Breast cancer is the most common cancer diagnosed in women worldwide. In India more women are affected by it now than ever before. It occurs about a decade earlier in Indian women compared to those in developed countries. While it is known that there are several factors that can increase a woman’s risk for breast cancer, like being overweight, higher alcohol consumption, smoking, early menarche, late menopause, delayed child-bearing and family history, researches still do not know exactly what causes normal cells to become cancerous. Hormones are considered to play a major role in the development of breast cancer, but there is still a lot that we need to know.
For thousands of years our genetics have not changed, but what has changed is the interaction of our genes with the environment. Our diet has changed dramatically from what our ancestors ate. At no other time in history have there been so many man-made chemicals in our environment, some of which are hormones disruptors. We have now found out that the microbes that live in our intestine can influence our health.
It is obvious that it is an interaction of genetics and environmental factors that have contributed to the alarming increase of breast cancer in recent years.
GUT MICROBES AND ESTROGEN METABOLISM
Many of you know that your gut microbes influence your health. But did you know that your gut microbes can influence how you metabolise Estrogen in your body? Estrogens, while being essential, are also related to some cancers. Higher levels of circulating Estrogens are related to endometrial (uterus), breast and ovarian cancers. Estrogens are metabolized in the liver and some of them enter the gut and interact with the gut microbes. According to Dr. Claudia Plottel, Associate Professor at NYU School of Medicine, “each person’s mix of gut bugs determines how much estrogen is recirculated, making the microbiome a key regulator of each person’s circulating estrogen levels over time”.
Dr. Plottel’s focus of research is the interaction between each woman’s gut microbiome and estrogen.
How can you take care of your gut microbes:
- Eat food and not “food-like” substances. Eating a diet of plants and unprocessed meat and fish has been shown to change the gut microbiota to a more diverse and healthy profile versus eating mostly processed food.
- Do not take antibiotics for minor illnesses.(If you do need to take antibiotics,please complete the course!)
- Avoid sweeteners like sucralose, aspartame, saccharin.
- Supplement with probiotics.
- Add fermented food to your diet.
ALCOHOL AND BINGE DRINKING
As somebody who likes red wine, I wish this was not true! But I don’t make the rules! Alcohol consumption is related to higher breast cancer risk in pre-and post-menopausal women. In fact, even light alcohol use by women (≤1 drink/day or ≤12.5 g/day) has been associated with higher risk for breast cancer. Binge drinking, defined as consuming four or more alcoholic drinks on one occasion, is much worse! So ladies, less than one drink a day and no binging (not even on red wine!).
(Not Inflammatory Breast Cancer)
Inflammation is your immune system’s reaction to any injury, toxin, allergen or microbes. Inflammation happens when chemical messengers called cytokines along with white blood cells and proteins rush to an area of damage and help in healing it. Damaged cells also release more chemicals that can increase inflammation.
Is all inflammation bad? No! You need inflammation to fight illness and injury. However, there are 2 types of inflammation: acute and chronic. Acute inflammation is short term and helps you to tide over immediate injury and goes away when the insult is absent. Chronic inflammation is long-term and this means that the immune system is working overtime. Chronic inflammation is the “bad guy/gal”. Chronic inflammation is related to many different diseases including cancer, heart disease, stroke, high blood pressure.
Chronic inflammation can be caused by
- Chronic infections such as hepatitis B
- Periodontitis (Inflammation of the tissue around the teeth, often causing shrinkage of the gums and loosening of the teeth)
- Toxic exposure
- Lack of sleep
- Having excess body fat. Fat cells produce inflammatory chemicals.
- Insulin resistance, diabetes.
- Unmitigated stress
- A diet low in fresh vegetables and fruit
- High intake of sugar, processed food and trans-fats.
Measuring blood levels of HsCRP will provide a good measure of the level of inflammation in your body. High HsCRP is associated with higher risk of breast cancer in all women. In an article in Nature Scientific Reports it was mentioned that this association was more pronounced in Asian women compared to European and American women.
ENDOCRINE DISRUPTING CHEMICALS
Endocrine-disrupting chemicals (EDCs) are substances in our environment, food, cosmetics, cleaning products that interfere with hormone production, metabolism, or action. Although the exact manner in which EDCs disrupt hormone action are not completely understood, there is enough evidence to suggest that many of them cause major harm to us. In fact, the problem of EDCs is serious enough that the World Health Organization and the Endocrine Society have produced documents on them.
Breasts are the only organs in the body that continue to change long after birth (during puberty, pregnancy and lactation). Therefore, the exposure of breast tissue to different substances throughout a woman’s life will have diverse effects depending on the time of exposure, the amount and also the mixture of different chemicals. What is alarming with respect to EDCs is their potential effects on the unborn child in utero and during early development.
Some of the EDCs affecting breast cancer risk are BPA, dioxins, DDT, Atrazine, Parabens, Pthlates,PFOA, Organic Solvents, DES, Polycyclic Aromatic Hydrocarbons, Vinyl Chloride.
Most of you know that vitamin D is important for calcium metabolism and bone health. However, many scientific studies in the last few years have indicated that Vitamin D has many actions that go way beyond maintaining your bones. Vitamin D regulates expression of genes important in development and progression of breast cancer & it is also an immune-modulator. Low levels of vitamin D3 have been associated with higher risk of breast cancer. Additionally, women with low vitamin D3 levels have shown worse prognosis after being diagnosed with cancer of the breast. Levels of 40-60 ng/ml (approx. 100-150 nmol/L) have been found to be protective against breast cancer (and many other conditions).
What can you do: Check the levels of Vitamin D3 in your blood.If levels are below the optimal levels, you will need to supplement with vitamin D3.
Can you get enough from exposure to sunlight?
This depends on many factors. For example, your skin colour will decide how much of sunlight you absorb. People with darker skin like Asian Indians, will not absorb much! Your absorption will also depend on how much time you spend in the sun and how much of your skin you expose. A study done on 20 young women in Korea reported that their baseline low levels of vitamin D3(about 11ng/ml) did not increase despite sun exposure for 20 minutes daily for 4 weeks during October November.
Amongst my patients in India I sometimes find blood levels of vitamin D3 in single digits in those who do not supplement! The lowest that I have found was 2ng/ml!
How much of Vitamin D3 should you take?
This will depend on your blood levels. If your levels are extremely low you may need a higher dose initially, but to maintain optimal blood vitamin D3 levels it is a good idea to take 4000-5000 IU capsules every day, rather than taking a high dose once a week. I find many people in India take a very high dose for 3-4 months and then stop.It is very important to measure vitamin D3 regularly because all of you will not respond the same way.
- Take care of your gut health.
- Avoid binge drinking and keep alcohol consumption to < 1 drink a day.
- Reduce inflammation.
- Minimize your exposure to Endocrine Disrupting Chemicals.
- Maintain optimal Vitamin D3 levels (40-60 ng/ml OR 100-150 nmol/L).
- Gunter, Marc J., et al. “Breast cancer risk in metabolically healthy but overweight postmenopausal women.” Cancer research 75.2 (2015): 270-274.
- White, Alexandra J., et al. “Overall and central adiposity and breast cancer risk in the sister study.” Cancer 121.20 (2015): 3700-3708.
- Mohr, Sharif B., et al. “Meta-analysis of vitamin D sufficiency for improving survival of patients with breast cancer.” Anticancer research 34.3 (2014): 1163-1166.
- Liu, Ying, Nhi Nguyen, and Graham A. Colditz. “Links between alcohol consumption and breast cancer: a look at the evidence.” Women’s Health11.1 (2015): 65-77.
- Guo, L. et al. C-reactive protein and risk of breast cancer: A systematic review and meta-analysis. Rep.5, 10508; doi: 10.1038/srep10508 (2015).
- Plottel, Claudia S., and Martin J. Blaser. “Microbiome and malignancy.” Cell host & microbe4 (2011): 324-335.
- Soto AM, Sonnenschein C. DDT, endocrine disruption and breast cancer.Nature reviews Endocrinology. 2015;11(9):507-508. doi:10.1038/nrendo.2015.125.
- Diamanti-Kandarakis E, Bourguignon J-P, Giudice LC, et al. Endocrine-Disrupting Chemicals: An Endocrine Society Scientific Statement. Endocrine Reviews. 2009;30(4):293-342. doi:10.1210/er.2009-0002.
- Lee S-H, Park S-J, Kim K-M, et al. Effect of Sunlight Exposure on Serum 25-Hydroxyvitamin D Concentration in Women with Vitamin D Deficiency: Using Ambulatory Lux Meter and Sunlight Exposure Questionnaire. Korean Journal of Family Medicine. 2012;33(6):381-389. doi:10.4082/kjfm.2012.33.6.381.
Disclaimer:The contents of this blog are for information only. This information is not to be taken as medical advice. Reading this blog does not establish a doctor-patient relationship.Please discuss with a knowledgable medical practitioner before implementing this information.