Breast Cancer Management and Treatment part 1

Research from The American Cancer Institute states that around 38% of breast cancers could be prevented with some simple lifestyle changes , such as regular exercise, eating more fruit and vegetables and maintaining a healthy weight. Other factors worth mentioning include reducing alcohol intake and quitting smoking. However, there are women already following this advice who still need help in understanding their susceptibility to contracting the disease.

Some women following healthy lifestyles; who exercise, eat well and don’t drink alcohol still get breast cancer and this is where a more in-depth understanding of cellular biology and pathways is required. For example, it is important to look at the health of the terrain on which the cancer grows. If the terrain is unhealthy, or encourages cancer growth, then the risk of cancer developing or re-occurring is much stronger.

Using the functional medicine approach, let’s look at the key factors in breast cancer risk beyond the conventional advice we’ve already explored.

Estrogen metabolism

Many studies have shown that having too much estrogen in the body can increase the risk of breast cancer. 2 Common ways in which estrogen levels are raised are by taking birth control pills for long periods of time, or having HRT after the menopause. A less common way of raising estrogen levels is through endocrine disruptors. These are compounds which mimic the effects of estrogen and can be found everywhere, from plastics containing BPA or PVC, to soaps and toothpastes. Various synthetic chemicals such as pesticides, herbicides, phthalates and plant based phyto-estrogens are also endocrine disruptors. Exposure to these compounds is everyday and cumulative, but your body can only process a certain amount of estrogen each day. So it’s not only your exposure to endocrine disruptors which is important to consider, but also how your liver metabolizes these compounds.

The liver is in charge of metabolizing estrogen out of the body, for it to work effectively the pathways for detoxifying estrogen need to be optimal, and your gut needs to have sufficient good bacteria and fiber attained from your diet. If the processes of detoxification or elimination are compromised, the estrogen compounds build up in the body over time and will increase your risk of breast cancer.

Another important factor is the percentage of body fat we have. As body fat increases so does our risk of breast cancer.3 This is because the fat produces an enzyme called aromatase, which increases the production of various estrogens. With an increased percentage of body fat, the amount of aromatase increases, which drives up estrogen levels. Body fat also produces inflammatory molecules like Interleukin 6 (IL6) and Tumor Necrosis Factor, (TNF) which have been shown to encourage cancer. Therefore, reducing body fat will reduce the risk of cancer.

Estrogen metabolites

One final point to mention is that when estrogen is broken down by the liver, some of the metabolites produced in the process can be carcinogenic. . 2-hydroxyestrone(2-OHE1), 4-hydroxyestrone (4-OHE1) and 16-hydroxyestrone (16-OHE1) are some of these metabolites. There are large variations in how individuals metabolise estrogen, depending on how each genetically unique liver produces metabolites. 2-OHE1 is considered a ‘good’ estrogen, because it is associated with reduced cancer growth.4 Conversely, 16-OHE1 has been shown to encourage tumor development and 4-OHE1 can cause DNA damage, so both are classified as ‘bad’ estrogens.5 In addition, reduced ability to form 2-OHE1 is linked to greater production of 16-OHE1.

Studies have shown that measuring the ratio of 2-OHE1 to 16-OHE1 can give an important indication of the risk of developing breast cancer.6 This ratio of ‘good to bad’ estrogen can be determined by a urine test. Studies have shown that women with breast cancer tend to have around a 2/16 ratio. A low 2/16 ratio may also increase the risk of other estrogen sensitive cancers, such as ovarian or cervical cancer.

Various measures can be taken to improve this ratio, for example reducing body fat, or taking supplements containing Indole-3-carbinol (I3C) or Di-indolemethane (DIM). Dietary intervention can also help, for example eating more kale, brussel sprouts and ground flax seed and increasing general fruit and vegetable intake. Optimizing the various pathways of estrogen detoxification is encouraged, this often requires looking more closely at the methylation, glucuronidation and sulfation pathways and assessing what dietary and supplementary methods should be used.

Estrogen metabolism is one aspect of investigating the risk of breast cancer, other factors which will be explored in later articles are the roles of insulin, inflammation, detoxification and gut flora.

Miles Price, Functional Medicine Specialist, AFMCP, FMP

References:

Centre for Health Protection, breast cancer. www.chp.gov.hk
EptsteinF. Estrogen and the risk of breast cancer. N Eng J Med 344. 4(2001): 276-285.
Bray G. THeunderlying basis of obesity: relationship to cancer. J Nutri. 132: (2002): 2451S-3455S
YooHJ, et al Estrogen metabolism as a risk factor for head and neck cancer. Otolarynol Head Neck Surg Mar 2001: 124(3): 241-247
MutiP, Bradlow HL, et al Estrogen Metabolism and the risk of breast cancer: a prospective study of the 2/16 hydroxyestrone ratio in premenopausal and postmenopausal women. Epidemiology 2000;11(6): 635-640
Kabat GC, O’Leary ES et al, Estrogen metabolism and Breast cancer. Epidemiology. Jan 2006; 17(1): 80-88