Beat the Odds

You can vastly improve your chances of keeping breast cancer at bay by creating an environment that promotes healthy cells and allows them to thrive.
By Sarah Gottfried

Every fall for the past decade or two, the pink ribbons have come out in force. Silk-screened on T-shirts; morphed into office staplers, car air fresheners, and key rings; printed on yoga mats and wine glasses; and affixed to a host of products from cosmetics to socks, they bring the urgency of breast cancer front and center—as do the countless women and men who run and walk with passionate commitment to raise funds for the cure.

Heart disease may kill more women, but the specter of breast cancer clearly looms much larger in our collective psyche. Perhaps because it feels personal and more invasive, breast cancer leaves us women far more vulnerable than any other condition we face. The disease ravages our breasts, after all, the very essence of our femaleness—both physically and psychologically. Our breasts provide nurturance and sustenance for our babies. They play a vital role in our intimate relationships. And they have an intricate connection with oxytocin, the feel-good neuroendocrine messenger of love and bonding.

While not everyone agrees on—or even knows—what causes breast cancer, researchers have identified a number of risk factors over which we can exercise some amount of control. Simply identifying them and making appropriate changes are not only empowering, they could keep this dread disease at bay.

Know Your Risks
“Our thinking about cancer has shifted,” says breast expert Susan Love, MD, author of Dr. Susan Love’s Breast Book. According to Love, we’ve gone from thinking that cancer was “one bad cell and its progeny, and that if we killed them all, the patient would live,” to understanding that, in order to grow into a destructive force, a mutated cell needs an environment within our body that eggs it on. “It’s like a kid growing up in a bad neighborhood with drive-by shootings, drugs, and gangs, who then moves to the country, goes to Boy Scouts, and joins the band,” says Love. “Chances are good he’ll turn out differently.”

Several factors conspire to create this malevolent cancer nursery, including the usual suspects like poor food choices, lack of exercise, inflammation, and heightened stress levels. Studies also show that any disruption in the body’s circadian rhythms—the natural pattern of bodily functions that are regulated by our 24-hour internal clock—can contribute to an increase in breast cancer. Another established factor? Your lifelong exposure to estrogen, whether produced within the body (endogenously) or outside (exogenously)—think prescription medications, such as the Pill and hormone replacement therapy (HRT), or any number of environmental pollutants. While some breast cancer risks are currently beyond our control—a genetic predisposition being a primary one—the following risk factors offer opportunities for positive change.

Disrupted circadians. The jet lag we experience when we travel across time zones is a temporary disruption of our biological rhythms, particularly our sleep/wake cycle, causing us to awaken at odd hours, crash in the middle of the day, and generally feel pretty awful. But even a minor disruption like this can also mess up the release of hormones, body temperature, and other bodily functions. More important, circadian rhythms affect the production and release of the stress hormone cortisol, which is produced in your adrenal glands atop your kidneys. Peak cortisol levels normally occur within a few hours of waking up (about 8 a.m.), when our bodies need jump-starting for the day ahead. From that high point, cortisol levels normally decrease throughout the day until they reach their lowest point just before you go to bed, allowing you to fall easily into restorative sleep and produce melatonin, one of the most powerful antioxidants in your body.

Fairly recent studies suggest that chronic circadian disruption can ad-versely affect our health and even con-tribute to cancer risk. We know, for instance, that nurses who work the night shift—and throw off the delicate balance of their circadian rhythms with artificial light at night—are at greater risk of breast cancer. In fact, the International Agency on Research in Cancer has classified shift work that involves circadian disruptions as “probably carcinogenic to humans.”

Excess estrogen. Produced in large quantities beginning at puberty, estrogen grows your breasts, widens your hips, and kick-starts your period. It’s the hormone that makes us women, but ironically, too much of it can also make us sick. Women who start their periods early, do not get pregnant (which causes estrogen levels to drop), and enter menopause late in life, all of which increase their exposure to estrogen, face a higher risk of breast cancer. While you can’t easily regulate how much estrogen your body produces, you can limit your exposure to xenoestrogens. These environmental chemicals mimic and interfere with the action of natural estrogen in the body, usually with serious consequences, such as early puberty and an increase in breast cancer risk. Of course, it’s a bit of a minefield out there, with more than 700 of these synthetic chemicals found in everything from personal products like toothpaste, deodorant, cosmetics, and sunscreen, to food preservatives (including the lining of cans), and certain types of plastic, particularly bisphenol A (BPA) and phthalates. You can avoid many of them by reading labels after checking the lists at the Environmental Working Group (ewg.org), the Breast Cancer Fund (breastcancerfund.org), and The Campaign for Safe Cosmetics (safecosmetics.org).

Affluence and stress. To some degree, breast cancer is a disease of the well-off. Women in North America and Western Europe have four times the risk of a diagnosis than their counterparts in Third World countries. While having money hardly causes cancer, women in wealthy countries encounter far more environmental chemicals, eat more red meat and other inflammatory foods, and are more likely to lead lives that disrupt their circadian rhythms. They also face far more stress, another breast cancer risk factor. Overscheduling and overwork, both at the office and at home, can create a chronic fight-or-flight response that floods the body with stress hormones, particularly cortisol, and increases inflammation in the body. As a result, women experience everything from fatigue, sleep deprivation, and anxiety, to sugar and wine cravings, in a vicious cycle that puts them at ever greater risk of breast cancer.

Inflammation. As researchers delve more deeply into the potential causes of cancer, they’ve discovered that chronic system-wide inflammation plays a critical role in creating an environment that encourages Dr. Love’s mutated cell to turn malignant. According to Love, you can reduce inflammation with “exercise, weight loss, and stress reduction either through yoga, meditation, or social support”; and by changing the environment, you may be able to keep mutated or future cancer cells dormant. Robert Newman, PhD, professor emeritus at The University of Texas MD Anderson Cancer Center, agrees. “Addressing inflammation is an important initial step in slowing the proliferation of all types of breast cancer,” he says, as well as preventing its occurrence in the first place.

Reducing Your Risk
It’s never the wrong time to take action against breast cancer, so why not start cleaning up your internal “neighborhood” now? Robust science supports the protective benefit of eating better, cutting back on alcohol, reducing inflammation, and exercising more regularly. Here’s what you need to do:

Change your diet. Luckily, how you eat can have a positive effect on how estrogen works in your body. Conventionally raised red meat and dairy, and the saturated fats they contain, raise your estrogen levels, while fiber-rich foods lower it. Victoria Maizes, MD, executive director at the Arizona Center for Integrative Medicine and professor of medicine and public health at the University of Arizona, recommends eating a plant-based diet that drastically reduces or eliminates animal protein. “There is a link between red meat and many cancers, including breast,” says Maizes. The likely culprit? Inflammation.

Fiber-rich foods help you excrete excess estrogen by binding with it and flushing it out of your body in your bowel movements. Studies show that women who eat high fiber foods have lower circulating estrogen levels; in fact, those with the highest fiber consumption have estrogen levels 20 percent lower than women with the lowest fiber consumption. I recommend 35 to 45 grams per day of fiber, yet the average American woman gets less than 14 grams per day.

Cut back on alcohol. If your liver is busy processing alcohol, it can’t adequately metabolize estrogen and excrete the excess into your bile, where it can then move through your intestines and out of your body. Furthermore, alcohol, which is converted into acetaldehyde, a chemical akin to formaldehyde, simply adds to your toxic load. It also raises cortisol levels, so the stress-reducing benefits you think you’re getting from that glass of wine may not actually exist. Other methods of stress reduction, such as yoga and other contemplative practices, are a better choice. Here’s the bottom line: eliminate alcohol or limit it to fewer than three to six glasses a week.

Get moving. An active lifestyle reduces breast cancer by 25 percent, according to Love, probably because it helps keep your weight down (excess weight is a risk factor) and helps reduce stress. How active is active? Brisk walking, jogging, bicycling, or some other aerobic activity for 30 minutes at least four times a week. And the more you exercise, the greater the benefit.

Keep doing yoga. Stress and cancer cells are a bad mix. When you skillfully manage stress—and reduce your perception of stress—with yoga, meditation, or contemplative practice, you improve your circadian rhythms and normalize your cortisol levels. You don’t want cortisol to be too high or too low, and yoga is a wonderful way to make sure your cortisol levels stay balanced.

Add supplements. An essential ingredient in your breast cancer prevention toolkit, vitamin D may counter estrogen growth, according to a study from the German Cancer Research Center. Supplement with at least 2000 IU per day (minimum), less in the summer, if you’re out in the sun (20 minutes of unprotected exposure). Turmeric, the Indian spice that makes curry yellow, shows great promise in cancer prevention as a powerful anti-inflammatory. Several studies suggest that people who add it to their diet (or take it as a supplement) have lower rates of breast cancer. And mice studies show curcumin (the active ingredient in turmeric) may slow the spread of breast cancer. If you have trouble with constipation, add fiber supplements to your daily regimen. Adding omega-3s to your cancer-fighting arsenal may reduce your risk of getting it (although the evidence is somewhat limited at this point), but plenty of studies show these essential fatty acids can help you reduce inflammation and stress hormones, such as cortisol.

Gentle Ways to Heal
Should you end up with a breast cancer diagnosis, the preventative measures outlined above will help you throughout treatment and recovery. Keeping your stress levels in check is imperative to healing. We know that yoga can do that—especially a yoga practice that has a strong meditative component. Cora Wen, a yoga teacher and pioneer in adapting yoga for breast cancer survivors, says lack of sleep and emotional anxiety can wreak havoc for women who have been diagnosed. “Since sleep is often shallow or interrupted,” she says, “the nervous system doesn’t get rest.” And once we’re sleep deprived, “many of the other systems don’t work so well, either, such as immune functioning, which is critical to prevent breast cancer recurrence.” Her gentle sequence, “Rock Your Way Toward Healing”, offers the nervous system the respite it needs to reset itself. Staying positive, feeling gratitude, learning to forgive, and other psychologically resourceful traits also appear to improve outcomes.

Of course, ultimately there are no guarantees. But you can vastly improve your chances of keeping breast cancer at bay by cleaning up the bad neighborhood that allows mutant cells to proliferate and creating an environment that promotes healthy cells and allows them to thrive.

Do You Have Too Much Estrogen?
Excess estrogen is a risk factor for breast cancer. Here are signs that your estrogen may be too high relative to your progesterone. If you have three or more of the following symptoms, consult your doctor to test your levels.

• Increased bloating.
• Weight gain resistant to the usual fixes.
• Brain fog.
• Abnormal pap smear.
• Mood swings, depression, anxiety, or general irritability.
• Heavy bleeding, irregular or painful periods, or endometriosis.
• Migraine headaches.
• Insomnia.
• Red flush on cheeks and nose.
• Gallbladder problems.

Sara Gottfried is a Harvard-trained MD with an integrative gynecology practice in Oakland, CA; a yoga teacher; and the author of the forthcoming book, The Hormone Cure (Simon & Schuster, 2013).