Many women have concluded that recent study results show that hormone replacement therapy increases breast cancer risk. A closer look at this study shows that the increase in risk was far less than half a per cent a year and may not be due to hormone
Janet M., a fifties-something woman, entered my office and said as she sat down, “I’ve read that if I take hormones I’ll increase my breast cancer risk. I’m going crazy without sleep and with these mood swings, but I don’t want to increase my breast cancer risk by taking hormones.”

Like many women, Janet heard that a recent study, the Women’s Health Initiative (WHI), definitively showed that hormone replacement therapy (HRT) at menopause increases breast cancer risk. Janet, like most people who heard about this study, didn’t realize that the WHI study found no statistically significant increase in breast cancer risk to women who took HRT.

When differences are not significant, an increase in risk may well be due to other factors, not the one being studied, such as HRT use. In this, as in the reporting of many studies, the emphasis was on the increase in risk, not whether it was likely to be due to the agent being studied or to its size.

In addition to statistical significance, the actual size of a risk is important in any woman’s decision making process. In this case the risk was exceedingly small – only 8 in 10,000 women a year – which is 0.08% or eight hundredths of one per cent! Janet was amazed to learn the actual size of the increase, and said, “You mean I was getting all concerned for a risk that small!”

“And,” I pointed out, “even this very small difference in risk may not be due to hormone use.” I explained that breast cancers take an average of eight years to reach about half an inch in size. This means that breast cancers starting in the first year of the study would not be detected for eight or more years. The study followed women for only about five years, so all or most of the breast cancers found during the study were probably present in an undetected state before the study began.

Janet asked if HRT use might have caused some breast cancers to grow more rapidly and therefore be detected sooner than eight years. This is unlikely. A number of studies find that breast cancers in women who were using HRT were not larger and were not dividing more rapidly than breast cancers in non hormone users. Also, breast cancers grow more slowly in older women. The average age in this study was 63, so breast cancers in this group would tend to grow more slowly and so take even longer than the eight year average to be detected.

Women in the WHI study used a particular type of hormone called Prempro. The results of this study therefore do not apply to other, newer approaches in which more natural hormones are used and a woman’s menstrual cycle is more closely approximated.

Janet was surprised to learn that in many studies women who use HRT do not have an increase in breast cancer risk compared to women who don’t use hormones, even when hormones are used for twenty years. Also, in another large study in which some women were assigned to take Prempro and others not, women who used Prempro had no significant increase in breast cancer risk.

As Janet left, she said, “I can see now that when I hear about a study I need to know how big a risk is, and not just that it is increased. I’ll also ask how long a study it was. This discussion has given me a whole different perspective.”

To learn more about commonsense tools for assessing breast and other cancer risks, attend a free telephone conference on Wednesday, January 22nd at 5:00 p.m. Pacific Time, 6:00 p.m. Mountain Time, 7:00 p.m. Central Time and 8:00 p.m. Eastern Time. To register for this unique TeleForum or to learn more about it, send an E-mail to [email protected] with “Cancer Risk TeleForum” in the subject line. Please include your name, E-mail address, and city and state in the body of the E-mail. Occupation or profession is optional, but it would be helpful to us. We will send a confirmation, including the number to call for this unique, free telephone conference.

You may also be interested in Dr. Kelly’s latest book, Assess Your True Risk of Breast Cancer. To learn more about this book, which helps women to manage their breast cancer risk and make decisions about genetic testing, see Dr. Kelly’s website: www.ptkelly.com.

WOMEN with breast cancer who walk at least an hour a week have a better chance of beating the disease than those who don’t exercise at all, researchers said. “It is well established that exercise plays an important role in preventing many diseases, including breast cancer,” said lead researcher Michelle Holmes of Brigham and Women’s Hospital in Boston.

“However, we found that women who are physically active after breast cancer diagnosis may lower their risk of death from breast cancer and cancer recurrence.” Even walking an hour a week lifted survival rates but exercising more than five hours a week did not confer any added survival benefit. The study noted discouraging estimates that women with breast cancer tend to decrease their levels of physical activity by two hours a week and those who are obese reduce activity even more.

Who isn’t familiar with the expression, “early detection is the best prevention?” We hear this term throughout the year and most everyone is familiar with this “catch phrase” as it relates to breast cancer. Obviously, a woman’s chance for survival improves when a cancer is found early. We hear that simple rhyming statement but are women really offered early detection?

Our “gold standard” for breast cancer screening is mammography, clinical breast exam and self-breast exam. Other techniques are used but ALL current technologies examine structure; something is formed and large enough to be seen or felt. However, it is well-documented that a mass that is detected by mammography has been growing for 8-10 years before it was detected. Is this early detection?

There exists a technology that can detect an issue YEARS before a tumor can be seen on X-ray or palpated during an exam and truly offers early detection. This technology has been approved by the FDA as an adjunctive screening tool since 1982 and offers NO RADIATION, NO COMPRESSION AND NO PAIN. For women who are searching for early breast cancer detection, digital infrared thermal imaging (DITI) may be of interest.

Historically, DITI fell out of favor shortly after its initial debut in the early 80s. When DITI was first introduced, strict protocols and trained technicians did not exist. Shortly after its initial beginnings, DITI fell out of favor as a diagnostic tool in the medical community.

There are now very strict protocols both for testing and interpreting. Perhaps due to these guidelines, thermography (as with all digital technology) has exploded in its technique and capabilities. Thermal cameras detect heat emitted from the body and display it as a picture on a computer monitor. These images are unique to the person and remain stable over time. It is because of these characteristics that thermal imaging is a valuable and effective screening tool. Tumors or other breast diseases measures warmer than surrounding tissue and can thereby alert a physician to a problem before a tumor is actually palpable.

Medical doctors who interpret the breast scans are board certified thermologists. Thermography is not limited by breast density and is ideal for women who have had cosmetic or reconstructive surgery, women who refuse mammography, or women who want clinical correlation for an already existing issue. Thermography, because it analyzes a developing process, may identify a problem several years before mammography. As we all know, early detection is important to survival.

DITI has an average sensitivity and specificity of 90%. An abnormal thermogram carries a 10x greater risk for cancer. A persistent abnormal thermogram carries a 22x greater risk for cancer. Thermography, as well as mammography is a personal choice for women. This decision ideally should be made in collaboration between you and your physician. However, thermography does not require a physician’s order.

Thermographic screening is not covered by most insurance companies but is surprisingly affordable for most people. For more information or to find a certified clinic in your area, go to www.proactivehealthonline.com.

We hear it all the time…lose weight for your health. Few people, however, realize the extent to which this is critical to their physical well-being and ultimately their life expectancy.

In January 2003, the Journal of the American Medical Association featured a study finding that obesity appears to lessen life expectancy, especially among young adults. The researchers compared Body-Mass Index (BMI) to longevity and found a correlation between premature death and higher BMIs. For example, a 20-year-old white male, 5’10” weighing 288 pounds with a BMI of greater than 40 was estimated to lose 13 years of his life as a result of obesity. Jamie McManus, M.D., F.A.A.F.P. and author of “Your Personal Guide to Wellness” notes that while this study referenced extreme levels of obesity, there are still millions of overweight people in developed countries with a life expectancy rate that is three to five years less than their healthy-weight counterparts. She also estimates that there are 600,000 obesity-related deaths each year in America.

Just how does obesity shorten our lifespan? The answer to this question is complex, yet there is a clear link between obesity and the development of cancer. An extensive study conducted by the American Cancer Institute involving 750,000 people showed that obesity significantly increased the risk of cancer developing in the following organs: breast, colon, ovaries, uterus, pancreas, kidneys and gallbladder.

Michael Thun, MD, vice-president of epidemiology and surveillance research for the American Cancer Society (ACS) says one reason obesity may raise cancer risk is because fat cells produce a form of estrogen called estradiol that promotes rapid division of cells, increasing chances of a random genetic error while cells are replicating, which can lead to cancer. In addition, fat centered around the abdomen may increase insulin and insulin-like growth factors in the blood, which may increase cancer risk.

“Women who are obese after menopause have a 50% higher relative risk of breast cancer,” notes Thun, “and obese men have a 40% higher relative risk of colon cancer…. Gallbladder and endometrial cancer risks are five times higher for obese individuals”. There is evidence that cancer rates in developed countries are increasing at 5 to 15 times faster than developing countries. A major contributor to this alarming reality has proven to be diet. In populations where the diet consists mostly of fresh fruit and vegetables and whole grains – in contrast to the typical Western diet of fatty meats, refined flours, oils and sugars – the risk of cancer is much lower.

The interaction of diet and the development of cancer is an active field of research and Dr David Heber, M.D., Ph.D. and author of “What Color is Your Diet”, says “It appears that diet has its most significant effects after the cancer has already formed, acting to inhibit or stimulate the growth of that cancer”. At the risk of oversimplifying a complex set of interactions, the typical Western diet that leads to obesity may actually act to stimulate the growth of cancer cells. It is never too late to improve your health through healthful eating and adopting a more health-giving lifestyle. Here are simple steps to follow which can make an immediate improvement to your health and vitality.

1. Check your Body Mass Index (BMI) to determine if weight has become health risk. According to the Centers for Disease Control and Prevention, 60% of Americans are overweight, defined as having a BMI (a ratio of height to weight) over 25. Of those, nearly half (27%) qualify as obese, with a body mass index of 30 or more. In 1980, just 15% of Americans were considered obese. You can check your BMI at the website below.

2. Match your diet to your body’s requirements. If you eat and drink more calories than your body requires you will put on weight. Learn to control calories and portion sizes, make recipes leaner, and eat infrequently from fast food restaurants. Also learn how to snack with healthful choices.

3. Color your diet with a large variety of colorful, cancer-fighting fruit and vegetables. There are seven different color ranges of both fruit and vegetables and by choosing between 5 to 9 daily serves from a wide range of fruit and vegetables, we are extending our consumption of cancer (and other disease) fighting nutrients.

4. Eat lean protein with every meal. Protein provides a powerful signal to the brain providing a longer sense of fullness. The right source of protein is essential to controlling your hunger with fewer calories and necessary to maintain your lean muscle mass. Choices of protein should be flavored soy shakes with fruit; the white meat of chicken and turkey, seafood such as shrimps, prawns scallops and lobster and ocean fish or vegetarians may prefer soy based meat substitutes.

5. Rev up your metabolism with activity. If you want to enjoy a lifetime of well-being, exercise is a key ingredient. Colleen Doyle, MS, RD, director of nutrition and physical activity for the American Cancer Society (ACS), says adults should do something for 30 minutes each day that takes as much effort as a brisk walk. Children should be active for an hour each day. We are more likely to develop habits around things we enjoy, so seek activities which you enjoy doing. It is also helpful to build physical activity into your daily routine: use the stairs instead of the escalator or lift at work, park your car in the parking bay furthest from the super marketing and don’t use the remote control to change TV channels.

6. Get support to ensure you develop a healthful eating plan and reach your goal weight. Whilst a small percentage of people possess the discipline to lose weight, many obese people have developed strong thoughts and habits concerning the food they eat. In order to establish new habits, most people respond well to some form of consistent encouragement and coaching. A study, “Effects of Internet Behavioral Counseling on Weight Loss in Adults at Risk of Type 2 Diabetes” shows that participants who had the support of weight loss coaching lost more weight than those who didn’t. The study concluded that the support of a weight loss coach can significantly improve weight loss results.

Being overweight or obese has been identified next to smoking, as the most preventable major risk to developing cancer. Even small weight losses have been shown to have beneficial health effects. So it’s never to late to start and you can never be too young or too old to be concerned about your health and do something about achieving a more healthy weight.

A returning patient called me yesterday. She was a breast cancer survivor when I saw her as a student intern in Chinese medical school. If I had been more confident at the time, I would have suggested she be diligent in preventing a recurrence of breast cancer, and explained how she might attempt that with Chinese medicine.

Even if I had, however, she might not have followed my advice, because Chinese medicine’s credibility has yet to catch up with its sophistication, efficacy, and research.

It’s well known that acupuncture can help with palliative strategies in cancer- for pain relief, itching relief, and nausea. The topic examined less often is: can Chinese medicine fight cancer directly? Many acupuncture teachers and practitioners warn us not to claim that it can – they suggest there’s some law against us treating cancer, and you can see how reactive conservative doctors might be to the idea. They are accustomed to having control of the treatment of all cancer, regardless of whether they can help individual patients, or how much damage their therapies cause. Still, there is research and a clinical track record that suggests Chinese medicine can do more than just reduce discomforts.

I can’t resolve all by myself in this short space the political issues and ethical issues of alternative medical treatment. But, I suggest that if a patient who refuses conventional treatment, then their alternative practitioners should find out everything they can and do all they can to help the patient recover, or at least become more comfortable.

Even in my small alternative medicine library, I have 2 books on Chinese herbs for cancer, and a third that summarizes the research on natural compounds used in cancer therapy. On PubMed, I found even more scientific references about herbs and breast cancer specifically. It’s not the case that there isn’t research on this topic. Instead, as with much Chinese medicine research, the information is either unknown, or unused by Western physicians. What follows is a short summary of the scientific information I found (in less than an hour) on alternative medicine and breast cancer. At the end, I’ve provided some herbal formulas for practitioners.

Human Studies on Natural Compounds for Cancer Therapy:
John Boik, MacOM, LAc has contributed a weighty work called Natural Compounds in Cancer Therapy (Oregon Medical Press, 2001). It not only reviews hundreds of scientific references, but also explains many specific cancer disease processes. The following human studies are drawn from that book, but their specific references are also included.

Scientific research is done either in vitro (test tube), in animals, or in humans. Knowing that any non-human research is easily discounted by skeptics, I’ve chosen only the human studies. However, the other studies are also interesting and helpful, so if you want more, get Boik’s book. All of the following are specific for breast cancer.

6 Bromelain tablets for 10 days corrected deficient macrophage activity. (1)
Vitamin C was found to not necessarily good for breast cancer and may actually have accelerated some patients’ deaths, but those who lived had fewer recurrences. (2,3)
Eleuthrococcus stimulated the immune system in breast cancer patients. (4)
Higher levels of fat intake in breast cancer patients was associated with increased risks of recurrence and death. (5)
In post mastectomy breast cancer patients, there were higher survival rates among those who took enzymes. (6)
Enzyme therapy also improved weight gain, fatigue, depression and quality of life. (6)
A diet of 20% fish oil (24g/kg) improved the anti-tumor effect of the chemotherapy drug mitomycin due to enhanced lipid peroxidation. [This was a combined human/animal study where human cells were studied after transplantation to an animal] (7)
Vitamin D3 helps chemotherapy drugs work better. (8)

Chinese herbs for Breast Cancer

I have access to three sources for Chinese herbs and breast cancer. One is a book called Anticancer Chinese Drugs by Lien & Li, which surveys more than 120 plants used to treat cancer, and examines the chemical structure and effects of individual compounds from those plants. Below are 4 compounds from this book specifically for breast cancer. Unfortunately, none of these are among the 500 or so common Chinese herbs referred to in the standard reference, Materia Medica, by Bensky & Barolet. Note that there are closer to 12,000 substances called herbs used here and there in Chinese medicine.

Labiatae I. longitubis inhibits br ca cells in vitro (Lien/Li, 10).
Maytansine (from maytanus oratus, serrata, buchananii, and hookeri) prevents polymerization of tubulin to microtubules (ibid, 85). (9)
9-hydroxy-2-methyl-ellipticinum (from ochrosia moorei and borbonica) has therapeutic value in advanced breast cancer (ibid, 78). (10)

In phase III clinical trials, VP-16 (from podophyllum berberidaceae) has caused responses in a number of cancers including breast cancer (ibid, 60). (11)

More Science:

A quick search of PubMed for more research on herbs for breast cancer yielded 4 interesting results:

Huang lian (coptis) inhibited tumor growth (gastric, colon, breast)… “These results indicate that traditional Chinese herbs may represent a new source of agents designed for selective inhibition of cyclin dependent kinases in cancer therapy.” (12)

Hemsleya amabilis extract significantly inhibited tumor cell growth and colony formation and promoted tumor cell death.(13)

Triptolide (TPL), a diterpenoid triepoxide purified from the Chinese herb Tripterygium wilfordii Hook F, in vitro inhibited the proliferation and colony formation of tumor cells and the antitumor effect of TPL was comparable or superior with that of conventional antitumor drugs, such as Adriamycin, mitomycin, and cisplatin. (14)

Huang qi root specifically inhibits gastric cancer cells growth in vitro – its mechanism is mainly inhibition of cancer cell growth, not attacking or dismantling of existing cancer cells. (15)

Chinese Herbal Formulas for Breast Cancer (For Practitioner Reference)

My final source is a book called Treating Cancer with Chinese Herbs (Hsu, Ohai Press, 1990). This book is mainly for practitioners to learn from and use. It is not scientifically referenced – of course, some Chinese physicians and writers are not familiar with the Western insistence on always quoting your sources, so some of this information may have science behind it. We just can’t tell from Hsu’s book. But here’s a suggestion patients can try at home:

Combine the juice of 90g of fresh asparagus (or 30g peeled) with yellow wine (a traditional Chinese wine made from rice) once a day.

References:

• Eckert K, Grabowska E, Stange R, et al. Effects of oral bromelain administrations on the impaired immunocytoxicity of mononuclear cells from mammary tumors. Oncol Rep 1999 Nov-Dec; 6(6):1191-9.
• Poulter JM, White WF, Dickerson JW. Ascorbic acid supplementation and five year survival rates in women with breast cancer. Acta Vitaminol Enzymol 1984; 6(3):175-82.
• Murata A, Morishige F, Yamaguchi H. Prolongation of survival times of terminal cancer patients by administration of large doses of ascorbate. Int J Vitam Nutr Res Suppl 1982; 23:103-13.
• Kupin VI, Polevaia EB. [Stimulation of the immunological reactivity of cancer patients by Eleuthrococcus extract.] Vopr Onkol 1986; 32(7):21-6.
• Saxe GA, Rock CL, Wisha MS, Schottenfield D. Diet and risk for breast cancer recurrence and survival. Breast Cancer Res Treat 1999 Feb; 53(3):241-53.
• Klaschka F. Oral Enzymes in Oncology: Clinical studies on Wobe-MuGos. MUCOS Pharma GmbH, 1997. http://www.mucos.de
• Shao Y, Pardini L, Pardini RS. Dietary menhaden oil enhances mitomycin C antitumor activity toward human mammary carcinoma MX-1. Lipids 1995 Nov; 30(11):1035-45.
• This refers to 7 studies, referenced in shorter style: Ravid A. Cancer Res 1999 Feb 15; 59(4):862-7. Studzinski GP. J Natl Cancer Inst 1986 Apr; 76(4):641-8. Moffatt KA. Clin Cancer Res 1999 Mar; 5(3):695-703. Vink-van Wijngaarden T. Breast Cancer Res Treat 1994 Feb; 29(2):161-8. Saunders DE. Gynecol Oncol 1993 Nov; 51(2):155-9. Cho YL. Cancer Res 1991 Jun 1; 51(11):2848-53. Tanaka H. Clin Orthop 1989 Oct; (247):290-6.
• There were promising Phase I trials on maytansine against breast cancer in the 1980’s, but phase II trials were disappointing.
• Juret P, Heron JF, Couette JE, Delozier T, Le Talaer JY. Hydroxy-9-methyl-2-ellipticinium for osseous metastases from breast cancer: a 5-year experience. Cancer Treat Rep. 1982 Nov; 66(11): 1909-16.
• Slayton RE, Blessing JA, Delgado G. Phase II trial of etoposide in the management of advanced or recurrent endometrial carcinoma: a Gynecologic Oncology Group Study. Cancer Treat Rep. 1982 Aug; 66(8): 1669-71. No abstract available.
• Li XK, Motwani M, Tong W, Bornmann W, Schwartz GK. Huanglian, A chinese herbal extract, inhibits cell growth by suppressing the expression of cyclin B1 and inhibiting CDC2 kinase activity in human cancer cells. Mol Pharmacol. 2000 Dec; 58(6): 1287-93.
• Wu J, Wu Y, Yang BB. Anticancer activity of Hemsleya amabilis extract. Life Sci. 2002 Sep 20; 71(18): 2161-70.
• Yang S, Chen J, Guo Z, Xu XM, Wang L, Pei XF, Yang J, Underhill CB, Zhang L. Triptolide inhibits the growth and metastasis of solid tumors. Mol Cancer Ther. 2003 Jan; 2(1): 65-72.
• Lin J, Dong HF, Oppenheim JJ, Howard OM. Effects of astragali radix on the growth of different cancer cell lines. World J Gastroenterol. 2003 Apr; 9(4): 670-3.

About the Author

Acupuncturist, herbalist, and medical professor Brian B. Carter founded the alternative health megasite The Pulse of Oriental Medicine (http://www.PulseMed.org/). He is the author of the book “Powerful Body, Peaceful Mind: How to Heal Yourself with Foods, Herbs, and Acupressure” (November, 2004). Brian speaks on radio across the country, and has been quoted and interviewed by Real Simple, Glamour, and ESPN magazines.

N.B This topic will make you understand why it is important to do a monthly breast exam. The earlier the cancer is detected, the better the prognosis.

Breast cancer staging

To stage cancer, the American Joint Committee on Cancer first places cancer in a letter category using the tumor, nodes, and metastasis (TNM) classification system. The stage of a breast cancer describes its size and the extent to which it has spread. The staging system ranges from stage 0 to stage IV according to tumor size, lymph nodes involved, and distant metastasis.

T indicates tumor size. The letter T is followed by a number from 0 to 4, which describes the size of the tumor and whether it has spread to the skin or chest wall under the breast. Higher T numbers indicate a larger tumor and/or more extensive spread to tissues surrounding the breast.

TX: The tumor cannot be assessed.
T0: No evidence of a tumor is present.
Tis: The cancer may be LCIS, DCIS, or Paget disease.
T1: The tumor is 2 cm or smaller in diameter.
T2: The tumor is 2-5 cm in diameter.
T3: The tumor is more than 5 cm in diameter.
T4: The tumor is any size, and it has attached itself to the chest wall and spread to the pectoral (chest) lymph nodes.

N indicates palpable nodes. The letter N is followed by a number from 0 to 3, which indicates whether the cancer has spread to lymph nodes near the breast and, if so, whether the affected nodes are fixed to other structures under the arm.

NX: Lymph nodes cannot be assessed (eg, lymph nodes were previously removed).
N0: Cancer has not spread to lymph nodes.
N1: Cancer has spread to the movable ipsilateral axillary lymph nodes (underarm lymph nodes on the same side as the breast cancer).
N2: Cancer has spread to ipsilateral lymph nodes (on the same side of the body as the breast cancer), fixed to one another or to other structures under the arm.
N3: Cancer has spread to the ipsilateral mammary lymph nodes or the ipsilateral supraclavicular lymph nodes (on the same side of the body as the breast cancer).

M indicates metastasis. The letter M is followed by a 0 or 1, which indicates whether the cancer has metastasized (spread) to distant organs (eg, lungs or bones) or to lymph nodes that are not next to the breast, such as those above the collarbone.

MX: Metastasis cannot be assessed.
M0: No distant metastasis to other organs is present.
M1: Distant metastasis to other organs has occurred.