabetes, painless joints, more energy, better sleep, a happier mood, an improved sex life, a sharper mind, less dementia, smoother skin, regular bowel movements, cleaner lungs, less cancer in every single organ in your body, a healthier planet, and a longer life. If you practice what I teach, you will radically reduce, if not completely prevent, many of the illnesses that ultimately lead to chronic and life-threatening diseases. You’ll feel a boost of happiness and satisfaction. You’ll implement your goals with ease—and never look back. A PIONEERING APPROACH TO BREAST HEALTH Since I founded the Pink Lotus Breast Center in Los Angeles in 2007 alongside my husband, Andy Funk, our mission has been to fuse state-of-the-art breast cancer screening, diagnosis, and treatment with preventive strategies and holistic, compassionate care. We’re out to save lives in a way that eliminates fear, instills confidence, and provides hope in a moment of panic. Pink Lotus aims to transform the delivery of breast health care in America and to help as many women as possible, regardless of their income or status in life. We see thousands of patients every year, with a wide range of concerns, and do our best to accept most insurances, including Medicare. For low-income uninsured or underinsured women, the Pink Lotus Foundation provides 100 percent free breast cancer screenings, diagnoses, treatment, and support to those who otherwise might not be able to receive any care at all. I am incredibly grateful that occasionally working with prominent celebrity voices affords me the unique opportunity to get my message about breast health and risk reduction into the world. Three days after I removed Sheryl’s breast cancer, she arrived in my office with a paper in hand and revealed, “I want to go public about this. Can you please fact-check this press release?” And Angelina Jolie’s New York Times op-ed, “My Medical Choice,” led to a permanent increase in BRCA testing documented around the world. I consider it an honor and duty to continue the conversations they started. While I’m best known as a surgeon, my ultimate mission as a physician is to get to people before they need to go under the knife. I do everything I can to teach others about breast health—I appear on television, contribute to our Pink Lotus Power Up blog, give lectures, publish articles, perform research, and sponsor campaigns. I want to empower you with facts and arm you with strategies to help you understand your breasts, reduce your cancer risk, and open your eyes to life-changing interventions and treatments if you are diagnosed with the disease. HOW TO USE THIS BOOK Educating yourself on breast health simply requires a commitment to living your best life. We should never die from something we can largely control. Can we control breast cancer? Admittedly, a percentage of breast cancer occurs in women who seem to have mastered all the things that promise to maintain health and wellness throughout life. Until that elusive cure or prevention vaccine shows up, our best efforts will occasionally be thwarted by uncontrollable mutations and unrecognized causes. Nevertheless, you do have significant power over this disease—let’s use it. A solid 50 percent—and perhaps as much or more than 80 percent—of all breast cancer could be eliminated from planet Earth if women understood that daily choices like food, drink, exercise, weight, toxic exposures, and mind-set create the environment inside the very cells of our breasts, which either stay healthy or turn malignant. Every single day, we make countless choices that bring us closer to cancer or move us farther away. The easiest cancer to cure is the one you never get. Here’s what you can expect as you move through all these pages. I suggest reading the entire book to best comprehend all the important information it contains, but I certainly understand if you want to jump directly to the sections that apply to you and your interests. To that end, let me give you a little direction so you can navigate straight to the topics that intrigue you most. In the first half of the book, I focus on boosting your breast savvy and teaching about lifestyle choices that reduce your breast cancer risk. In part 1 (#u6fa3b442-40e9-5537-bd64-d03651a6e332), you’ll learn how to care for your breasts and never again mind the myths surrounding breast cancer’s causes. I have spent much of the last two decades researching the connection between lifestyle and cancer, and many of the things you’ve heard cause breast cancer are false. In part 2 (#uf9ce9f1a-4d5d-50d4-8bd9-a470a2dcb1b5), we’ll discuss what else you can do besides showing up for your yearly mammogram and hoping that you don’t find a lump in the following 364 days. I’ll help you reduce your cancer risk based on food and lifestyle changes, particularly those that keep estrogen in check, since estrogen fuels 80 percent of all breast cancers. The healthiest meals are plant-based, low fat, and high fiber: an abundance of fresh fruits and vegetables (preferably organic), 100 percent whole grains like brown rice and oats, nonanimal proteins such as lentils, beans, and soy, with a cup of green tea on the side. I will also talk about choices like supplements, exercise habits, weight control, and hormones that can impact risk. In the second half of the book, I’ll explore uncontrollable risk factors for breast cancer, plus outline your medical choices if you’re at elevated risk for, newly diagnosed with, living with, or navigating life after breast cancer. In part 3 (#litres_trial_promo) specifically, I’ll detail the operations and medications that mitigate risk. I field a lot of questions from patients about genetics and BRCA mutations in particular, and will share the latest research on mutations and what they mean for you. The key with uncontrollable risks is to understand them and then to use them to inform controllable choices. And if you do have elevated risk, this doesn’t mean there is a one-size-fits-all protocol. Some patients choose prophylactic surgery. Others don’t want to go anywhere near the knife but take preventive medications. Still others decide to improve lifestyle factors combined with an aggressive screening regimen. If you’re struggling with medical choices, in part 4 (#litres_trial_promo) I’ll help you find a path that leaves you feeling confident and comfortable with your decisions. I will review surgical options, explain the differences between lumpectomy and mastectomy, endocrine and immunotherapy, radiation and chemotherapy, and address specific questions I repeatedly hear at my center. It turns out acronyms abound in medicine, and in the interest of keeping you easily moving through our time together in this book, I use a number of them. To that end, please reference the appendix, a handy-dandy table that puts all those acronyms into a tidy little list. I’ve been sure to back up every claim I make with reference to a study, a paper, or a text. These endnotes are quite extensive, so I’ve placed them online for easy searching at pinklotus.com/drfunkendnotes (http://pinklotus.com/drfunkendnotes). Long quotes from studies or articles, and the endnotes attached to data in tables, have been retained at the back of the book. So let’s get started! I firmly believe that knowledge is power, and power replaces fear with confidence and joy, which motivates you to implement changes—changes that I know could save your life, and in turn, make the lives of all those whom you love, and who love you in return, all the more joyful too. PART 1 (#ulink_ebee4193-f818-5b3f-9f9f-f7e711c10df5) BREAST HEALTH BASICS (#ulink_ebee4193-f818-5b3f-9f9f-f7e711c10df5) CHAPTER 1 (#ulink_e9f7366a-9a42-5ecf-8914-e5ffc91c1f85) Breast Care ABCs (#ulink_e9f7366a-9a42-5ecf-8914-e5ffc91c1f85) Take it from someone who’s around breasts all day, every day, and has been known to dream of them at night—women can have very emotional associations with their breasts. It takes a strong sense of self, which I hope we all strive to achieve, to say, “I am not my breasts,” because breasts connect in undeniable ways to femininity, sexuality, body image, and womanhood. Our feelings about our breasts run the gamut from pride in their shape and size, to awe over their milk-producing and life-affirming function, to trepidation and dread that someday they may give us cancer. To this last point, despite our fears, there have been few solid guidelines on how to improve your breast health, lower your risk of getting cancer, optimize your outcomes if you’re faced with a diagnosis, and make informed medical choices after treatment—until now. I’d like to start off here with a few basics about breast health: the parts and functions of your breasts, surprising facts about the “girls,” and how to take good care of them so you live a long, vibrant life. Understanding the breasts you’re caring for will ultimately go a long way to reducing their cancer risk. While you can’t control all your risk factors—some, like being a woman and getting older, are nonnegotiable—you can influence and reduce more than you may know by recognizing the factors that are under your control and then adjusting your life choices accordingly. BREASTS 101 When it comes to your chest’s general anatomy, breasts remind me of a funky Jell-O fruit salad. Imagine one of your breasts as many bunches of grapes that you’re holding by the top of the largest stems (at the nipple). As you picture these bunches, see all the tiny connecting stems as the tubes that carry milk out of the nipple during lactation (they exist whether you ever get pregnant or not). The stems all connect to grapes, which represent the milk-producing lobules of your breast. The entire breast has fifteen to twenty lobes (grape bunches), and all the stems coalesce toward the nipple, with eight to twelve milk ducts opening on your nipple’s surface. Patrick J. Lynch, medical illustrator; C. Carl Jaffe, MD, cardiologist. https://commons.wikimedia.org/wiki/File:Breast_anatomy_normal.jpg. Now, push that entire bunch of grapes and stems, which together comprise what we call glandular tissue, into a mold of Jell-O that’s shaped like your breast and sits on top of your chest wall muscles. (By the way, imagine if Tupperware actually made breast molds. They’d make a killing at “bye-bye breast” parties—or as one of my patients called hers, “Ta-ta, ta-tas!”) The Jell-O represents the supportive structures that surround the breast gland, composed of stroma (a kind of connective tissue), adipose tissue (fat), ligaments, lymphatics, and blood vessels. The lobules and ducts, or grapes and stems, are usually what become cancerous (milk ducts alone are responsible for 75 percent of all breast cancers), but the Jell-O rarely does. For example, a Mayo Clinic review of all breast cancers in women over fifty-nine years old showed that a stromal-based breast cancer, called primary breast sarcoma, accounted for only 0.0006 percent of breast malignancies. Breasts range in size from absent, as seen in a rare disease called Poland Syndrome, to ones that swing down to your knees. Cups go from AAA to L—with the average American cup size being a D; Russia, Sweden, Norway, and Finland have cup sizes larger than D; Australia, France, Italy, the UK, Canada, and South America average a C; in Africa and Asia, women are A/B. Few women have a perfect match. In most, the left breast is up to 20 percent larger than the right (sudden one-sided changes in size are not normal, so if that happens, see your doctor). Your breast size and “perkiness” mostly come from a genetic patchwork of markers handed down from both of your parents to you, plus nutrition and the influence of estrogen, progesterone, insulin, and growth factors during your early years, puberty, pregnancy, lactation, and menopause. Fatness, exercise, aging, skin quality, and hormone use also influence size and shape. Since your breasts contain a genetically predetermined amount of fat, your breasts expand when you do. And contrary to what you may have heard, there’s no direct connection between the size of your breasts and your risk of getting breast cancer. Your actual breast takes up more space on your body than you probably realize—a point to keep in mind when you do your breast exam every month, as I’ll discuss next. The girls aren’t limited to the two fleshy mounds nestled into your bra. Each breast technically goes all the way up to your collarbone (the clavicle superiorly), centrally to your breastbone (the sternum medially), down to the curve you associate with being the bottom of your breast (the inframammary fold inferiorly), and off to the side of your chest wall (the anterior border of the latissimus dorsi muscle laterally). Another bit of breast tissue extends like the point of a teardrop toward the armpit, called the axillary tail, located just beneath the hair-bearing part of your axilla. Sometimes this tissue actually extends into the armpit itself, which is called axillary accessory breast tissue. When rather pronounced, it bulges out, covered by skin. Depending on whether this happens on one or both sides, you might feel as though you have three or four breasts. An axillary accessory nipple could even connect that breast tissue to your skin, and yes, this means you could actually breastfeed from your triple nipple one day. All breasts are lumpy, not just cancerous ones. Who in the world ever referred to breasts as melons? Did that person ever feel a breast before? Melons are uniformly firm, round, and very smooth—and they don’t budge when you poke them. The natural terrain of the breast is more like a mountain range with peaks and valleys covered in a blanket of snow (fat) and then wrapped in skin. When you run your fingers across that skin, the snow feels soft until you push deep enough to feel a mountain peak, and with a valley on both sides, that peak sure feels like a lump. The only way to trust that that’s a mountain and not a malignant intruder is to either see a doctor, or to know that it’s been there forever and it’s just your normal anatomy. All breasts have lumps, breasts are lumps, and they feel lumpy. The denser your tissue, the lumpier you feel. Genetics determine breast density, as do the estrogen levels in your body. Lastly, there’s the surface of the breast. Arteries and veins circulate blood flow to nourish the breast skin, and in lighter-skinned ladies, sometimes we can see the veins rather clearly; also, conditions that increase blood flow will dilate those veins, making them more apparent—especially after exercise, or during pregnancy, or in certain cancers. Nipples can be dark or light, smooth or textured, pointing out, level, or inward, and range in size from flat to a pencil eraser or sugar cubes—it’s all normal. The colored skin around the nipple base is called the areola, and its diameter varies from dimes to saucers, generally 1.5 inches to 4 inches (4–10 centimeters). Some people have additional nipples, called supernumerary nipples, located along two vertical “milk line” arcs from the armpits to the normal nipples to the left and right groin. Occurring in 1 per 8,000 people, these either look like flat moles or have a raised bump. Celebs with extra nipples include Mark Wahlberg (three) and Harry Styles (four), so no shame there. If you zoom in on the areola, there’s so much more to see. All women have hairs that grow at the areolar edge coming from hair follicles. We have fifty million follicles on our skin, so sometimes a few unwelcome strays grow right there. They usually show up in response to hormone changes: puberty, pregnancy, menstruation, menopause, or birth control pills. You can safely tweeze them out or get electrolysis. Tweezing sometimes leads to ingrown hairs, which then cause tiny raised pimples and white sebum to collect. Makes you wonder why you thought tweezing would make the area more attractive. Areolar bumps called Montgomery glands are tiny sebaceous glands whose function is to lubricate the nipple (per textbooks), but since that seems like a fairly useless function and doesn’t even make sense anatomically since they are not on the nipple, I just tell people they are normal and benign and won’t go away no matter how much you squeeze them. You can also get tiny blackheads at the edge of the areola; just wash the area and occasionally exfoliate as you would do to your face at night. If you notice an itchy, scaly, flaky rash on your nipple or areola, call your doctor. MORE NIPPLE FUN FACTS! • Some people are born without nipples, which is called athelia. There are about seven thousand diagnosed cases worldwide. • Nipple stimulation and genital stimulation affect the same part of the brain. One-third of women can reach orgasm solely through having their nips caressed. • If you use a magnifying glass to examine the areola, you will find hairs growing on the areolar border of all adult living human beings. • When supernumerary nipples occur outside the milk line, they’re called ectopic, and can be as far from your chest as the sole of your foot. • Why do men have nipples? Because we all start out as girls! Nipples show up in utero before sex organs do. And then they just stick around (and out). GET HANDSY IN THE NAME OF HEALTH Healthy breasts require regular at-home breast exams, but don’t let them stress you out. The goal here is to get a lay of the land and learn what all your lumps feel like. This way, if you develop something new or different, you’ll be the first to find it. Next to risk reduction, early detection ranks second as our best defense against cancer. I suggest starting a self-exam routine in your teens and doing one every month. Teenagers virtually never get breast cancer, but it helps them later to be familiar with their breasts now. Whatever your age, time exams to one week after your period since that’s when they’re the least lumpy, tender, and confusing. If you don’t menstruate anymore, make the first day of every month your exam day. The whole exam should take three minutes, and it may just be the most reassuring part of your day. If anything seems out of the ordinary, trust your intuition and see your doctor. Ready? 1. First, give your breasts a good stare. Disrobe from the waist up, stand in front of a mirror, and then scrutinize the breasts peering back at you. Visually scan them for shape, size, or contour changes, plus skin alterations like thickening, redness, dimpling, retraction, and bulging out. Your nipples should be pointing the way they always point—straight ahead, left, right, naturally inverted, or headed south checking for spare change on the floor. 2. Next, check to see if your breast tissue dimples or bulges out while watching your breasts in the mirror in two different positions. In the first posture, put your hands on your hips and push in so that you’re flexing your chest muscles. Any funny dents or bumps? In the second pose, raise both hands overhead like you’re getting arrested. All clear? 3. Exam time! Either reclining on your bed or standing in the shower—whatever is comfortable for you—put a little lotion or shower gel on your fingers to help them glide across the breast tissue. Pick one of the following four patterns to trace over your breast tissue: (1) up and down the length of the breast vertically, (2) left to right across the breast like words on a page, (3) concentrically in circles like a target sign, or (4) radially like spokes on a wheel. Whatever pattern you choose, the results will be the same—just be sure to use the same technique every month so your fingers develop an unconscious memory of the tissue. 4. Start with your left breast, and raise that left arm behind your head to flatten the tissue as much as you can (I know—some breasts are way too floppy to flatten). Use the fat pads of the three middle fingers on your right hand to do the exam. You’re feeling for a new lump or thickening. Start in your armpit, then transition to the upper outer part of your breast and make tiny circles gliding across the breast until you’ve evaluated the entire breast in whatever pattern you chose from number 3 above. Don’t ever lift your fingers off your breast skin as you do this. Repeat the entire exam three times—first with a light touch, then medium, then deeper still. 5. Gently squeeze your nipple a few seconds. At some point in your life, you will probably elicit discharge from your nipples due to tiny amounts of fluid always present in the breast ducts. It’s normal to have discharge when you squeeze or stimulate the nipples, but fluid should never come out by itself without touching the nipple (e.g., staining your bra cup or PJs). If you squeeze out bloody or clear-like-water fluid, or if discharge is spontaneous, see your doctor. I don’t care about nonspontaneous discharge that’s any color other than bloody or clear like water. 6. Repeat on your right breast. You’re done for the month! 7. Visit easybreastexam.com (http://www.easybreastexam.com) to watch a demonstration video. WHAT TO LOOK FOR DURING A BREAST SELF-EXAM (BSE) In 2017 an image from Worldwide Breast Cancer depicting bright, cheerful lemons in an egg carton went viral with the caption “What Breast Cancer Can Look & Feel Like.” Worldwide Breast Cancer, “What Breast Cancer Can Look & Feel Like,” © Worldwide Breast Cancer, 2017. Used by permission. Knowyourlemons.org. So smart. I love this! Certain signs of breast cancer are seen and not felt, so they should be seen. It’s said a picture is worth a thousand words. And looking at lemons, well . . . they don’t make you squirm or feel embarrassed, and it’s hard not to associate these yellow balls of fruit with sunshine and lemonade. Here’s the list of signs shown in the picture: • a thick area • a dimple • nipple with crusting, itching, pain, rash, cracks, peeling, flaking, scaly, or bleeding skin • redness or heat • new fluid from the nipple (especially bloody/brown or clear like water) • skin sores (that are not typical skin conditions) • a bump • a growing vein • a sunken nipple that is pointing in a new direction, getting flatter, or inverting (retracting inward) • a change in size or shape (especially one side only) • skin that looks like an orange peel (larger pores, orange/red discoloration) • a hard lump deeper inside the breast Also worth noting: • swelling or lumps where lymph nodes are located: armpit, around the collarbone, in your neck • pain or tenderness in one spot, constant, not changing with your periods Any one of these findings is a good enough reason to check in with your doctor. No one will think you’re paranoid, and most times we discover a noncancerous reason behind the signs. So if your breast reminds you of one of those lemons in the egg carton, get it checked out. On the other hand, don’t fret that finding breast cancer is all up to you. That’s why you get breast imaging and annual breast exams with your doctor. BREAST HEALTH BY THE DECADE Though you can improve your breast health at any age, you’ll want to keep a certain level of vigilance in mind based on where you are in life. Let’s take a look at my recommendations for optimal breast health, based on the decades in life. The median age for breast cancer in the United States is sixty-two years old, so half of women are diagnosed at or after sixty-two, and half before sixty-two; so if you’re at, over, or under sixty-two, I want you to pay attention. As a teenager, you’re in a sweet spot for breast health. With a lifetime of conscientious habits ahead, I don’t want you to worry about your breasts as they develop. Learn to do a breast self-exam (BSE) and do it every month, one week after your period starts, because the younger you learn to recognize lumps and bumps, the more familiar you will be with any changes that occur in the future. My unforgettable friend Mary Ann Wasil began the Get In Touch foundation to help young girls demystify and understand their breasts by teaching them the potentially lifesaving skill of breast self-exam. Check out their site, getintouchfoundation.org, to learn creative ways to spread knowledge and skill regarding BSE. If you have a family history of breast cancer prior to age fifty, your mother or father (whoever is blood-related to the person with cancer) should schedule a genetic counseling and risk assessment visit for her/himself, the result of which will further inform you about your own risks. Know, though, that breast cancer as a teen is a reportable phenomenon, with chances being less than one in a million. Women in their twenties and thirties need to take breast health more seriously than they did when they were younger. If this is you, do your BSE once a month, one week after your period starts or the first day of every month if you do not have a period. Visit the gynecologist for an in-office manual exam, called a clinical breast exam (CBE), every three years, plus schedule a genetic counseling and risk assessment visit if it’s appropriate due to family cancers. Women under the age of forty with breast cancer have more aggressive tumors, so it’s crucial to stay aware. A decade or two later, in your forties, continue doing a BSE once a month, but start seeing your gynecologist annually for a CBE for the rest of your life. You’ll also need to add a mammogram once a year, and if your breasts are dense, get an ultrasound too. And from here on out, that’s the deal, ladies, whether you’re in your fifties, seventies, or nineties. If you’re considered high risk, we layer a little extra on top of all this advice. Various factors determine what makes a woman high risk, with the most outstanding being whether any marker lesions have been identified in your own breast tissue, and how many of your relatives have had breast cancer, especially under age fifty. If this sounds like you, take our anonymous, free genetics quiz at pinklotus.com/genequiz (http://pinklotus.com/genequiz). Talk to your doctor about more frequent testing beginning ten years prior to the age of your youngest relative with cancer, and be sure to inquire about CBE twice a year, annual mammograms, and possibly ultrasound and/or breast MRI. You might also want to discuss the benefits of risk-reducing medications and operations. More on this in part 3 (#litres_trial_promo). WHAT IT MEANS TO LOWER YOUR RISK FACTORS We’re going to spend a lot of time discussing risk factors for breast cancer in this book, so I want to be sure you understand what I’m talking about straight away. Simply put, a risk factor is anything that increases your chance of getting a disease, but does not definitely cause the disease. We don’t understand all of what causes breast cancer, so it’s impossible to eliminate every last variable and declare, “There, I prevented it!” with the same assurance that you could cry, “Five in a row. Bingo!” In that way, prevention doesn’t exist, but risk reduction does—and you, my friend, are in the driver’s seat. Think of it this way: driving fast doesn’t automatically mean you will have a car accident, but it certainly increases the odds. Car accidents are caused by the collision of a vehicle with something else, and driving fast is just one risk factor for collisions. Deciding to drive fast backwards while also texting on a dark road in the rain combines multiple risk factors for a collision, but the actual cause would still be the undeniable imprint of that tree trunk smashed into your car trunk. So how do you avoid colliding with breast cancer? Know your breasts, understand what they’re about, and take good care of them. This last point includes making the strategic and rather simple dietary and lifestyle improvements I outline in this book. After all, as I mentioned in my intro, researchers find that among women who, prior to menopause, (1) exercise, (2) don’t drink alcohol, (3) don’t smoke, and (4) shift their diet away from meat and dairy toward whole food, plant-based eating slash their odds of getting breast cancer in half. And postmenopausal women’s odds are sliced by 80 percent. In the medical world, this represents an incredible triumph when you consider that women endure chemotherapy for a mere 10 percent average improvement in survival over those skipping chemo. How has all this powerful information eluded you so far? It’s hardly your fault. Evidence-based advice on breast health, particularly when it comes to cancer prevention, is publicly doled out in drips and drabs—a magazine article here, a brief morning show segment there. And when we do hear a tip, it’s often in isolation and gets lost in the shuffle of everyday life. So you might find out that consuming cinnamon improves breast health, but who, with so many spinning plates, remembers to make this part of her daily diet—and without guidance, who actually knows how? Our daily habits are set in stone or bring us comfort, so it’s hard to make changes to an established routine. But I will show you how. I also need to point a manicured finger at our flawed educational system. During my four years of undergrad, four years of med school, five years of general surgery training, and my surgical breast fellowship, nutrition was a fleeting mention in the form of the Krebs cycle in the middle of one lecture—and for many of us physicians, that was twenty to forty years ago. Most doctors do not explore the science of eating or the impact of lifestyle choices to the degree that knowledge affects their own behavior, let alone yours. I know this is true because when I shared some of this book’s content with my cancer patients, countless times I heard, “Wow, I had no idea. You know, I asked my doctors what I should do and eat now that treatment has ended, and they just told me, ‘You did everything you were supposed to do. You’re fine; don’t worry about it. Live your life.’” Not so, my friend. You’re not done yet. Even when doctors do recognize the nutrition–illness connection, part of the reason they don’t tell you much is a reimbursement issue. Just as insurance companies don’t pay for your gym membership, weight-loss program, or stress management course, they don’t reimburse us doctors to spend time detailing preventive strategies. Doctors already need to stay up-to-date on what you expect from them, like screening guidelines and the best treatments for all the diseases they handle, which leaves no time for researching and dispensing extra freebies like, “Hey, did you know that three cups of green tea a day cuts breast cancer risk in half?” (By the way, did you?) So when you put all that together, the question isn’t how did you not know this—but how could you have possibly known at all? Nobody’s taught you to connect food and lifestyle to breast health the same way you might relate it to, say, the strength of your heart or brain. Which is funny, because your breasts coexist with the same body as these vital organs. The good news is that food science matters now more than ever, as the global health outlook becomes increasingly dismal. Both patients and doctors are becoming more interested in how nutrition and lifestyle affect risk reduction, causation, and reversal of disease processes. Of course, my central concern right now is your breasts (well, and your heart, since the number-one killer of women is heart disease; lucky you, my advice helps both problems). Up to 90 percent of the risk factors that determine optimal breast health lie entirely in your hands—so you are in control of you. Not your doctors, genes, or fate. You are with your breasts all day long, every single day. If you spent that much time with anything or anyone—a child, a spouse, a pet, even a car—you’d make sure they were in good shape. Why treat your breasts any differently? TRUE, THAT’S FALSE In coming chapters, we’ll discuss how to keep your breasts and body as healthy as they can be, but first let’s set the record straight on what does not cause breast cancer. Myths abound out there that puzzle my patients and the public, and they don’t hold up in studies. (Quoting studies is a theme you’ll find throughout this book because the pervasiveness of myths is such a peeve of mine.) If you’re aiming for optimal breast health, there’s no room for bogus claims. CHAPTER 2 (#ulink_aa10d6a4-4439-5bad-a9c8-49908bbabb7c) Debunking Breast Cancer Myths (#ulink_aa10d6a4-4439-5bad-a9c8-49908bbabb7c) In this book, we’ll talk at length about how to eat, drink, exercise, and behave in ways that optimize breast health and reduce your risk of cancer—all supported by credible, exciting research. But for as much useful information that’s out there, way too many myths persist that confuse and distract us from what we need to know. I can’t tell you how often patients come to me paralyzed with fear because they’ve read or heard that something they’ve done in the past—or currently do—will ruin their health. Genetic myths, hormone-related myths, dietary myths, environmental myths: I could play volleyball all day with all the false ideas flying around—set up, smash, repeat. I know, I shouldn’t be carrying my cell phone in my shirt pocket . . . My nutritionist said to eat grass-fed beef. That reduces cancer, right? Did my IVF drugs give me this breast lump? Oh, ladies. Let’s let go of the anxiety and misinformation you’ve unwittingly come to trust and start implementing the meaningful changes that science shows will help you live a longer and more vibrant life. It’s time to debunk the most common breast myths that have kept your armpits smelling and your cell phone ten feet from your wireless bra. THE TRUTH ABOUT GENES, GENDER, AND DESTINY As I’ve mentioned, genetics play a less important role than you probably think. Consider this fact: the identical twin sister of a woman with breast cancer has only a 20 percent chance of getting breast cancer one day—which, by the way, is the same risk as anyone with an affected sister. Since these twins share the exact same DNA, if genetics called all the cancer shots, risk should approach 100 percent—but it doesn’t, because genes aren’t the be-all end-all many people think they are. Patient after patient tells me that there isn’t any breast cancer in her family, so she’s not really at risk. Yet 87 percent of women diagnosed with breast cancer do not have a single first-degree relative with breast cancer. In fact, only 5 to 10 percent of breast cancers currently prove to be hereditary, meaning that they occur because abnormal gene mutations pass from parent to child. Of course, a vitally important part of assessing your risk includes genetic screening and family history, and I encourage every woman to use the free test on our website to see whether further testing would be warranted (pinklotus.com/genequiz (http://pinklotus.com/genequiz)). But if we can only blame our parents’ DNA 10 percent of the time, then factors outside of inherited genetics cause breast cancer 90 percent of the time. A major goal of this book is to teach you how to proactively make daily choices that reduce nongenetic cancer risk. Why passively await a breast cancer diagnosis when you can get actively involved in deterring it? Patients also think their mother’s family history of breast cancer matters much more than their father’s. Clearly, you are 50 percent your father’s DNA. You inherit genes from both sides—your maternal and paternal family histories count equally. Even doctors get this wrong. So when assessing familial risk, don’t just pay attention to your maternal lineage. Look at first-, second-, and third-degree relatives on both sides: parents, siblings, and your own children; grandparents, aunts/uncles, nieces/nephews, your own grandchildren; great-grandparents, great-aunts/great-uncles, first cousins, grandnieces/grandnephews, and your own great-grandchildren. When reviewing your father’s side, look for breast and ovarian cancers hiding in the women of more distant generations. Especially when the family tree lacks ladies, pay attention to mutation-associated cancers that show up more frequently in men than breast cancer, such as early-onset colon, prostate, and pancreatic cancers. And speaking of the guys, most think they can’t get breast cancer, but since they actually do have breast tissue, they’re susceptible too. Male breast cancer accounts for approximately 0.8 percent of all breast cancer cases, about 2,470 men annually. In American men, the lifetime risk of breast cancer approaches 1.3 in 100,000. Interestingly, stage for stage, men survive cancer at the same rates as women; however, due to a lack of awareness that male breast cancer is even a possibility, their diagnoses usually come at later stages, increasing overall mortality rates. Another erroneous myth about breast cancer relates to age—that it only happens to older people. While certainly less common among premenopausal than postmenopausal women, breast cancer does not discriminate when it comes to age. In the United States, 19.7 percent of all breast cancers and 11 percent of all breast cancer deaths occurred in women under fifty years old (specifically, 48,080 invasive breast cancer diagnoses, 14,050 in situ cancer diagnoses, and 4,470 breast cancer deaths befall women under fifty years old). In fact, the median age of breast cancer in the US is sixty-two years old, which means that exactly 50 percent of breast cancers are diagnosed under age sixty-two, and 50 percent are diagnosed at or over age sixty-two. No matter what your age, cancer cells shrink at the sight of healthy living, so we can employ the anticancer strategies in this book during all decades of life. Finally, the misunderstood stat that all women have a 1 in 8 chance of getting breast cancer is one of the most commonly quoted statistics out there. While it’s correct, truth be told, you don’t walk around every day of your life with 1 in 8 odds of getting breast cancer! If that were true, you’d probably have cancer by next month. Breast cancer risk increases as you get older. A woman’s chance of being diagnosed with breast cancer during her twenties is 1 in 1,567 (not 1 in 8); her thirties, 1 in 220; forties, 1 in 68; fifties, 1 in 43; sixties, 1 in 29; seventies, 1 in 25; finally reaching the oft-quoted 1 in 8 as a cumulative lifetime risk once she hits eighty. You know those pictures with a lineup of eight “woman” icons like the ones you see on a public restroom door? They sport a caption that reads, “One in eight women will develop breast cancer in her lifetime.” Really, the icons should not be youthful triangles. We need a few canes and wheelchairs in there to more accurately reflect risk as it pertains to age. FACT: YOUR DIET MATTERS—A LOT Frankly, one of the most dangerous falsehoods circulating out there states that your diet doesn’t impact breast health, which is completely bananas and wrong. What you put into your body influences estrogen levels, inflammation, blood vessel formation, cellular function, and destructive free radicals, to name a few cancer-related processes. What’s more, the core genetic mutation within a cancer cell cross-talks with hundreds of other genes, turning them on or off to suit the cancer’s survival instincts. Cancer growth isn’t the handiwork of a single gene; it’s the product of a network of genes. A human study in men with prostate cancer proved that by using only diet and healthy lifestyle interventions, the cross-talking chatter got turned down in 453 bad genes, and turned up in forty-eight good ones. Oh yes, nutrition matters, you can bet your life on it. I’ve devoted the next two chapters to foods that work to enhance breast health or flat-out destroy it, but a few phony food rules come up so often that I’d like to take a moment to slam them down. First up, wake up to coffee. A lot of the women I meet believe that coffee causes breast cancer, but absolutely no link exists between your sacred cup of joe and breast cancer. In fact, mounting evidence suggests that coffee might actually have a preventive effect. That being said, the caffeine in coffee isn’t always a plus for your breasts, as it can increase breast pain and breast cysts, particularly in young women with fibrocystic breast changes—but that’s not cancer. So if your breasts don’t hurt, it doesn’t hurt your breasts to love a latte. And speaking of lattes, the idea that dairy causes breast cancer is unproven. Evidence from more than forty case-control studies and twelve cohort studies does not support an association between dairy product consumption and breast cancer risk. It sounds intuitive to say that the presence of hormones, growth factors, fat, antibiotics, and chemical contaminants often found in dairy would lead to a proliferation of cancer cells, especially hormonally sensitive breast cancer cells, but the evidence contradicts our intuition. That being said, dairy is a major source of saturated fat, so you must be mindful of how fat influences your risk, which we discuss in chapter 4 (#litres_trial_promo). At first blush, the evidence seems to point toward the fact that no causative link exists between the consumption of red meat, white meat, total meat, or fish and breast cancer. Hit the brakes and screech to a skidding stop! Ladies, it took my writing this book to live inside the hundred-plus confusing and contradictory breast/meat studies and really figure it out. Meat is so toxic to your breasts that even the slightest consumption of it nullifies a measurable difference between “high” and “low” meat consumers. Only when you compare zero/zippo meat consumption to any meat consumption might you arrive at the truth. Minimize meat. See you in chapter 4 (#litres_trial_promo) to understand why. Finally, I hear from a lot of my most nutrition-savvy patients that acidic foods alter the body’s pH balance to the extent that it could cause breast cancer. But here’s the thing: your body tightly regulates your blood pH to be 7.35 to 7.45 no matter what you eat, and even minor changes to this range would cause severe symptoms and life-threatening illness. According to the American Institute for Cancer Research, this myth clashes with everything science teaches about the chemistry of the human body. There isn’t much wiggle room, since a pH outside of 6.8 to 7.8 equals certain death. And don’t be fooled by test kits said to rate your body’s acidity through urine. If you check the pH of your urine, and it’s not a perfect 7.35, that’s because your body constantly fine tunes excess acid or base to maintain proper blood pH balance, and it does so by excreting the excess in your urine. That said, it’s true that cancer cells flourish in acidic microenvironments. However, it’s the cancer itself that creates the acid it bathes in, so consuming low pH foods doesn’t provide a happy place for cancer; cancer doesn’t even need you for that. Besides, stomach juices are pure acid at pH 1.5 to 3.5. Your alkaline water slides down the esophagus and splashes right into an acidic bath; it will not change your body’s pH, and it will not neutralize a cancer cell’s acidic little world. I will say that the foods (nuts and veggies) you would consume in a (futile) effort to change your pH to more alkaline actually pack a massive punch to cancer cells via high antioxidant levels, DNA–damage control, and immune system support, but it’s not from making you alkaline. BOGUS LIFESTYLE BELIEFS We’ll dive into the lifestyle changes that matter most in chapter 5 (#litres_trial_promo), but I’d like to first clear the decks on certain popular myths so you don’t think I’m skipping these. Let’s talk bras. They don’t start or stimulate breast cancer, thankfully, because we need their unwavering support. Underwire bras, tight bras, sleeping in a bra, or wearing a bra more than twelve hours a day has no connection to risk. I’ve heard the claims, and initially they seem so plausible that one might believe they have a basis in fact. I repeatedly hear two schools of thought. One involves stating that tight bras compress the lymphatic system of the breast, which leads to toxins building up within the breast tissue itself, deleteriously altering the cells. This has no grounding in breast anatomy or physiology. We treat breast lymphedema (a blockage of lymphatic fluids within the breast that infrequently occurs after cancer surgery and radiation) with, among other strategies, breast compression. The other smart-sounding hypothesis proposes that the underwire itself conducts environmental electromagnetic fields (EMFs). As you will read in a minute, even if this antenna theory were true, EMFs don’t cause breast cancer. A 2014 study compared bra-wearing habits between postmenopausal women with and without invasive breast cancer. Researchers found that details such as cup size, underwire presence, age first beginning to wear bras, and average hours worn were not associated with an increased risk of breast cancer. So, ladies, whatever you feel is appropriate in terms of chest support, I support you. Next up: antiperspirants and deodorant. You can officially slow your search for the ultimate natural substitute because no scientific evidence backs the claim that antiperspirants or deodorants cause breast cancer due to toxin buildup or aluminum exposure or parabens. As a reminder, antiperspirants block the pores with astringents such as aluminum chlorohydrate so that they can’t release sweat, thereby preventing bacterial buildup and odor. On the other hand, deodorants don’t prevent sweating but rather neutralize the smell of excess bacteria by combining fragrances that mask odor with propylene glycol that creates an environment where bacteria can’t grow. One cancer-linking theory purports that pore-plugging aluminum compounds absorbed near the breast contain estrogen-like activity. As we will review later, estrogens feed and fuel the majority of breast cancer cells. Therefore, the presence of estrogen-behaving compounds might increase the division of cancer cells. A second study suggests that aluminum itself directly negatively affects breast tissue cells. But a 2014 systematic review of peer-reviewed literature regarding these two potential health risks posed by aluminum concluded that no such relationships exist. Maybe it’s not the aluminum? One publication found traces of a preservative called parabens inside a tiny sample of twenty breast cancer tumors. As “endocrine disrupters,” parabens demonstrate weak estrogen-like properties, but the study in question made no cause-and-effect connection between parabens and breast cancer, nor did it conclusively identify how they got there in the first place. Parabens have even been found inside tumors when women don’t use underarm products at all. Besides, the dose of parabens required to initiate a mutation in a human breast would be much higher than that absorbed through the application of a stick or spray. Additionally, most brands no longer use parabens, but if you’re still worried about this, choose a product that specifically says paraben-free on the packaging. Another widely circulating rumor claims that antiperspirant prevents you from sweating out toxins, which can then accumulate in the lymph nodes and cause breast cancer. To draw conclusions that wipe the sweat off our concerned brows (and pits), we need epidemiologic studies that compare two groups of people who are alike except for one deodorant factor. Luckily we have a few. In 2002, researchers at the Fred Hutchinson Cancer Research Center in Seattle conducted an epidemiologic study to address the sweat issue and other antiperspirant-related toxicity theories. They compared 1,600 women with and without breast cancer and found no link between breast cancer and antiperspirants, with or without shaving. A similar but smaller Iraqi study of 104 women with and without breast cancer also showed no link. The only published epidemiologic study with a competing point of view observed 437 Chicago-area breast cancer survivors and divided them according to underarm habits. The author found that women who used antiperspirant/deodorant earlier in life and more frequently and with underarm shaving were statistically more likely to develop breast cancer at an earlier age. He theorized that aluminum salt substances found in these products entered the lymphatic system through nicks in the skin caused by shaving. However, this study did not demonstrate a conclusive link between underarm hygiene habits and breast cancer. Furthermore, a major study no-no existed: the omission of a control group of women without breast cancer. The studies with the most research cred always have a control group. And one more thing: girls who use deodorant and shave earlier than others probably went through puberty sooner. Strong evidence shows that the earlier periods start (menarche), the higher the breast cancer risk. The National Institutes of Health (NIH), American Cancer Society (ACS), National Cancer Institute (NCI), and the US Food and Drug Administration (FDA) report that no conclusive evidence links the use of underarm antiperspirants or deodorants to the development of breast cancer. On the flipside, some argue that we see a lower prevalence of breast cancer in developing countries where women don’t use these products. But in Europe, where antiperspirants are not widely used, the rate of breast cancer is higher than in the United States, so it seems that factors much more influential than sweat-stopping antiperspirants and odor-eating deodorants are at play. While we’re talking chemicals, let’s move on to hair relaxers, particularly those feared to cause cancer in African American women. No doubt about it: cancer-causing compounds abound in hair products, but luckily for African American women who sport straight and silky hair, hair relaxers don’t make a cancer connection. Hair relaxers or straighteners, in the form of lotions or creams, chemically straighten curly hair by altering the hair’s internal structure. Product ingredients can enter the body through scalp burns or open cuts and sores. Since millions of African Americans use relaxers to reduce curl—one study found that 94 percent of African American women surveyed under age forty-five had used them at some point in their lives—these products have become the subject of much scrutiny, particularly as they may or may not relate to causing breast cancer. Funded by the National Cancer Institute (NCI), researchers followed over 48,000 African American women for six years in the Black Women’s Health study. A number of parameters were evaluated with respect to health and habits. Participants included women who had used hair straighteners seven or more times a year for twenty years or longer. When analyzing the 574 new cases of breast cancer that occurred during the study, researchers could not find any association between breast cancer risk and the duration of hair relaxer use, frequency of use, age at first use, number of burns experienced during use, or type of hair relaxer used. Perhaps what we should be focusing on isn’t straighteners specifically, but the fact that there are numerous and potentially cumulative health hazards hiding in our self-care products—particularly in African American communities. Specifically, hair products, including shampoos, conditioners, oils, dyes, relaxers, and root stimulators, containing estrogens and placental extracts can mimic estrogen in our bodies so much that use of these hair products in early life has been considered a major contributor as to why the proportion of girls at age eight who experience early puberty (precocious puberty) is nearly four times greater for African Americans than for whites (48.3 percent and 14.7 percent, respectively). Check hair product labels and avoid using ones that contain estrogens, other hormones, and placenta, particularly for young children or while pregnant. PIERCINGS AND TATS If you’re worried about the nipple piercings and body tattoos you got during your punk phase in college, let me put your mind at ease. Nipple piercings don’t cause breast cancer. Studies show that nipple piercings can cause breast infections, or theoretically create difficulties with breastfeeding, but they don’t cause breast cancer. Tattoos also can cause infection and allergic reactions; sterile needles and uncontaminated ink minimize that risk. Unlike piercings, tattoos fall under the “not sure, probably fine” cancer category. Studies show that skin cancers do not occur any more frequently than would be expected at the location of a tattoo, which should reassure breast cancer patients recreating a 3-D–appearing nipple and areola on mastectomy skin, or tattooing makeup in anticipation of chemotherapy-induced eyebrow and eyelash loss. On the other hand, when I remove lymph nodes during a cancer operation on someone with upper body art, the pathologist usually identifies tattoo pigment trapped within a node or two because the skin lymphatics drain ink to that location. No reports find that tattoos increase breast cancer risk, or that nodes with ink are more likely to contain metastatic breast cancer; however, ink does contain phthalates, hydrocarbons, and a number of other potential carcinogens and endocrine disruptors, which, as part of a larger whole, possibly impact breast cancer risk (see chapter 5 (#litres_trial_promo)). For mastectomy patients who worry about FDA warnings to “think before you ink,” pretty real-looking silicone reusable nipple prostheses come in a shade that matches skin tone; they just stick in place. An option: pinklotus.com/adhesivenipple (http://pinklotus.com/adhesivenipple). RADIATION REBUKES In our increasingly tech-reliant world, a lot of patients worry about radiation affecting breast cancer risk—specifically from mobile (cell) phones and power lines. Based on the studies available, this doesn’t appear to be a concern. Phew. In 2018, the number of mobile phone subscriptions (6.8 billion) approached the number of people on Earth (7.5 billion). Since these devices emit radio-frequency (RF) signals and electromagnetic fields (EMF), their ubiquity has generated public concern over possible adverse health effects. The real controversy centers on cell phone use and the risk for brain cancer, but breasts have a way of getting attention too. From what we can tell, mobile phones can’t cause breast cancer, even if you tuck them in your bra, because they do not emit the right type of energy (or a high enough amount of energy) to damage the DNA inside breast cells. In order to communicate with service towers, cell phones emit EMF. Body tissues absorb some of this radiation during regular phone use; usually those nearby tissues would be your face and brain, not your breast, but in the quest to be hands-free, many women tuck that smart box into a bra or shirt pocket. Here’s the key concept: mobile phone EMF is nonionizing, and as such, the energy waves are too wimpy to break DNA and other biochemical bonds. Besides your phone, other nonionizing sources of radio-frequency signals include microwaves, television, radio, and infrared. In contrast to nonionizing EMF, X-rays, gamma rays, and ultraviolet (UV) radiation emit ionizing EMF. These do create enough energy to mutate DNA, which can potentially lead to cancer. Common ionizing sources include sun exposure (UV rays) and medical X-rays like CT scans and mammograms. For a cell phone’s energy to go from nonionizing to ionizing, it would have to get 480,000 times stronger than it currently is. Several notable studies have examined the cell phone/cancer connection as it relates to brain tumors. Only one of these authors observed an increase in brain tumors with the use of mobile phones, and all the other studies could not reproduce the correlation. No study has postulated that cell phones cause breast cancer. If you carry your phone in your bra, I’d be more concerned about accidentally texting a photo of your breast to your boss than causing cellular damage to your breast DNA. Living near power lines can’t cause cancer either. Power lines emit both electric and magnetic energy that’s too muted to damage breast DNA. Additionally, walls, cars, and other objects shield and weaken the energy from power lines. When rates of female breast cancer on Long Island ranked among the highest in New York State, a 2003 study set out to explain possible environmental reasons why. One theory was that EMF caused the hike in cancer. Rather than using indirect measurements of EMF exposure (such as occupation or distance from power lines), investigators performed comprehensive in-home assessments of magnetic field exposure and only looked at women living in the same home for at least fifteen years. They compared these data between almost six hundred local women with and without breast cancer; in the end, they found no link between the disease and EMF emitted by power lines. A nationwide Finnish study and a Seattle-based study also concluded that typical residential EMF generated by high voltage power lines do not elevate overall cancer risk in adults. Similar to the EMF from cell phones, magnetic energy from power lines produces a low-frequency, nonionizing form of radiation that doesn’t mess with the breast. Maintaining that the weak EMF derived from power lines could have a catastrophic biologic effect sounds plausible to most of us because we don’t readily understand physics; but to a physicist, it’s a laughable proposition. Consider this factoid: the magnetic field from the earth itself is 150 to 250 times stronger than ones from power lines. If a power line’s small magnetic field could cause breast cancer, then just inhabiting Earth for a few years should lead to a total body cancer transformation. HORMONE-RELATED HEALTH WORRIES A lot of women express concern that certain health habits increase their risk—most of which circle the topic of affecting their estrogen levels, since estrogen feeds the majority of breast cancers. However, a bunch of these worries are, in fact, myths. I’ve repeatedly heard the popular rumor that oral contraceptive pills (OCP)—birth control pills—cause breast cancer. But if you are at normal risk for breast cancer, an unexpected pregnancy will add a lot more worry to your life than OCPs. Strong evidence from fifty-four studies concludes that current OCP users have a tiny 24 percent increase in the risk of having breast cancer diagnosed while they are taking OCPs and then the risk becomes 16 percent one to four years after stopping, 7 percent five to nine years after stopping, and no risk ten years out. Why do I call that “tiny”? Let me make this brilliant point: if you are twenty, the probability of developing breast cancer by age thirty is 1 in 1,567, so it only takes one more breast cancer case (2 in 1,567) to suddenly proclaim that rates went up 100 percent. And since studies say it’s 24 percent, your new risk will actually be 1.24 in 1,567 on OCPs. Pretty tiny, right? Depending on your personal risks, the bump in breast cancer might be offset by the fact that OCPs reduce colorectal cancer by 14 percent and endometrial (uterine) cancer by 43 percent. And if you’re a BRCA gene mutation carrier, there’s OCP good news for you too. After six years of use, OCPs reduce the risks of ovarian cancer by 50 percent for BRCA-1 and 60 percent for BRCA-2—with no increase in breast cancer. All premenopausal BRCA carriers with ovaries who are not trying to get pregnant should take OCPs to slash ovarian cancer risk. Women who have had or are considering in vitro fertilization (IVF) also shouldn’t fret that it causes breast cancer. Given the causative connection between hormones and breast cancer, fertility treatments have come under suspicion since they involve ten times the normal exposures of estrogen and progesterone each time the ovaries are stimulated. No evidence strongly connects fertility drugs with increased risk. A multitude of studies conclude that prospective moms using any of the ovarian stimulation medications associated with IVF, including clomiphene citrate (Clomid), gonadotropin-releasing hormone (GnRH antagonist, Lupron), human chorionic gonadotropin (hCG), follicle stimulating hormone (FSH), luteinizing hormone (LH), and progesterone, do not have a higher risk of breast cancer. In fact, works published since 2012 on the matter not only suggest a lack of interaction, but even a protective role of ovarian stimulation, as emphasized in two meta-analysis studies that pool the results of over 1.5 million infertile women who underwent IVF. And for those of you who have endured over seven cycles of IVF, I have reassuring news: the largest, most comprehensive study to date followed over 25,000 infertile Dutch women for twenty-one years, and guess what? Your tenacity paid off (I hope with a baby too): breast cancer risk was significantly lower in women undergoing seven or more cycles compared to those receiving one to two cycles. For all the twenty-one years they were followed, breast cancer risk among IVF-treated women was no different from that in the general Dutch population. There are exceptions, naturally, but they’re few. For example, one notable study from Australia did find an increased rate in women starting IVF under the age of twenty-four, but that’s an unusually young group to undergo IVF, and the study otherwise showed no overall increase in risk. Abortions and stillbirths don’t cause breast cancer either, though a link has often been suspected due to the estrogen surges that occur with pregnancy. I want all of you affected personally by any type of terminated pregnancy to read on and know this good news applies to you! When most women hear the word abortion, they commonly consider that word to mean an induced abortion, a medical procedure performed to voluntarily end a pregnancy. But there’s also the natural event of a spontaneous abortion, usually referred to as a miscarriage, which means the loss of a fetus before five months (twenty weeks) into the pregnancy. These generally result from genetic issues with the fetus that are incompatible with life, or from problems with the environment in which the unborn child is growing. And then there’s a stillborn birth, which refers to the death of a fetus after five months’ gestation while still in the uterus. While the cause is usually unknown, common identifiable reasons include nicotine, alcohol, or drugs taken by the mother, physical trauma, umbilical cord problems, Rh disease, and radiation poisoning. Research examining whether abortions cause breast cancer should relieve any concerns you have. Data from fifty-five studies spanning sixteen countries and including 83,000 women with breast cancer show no connection between breast cancer and spontaneous or induced abortions. A panel of over one hundred leading world experts convened by the National Cancer Institute (NCI) in 2003 performed a rigorous review of the scientific evidence regarding abortions and breast cancer risk. They concluded that no correlation exists between breast cancer and abortion, either spontaneous or induced. They deemed the level of scientific evidence for these findings as “well established,” which is the highest level achievable. With such an important and charged issue as abortion, we must be right when declaring a connection or not. We must rely upon data that is free from responder bias. We deserve and have the highest level of evidence from which to draw conclusions. Hence the consensus statements of both the 2003 NCI report and the concurrent American College of Obstetricians and Gynecologists (ACOG) Committee on Gynecologic Practice report rely upon only the most rigorously conducted research. Ethical and political disputes aside, let’s hear this good news clearly: “the totality of worldwide epidemiological evidence indicates that pregnancies ending as either spontaneous or induced abortions do not have adverse effects on women’s subsequent risk of developing breast cancer.” DOES CHANGING YOUR ANATOMY CAUSE CANCER? Making changes to your natural anatomy doesn’t cause breast cancer, though you might worry it would based on misinformation that trauma (accidental or surgical) upsets the natural state of things. Let’s first talk breast implants: if you have them, should you have regrets too? Whether saline or silicone, above or below your chest muscle, decades old or brand new, textured or smooth, round or shaped, implants do not cause breast cancer. In fact, a study of 3,139 women who got an augmentation between 1953 and 1980 shows that, after an average of 15.5 years, these women have 31 percent less breast cancer than would be expected. And this isn’t the only such study. A meta-analysis of seventeen studies also showed a significant decrease in cancer incidence among those with cosmetic implants by one-third. Before you rush out to protect your breasts with implants, the decrease in risk likely corresponds to the facts that women with implants generally have a lower body mass index (BMI) than those without implants, and have their children prior to age thirty, two known factors that decrease breast cancer. That being said, implants can complicate the detection of an existing breast cancer, so I do recommend more rigorous screening for those who have them. Generally speaking, women with breast implants in whom breast cancer develops are diagnosed at similar stages and have equivalent survival rates as compared with breast cancer patients without implants. It’s important to note, however, that the World Health Organization has confirmed a probable association between breast implants and the rare development of anaplastic large cell lymphoma (ALCL), a cancer of the immune system, but that is not the breast, and ALCL is not breast cancer. Implant-associated ALCL occurs in approximately 1 per 5,000 women with textured implants (rarely with smooth implants) and presents with fluid forming around the implant an average of eight years after placement. Thankfully, just removing the implant and the capsule that forms around it completely cures 97.5 percent of women. If needed, those affected can receive a targeted antibody-drug called brentuximab; chemotherapy and radiation are rarely indicated. We also know that while implants don’t cause cancer, augmentation and implants after mastectomy can present long-term complications, including changes in nipple or breast sensation, undesirable implant positioning, implant rupture, tight scar tissue around the implant (capsular contracture), or persistent pain. On the other end of the spectrum, you should also know that no link exists between breast reduction surgery (reduction mammoplasty) and breast cancer. In fact, you may actually see a decrease in breast cancer risk. Medical literature supports the notion that breast reduction surgery decreases risk consistently around 30 to 40 percent, with even higher numbers reported when removing two cup sizes (over six hundred grams) of tissue per breast. By removing additional ducts and lobules that carry the potential to become cancerous, there aren’t as many around to cause trouble. Another prevailing theory as to why reductions help suggests that removing fat (i.e., adipose tissue) favorably changes the world where breast cells live, called the microenvironment. While we’re on the topic, you should know that breast size doesn’t directly affect risk either; small-breasted women don’t have less risk of breast cancer than large-breasted ones. However, there’s one connection between breast size and cancer when analyzing the composition of your breast tissue. Remember, the more ducts and lobules you have (as opposed to adipose tissue), the more cells you possess that can become cancerous. To demonstrate, a prospective study compared self-reported bra size and cancer risk among of 88,826 premenopausal women followed for eight years. They held a number of factors constant so as to isolate the effect of breast size. After stratification by body mass index (BMI), they found a significant trend for increasing bra cup size and greater breast cancer risk in one and only one group—the leaner women. Among overweight or obese women, no association between bra cup size and breast cancer was found. In other words, leaner women with generous breasts have more breast cancer precisely because they have very little fat, and therefore, a lot more glandular tissue. More glandular tissue simply equals more breast cancer risk. In this group of 420 leaner women with breast cancer, 96 percent wore smaller than a D-cup, so the subgroup of large-breasted lean women at risk due to size alone is small. The vast majority of large breasts are large because of all the fat surrounding the glandular tissue (and as stated, this fat is very unlikely to become cancerous). Conversely, small breasts generally have less fat, and potentially have the same net volume of glandular tissue as many larger breasts. Therefore, in the final analysis, women should have a similar incidence of breast cancer risk irrespective of their breast volume. The majority of studies attempting to correlate size to risk conclude that no such association exists. ACHOO! CAN YOU “CATCH” BREAST CANCER? Wondering if you can catch breast cancer or give it to someone else—whether it’s by breathing it through the air, or from exposure to bodily fluids such as breast milk, blood, and saliva, or from sharing utensils, kissing, or having sex—might at first seem ridiculous. But this is actually a real question I’m asked. So here’s your real answer. When the DNA within a breast cell mutates, that cell starts to grow and divide and spread without control or order; that’s how cancer happens. And that’s the only way it starts. Exposure to someone else’s mutated breast cell doesn’t do anything to your own cells’ DNA. Yet several studies have shown that many people believe breast cancer to be contagious; these findings suggest a pressing need to develop breast cancer educational programs. What’s encouraging is that in 1964, 20 percent of residents interviewed in Perth, Australia, believed that cancer is contagious; however, when that same interview was repeated forty years later, only 3 percent expressed that same belief. In other words, improved education about health issues can impact beliefs. We need effective community-based interventions that target the demographics most vulnerable to these faulty myths, which tend to be recent immigrants and those of lower socioeconomic status. Busting myths can change behavior and, in turn, improve cancer outcomes. SEND ME YOUR BREAST MYTHS! Heard of another myth and you just can’t figure out the truth? I want to hear about it! Head on over to pinklotus.com/breastmyths (http://pinklotus.com/breastmyths) and tell me more. I choose the best myth submissions and debunk them for you on our Pink Lotus Power Up blog. PART 2 (#ulink_fc77e8b5-8e6f-5134-8421-3137321ad8e1) REDUCING CANCER RISK (#ulink_fc77e8b5-8e6f-5134-8421-3137321ad8e1) CHAPTER 3 (#ulink_77a1e2c7-56ee-5557-b389-298a8e5ed664) Eat This (#ulink_77a1e2c7-56ee-5557-b389-298a8e5ed664) “Hey honey, can you run over to aisle five and grab a jar of flavonoids? You’ll see it next to all the polyphenols . . .” Though your ability to track down such cancer-kicking, life-giving antioxidants isn’t this obvious, I am about to make your life easier by showing you where to find the best food-based nutrients to support your breasts and body. I think you’ll love that they’re not found in obscure, disgusting, or pricey foods. They’re yummy, affordable, and located in every grocery store around the world. When eating food, as opposed to supplements, we don’t consume individual nutrients, like swallowing a spoonful of one essential amino acid. We eat meals and snacks with combinations of ingredients inside a variety of foods. Therefore, an obvious difficulty arises when trying to arrive at a definitive, “Yes, consuming 5 milligrams of this decreases breast cancer risk by 50 percent.” Nonetheless, trends do emerge when one examines the body of literature related to this topic, so let’s be trendy, shall we? THE MIGHTY PHYTOCHEMICAL (A.K.A. PHYTONUTRIENT) The key to using food to protect yourself from breast cancer is to understand that food holds the power to alter the following factors inside of you: estrogen levels, growth factors, new blood vessel formation (angiogenesis), inflammation, and immune system function. Each of these factors affects what we call a tumor’s microenvironment—the fluids and cells that bathe, support, and fuel potential cancers . . . or seek and destroy them. You choose. When your microenvironment cries out, “Pro-cancer!” cancer cells can form and multiply. I want you to regularly ingest foods that make your breast microenvironment unpleasant to tumors by shouting out, “Anticancer!” The ones that do so the loudest come naturally packed with phytochemicals. Phytochemicals are plant-derived molecules (phyto means “plant” in Greek) known to possess profound anticancer and anti-inflammatory properties that directly target the very processes that cancer cells use to develop a tumor. Imagine a normal cell happily humming along when, unexpectedly, in a matter of days, what was normal becomes mutated by factors like the sun’s UV rays, cigarette smoke, or carcinogenic foods. This mutated cell transforms into a cancer seed. Whether or not that seed takes root and blooms into a full-blown cancer capable of destroying your life depends on the microenvironment—the soil in which cancer seeds either flourish or fail. In 1974, the National Institutes of Health (NIH) funded a study that showed that breast cancers implanted into female rats shed tumor cells into the bloodstream at dizzying rates. From one cubic centimeter of breast cancer—the size of a peanut M&M or sugar cube—cancers will shed 3.2 million malignant cells into the bloodstream every twenty-four hours. Kind of makes you catch your breath, doesn’t it? How, then, doesn’t every cancer story have a fatal ending? The majority of these cells are rapidly cleared from the blood by a functional immune system, and if breast cells do arrive in a foreign land like the liver, they usually stop dividing and perish—unless they find that soil conducive to growth. How do we engineer soil that stops cancer seeds from sprouting? In the most comprehensive study of human nutrition ever conducted in the history of science, the China Study, the authors observed that nutrition is infinitely more important in controlling cancer growth (the soil) than the dose of the initiating carcinogen (the seed maker). In other words, healthy cells can wear nutritional armor that protects against mutations when they get exposed to bad things, so they don’t become seeds. Furthermore, even if some cells mutate into malignant seeds, by maintaining an anticancer microenvironment, seeds wither away. But in a pro-cancer body, that mutated cell multiplies and divides over and over again, as weeks turn to years, becoming decades of growth without the body’s ability to control these cells the way it controls normal aging cells. Eventually, that little zombie creates its own blood supply to bring itself even more of the nutrients it needs to now rapidly progress into a cancerous mass that you suddenly feel in your breast, making you gasp and say, “What? That was not there yesterday.” Let me introduce you to some of the powerful plant compounds that block carcinogenic action—like sulforaphane and indole-3-carbinol (broccoli, kale), genistein (soy), diallyl sulphide (garlic), and ellagic acid (berries, walnuts)—and can save your life. Plants preceded humans on this earth, and they developed some awesome weaponry to protect themselves against adversaries like the sun’s UV rays, microorganisms, and insects. So we are going to pay serious attention to them, just as scientists have for many years. Plants behave like little pharmacies, auto-dispensing molecules that kill off bacteria, viruses, and fungi before these attackers kill them. Let me ask you this: If you were to eat plants, would their protective powers extend to you as a human? Of course they would! Folk medicine isn’t folklore. The medicinal gifts of the Amazonian jungle provide the basis for countless medications sold by pharmaceutical companies. A number of natural chemicals known to actively block the birth and growth of cancer cells (carcinogenesis) have been isolated from fruits and vegetables. When cancer seeds do form, these same phytochemicals enable or disable the soil’s microenvironment everywhere in your body—in the breast, yes, but also in the liver and lung and bone and brain—in all the places where breast cancer likes to travel. Phytonutrients include curcumin (turmeric), epigallocatechin gallate (EGCG, in green tea), resveratrol (grapes, wine), omega-3 fatty acids (flaxseeds, avocado), procyanidins (berries), genistein (soy), lycopene (tomatoes), anthocyanidins (apples), and limonene (oranges). Research reveals that phytochemicals exude serious anticarcinogenesis powers by • providing antioxidant activity and scavenging free radicals, which stop harmful things we consume and encounter (i.e., carcinogens) from becoming cancer cells in our bodies • preventing DNA damage • repairing broken DNA • destroying harmful cells in our body • tempering the growth rate of cancer cells • inhibiting new blood supply to tumor cells (anti-angiogenesis) • stimulating the immune system • regulating hormone metabolism • reducing inflammation • supplying antibacterial and antiviral effects THE ACCLAIMED ANTIOXIDANT The most famous phytochemicals behave as antioxidants, such as vitamins C and E, beta-carotene, and lycopene. But what are antioxidants, and what do they do? Don’t worry, this won’t become a biochemistry lesson, but you need to understand the battlefield we call oxidative stress. Free radicals are bad oxygen molecules, acting like a dog without a bone. Because they need an electron to make themselves stable and happy, they steal it from any cell next to them, and this now makes the adjacent cell unhappy, so it steals from its neighbor, and so on and so on. What-oh-what can stop all the oxidative madness? Antioxidants can halt this cascade of free radical formation and ravaging cell damage. A kind-hearted, life-giving molecule, the antioxidant says to the oxidant, “Hey dog, take my electron. I’m super stable even without that bone. You need it, and I don’t.” Free radicals are actually necessary to some degree in that they help us breathe (useful, I would say); they combat infection and can actually kill the cancer cells they help cause (ironic, but also useful); and they start the inflammatory response to injury so that your body can repair itself (that’s nice). But if more “bad” hangs around than there is “good” to stop it, then oxidative stress results, and when this imbalance persists day after day, year after year, your body’s cells and DNA get too beat up. Sickness results. Basically, whichever organs these free radicals injure the most frequently determines what diseases you’ll get. If it’s your blood vessels, hello heart disease. If it’s your muscles, you’re chronically fatigued or have fibromyalgia. If it’s your brain, I forgot what happens—oh wait, dementia and Alzheimer’s. If it’s your gut, bowels get irritable. If there’s excessive free radical damage in your breast tissue, well . . . Eliminate oxidative stress, and you just might live forever. The role of antioxidants in tempering oxidative stress only scratches the surface of the anticancer abilities of phytonutrients, as evidenced by antioxidant activity being just the first of our ten bullet points above. If you really want to defeat cancer, then eat like you mean it. I have something to share that will transform your eating forever. Every meal creates damaging free radicals in an effort to digest food; that is, oxidative stress rules what’s called the postprandial—after a meal—state. In fact, harmful oxidation is so high with the standard American diet (a.k.a. SAD) that most people go to bed every night with fewer antioxidants than when they woke up. How can you reverse this? Well, a study gave people a standard breakfast and measured their oxidized LDL cholesterol levels hourly. Cholesterol tracked up and up, and by noon, the participants were in a hyperoxidized state, ready to chow down their next SAD meal. What happened when people ate the same meals with one change: they added a cup of strawberries? All it took was one cup of antioxidant-packed strawberries with that same breakfast, and oxidative stress levels returned to baseline by noon! I hope your eyes just widened and nearly popped out of your head. Imagine if the meal weren’t pancakes and bacon, or steak and eggs plus that strawberry cup, but rather, steel cut oatmeal plus berries? Wow—then you would be building up health instead of staying neutral. The take home point: eat antioxidants with every meal (not just a cup of blueberries in the morning, and you’re done for the day). Every meal creates an oxidation battle—fight back with antioxidant-rich plant-based foods every time you lift fork to mouth. The Mediterranean diet (MedDiet) comes up often as a healthy way to eat, and not surprisingly, it makes phytonutrients a priority, emphasizing fruits, vegetables, whole grains, olive oil, fish, and red wine in moderation. The MedDiet theoretically creates a microenvironment that cancers should consider hostile . . . so what happens when you put it to the test? Recently, nineteen studies unanimously showed strong benefits of the MedDiet to reduce the risk of total mortality from all the illnesses we fear: heart attacks, strokes, cognitive decline, and cancer. Could the MedDiet be the reason why breast cancer rates have been lower in Mediterranean countries (such as Spain, Italy, Greece) than in the United States, and northern and central European countries (such as Scotland, England, Denmark)? In a multicenter study from Spain, adherence to a MedDiet decreased the occurrence of all breast tumor subtypes, but most notably, the aggressive triple-negative breast cancers (TNBC) dropped by 68 percent. A Dutch study of over 62,000 women tracked for twenty years showed a 40 percent drop in TNBC on the MedDiet. Finally, a ten-country European study followed a whopping 330,000 women for eleven years and found 20 percent less TNBC with a MedDiet. Well, I’d say the MedDiet passed the longevity test with flying (antioxidant-rich) colors. THE PERFECT PLATE So what does a plate loaded with antioxidants and other cancer-fighting nutrients look like? The ideal meal is largely plant-based with an abundance of fresh fruits and vegetables, healthy fats, whole grains, legumes, occasional fish or lean meats (or not, as we later discuss), with a cup of green tea—and sometimes wine—on the side. Your plate at any given meal should be 70 percent full of fresh fruits, vegetables, and leafy greens (kale, spinach, collards), and 30 percent packed with whole grains and protein (legumes and soy). Don’t fear starchy veggies like sweet potatoes and butternut squash; go for a deep-colored rainbow of foods, since the color contains the phytonutrients (chlorophyll makes a mean green; carotenoids create yellow and orange; flavonoids equal blue, red, and cream). For example, red jasmine rice extract reduced the migration and invasion of human breast cancer cells in a petri dish; the same thing happened with bran extract from brown rice dripped onto breast cancer cells. But white rice extract did nothing; what’s more, black rice extract fed to mice with human breast cancer grafts (I know, science can be cruel) clearly suppressed tumor growth and angiogenesis. So be colorful. And FYI, sprouting, soaking, and fermenting whole grains forms a more digestible carbohydrate. A typical meal for me follows the 70/30 rule. I’ll eat a huge salad with a thick, delicious whole grain base across half the bottom and legumes on the other. I pile kale, arugula, and broccoli sprouts atop this layer, and then I vary what gets thrown on next among about five to ten different foods that suit my mood: raw broccoli (always), cherry tomatoes, artichoke hearts, sweet yellow peppers, fresh blueberries, avocado, a heap of hummus, and pumpkin seeds. My dressing involves a blend of apple cider vinegar, crushed garlic, ground pepper, and herbs. But honestly, if this concept is new to you, and you need a little Thousand Island or creamy ranch to enjoy it, go ahead. I’m so psyched that your plate has all those antioxidants, you won this meal’s oxidative stress battle already. MY IDEAL MEAL, DECODED . . . We all know our fruits and vegetables, and we even have a number of go-to faves, but when I got started eating a whole food, plant-based diet and wanted to find hearty replacements for my butter, eggs, and salmon fillet, I ran into quite a few delicious discoveries. So may I introduce to you . . . • Healthy fats: Avocados, nuts (walnuts, pecans, pistachios, cashews, macadamia, almonds), seeds (ground flax, chia, sunflower, sesame), nut and seed butters (almond, cashew, sunflower), olives, tofu, edamame, at least 70 percent cacao dark chocolate, extra virgin olive oil, organic expeller-pressed canola oil. • 100 percent whole grains: Whole wheat and whole grain bread and pasta, brown/wild/black/red rice, whole oats, quinoa, freekeh, farro, popcorn, whole rye, whole barley, buckwheat, whole wheat couscous, bulgur, amaranth, sorghum, teff. • Legumes: Beans (kidney, garbanzo, lima, fava, mung, black, soy), peas (green, snow, snap, split, black-eyed), special nuts (peanuts, soy nuts), and lentils (brown, green, red, black, yellow). RELATIVE WHAAA? Before we chase a rainbow of healthy foods, we need a stat course in statistics. I want you to understand two important terms, relative risk and absolute risk, so you have a way of digesting the numbers I use to explain how your diet and lifestyle choices impact cancer risk. Relative risk compares the chance of getting a particular disease when people are exposed to a certain factor with the chance of people getting the disease who are not exposed to the same factor. The easiest analogy is smoking and lung cancer; no one will be surprised to hear that the relative risk for those who smoke is way higher than for those who don’t. So now, let’s talk breast cancer and compare not eating enough fiber to chowing down plenty of fiber. Fact: if you don’t eat at least 30 grams of fiber per day, your breast cancer risk goes up 50 percent. This means you have a 50 percent increase in breast cancer relative to the high-fiber consumer. But what you really want to know is how this affects absolute risk. Absolute risk takes you out of the one context of fiber and puts you back into the context of all women, including your fiber factor. The numbers show that women have a 1 in 8 risk of developing breast cancer by the time they reach age eighty, so how does “50 percent” alter this risk in a low-fiber consumer? Well, 50 percent of 1 is 0.5. So a 50 percent increase in relative risk takes your absolute risk from 1 in 8 to 1.5 in 8. Indulge me as I share two more interesting ways to assimilate this statistical information. First, the other person in our example—the fiber lover—had 50 percent less breast cancer, yes? Again, 50 percent of 1 is 0.5, but this time a decrease in relative risk takes absolute risk from 1 in 8 to 0.5 in 8. As we dive into all that I have learned and plan to show you, we will use these powerful additions and subtractions to our lifetime risk of breast cancer to try to optimize health. Second, risks may come and go, especially if we step up our anticancer game and change our behavior. Sometimes it’s reassuring if you look at your absolute risk over a shorter period of time than an entire lifespan. For example, if you are currently forty-two years old, it turns out that your absolute risk of developing breast cancer this year is 1 in 680. If you don’t consume lots of bran cereals and fiber-rich fruit, your risk becomes 1.5 in 680—see, a “50 percent increase” barely moved your absolute risk at the age of 42. When you read about a risk factor, and it says you are 300 percent more likely to have breast cancer because you drank something, remember to relate it to absolute risk. A 300 percent increase means a forty-two-year-old with a 1 in 680 chance without the drink of something now has a 4 in 680 chance. I doubt you’d take those odds to Vegas. So nobody panic, but remember that eventually all the little trees of relative risk (all the daily choices about each food or habit) add up to a forest, which determines the health of your breasts. KNOW YOUR PHYTOS As difficult as it may be to pinpoint a single nutrient and confirm its cancer-fighting capacity, scientists have identified tens of thousands of phytochemicals and continue to study their complex functions. So far, these nutrients appear to be little masterminds at playing the anticancer game. The exquisite and truly unknowable power packed into foods like broccoli and berries, and then the complex cascade of events that follow from your stomach to the insides of your every cell . . . it’s dazzling. If the starring role of that movie goes to a Big Mac, it’s more horrifying than dazzling, but that’s the next chapter. The following cast of characters represents the A-listers, the most fabulous phytonutrients in town, and they should make daily appearances in the story of your life. Start including these foods in your grocery cart today. In 2009, researchers used data from surveys that capture what Americans eat on a daily basis (the National Health and Nutrition Examination Surveys, NHANES), as well as data about nutrient content from the United States Department of Agriculture (USDA) and other published literature to estimate “the phytonutrient gap”—that is, how far we fall short of the recommended five to thirteen fruit and vegetable servings a day. They grouped our phytonutrient A-listers above into one of five color categories depending on the primary pigment of the foods in which they are found. Based on this report, here’s your fun and informative breakdown of the rainbow we eat (or don’t eat, as the case turns out): • Green: 69 percent fall short (kiwi, honeydew melon, broccoli, kale, spinach, avocado, peas) • Red: 78 percent fall short (apples, grapefruit, raspberries, tomatoes, beets, kidney beans) • White: 86 percent fall short (pears, cauliflower, chickpeas, garlic, onions, mushrooms) • Purple/blue: 88 percent fall short (plums, grapes, blueberries, eggplant, turnips) • Yellow/orange: 79 percent fall short (banana, pineapple, peach, lemon, carrots, yams) Yowza—a phytonutrient gap exists in 8 out of 10 Americans. Ideally, you should consume ten servings of fruits and vegetables daily (this quantity averages about five cups). While we could debate the exact balance of servings per color, a simple goal should be to eat two servings from each color each day. Choose the richest, most vibrantly colored foods whenever possible, since color generally reflects phytonutrient content. THE TEN BREAST SUPERFOODS Ready for the ten most powerful superfoods that just might stop breast cancer cold in its tracks? #1: Cruciferous Vegetables and Leafy Greens These include broccoli, cauliflower, cabbage, brussels sprouts, turnips, radish, watercress, kale, arugula, collards, bok choy, and Swiss chard. The high isothiocyanate exposure from cruciferous vegetables may be the primary reason for breast cancer reduction. In order to get the most bang for your broc, eat it lightly steamed or raw, and chew it thoroughly to break down the cell walls, which then allows the molecules to mix together, creating (yes, it was not there before) sulforaphane, the superstar of all isothiocyanates. Sulforaphanes display ridiculous talent when it comes to seeking out and destroying potential breast cancer cells. And broccoli sprouts contain one hundred times the sulforaphane of broccoli. If that weren’t enough, greens also provide indole-3-carbinols, which exit excess estrogen out the urinary door. A study following nearly 52,000 African American women for twelve years analyzed food consumption and found that cruciferous veggies cut breast cancer by 41 percent among premenopausal ladies consuming more than six servings a week. #2: Dietary Fiber Think whole grains, beans, and veggies. Estrogen feeds and fuels 80 percent of all breast cancers. Unfortunately, most women don’t know this fact, or that estrogen can be suppressed with a targeted diet. Fiber crushes cancer’s dreams when it binds estrogen and toxins in your gastrointestinal tract (you poop them out!), improves insulin sensitivity, and releases a litany of antioxidant vitamins and anticancer compounds. High vegetable intake even quells the more aggressive estrogen-negative tumors. Strive to consume more than 30 grams of fiber per day to decrease breast cancer risk by as much as 50 percent. Even just 20 grams gives you a 15 percent cancer reduction. What does 30 grams look like? It’s three to five servings a day of high fiber foods, such as the following: • one cup of boiled split peas, lentils, black beans (15 grams), lima beans (13 grams), baked beans (10 grams), green peas (9 grams) • one avocado (13.5 grams) • one half cup of passion fruit (12 grams) • one medium artichoke (10.3 grams) • one cup of raspberries (8 grams) • one cup whole wheat spaghetti (6.3 grams) or pearled barley (6 grams) • one medium pear (5.5 grams) • three-quarters cup bran flakes (5.5 grams) • one cup of broccoli (5 grams) How many American adults fail to consume enough daily fiber? Ninety-seven percent. You and I will be in the 3 percent. Long live legumes (and us)! #3: Berries In decreasing order of antioxidant/free radical scavenging power, please meet and greet the wild blueberry, cranberry, blackberry, raspberry, strawberry, and cherry. Compounds like ellagic acid, anthocyanidins, and proanthocyanidins interfere with cancer cell signals, encourage cancer cell suicide (apoptosis), and inhibit angiogenesis. Frozen berries more rapidly release these polyphenol heavyweights than fresh berries, but either fresh or frozen, throw them into oatmeal, smoothies, and salads—nobody’s looking, go ahead and just pop them straight into your mouth. I also love the Indian gooseberry, which has 124 times the antioxidant power of a blueberry, and works synergistically within the body to extinguish oxidative damage from free radicals. You can use it in the powdered form, amla, as I do in my Antioxidant Smoothie recipe at the end of this chapter. #4: Apples Can an apple a day keep breast cancer away? Seems so! The flavonols and catechins in all apple peels and the anthocyanins in red apples work against every metabolic pathway cancers try to take, at least in animal models. Daily apple eaters (not pie, people) have 24 percent less breast cancer than those eating fewer apples. Extracts from the peel stop cancer cells in the lab ten times more effectively than from the flesh of the same apples, so eat them whole or blended, but not juiced. #5: Tomatoes One of the carotenoids, lycopene, colors tomatoes bright red and is most concentrated in the skin. As a powerful antioxidant, lycopene exhibits anti-inflammatory and anti-angiogenesis abilities, both plausible reasons for the reported decrease in breast cancer among women with high tomato intake. Unlike most phytochemicals, which are best consumed in their raw state, heating tomatoes for fifteen minutes increases the lycopene bioavailability by 300 percent. They are fat-soluble, so bump up absorption even more by saut?ing or roasting them in a touch of olive oil. #6: Mushrooms Mushrooms aren’t technically fruits, vegetables, or even plants—they’re fungi, but they’re also delicious and nutritious. Who would’ve guessed that fancy mushrooms like portobello, chanterelle, and oyster have fewer flavones and isoflavones than the little ol’ white button? True, the buttons carry the highest estrogen-blocking abilities of all these mushrooms and inhibit an enzyme, aromatase, which normally converts precursors of estrogen to its cancer-causing active form. A daily intake of 10 grams or more—the equivalent of half a button mushroom—dropped breast cancer rates in Chinese women by 64 percent compared with age-matched “no mushroom” eaters, and by 89 percent when they sipped a halfcup of green tea to boot. Studies credit polysaccharides in medicinal mushrooms with stimulating immune response pathways and exhibiting direct antitumor ninja skills. #7: Garlic, Onions, Leeks, Shallots, Chives, Scallions Crush, chop, or chew them, but these immunity-boosting bulbs need to be fresh to unleash the antiproliferative and antioxidant protection of the phytochemical allicin. A French study showed an astounding 75 percent drop in breast cancer with eleven to twelve weekly servings of the allium vegetables such as garlic and onions. Vampires were also reported missing. #8: Turmeric and Spices Could curcumin, the most active ingredient in the pungent yellow herb turmeric be the reason breast cancer rates in India are five times less than in Westernized countries? Curcumin decreases estrogen, induces cancer cell apoptosis, suppresses inflammation (COX-2 inhibition), and inhibits free radicals. In fact, human blood samples were exposed to free radicals in a lab one week, and when this exposure was repeated on fresh samples from the same people the following week, they sustained half the oxidative DNA damage. What changed in one week? The study subjects merely consumed one daily pinch of turmeric. Piperine, found in black pepper, increases the bioavailability of curcumin from barely detectable to 2,000 percent higher. Mixing 1/4 teaspoon of turmeric powder or a quarter inch fresh turmeric root with 1/4 teaspoon of black pepper and one tablespoon of fat like ground flaxseeds helps with absorption and avoids elimination by the liver—and makes a great topping for salad, rice, or vegetable dishes. While straight curcumin is powerful, it shows less cancer inhibition than turmeric when the two go head-to-head against breast cancer cells in a petri dish, so you may as well reap all the benefit you can from turning things ochre yellow (like I did the inside of my blender) and choose turmeric. Avoid turmeric if you have gallstones; it stimulates gallbladder contraction, which can lead to a painful gallbladder attack. Spices contribute far more than color and flavor to food; they beneficially affect inflammation, free radical formation and cancer cell proliferation, apoptosis, angiogenesis, and immune function. So while we’re feeling spicy, let me also suggest anticancer cooking with clove (second only to that gooseberry in antioxidant potency), ginger, paprika, cumin, cinnamon, sage, rosemary, oregano, thyme, and anything else inside the box below that you think adds zest and zing. Incidentally, cassia cinnamon contains much more of the blood thinner, coumarin, than does Ceylon cinnamon; coumarin can also be toxic to the liver at doses of 1 teaspoon a day, so favor Ceylon if you consume cinnamon regularly. HEY, HERB, LET’S SPICE IT UP A pinch of this and a dash of that can transform bland and boring into “Yummy yummy, seconds, please!” Over 180 spice-derived phytonutrients have been explored for their health benefits, so the most impressive of these deserve some shelf space, please. If salt and pepper is your idea of a spice rack, try incorporating these breast-friendly herbs and spices into your cooking and experience the flavorful taste of cancer fighting: • allspice • barberries • basil • bay leaves • black pepper • caraway • cardamom • chili pepper • chili powder • chives • cilantro • cinnamon (Ceylon) • clove • coriander • cumin • curry powder • dill • fennel • fenugreek • garlic • ginger • horseradish • kokum • leeks • lemongrass • marjoram • mint • mustard powder • onions • oregano • nutmeg • paprika • parsley • rosemary • sage • saffron • scallions • shallots • thyme • turmeric / turmeric root #9: Seaweed Seaweed reduces the estrogen burden in the body by promoting urinary excretion and altering the gut bacteria. A Korean study showed that daily consumption of gim (like a sheet of nori, the sushi wrap) drops breast cancer by over 50 percent. Common seaweeds include nori, wakame, arame, mekabu, kombu, dulse, Irish moss, and spirulina. Try snacking on sheets of nori instead of chips, or roll up veggies and colored rice in a nori wrap. Throw a teaspoon of powdered spirulina into a smoothie or salad dressing, or shake seaweed flakes (found online or in Asian markets) instead of salt onto any meal. #10: Cacao Packed with flavonoids and procyanidins, cacao powder (not Dutch-processed) can be added to berry smoothies to satisfy a sweet tooth. Consuming 1.5 ounces (40 grams) of more than 70 percent cacao solid dark chocolate gets an anticancer thumbs up, as it delivers antioxidants more than it does cocoa fat and sugar. THERE’S SOMETHING SPECIAL ABOUT SOY—NO, REALLY It’s time to set the record straight on this healing ingredient because it gets an unfair bad rap. Soy contains isoflavones, some of which act as phytoestrogens (plant-based estrogen-like compounds), and estrogen fuels most breast cancers, so I’ll bet somebody somewhere told you, “Say no to soy!” and you spit that miso soup right out of your mouth. Most physicians believe this to be unchartered territory, so they err on the side of caution and advise you to avoid all phytoestrogens. I guess they haven’t seen the evidence, so let me show you. First of all, we have two totally different estrogen receptors (ER) in our bodies: ER-alpha and ER-beta. When estrogen from any source stimulates these receptors, the cells respond according to their programmed function. In the breast, ER-alpha sends signals to cancer cells to multiply and divide, whereas ER-beta actually exerts an antiestrogen effect. It turns out our natural estrogens love ER-alpha (yes, the ones implicated in cancer); but soy phytoestrogens, like genistein, bind 1,600 percent more to ER-beta than alpha. When bound to its ER-beta throne, soy actually blocks estrogen from sitting in the alpha chair. And if soy should land in ER-alpha, it has about one-tenth to one-hundredth of the signaling capacity of real estrogen, so soy essentially occupies but inactivates ER-alpha receptors. On top of that, soy stops the conversion of other steroids into estrogen. Okay, if that’s true, then people who consume soy should drop their circulating estrogen, right? Right. A group of premenopausal women in Texas drank three twelve-ounce cups of soy milk a day for one month. Depending on where they were in their menstrual cycles, blood levels of estrogen dropped between 30 to 80 percent in all of them, and estrogen levels stayed lower than baseline for another two to three months. Wow, so soy really does slow down estrogen production. With less estrogen from a few daily servings of soy, should we then expect to see less breast cancer forming? Yes. One study examined the dietary intake of over 73,000 Chinese women and concluded that consuming soy during childhood, adolescence, and adult life protects against breast cancer, especially when consumed in youth. Early soy intake (more than 1.5 times per week, not much) during childhood reduced adult-onset breast cancer by 58 percent in a study of Asian women in California and Hawaii, so tell your daughters to soy it up. Even among Korean BRCA gene mutation carriers, largely considered to be at the mercy of their DNA breaks, a reduction in breast cancer up to 43 percent was noted in high soy consumers. Okay, so far soy blocks estrogen effects on ER-alpha; it lowers estrogen levels in the blood; it protects against making breast cancer; but . . . what if you already had an estrogen-driven cancer, and now you’re on a drug that blocks estrogen’s actions in your body, like tamoxifen? Will the isoflavones in soy interfere with these drugs? Until 2009, we weren’t sure. In the Life After Cancer Epidemiology Study, 1,954 multiethnic survivors on tamoxifen (estrogen-driven cancers) were followed over six years; those eating the most tofu and soy milk products had a 60 percent reduction in breast cancer recurrence compared to women ingesting low soy amounts. Isoflavones not only deal favorably with estrogen, they exhibit antiproliferative, antioxidant, anti-angiogenesis, and anti-inflammatory properties such that soy even keeps estrogen-negative tumors at bay. The largest soy study to date in breast cancer patients followed over 6,200 multiethnic women from the United States and Canada for 9.4 years. For those consuming merely 0.5 to 1.0 servings of soy a week, researchers observed a 21 percent decrease in all-cause mortality compared to lower soy consumption; this increased to 51 percent for estrogen-negative cancers, and 32 percent for those estrogen-positive cancer patients not taking antiestrogen therapy. Another study with over 5,000 breast cancer patients found a 29 percent decrease in death and a 32 percent drop in recurrence for high soy consumers, independent of receptor status. Even just one cup of soy milk a day provides enough phytoestrogens to reduce recurrence by 25 percent. So soy consumption after breast cancer is safe and protective. Soy does not increase breast cancer but in fact decreases the occurrence, recurrence, and death rates in every single study exploring this matter since 2009. What’s a safe soy to consume? Choose soy products specifically labeled USDA organic, 100 percent organic, or non-GMO. Although 94 percent of soy comes from genetically modified organisms (GMOs), non-GMO products shouldn’t be hard to find; most GMO-soy is fed to livestock and not you (unless you eat the livestock). Soy is a “complete protein,” meaning it contains all of the essential amino acids necessary for biological function. Strive to consume two to three servings of soy food every day; whole food soy far outranks processed, and fermented whole soy products like tempeh, miso, tamari (a fermented soy sauce), and natt? are the best. The natural fermentation process accomplishes two things: it lessens gas and bloating with good-for-your-gut probiotics, and it converts soy’s powerful isoflavones into their most active form, making this superfood even more super. Tofu, soybeans (edamame), roasted soybeans, and soy milk are great ready-to-consume options. Avoid soy milk made from soy protein or soy isolate; you want to see whole organic soybeans written as the first ingredient on your milk label. Processed soy products lose some of the nutritional value found in whole foods but provide great substitutes for meat, sauces, cheese, eggs, yogurt, and milk. ESSENTIALS: VITAMINS, MINERALS, AND A LITTLE SUPPLEMENTAL INFO If your cells could write an editorial, “A Day in the Life of a Body,” they’d gush about how they hold in high esteem around thirty different essential vitamins and minerals that they cannot produce on their own. Cells use these raw materials to perform hundreds of life-sustaining functions. Your cells would say that consuming whole foods, and not supplements or pills like a single vitamin, exposes them to at least 25,000 phytochemicals, the complexities of which we only poorly understand. These bioactive food constituents can work individually, like what you get from a supplement, but I don’t want you to miss out on all the additive and synergistic ways this vast community of chemicals comes together to thwart disease development. For instance, sure, vitamin C is an antioxidant, but eating a whole orange unlocks other weapons, like limonene, which accumulates inside breast cells where it can protect against the onset of cancer. Your chewable vitamin C didn’t know about limonene-flavored chemo! With rare exceptions—noted in the B , folate, and vitamin D sections below—balanced eating remains the safest and most efficient way to get adequate amounts of the vitamins and minerals you need. Here are the biggies: Vitamin A: Fenretinide (200 milligrams per day), an analogue of vitamin A, promises a 35 percent reduction in recurrent or new breast cancers in premenopausal women. It’s found in carrots, sweet potatoes, kale, spinach, broccoli, and yellow squash. Beta-carotene: An eleven-study meta-analysis showed an 18 percent breast benefit from beta-carotene. It becomes vitamin A in your body, so add apricots, cantaloupe, and sweet red peppers to our vitamin A-rich foods listed above. Vitamin B6: Vitamin B confers a 30 percent reduction. Eat avocado, pinto beans, molasses, sunflower seeds, sesame seeds, and pistachios; if you consume meat, you can find B in tuna, chicken, and turkey breast. Vitamin B12: B exerts a 64 percent breast advantage in premenopausal women. Find it in shellfish, fish, meat, poultry, liver, dairy, eggs, fortified cereals. For vegans and adults under age sixty-five who do not consume adequate amounts of the stated B sources, take cyanocobalamin (not methylcobalamin) 2,500 mcg weekly supplements, and for those at or over sixty-five, ingest cyanocobalamin 1,000 micrograms a day. Folic Acid (Folate): Folate works alongside B and B to engineer glutathione, the most powerful of all intracellular antioxidants, which detoxifies and eliminates carcinogens. You’ll find folate in foods like peas, beans, nuts, spinach, collard greens, asparagus, and fortified whole wheat sources. In the Nurses’ Health Study, high levels of serum folate led to 27 percent less breast cancer. Among those in this study averaging one glass or more of alcohol a day, the drinkers who consumed the most folate from food or supplements plummeted their cancer risk by 89 percent compared to drinkers who had low folate. You see, alcohol inhibits the conversion of folate into its helpful DNA-repairing form called methylfolate. Therefore, moderate drinkers (one or more drinks a day) should consider taking methylfolate (not folic acid), 800 micrograms once a day—or stop drinking so much. Vitamin C: When you think vitamin C, you may think orange juice, yet citrus fruits—oranges, tangerines, grapefruits, lemons, and limes—bestow a modest 10 percent reduction in breast cancer. When you add other vitamin C sources (and therefore multiple phytonutrients), like carrots, sweet potatoes, greens, and broccoli, you amp up the protection to 31 percent. Vitamin D: The sunshine vitamin deserves the spotlight it’s stolen. At proper doses, vitamin D exerts protective effects: more than 800 IU (International Units) per day confers a 34 percent decrease in breast cancer among postmenopausal women. Bump it to 50 percent protection with dietary doses of 2,000 IU a day combined with approximately 3,000 IU synthesized in your skin after twelve minutes of daily sunlight exposure without sunblock. Excellent vitamin D sources include fortified milk and soy milk, fortified tofu and cereals, UV-exposed mushrooms (stick them in the sun for two days), sardines, salmon, and the very best source: you + sunshine. If you live anywhere in the world north of 40 degrees latitude (New York, Barcelona, Rome, Toronto, Budapest, Zurich, Vienna, Munich, Paris) or south of 40 degrees latitude (Queenstown, Sydney, Cape Town, Buenos Aires), if you are over sixty years old, or if you have darker skin and spend less than thirty minutes a day in the sun, you need a vitamin D boost. Take 4,000 IU daily during winter months when the sun doesn’t shine. The latest research suggests that you reduce cancer the most with a serum level of 40 to 80 nanograms per milliliter, which often requires 5,000 IU or more, so at your next doctor visit, get your vitamin D blood level checked and ask your physician to optimize your supplement strategy if you need one. Calcium: Dietary calcium, 1,250 milligrams per day, reduces breast cancer by 20 to 50 percent, and up to 74 percent for premenopausal women, probably by decreasing fat-induced cell proliferation, neutralizing fatty acids, and binding mutagenic bile acids. You’ll find it in kale, broccoli, all dark leafy greens, yogurt, cheese, milk, soybeans, fortified cereals, and grains. Long-Chain Omega-3 Alpha-Linolenic Acid (ALA): For those who do not consume fish, you might not generate enough long-chain ALA from your intake of short-chain ALA (see the next section on fats). Be sure you get enough of this essential fatty acid for optimal brain health, and supplement with either omega-3 fish oils or with fish-free yeast- or algae-derived long-chain ALA, 250 milligrams daily. SPEAKING OF FATS . . . Fat used to be a dirty word, remember? We thought that if you don’t eat fat, you won’t be fat. Turns out that if you don’t eat fat, you will be dead. Fat efficiently stores energy, supplies energy, and regulates body temperature; fat surrounds your nerves, brain tissue, and eyeballs like teacups in bubble wrap; fat transports vitamins, makes steroids, supports cell growth and function, and keeps your skin from looking like a sharpei. But do you know the difference between friendly fat and foe fat? Let’s talk friendly fats here. What’s the healthiest fat? An unsaturated fat. These contain polyunsaturated fatty acids known as PUFAs, or as I like to say, “PUFA! There goes a cancer cell.” PUFAs are liquid at room temperature. They are essential, which means your body can’t make them, and you can only find them in food. You need them if you plan to do things like move your muscles or stop bleeding when you’re cut. You find omega-3 PUFAs, also called alpha-Linolenic acid (ALA), in flaxseed, walnuts, canola oil, unhydrogenated soybean oil, and oily fish like salmon, herring, sardines, and mackerel. Beneficial fats also include monounsaturated fatty acid or MUFA, as in “MUFA! More Fa me!” (I’m hoping my goofy mnemonics help you with label reading, which we discuss soon.) Find MUFAs in oils like olive, canola, sesame, walnut, peanut, almond, flaxseed, borage, and high-oleic safflower or sunflower oils; whole food sources include avocados, olives, almonds, cashews, pecans, macadamias, and nut butters. By the way, oils can contain blends of different PUFAs and MUFAs and saturated fat, so they can be in three places at once. Pick the purest unsaturated fats, and minimally consume or eliminate saturated fats from sources like meat, chicken, oil (avoid safflower, sunflower, hydrogenated soybean, corn, coconut, and palm oils, further discussed in chapter 4 (#litres_trial_promo)), butter, and cheese. A number of studies confirm the benefits of MUFAs and omega-3 PUFAs. In the largest study to look into the fat-cancer connection, European researchers followed 337,327 women in ten countries over eleven years. They found that women who ate the most saturated fat were about 30 percent more likely to develop breast cancer. Remember when Mama told you to eat your vegetables? Mama’s always right. Emerging evidence confirms that eating more vegetable fat (PUFA, MUFA) and nuts at ten to fifteen years old significantly decreases postmenopausal breast cancer many years later. The Nurses’ Health Study II showed a 42 percent reduction for increased vegetable fat consumption during high school years. For more insight into a friendly fat’s power, consider flaxseeds (a MUFA). They offer the most concentrated source of omega-3 fat on the planet, and over one hundred times the lignan phytonutrient content of most other foods. Lignans exhibit all kinds of anti–breast cancer virtues related to lowering estrogen and stopping cancer cell growth. In one study, forty-five women got a breast biopsy that showed precancerous cells. This put them at high risk. They simply ate one teaspoon of ground flaxseed a day for a year, and then repeated the biopsy. Precancerous cell changes reverted to normal in 32 percent, and a biomarker for cell division called Ki-67 went down in 80 percent of the women. Toss a spoonful of ground flaxseed onto your salad at lunch today (whole flaxseeds go straight out the other end), or blend into a smoothie as I do. If there’s only one thing you change after reading this chapter, may it be in the form of one to two tablespoons of ground flaxseeds daily. True that. Not All Oil Is Evil: Extra Virgin Olive Oil Just like wine, the quality of olives varies from region to region, and the processing of olives leads to different qualities of oil. Extra virgin olive oil (EVOO) ranks supreme, for the sole reason that it contains the highest oil levels of cancer-kicking antioxidants: phenols, polyphenols, and lignans. It also gets bragging rights about its high squalene content, a molecule that inhibits the ras oncogene. The phytonutrient oleocanthal swims abundantly in this golden oil and bears a striking chemical similarity to ibuprofen, which decreases inflammation in your body. Besides taking away inflammation, EVOO also regulates insulin secretion and lowers blood-sugar levels, which really annoys cancer cells (remember the microenvironment?). Most studies investigating whether EVOO exerts protective effects against breast cancer conclude YES in all caps. In the only prospective randomized trial (the best type) looking at the MedDiet, 4,152 women (no personal cancer history) aged sixty to eighty were randomly allocated to a MedDiet supplemented with EVOO, a MedDiet with mixed nuts, or a control diet (advised to reduce dietary fat). At 4.8 years follow-up, thirty-five breast cancers developed (eight in the oil group, ten in the nuts group, seventeen in the control group). The MedDiet plus EVOO group was 68 percent less likely to have breast cancer than the control. There’s one oil-slick caveat to all this I must mention: as an isolated, concentrated nutrient entirely stripped of its vitamins, minerals, fibers, and other phytochemicals, EVOO becomes simply fat without the power and function it once had back in its oval olive days. Always prioritize whole foods, as they are best for the breast. Don’t cook with EVOO, because you will destroy all its awesomeness; use organic canola, or try broth, vinegar, or water to keep food from sticking while you cook. Store your oil away from light to keep from degrading nutrients, and replace open olive oil every three months. Use in salad dressings, sauces, pesto, smoothies, drizzle onto already cooked foods, and substitute it for butter or margarine. And trust me, not all fat makes you fat; in fact, extra virgin olive oil consumption aids in weight loss. READY TO WASH IT ALL DOWN? Let’s start this off with a pop quiz. What’s the most common beverage enjoyed by centenarians, a.k.a. people over one hundred years old? Water, grapefruit juice, tea, or red wine? If you guessed tea, you’re a smart crumpet. And when it comes to breast health, your beverages of choice should include tea, coffee, and the ever-clear winner, water. Tea’s Not Teasing To me, tea is liquid gold. You derive a number of health benefits from all types of tea—green, black, white, oolong, and pu’er—so enjoy your favorite, but know that herbal tea does not come from the powerful tea plant, Camellia sinensis. As such, herbal tea lacks tea catechin flavonoids like the antiooxidant epigallocatechin gallate (EGCG), but it still gets a high-five for antioxidant activity. When it comes to the breast, green surpasses all other tea. Three cups of green tea a day can reduce risk of breast cancer by as much as 50 percent! Researchers go gaga over green tea. Over 500 Asian American women in Los Angeles County with breast cancer were compared to 594 without cancer. Women who drank less than 85.7 milliliters (one-third cup) of green tea daily were 29 percent less likely to have breast cancer, and those who drank more than 85.7 milliliters (one-third cup) were 47 percent less likely to have breast cancer, as compared to women who did not drink green tea at all. A meta-analysis combining seven studies of cancer incidence between green tea drinkers and nondrinkers echoes these findings. Then there’s the question of cancer recurrence: can green tea decrease the chances of cancer coming back again? A striking study showed that Japanese women with stage I breast cancer who drank more than three cups of green tea a day were 57 percent less likely to recur, and stage II cancer patients were 31 percent less likely to recur than women in both groups who drank less green tea. The brewing of black and oolong teas destroys catechins like EGCG, so gulp down the green variety when combating risk of breast cancer. If you’re not a huge fan of green tea, I still want you to reap the rewards from it, so just plug your nose and chug down three cups or add it to a smoothie (I put matcha—green tea powder—in mine and consume the entire leaf). Three cups of green tea equals the caffeine content of one cup of coffee; although decaffeinated green tea has one-third the antioxidants of caffeinated, drinking some tea is better than none, even if you prefer decaf. In high to low polyphenol concentration, brewed hot green tea far outweighs instant preparations, iced, and ready-to-drink green teas. Tea aficionados will tell you that tea bags literally contain the bottom of the tea barrel, the lowest quality tea known as fannings or dust. It all boils down to freshness, flavor, and cost, but nowadays you can also find whole leaves in a tea bag. To see what all the fuss is about with loose-leaf tea, place one teaspoon of green tea leaves in a cup, pour in four ounces of hot water, cover and steep for three minutes, then pour through a kitchen strainer into your mug. Whether you dunk and dash, or steep then strain, you will receive that precious EGCG either way you brew it. Always add a squeeze of lemon, since citrus quintuples the antioxidant absorption of your green tea. Конец ознакомительного фрагмента. Текст предоставлен ООО «ЛитРес». Прочитайте эту книгу целиком, купив полную легальную версию (https://www.litres.ru/kristi-funk/breasts-an-owner-s-manual-every-woman-s-guide-to-reducing-canc/?lfrom=688855901) на ЛитРес. Безопасно оплатить книгу можно банковской картой Visa, MasterCard, Maestro, со счета мобильного телефона, с платежного терминала, в салоне МТС или Связной, через PayPal, WebMoney, Яндекс.Деньги, QIWI Кошелек, бонусными картами или другим удобным Вам способом.