Saturday, February 16, 2013

Can Breast Cancer Be Prevented?

Breast cancer sucks! It afflicts our mothers, grandmothers, sisters, wives, daughters, aunts, girlfriends, and even men. Pink ribbons everywhere speak to its far-reaching effects. We walk for breast cancer, make donations, and highlight it every chance we get. Everyone knows someone who has been diagnosed with it. Breast cancer devastates lives and families. For survivors, it hangs over their heads like a 'Sword of Damocles,' ever fearful of a relapse.

So what are we doing about it? The National Institutes of Health spent almost $2.4 billion on breast cancer research in fiscal years 2008 to 2010. The question is do we have the right strategy to stop its growth? Are we making the right research moves? The answer is unfortunately mostly no.  Maybe now, that will finally change.

On October 8, 2008, Congress passed the Breast Cancer and Environmental Research Act. The Act required the Secretary of Health and Human Services (HHS) to "establish an Interagency Breast Cancer and Environmental Research Coordinating Committee (IBCERCC) of federal and nonfederal members to examine the current state of breast cancer and the environment, research and make recommendations for eliminating any knowledge gaps in this area."

A new report just published after nearly four and a half years of meetings and information gathering, highlights the committee's conclusions that breast cancer research needs to focus more aggressively and coherently on environmental factors that may contribute to its development. Chemicals, radiation, drugs and consumer products are foremost among the environmental factors addressed in the report, but so are less obvious factors related to lifestyle and socioeconomic concerns.

But the most important recommendation of the committee is evident in the title of its report, "Prioritizing Prevention." Why? Because according to the report, "despite decades of productive breast cancer research, the number of women diagnosed with breast cancer continues to rise.  In 2012, 227,00 women and 2,200 men will be diagnosed with breast cancer and 40,000 women will die from it."

While untold money has been spent on early detection of breast cancer and on research for treatments, scientists and doctors have barely dented the epidemic of cases.  Along comes a federal commissioned group tasked with stepping back and figuring out where we should spend our resources and what does it decide? Spend the most money on prevention, it urges.

The facts are clear. Most women who get breast cancer have no family history. The interaction of genetic and environmental factors are known to play a role because as the report states, "breast cancer rates can vary with changing environmental circumstances." Like most cancer and disease prevention efforts, the committee recognized that efforts to prevent cancer have lacked sufficient resources and that moving forward, our limited resources should be mostly reapplied towards prevention versus detection and/or treatment/cure.

The report's first recommendation states that not enough has been done "to identify and mitigate the environmental causes of the disease." It asks that we prioritize prevention. It states that we should modify "social and lifestyle factors implicated in breast cancer." Early this past week, I wrote a blog before this report came out asking "Isn't It Time We Got Serious About Prevention?"  I don't know how many more federal dollars will be spent trying to figure out where we should spend our valued research dollars, but one thing should be certain-avoiding cancer should be our number one priority.

In addition to protecting its citizens from known environmental carcinogens found in foods, household chemicals, and pollutants, the government needs to pay doctors to take the lead in helping patients modify lifestyle factors, such as obesity, to prevent cancer. Even among cancer survivors, recurrence rates are much higher among obese women. A recent study showed that breast cancer survivors who lose weight reduce the rate of the return of the disease.

It is sometimes lonely for me to keep crying out about the importance of choosing the right foods and staying physically active, managing stress effectively, socializing, finding meaning and purpose, and getting adequate sleep, but it's reassuring that others are now reaching the same conclusions about the importance of lifestyle factors. A recent study showed that flaxseed, for example, may prevent breast cancer. Did anyone even hear about the study? (Here's the study: Consumption of flaxseed, a rich source of lignans, is associated with reduced breast cancer risk. based on this one study, should women run out and consume lots of flaxseed? I don't know the answer. In general flaxseed is a healthy foodstuff, but does it really prevent breast cancer? We need more studies to know for sure and so the question is why aren't there more studies looking at the role of diet in breast cancer prevention?

A review of the last two hundred plus studies published about breast cancer prevention revealed that only a handful of studies focused on actual prevention. (By the way, one interesting study showed a correlation between sun exposure and reduced rates of several cancers. The more sun, the less cancer. The researchers felt more was involved than the fact that it's known that the more sun you get, the more Vitamin D you produce.  I have always been a fan of daily sun exposure and encourage my patients to get at least a half hour of sun exposure everyday without fail. I do caution them, however,  to cover their faces with wide brim hats.  Here's the study:
Is prevention of cancer by sun exposure more than just the effect of vitamin D? A systematic review of epidemiological studies.

A recent study looked at the role different fats play in breast cancer development and showed that only the Omega-3 fats seem to be protective. (Here's the study: Dietary intake of specific fatty acids and breast cancer risk among postmenopausal women in the VITAL cohort.  Another study focused on the role that the combination of polyphenols (found in berries, etc.) and alcohol play in breast cancer development. (Here's the study: Dual association between polyphenol intake and breast cancer risk according to alcohol consumption level: a prospective cohort study. As the federal committee just concluded, we need a lot more of these types of studies focused on prevention and environmental factors such as diet.

You get the drift. There are scattered studies that fail to nail down any real conclusions, which leaves everyone to their own devices to figure it out or do nothing. If you are one of the people trying to figure it out, here's what I can tell you at this point. Prevention efforts seem to pay off and lifestyle intervention is the key. "Prevention is the key to reducing the emotional, physical, and financial burden of breast cancer," wrote the committee. "By urgently pursuing research, research translation, and communication on the role of the environment in breast cancer, we have the potential to prevent a substantial number of new cases of this disease in the 21st century."

My preventive medicine practice can show you how today; I want to help you, but you need to want to be helped. Make the right choices now and enjoy the fruits (no pun intended) of wise decision-making. With one out of three women developing some form of cancer and one out of two men doing the same, again I ask, isn't it time you got serious about preventing cancer? Stop waiting for the terrible news and take charge of your health today. There's no better time!

Remember, prevention is preferable to cure.

1 comment:

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