Breast Cancer: Most of what you need to know! Delia Garcia, MD. Breast Oncologist Certified Health Coach

Transcription

1 Breast Cancer: Most of what you need to know! Delia Garcia, MD Breast Oncologist Certified Health Coach

2 My Practice:

3 Objectives Scope of the Problem Risk Factors Early Detection Heredity & Genetics Overweight & Obesity Food and Lifestyle Putting Soy to Rest!

4 Scope of the Problem: 1 in 8 US women about 12% 2017: 252,710 new invasive 63,410 non-invasive 40,292 deaths each year Rare in men American Cancer Society 2017

5 Percentage of New US Cases by Age National Cancer Institute (SEER Results )

6 Breast Cancer Worldwide Most common CA worldwide 1.7 million new cases yearly Leading cause of CA death in underdeveloped countries 522,000 deaths each year More advanced in poor countries; more curable in developed countries Globocan: International Association of Cancer Registries

7 The Good News! Mortality rate decreased in 39 of 47 countries Exception: South Korea, Brazil, Colombia Westernization equates with increased mortality US & Europe marked decrease in mortality in past 25 years 5-year survival rate in the US 89.7% in 2013! SEER Data

8 Risk Factors for Breast Cancer All women are at risk! Median age is 61 Early menarche; late menopause Breast feeding Hormone therapy Family history: risk is double if mom, sister, daughter (3x if 2 relatives; 4x if 3 or more relatives) American Cancer Society

9 The REAL Culprits Overweight 1.5 times higher Obesity 2 times higher Lack of exercise, 25% higher 2-3 drinks/day = 20% higher risk University of Oxford American Cancer Society

10 What s with the WEIGHT? Estrogen dominance (higher circulating estrogen levels) = precursor for breast cancer Fat is the largest source of estrogen in postmenopausal women Ditto for uterine cancer

11 Early Detection (is NOT prevention) Mammography Average 1.5 cm; 15% LN+ MRI: dense breast tissue; BRCA positive; younger women **Early stage: better prognosis

12 Genetics: BRCA 1 and 2 Only 5% of cancers are attributable to the BRCA genes Less than 1% in general population 2% of Ashkenazi Jews: 50-60% risk of cancer Other mutations may increase risk

13 Epigenetics Genes play a small role It s not what our genes do to us; It s what we do to our genes! Turn genes off or on

14 Turning Genes On (or Off)! Smoking Radiation exposure Stress: cortisol, insulin Pesticides Chemicals Diet & lifestyle

15 Chemicals from Plastic Bottles All plastics my leach chemicals scratched or heated BPA (bisphenol A) weak synthetic estrogen Hormone disruptor Induce breast cancer development & growth Breastcancer.org

16 Plastic Bottles and Containers Use glass, steel or ceramic bottles Use BPA free bottles, including baby bottles Don t cook in plastic containers or use roasting bags BreastCancer.org

17 Let s Talk Heterocyclic Amines (a.k.a. grilled meats) Long Island Breast Cancer Study 2007: 47% higher lifetime risk in women eating grilled, barbequed or smoked meats Chemicals formed by cooking at high temps: damage DNA, initiate & promote CA growth Also found in cigarette smoke; detected in breast milk Iowa Women s Health Study: well done meats = 5x greater risk

18 Let s Talk Melatonin! Peaks 2 am 5 am to regulate sleep Light at night disrupts melatonin that inhibits tumor growth & development Night workers: increased breast cancer risk by 40% (meta-analysis) Curr Environ Health Rep 2017 Aug 2

19 Let s Talk Exercise! NHS: 3,000 nurses with Stage I-III breast cancer Women who exercised 3-5 hours/week had lowest risk of death More than 5 hours: similar risk To burn ONE Pound of fat, you have to run 33 miles! JAMA 2005

20 70 studies on lifestyle & breast CA Exercise reduces risk of death by 40% But, only 13% achieve 30 min/day x 5 days 20% lower circulating estrogen with 5 hrs/week Walk hour/day must work up a sweat to count Let s Talk Exercise! Br J Sports Med. 2008;42(8):636-47

21 Let s Talk Diet! Health is a complicated issue. All the contributory causes of cancer and other diseases are not presently known. A variety of external factors interact with genetics Nevertheless, the preponderance of evidence demonstrates that superior nutrition can almost always overwhelm a family history of cancer. The vast majority of diseases are still avoidable. Joel Furhman, MD: Eat to Live & Disease Proof Your Child

22 What Should We Be Eating? Super Foods: Fruits Berries Vegetables Whole grains Nuts Seeds Beans Legumes

23 Habits of Disease vs Habits of Health Habits of Disease VS Habits of Health

24 People do not decide their futures. They decide their habits, and their habits decide their futures! Lifelong Transformation

25 Let s Talk Alcohol! Alcohol classified as a definitive breast carcinogen Regarding breast cancer, no amount is safe Toxic breakdown product is acetaldehyde Harvard Nurses Health Study: Even 1 drink per day = small increase Red wine no risk: compound in skins suppresses estrogen synthase used by CA to create estrogen World Health Organization 2010

26 Let s Talk Low Fat Meals! WINS Trial: 2437 postmenopausal women Standard (40% fat) versus low fat (20%) Low fat: 24% decrease in recurrence at 5 years If ER negative, the benefit was 42% reduction! J of Natl Cancer Institute 2006 Fuddruckers: hardly any left!

27 Let s Talk Plants! 1,500 women Eating 5+ servings of fruits & vegetables Walking 30 minutes daily X 6 days Significant survival advantage: half the risk of dying of cancer 2 years post diagnosis J Clin Oncol. 2007;25(17):

28 Let s Talk Animal Products! Strong association between animal foods and cancer Blood cholesterol strongest predictor of cancer risk As cholesterol levels decreased, cancers of the liver, rectum, colon, lung, BREAST, stomach, esophagus, brain decreased dramatically!

29 Let s Talk Statins! Women taking statins for 10+ years had double the risk of invasive breast cancers 1 in 4 women over 45 may be taking statins Since the #1 killer of women is heart disease, a plant-based diet makes the most sense Centers for Disease Control 2010

30 Obesity and Breast Cancer Higher levels of insulin Review of 40 studies: breast cancer 16% higher with diabetes (independent of obesity) 11% increase risk for each 11# gained in adulthood Higher recurrence & death Br J Cancer 2012; 107: Natl Cancer Inst 2015; 107

31 Let s Talk Flaxseeds! Source of omega-3 fatty acids Lignans: phytoestrogens activated by gut bacteria Lignans reduce risk (also in berries, grains, leafy greens) NCI 2010: 45 women precancerous breast biopsies 2 t daily x 1 yr = 80% lower Ki-67 + improved biopsies Cancer Prev Res. 2010;3(10):

32 Randomized, double-blind, placebo controlled Let s Talk Flaxseeds! Women scheduled for breast cancer surgery Flaxseed muffin vs non-flax muffin/daily x 5 wks Decreased cell proliferation & aggressiveness and increased cell death rate Clin Cancer Res. 2005;11(10):

33 What Does NOT Increase Breast Cancer? Abortion Infertility drugs Hair dyes Antiperspirants Breast implants Prophylactic surgery Soy consumption American Cancer Society

34 Let s Talk Soy! Rich in phytoestrogens called isoflavones Estrogen-like effects and potential interaction with Tamoxifen has led to concern about soy and breast cancer

35 Shanghai Breast Cancer Survival Study 5042 women 20 to 75 years with breast cancer Soy intake independent variable Assessed at 6, 18, 36 and 60 months Soy: significantly decreased risk of death & a lower recurrence Regardless of receptor status and use of Tamoxifen JAMA Dec 2009

36 Putting Soy to Rest! 6,235 women with breast cancer 10-yr F/U Top 25% soy consumption: 21% less likely to die of any cause compared to those eating least soy 17% Hispanic; 12% black; 11% Asian (lower soy intake than Asian countries) No detrimental effect in ER+ tumors Fang Zhang, MD; Tufts University Cancer 2017 Jun 1; 123(11):

37 Putting Soy to Rest! 5 studies on survivors & soy Live significantly longer Lower risk of recurrence 1 cup soy milk/day = 25% lower recurrence Regardless of receptor status Regardless of age Asian Pac J Cancer Prev. 2013;14(4):

38 Final Thoughts! Soy foods prevent breast cancer Benefits women who have breast cancer Fiber... Isoflavones: Genistein interferes with cell growth & proliferation Other benefits: prevention of hypertension, diabetes, CV disease Soy before & during puberty strongest protection Cancer 2017 Jun 1;123(11):

39 Health Coaching LOVE Support Guidance Without judgment Walking alongside Believing in them before they believe in themselves

40 Facebook page Weekly support call Weekly webinar Events Hope Accountability Safe haven Knowledge Caring Creating the best version of self Community of Support

41 Patience & Compassion Spectrum Meet people where they are Realistic goals Baby steps Celebration calls/videos... LISTEN; ask questions Not expecting change overnight May not have resources... Family support... Knowledge (how to steam veggies)...

42 Alcohol, Plants, Normal BMI... 30,000 postmenopausal women, 7 year F/U None had history of Breast Cancer Limiting alcohol, eating mostly plant-based; maintaining normal weight = 62% reduction in breast cancer! American Institute for Cancer Research

43 How to Lower Breast Cancer by 30%! JUST 4 Things: Avoid smoking Drink very little alcohol (red wine only) Maintain a healthy body weight Skip the hormone replacement therapy Nilanjan Chatterjee, Johns Hopkins JAMA 2016

44 Catherine with 2 year old son Single mom Busy job 7 cm cancer 38 of 42 positive nodes Told she had 2 years or less to live

45 Eat good food & move your body Maintain a healthy weight Embrace the scale as your friend Read good books (turn off the TV) Hang out with positive people Create relationships & LOVE freely Adopt a pet (from a shelter) Seek help

46 MY CHILDREN ARE MY REASON!

47 Delia Garcia, MD Facebook.com/deliagarciamd mobile