Health

During National Breast Cancer Awareness Month this October, women have even more reason to start paying attention to preventative measures: According to recent research presented at this year’s European Breast Cancer Conference (EBCC), taking specific steps to help lower the risk of breast cancer can make the difference between a healthy checkup and a dangerous diagnosis. Researchers analyzed years of studies and data from the International Agency for Research on Cancer to deduce that one-third of all breast cancer cases can be avoided simply through diet and exercise—a surprising conclusion that raised eyebrows worldwide and contradicts the common conception that some women are powerless against the disease due to genetic makeup or family history. What’s more, new research continues to compile to show exactly which nutritional and physical approaches can help best reduce your risk.

Ready to take action? We’ve sifted through the latest studies and talked to the leading experts so that you can know—and do—everything possible to prevent the disease.
During National Breast Cancer Awareness Month this October, women have even more reason to start paying attention to preventative measures: According to recent research presented at this year’s European Breast Cancer Conference (EBCC), taking specific steps to help lower the risk of breast cancer can make the difference between a healthy checkup and a dangerous diagnosis. Researchers analyzed years of studies and data from the International Agency for Research on Cancer to deduce that one-third of all breast cancer cases can be avoided simply through diet and exercise—a surprising conclusion that raised eyebrows worldwide and contradicts the common conception that some women are powerless against the disease due to genetic makeup or family history. What’s more, new research continues to compile to show exactly which nutritional and physical approaches can help best reduce your risk.

Ready to take action? We’ve sifted through the latest studies and talked to the leading experts so that you can know—and do—everything possible to prevent the disease.

Exercise more—and turn up the tempo.

Study after study has shown that exercise helps lessen the likelihood of breast cancer, but how much do you really need to lower your chances? Carlo La Vecchia, MD, of the University of Milan, who helped present the exercise-diet conclusion at the 2010 EBCC, recommends logging at least “three to four hours of moderate exercise” a week. That’s a great starting goal, says Kathleen Wesa, MD, of the Integrative Medicine Service at Memorial Sloan-Kettering Cancer Center in New York City, but “I suggest women aim for 30 to 60 minutes of moderate to vigorous activity five days per week.” Wesa defines 100 steps per minute while walking as moderate. “You want to increase your level of fitness, and if you’re sauntering, that’s not going to be effective.”

Indeed, going for a light walk or watching TV while leisurely pedaling the stationary bike may not be enough, according to a recent National Cancer Institute study of more than 110,000 postmenopausal women. Researchers tracked participants’ exercise habits for a decade to find that those who logged more than seven hours of moderate to vigorous exercise a week for the past 10 years were 16 percent less likely to be diagnosed with breast cancer than those who remained inactive or exercised less or not as vigorously.

If the word “vigorous” triggers a guttural reaction, John Potter, MD, professor of epidemiology at the University of Washington and senior advisor of Seattle’s Fred Hutchinson Cancer Research Center, says to start slowly. “Any activity is better than nothing,” says Potter, who recommends exercise-phobes begin by walking 30 minutes four days a week, then work up slowly to daily, regular intense activity lasting up to an hour. “Vigorous exercise—getting sweaty and breathing hard—is better than low-intensity exercise, but any exercise is better than setting the bar too high so that it causes failure, too much pain, or an injury,” Potter concludes.

Eat fruits and vegetables—but some more than others.

When asked which foods he deemed best for lowering the likelihood of breast cancer by that whopping one-third, La Vecchia responds that “a diet rich in fruits and vegetables, and thereby in micronutrients and food components like flavonoids, appears to be most favorable.” (For more on micronutrients, see “Eat for Optimal Health” on page 25.) This—as well as the long-standing recommendation from the American Cancer Institute to eat five or more servings of fruits and vegetables daily to prevent cancer—contradicts a much-publicized 2010 study from Mount Sinai School of Medicine’s Tisch Cancer Institute that found only a weak association between high produce intake and reduced cancer risk.

So which is it? Does food matter? “Not all fruits and vegetables are created equal, and not all people respond the same way to their presence in the diet,” says John Milner, PhD, chief of the nutritional science research group for the National Cancer Institute. “But fruits and vegetables likely play an important role in breast cancer risk reduction, as well as in the risk reduction of many other diseases.” Milner says berries, cruciferous vegetables like broccoli, and bulb crops, including onions, leeks, and garlic, have the strongest data from the most studies to suggest that increased intake can help lower your likelihood. Additionally, he says, women should consider upping their intake of pomegranates: A new study from Israeli researchers discovered that pomegranate seed oil causes breast cancer cells to self-destruct in laboratory experiments. Milner and other experts believe the fruit, when consumed frequently and over time—within an appropriate caloric intake—may also help decrease a woman’s chance of getting breast cancer.

Adopt a Mediterranean diet—but keep it to one glass of wine a day

Boosting your dietary intake of fruits and vegetables is critical regardless of your everyday nutritional approach, but if you really want to do everything you can to guard against breast cancer, adopt the Mediterranean diet, say top experts. A study of more than 14,000 Greek women published in the American Journal of Clinical Nutrition in July found that postmenopausal women who adhered to a Mediterranean-style plan—or who ate primarily whole grains, nuts, legumes, olive oil, fish, and up to 10 servings daily of fruits and vegetables—were 22 percent less likely to develop breast cancer than those who didn’t follow or only partially complied to the diet.

According to Roger Clemens, PhD, spokesman for the American Society of Nutrition, which publishes the journal in which the study appeared, the Mediterranean diet helps reduce cancer risk because it combines the right types of cancer-blocking foods into one healthy approach. “Consuming no one food or food group alone prevents breast cancer,” Clemens explains. “But eating the right blend of foods really reduces your risk of the disease.”

The caveat, say researchers, is to ensure that you do really adhere to the diet. “I recommend people eat three to five servings of fruits and three to five servings of vegetables daily, along with plenty of lean protein, extra-virgin olive oil, and unprocessed whole grains,” Wesa says.

Although wine, particularly red, has received much acclaim as an important age-reversing, disease-fighting component of the Mediterranean diet, most experts advise women at risk for breast cancer to drink no more than one five-ounce glass of the heart-healthy beverage a day. “Alcohol intake is a nuanced message,” says Michelle Holmes, MD, associate professor of epidemiology at the Harvard School of Public Health. “We know that drinking alcohol increases a woman’s risk of getting and dying from breast cancer, but moderate alcohol intake can also decrease her risk of getting and dying from heart disease. The balancing point—where the benefit of decreasing heart disease is more than the downside of increasing breast cancer—occurs among women who consume a half-glass or full glass of alcohol per day.”

Know your BMI­—then change it.

Exercising more and opting for fewer processed grains and sugars and more fruits and vegetables will help you maintain, if not lose, weight. But for overweight and obese women, lowering overall body mass index, or BMI—the standard measure of body fat based on height and weight—should be priority No. 1. “Being overweight or obese is a major risk factor not only for breast cancer, but for many diseases,” Wesa says. Why? The reason is threefold, Potter explains. First, obesity increases the body’s insulin levels and insulin-like growth factors (IGFs) that have a growth-promoting effect on cells—especially, perhaps on malignant and pre-malignant cells. But being overweight also boosts the body’s estrogen levels, which research shows stimulates cell growth of estrogen-sensitive breast cancer—the most common type of breast cancer among Western women. Finally, Potter says, recent studies have also proven conclusively that overweight and obese women have higher levels of inflammation, which provide an unsafe pro-cancer environment for the development of the disease in the breasts, lungs, and other organs.

According to the National Cancer Institute, any BMI over 25 increases a woman’s likelihood of incurring breast cancer significantly, while a BMI of more than 30, which is considered obese, pushes a woman’s risk of developing the disease to more than 60 percent, reports a 2006 British study of more than 6,000 women. To lower your risk, start by learning your BMI: Visit the National Institutes of Health’s website for a free online BMI Calculator (nhlbisupport.com/bmi). If your number is over 25, begin exercising and reducing your daily caloric intake immediately, while choosing fresh produce, lean protein, and healthy fats over processed carbohydrates, fatty meats, and sugary foods. “I won’t quibble with someone saying, ‘I’m big boned or muscular and can thereby weigh more and still be healthy,’” says Christine D. Berg, MD, chief of the early detection research group of the National Cancer Institute. The take-home? Stop making excuses and start taking steps that can help prevent your risk of breast cancer—it may just save your life.

Find toxins in your home—and eliminate them.

Diet and exercise aren’t the only factors that can increase your breast cancer risk. More and more studies examining the effects of environmental toxins suggest that everyday chemicals found in our homes and water supply may be responsible for rising rates of the disease, the incidence of which has increased by 30 percent over the past 25 years, says the American Cancer Society. Here are three ways to reduce your risk, according to Ruthann Rudel, director of research for the Silent Spring Institute, the leading nonprofit research group focused on finding links between the environment and breast cancer.

Throw out your chemical cleaners.

A 2010 study by Rudel and her colleagues published in Environmental Health found that frequent use of common chemical cleaners may increase a woman’s risk of breast cancer by as much as 50 percent. According to Rudel, many commercial cleaners contain hormone-disrupting chemicals that could effectively increase estrogen levels, shown to interfere with cell growth and development. Since scientists aren’t sure exactly which chemicals are hormonally active—and the chemicals aren’t tested before being added to commercial cleaners—Rudel says it’s best to limit use of commercial products, choosing toxin-free, simple alternatives like vinegar whenever possible. (For more on green cleaning products, go to naturalsolutions mag.com and type “Is Your Home Toxic?” into the search box.)

Increase indoor air quality by decreasing consumer products. In a study published in Environmental Science & Technology in August, Silent Spring researchers discovered that concentrations of endocrine-disrupting chemicals (EDCs) are higher in our homes than in outdoor air. “Based on laboratory experiments, EDCs in high concentrations increase the risk of breast cancer,” Rudel says. EDCs, found in commercial furniture, carpets, detergents, clothing, electronics, and building products, are difficult to avoid altogether, but Rudel says you can reduce your exposure simply by buying fewer commercially produced goods (do you really need that plastic bowl or another table for the foyer?). When remodeling or moving, she adds, opt for chemical-free rugs (avoid additives like “stain-resistant”) and choose woods instead of vinyls and plastics. Also, allow new products, including newly dry-cleaned clothes, to off-gas outside before bringing them inside.

Investigate the water supply. Ongoing research from the Silent Spring Institute continues to show that our groundwater supplies can be contaminated with high levels of endogenous hormones, chemical cleaners, and certain pharmaceutical drugs—all of which can increase your chances of incurring breast cancer. Rudel suggests women contact their local water department to find out about their water source—you can also look up your water supply online by visiting the Environmental Working Group’s Tap Water Database (ewg.org/tap-water/whats-in-your-water). Or you can buy a home-testing kit or send your water to a state-certified lab to be tested (find one by calling the Safe Drinking Water Hotline at 800.426.4791 begin_of_the_skype_highlighting 800.426.4791 end_of_the_skype_highlighting or visiting epa.gov/safewater/labs). 3M Clean Water Solutions (3mcleanerworld.com) offers free testing in some cities and then will suggest the right filter to address the contaminants found in your water.

If your water’s chlorinated or shows concentrations of nitrate (a chemical in fertilizer and septic-tank runoff) over 1 mg/L, invest in a filter, says Rudel, adding that you must change the filter when recommended to avoid oversaturation and the release of collected toxins back into the water. Finally, don’t even think about buying bottled water unless you choose a supplier that doesn’t use endocrine-disrupting bisphenol-A in its plastic bottles or jugs.

Radiologists have devised a better way to perform a mammogram, called digital tomosynthesis. An X-ray tube moves in an arc around the breast, capturing several images. The information is then sent to a computer, which produces clear, highly focused 3-dimensional images of the breast.

One out of seven women will develop breast cancer in her lifetime. Up until now, a mammogram has been the best hope for early detection. But mammograms can be uncomfortable and difficult to read. Now, new technology may change all that.

For most women, the prospect of getting a mammogram is scary.

"I think for many radiologists, the prospect of interpreting mammography is a very scary thing," said Elizabeth Rafferty, a radiologist at Massachusetts General Hospital.

That's because 50-percent of women have dense breast tissue and on a mammogram, that density looks similar to cancer.

"It's really like a 'Where's Waldo.' I'm trying to find the thing I'm interested in, but it looks like everything else in the sea of normal structures," Rafferty said. But a new technology called tomosynthesis is helping radiologists pinpoint cancer as small as two millimeters. Tomosynthesis builds on digital mammography by taking multiple images. An x-ray tube moves in an arch around the breast at different angles. A computer then combines the information into a 3-D image.

"The radiologists can look at it like pages of a book, looking at one area of the breast in isolation," Rafferty said.

Traditional mammograms only take two angles of the breast. Depending on breast size, tomosynthesis takes at least 11 different angles. Another bonus -- tomosynthesis uses less compression than traditional mammograms and that means less pain for the patient. Doctors are awaiting FDA approval. The cost of the test is expected to be about the same as a traditional mammogram.

The American Association of Physicists in Medicine and the Optical Society of America contributed to the information contained in the TV portion of this report.

A new kind of MRI machine helps doctors diagnose breast cancer earlier. Patients lie on their stomach and their breasts are placed in two coils, which focus radio waves and allow for more complete images that give a three-dimensional look inside the breast

WHITE PLAINS, N.Y.--Two-hundred thousand women will be diagnosed with breast cancer this year in the United States. Mammograms, however, may not be the best way to detect it. Now, there's a new test to help doctors pinpoint and treat breast cancer.

Suzette Lipscomb knows how to get the most out of every moment and she plans to share most of those moments with her little girl, Ava. "I always wanted a little girl, but I was a little afraid that I may pass on some type of tendency toward the disease," Suzette says.

The disease she feared? Breast cancer. Her grandmother beat it and so did she. It wasn't easy though, during her battle she was forced to make a difficult decision. Suzette says, "I was trying to make a decision as to whether or not to remove both my breasts."

Richard Reitherman, a breast radiologist at CAD Imaging Sciences in White Plains, N.Y., used the new cadsciences breast imaging system to help decide which treatment would work best. For the test, patients lie on their stomach with their breasts in two coils, which help focus radio waves for more complete images.

"She and her surgeon know exactly how big the tumor is, so it gives her the best treatment," Dr. Reitherman says. For Suzette it showed her second breast was clear.

A dye injected into the patient helps pinpoint cancer and if chemotherapy treatments are working. In the scan, the red areas are cancer -- cancer that was missed in a mammogram. In fact, 20 percent of women who don't have the cad-sciences MRI will need a second surgery, something Suzette was able to avoid.

"I feel like the luckiest woman alive that not only did I have my cancer caught early enough that I'm alive, but that I was able to have a child," Suzette says.

Not all women are candidates for this cadsciences MRI. It's used for women who have already been diagnosed and need to know a course of action. It's also used for women who are high risk and have a family history of the disease. The procedure takes about 30 minutes; results are available 15 minutes later.

A powerful new breast cancer treatment could result from packaging one of the newer drugs that inhibits cancer's hallmark wild growth with another that blocks a primordial survival technique in which the cancer cell eats part of itself, researchers say

While they are powerful killers of some breast cancer cells, new drugs called histone deacetylase inhibitors, or HDAC inhibitors, also increase self-digestion, or autophagy, in surviving, mega-stressed cells, Medical College of Georgia Cancer Center researchers reported during the Molecular Targets and Cancer Therapeutics International Conference in Boston. The conference is sponsored by the American Association for Cancer Research, the National Cancer Institute and the European Organisation for Research and Treatment of Cancer.

"To meet the energy demands of growth and survival, cancer cells start eating up their own organelles, so that surviving cells become dependent on this autophagy," says Dr. Kapil Bhalla, director of the MCG Cancer Center.

"By also using autophagy inhibitors, we pull the rug out from under them. The only way out is death," he says.

Researchers showed the potent HDAC inhibitor panobinostat's impact on autophagy in human breast cancer cells in culture as well as those growing in the mammary fat pads of mice. When they added the anti-malaria drug chloroquine, which inhibits autophagy, breast cancer kill rates increased dramatically.

"As breast cancer is growing, it's developing these mechanisms of resistance to death," says Dr. Bhalla, Cecil F. Whitaker, Jr., M.D./Georgia Research Alliance Eminent Scholar in Cancer and Georgia Cancer Coalition Distinguished Cancer Scholar. "What we are saying is there is a new way to affect a resistant population."

Fundamentals of survival and growth put a lot of stress on cancer cells. Their drive for both comes from the activation of oncogenes and loss of tumor suppressor genes that leaves cells looking desperately for ways to support their marching orders. Much like the extreme measures plane crash victims may take while stranded on a frozen mountaintop, autophagy becomes a survival strategy for the most stressed out cancer cells.

Stress kicks in as cancer cells quickly outgrow available blood supplies and nutrients, which stimulates new blood vessel formation and consumption of unprecedented amounts of fuel. Alterations in gene copy numbers create an imbalance in gene products or proteins adding to the stress of cancer cells, which are starting to make improperly folded -- and functioning -- proteins.

Protein degradation gets revved up and cells also start making more heat shock proteins which are supposed to help properly fold proteins and protect against cell death, a stress cause and effect Dr. Bhalla showed nearly a decade ago. He suspected then the connection he just found: promoting autophagy is one way heat shock proteins carry out their protective mission.

This is where HDAC inhibitors come into play: they promote acetylation or a modification in the key heat shock protein, hsp70, which further promotes autophagy. "Basically HDAC inhibitors promote acetylated hsp70 which promotes autophagy on which a stressed-out cancer cell depends," Dr. Bhalla says.