An Alternative View of Breast Cancer Support: Part I

Breast Cancer Overview:
Breast cancer is the most common cancer of women in North America, with only 1% of breast cancer patients being male. In North America, approximately 1 in 7 women will develop breast cancer at some point in her life. Breast cancer is the second leading cause of death in American women, second only to lung cancer. Fortunately, due to the fact that it is reasonably treatable, the 5-year survival rate is approximately 84%.

What is Breast Cancer?
Cancer cells are often present as much as 10 years before a mass is finally detected.  By the time a breast cancer is detectable, it has grown to at least one centimeter in diameter and consists of one billion cells. Cancer cells go through a process called doubling time, which is the time required for one cell to divide into two cells.  The rate varies from about 21 to 188 days, depending on age and the type of breast cancer. Aggressive cancers have a faster doubling time. Breast cancer in young women tends to be much more aggressive than breast cancer occurring in post-menopausal women.

When palpable, breast cancer is most often felt as a hard, irregular-shaped, non-tender mass that feels as if it is attached to the tissue beneath it. There may be associated nipple discharge, changes in nipple size or shape, swollen axillary lymph nodes, and/or puckering of the skin near the site of the mass.

Risk Factors:
There are a number of risk factors involved in your chances of developing breast cancer. Some are within your ability to modify and some are not.

Non-Modifiable Risk Factors:

• Genetics (BRCA-1, BRCA-2, HER-2)
• Family History of Breast Cancer
• Personal History of Breast Cancer
• Age
• Early Onset of Menses
• Race and Ethnicity
• Certain Types of Fibrocystic Breasts
• Prior Radiation Exposure
• Diethylstilbestrol Exposure (DES)

Modifiable Risk Factors:

• Recent Oral Contraceptive Use
• Hormone Replacement Therapy
• Nulliparous (Never Having Children)
• Having Children After Age 30
• Not Breast Feeding
• Alcohol Use
• Lack of Exercise 
• Overweight or Obesity
• Diet High in Saturated Fat
• A High Glycemic Diet
• Depression
• Exposure to Dopamine Antagonists
• Environmental Toxins
• Night Workers
• Not Sleeping Enough

Types of Breast Cancer:
There are approximately 30 different types of breast cancer, as well as a series of different grades and levels indicating severity. Generally, breast cancer is divided into two categories: Ductal and Lobular. The majority of breast cancers are ductal and this category includes papillary, mucinous, and combination cancers. Paget's Disease and inflammatory carcinoma are examples of breast cancer that are neither ductal or lobular.

Approximately 86% of breast cancers originate in the ducts, whereas 12% start in the lobes, which are located at the end of the ducts. The term "in situ carcinoma" refers to cancer at its early stages, when it is isolated to the immediate area where it originated. With regards to breast cancer, this would refer to the ducts (ductal carcinoma in situ) or the lobules (lobular carcinoma in situ). This type of cancer has not invaded the surrounding fatty tissue in the breast, nor has it metastasized to other organs in the body. If the cancer does move from the immediate area where it began, it becomes described as "invasive".





Non-Invasive Breast Cancers:

Ductal Carcinoma In Situ (DCIS):
DCIS is the most common form of non-invasive cancer, with one-fifth of all new breast cancer cases falling into this category.  DCIS is the presence of abnormal cells inside a milk duct in the breast and is considered the earliest form of breast cancer. It is classified as being Stage 0 due to the fact that it is limited to an immediate area inside the duct. DCIS typically has no accompanying symptoms, although as the ducts clog with cancer cells, you may be able to feel a soft thickening of the breast. As a result, DCIS is almost always found via mammogram, where the image appears to have tightly clustered, irregularly shaped microcalcifications. Although DCIS is not life-threatening, if left untreated, 20-25% of women would develop invasive cancer up to 25 years after the initial biopsy. If tumor necrosis is present, the DCIS is considered more aggressive and is termed "comedocarcinoma". Women who opt for a lumpectomy with radiation have a 5-15% risk of local recurrence. For women having mastectomy, the risk of local recurrence drops to less than 2%. This risk is further reduced by half if women choose to take post-surgical hormonal therapy.  If DCIS is treated with excisional biopsy alone, women have a 30-50% chance of developing an invasive ductal cancer within the same breast. Routine axillary dissection is unnecessary with DCIS, as axillary metastases occurs in less than 5% of patients. Nearly all women diagnosed in  the early stages of DCIS can be cured, with a five-year survival rate of more than 99%.

Lobular Carcinoma In Situ (LCIS):
Although LCIS sounds like a type of breast cancer, it actually is not. Rather, it is a risk factor or marker for a 2.4% higher risk of developing invasive ductal or lobular carcinoma in either breast. LCIS is an uncommon condition, occurring only about 2% of all breast biopsies. LCIS will not become invasive and will not develop into breast cancer, so removing it is not the answer. However, women with LCIS have a 1% per year and up to a 30% lifetime risk of developing an invasive breast cancer. Although the cause of LCIS is unclear, it begins when cells in a lobule of a breast develop genetic mutations that cause the cells to appear abnormal. LCIS is typically discovered as a result of a biopsy for other reasons, and does not usually show up on mammograms.


Invasive Breast Cancer:


Invasive Ductal Carcinoma:
Representing 80% of cancer diagnoses, IDC is the most common form of breast cancer. IDC is cancer that originated in the duct and has now invaded the surrounding fatty tissue of the breast.  As with any cancer, there may be no signs or symptoms. However, signs and symptoms which warrant a trip to the doctor include the following: breast lump (usually feels hard, firm and irregular), thickening of breast skin, swelling in one breast, rash or redness of the breast, new pain in one breast, nipple pain or nipple inversion, dimpling around the nipple or on the breast skin, lumps in the underarm area, changes in the appearance of of the nipple or breast that are differ from the normal monthly changes you may typically experience.  Conventional treatment of IDC is determined by the exact type of cancer and at which stage. Depending on these factors, most women undergo a combination of any of the following: lumpectomy, mastectomy, sentinel node biopsy, axillary node dissection, radiation, chemotherapy, hormonal therapy, biologic target therapy, breast reconstruction.
There are four additional types of IDC that are less common:

• Medullary Ductal Carcinoma: This type of cancer is rare, accounting for only 5% of breast cancer. It is less aggressive, with a five-year survival rate of 82%. This tumor usually shows up on mammogram and can feel like a spongy change of breast tissue rather than a lump.
• Mucinous Ductal Carcinoma: In this type of breast cancer, cancer cells also produce mucous, and the mucous and breast cancer cells come together to form a tumor. The five-year survival rate for this type of breast cancer is 95%.
• Papillary Ductal Carcinoma: This type of cancer becomes invasive only in rare cases and has a five-year survival rate of 96%. It is common among women age 50 and it treated like DCIS.
• Tubular Ductal Carcinoma: This type of cancer is usually less aggressive and accounts for less than 2% of all breast cancers. The five-year survival rate is 96%.

Invasive Lobular Carcinoma: 
ILC is the second most common form of breast cancer in the U.S., representing between 10-15% of all diagnosed invasive breast cancers. This type of cancer is harder to detect on mammogram because of the way it grows. Women with ILC must choose their surgeon carefully. In order for a breast cancer surgery to be successful, the cancer must be cleared from the tissue all the way around the tumor. ILC has a branch-like growth pattern, which makes this more difficult. From a conventional perspective, ILC is treated with a lumpectomy or mastectomy, and treatment may also include radiation, chemotherapy, hormonal therapy and/or biologic targeted therapy. The five-year survival rate of ILC is 84%.

Inflammatory Breast Cancer:
Inflammatory breast cancer is rare, accounting for only about 1% of all breast cancers. It also develops rapidly, making it an aggressive form of breast cancer. This form of cancer forms when cancer cells block the lymphatic vessels in the skin covering the breast, causing the characteristic red, swollen appearance of the breast.  The skin of the breast may also feel warm and have a thick, pitted appearance. Inflammatory breast cancer is considered a locally advanced cancer, which means it has spread from it origin to nearby tissues and possibly to local lymph nodes. It is considered a Stage III breast cancer, which may quickly become stage IV. Due to its presentation, this type of cancer can be confused with mastitis or dermatitis. If you have what appears to be a rash or infection, see your doctor immediately. Conventional treatment of inflammatory breast cancer includes the following: Neoadjuvant chemotherapy, mastectomy, radiation, hormonal therapy, biologic target therapy, mastectomy.  The five-year survival rate of this type of breast cancer is 18%.

Paget's Disease:
Paget's disease is a form of breast cancer that begins in the ducts adjacent to the nipple and spreads to the nipple and then to the areola. It accounts for between 1-5% of all breast cancers, making it relatively rare. The cause of Paget's Disease is unknown, but experts speculate that it is due to an underlying ductal carcinoma, typically DCIS, although it can be associated with an invasive cancer. Sign and symptoms of this type of breast cancer include the following: redness, irritation, crusting, scaling, bleeding, oozing. burning, itching, all of the skin of the nipple and/or areola. Signs and symptoms may also include: a tingling or burning sensation, straw-colored or bloody nipple discharge, a lump in the breast, thickening of the skin of the breast, a flattened or turned-in nipple. A painless mass felt under the reddened area is usually indicative of invasive cancer. Some of these signs and symptoms are similar to eczema and the skin changes may fluctuate early on, giving you the impression that your skin is healing on its own. As a result, women generally have this condition for six to eight months before a diagnosis is made. Conventional treatment includes the following:  Lumpectomy, mastectomy, radiation, hormonal therapy. The five-year survival rate for Paget's Disease is 79%.

Naturopathic Approach to Supportive Breast Cancer Treatment: 
The following list is meant to illustrate some of the tools naturopathic doctors have at their disposal to help women on their journey through breast cancer. It is my professional opinion that breast cancer care requires the combination of traditional as well as alternative medicine, and this list is in no way suggested as a replacement for conventional care.  Furthermore, as it is lacking in crucial information regarding dosage and safety, as well as the fact that some of these supplements may interfere with certain cancer treatments, it is imperative that you work closely with a qualified, licensed naturopathic doctor before starting anything outside the scope of your conventional doctor's instructions.

• Vitamin A: Helps to improve the tissue tolerance of women undergoing chemotherapy or radiation. Cells with a fast turnover time are affected most by chemotherapy and the use of vitamin A results in less damage to these cells, particularly those lining the inside of the intestines and mouth.  Vitamin A is more effective when taken with zinc and adequate vitamin E. 
• Beta-Carotene: Has been shown to reduce the risk of pre-menopausal breast cancer by up to 90%. 
• Vitamin B6: Reduces prolactin levels. Results in higher levels of progesterone, as well as the production of more protective estrogens and less harmful estrogens. 
• Vitamin B12: Can relieve side of effects of certain chemotherapy drugs, including peripheral neuropathy and low white blood cell count.
• Inositol and Inositol Hexaphosphate (IP6): Evidence has demonstrated that IP6 has a positive effect on tumor suppressor genes, such as p53. When inositol is combined with IP6, they enhance the ability of natural killer cells to target cancer cells. 
• Vitamin C: According to the lowest estimates, supplementation with vitamin C can reduce the risk of breast cancer in menopausal and post-menopausal women by 5-10%. Higher estimates suggest that risk could be reduced up to 16% in menopausal and up to 37% in post-menopausal women. Vitamin C also helps to prevent tumor growth and metastasis by assisting white blood cell activity to improve immune system function. Taking vitamin C with bioflavonoids helps the vitamin C to stimulate detoxification of chemicals, toxins, and drugs in the liver.
• Vitamin D3: This vitamin is crucial in the treatment of ER- breast cancer, and very beneficial in the management of breast cancer in general. Vitamin D3 also reduces risk of aggressive premenopausal breast cancer and strongly activates macrophages to destroy tumors.  Low vitamin D status is also associated with poorer breast cancer outcomes, when compared to normal vitamin D levels, including a 94% increased risk of metastases, and a 73% increased risk of death. 
• Vitamin E: Heals damaged tissue, regulates hormones and acts as an antioxidant. Vitamin E as alpha-tocopherol has also been shown to reduce the risk of breast cancer in pre-menopausal women with a family history of the disease. Vitamin E in the form of tocotreinols inhibits both estrogen positive and estrogen negative breast cancer cells.
• Vitamin K: Works synergistically with vitamin C to create fee radicals in cancer cells, which produces hydrogen peroxide, which thereby fragments the DNA, damages the cell membrane, reduces the cell cytoplasm, and eventually causes cancer cell death.
• Astragalus  This herb boost the immune system, thereby helping to improve cancer outcomes. 
• Alpha Lipoic Acid: Reduces the ability of cancer to metastasize or become invasive, as well as reduces the cancer-causing effects of environmental toxins on breast tissue. This should not be used during the active phase of our conventional medical treatments, but during the detoxification and recovery phase.
• Artemesia: Is an effective pro-apoptotic agent that research has shown kills 100 cancer cells for every 1 healthy cell, vs chemotherapy which has been shown to kill 1 healthy cell for every 5 cancer cells.
• žAshwaganda: In vitro studies have shown that this herb reduces cell proliferation and increases apoptosis in ER+ and ER- human breast cancer cells.
• Boswelia:  An anti-inflammatory agent.
• Bromelain: Controls growth and angiogenesis, inhibits invasiveness and growth of tumor cells and helps control progression and metastasis.
• Calcium-D-Glucarate: High risk of cancer has been associated with low levels of this nutrient. Supplementation with calcium-D-glucarate increase glucoronidation in Phase II liver detoxification pathways, which helps to regulate estrogen metabolism, decrease levels of estradiol, and  thereby prevent hormone dependent breast cancer.
• Chromium: This mineral is crucial in the maintenance of blood sugar levels and for maintaining low blood levels of insulin. Women with increased levels of insulin have a threefold increased risk of breast cancer.
• Co-Q-10: Evidence has shown this nutrient to be effective in treating breast cancer in human trials, with evidence of tumor regression.
• Flaxseed Lignans: Has been shown to be significantly effective at preventing the spread of breast cancer and has been shown to reduce the rate of growth of breast tumors.
• Glutathione: The most powerful antioxidant. It is a detoxifier of pollution, heavy metals, alcohol, drugs, pesticides, tobacco, herbicides, xenobiotics, smog, petroleum hydrocarbons, many carcinogens and tumor promoters. This should not be used during the active phase of our conventional medical treatments, but during the detoxification and recovery phase. 
• Grape Seed Extract: Has a profound effect on breast cancer as being an aromatase inhibitor, antiangiogenic and cytotoxic.
• Green Tea EGCG: Antioxidant, inhibits angiogenesis. At higher doses it must be taken with vitamin E to prevent liver and kidney oxidative stress. It has been shown to prevent recurrence of Stage I and II cancers by at least 17%.
• Indole-3-Carbinol (I-3-C) and DIM: Converts 16-hydroxyestrogens (the bad estrogens) into 2-hydroxy forms (the good estrogen). Both I-3-C and DIM have demonstrated an ability to inhibit the growth of breast cancer cells in humans and to stimulate cell death. I-3-C has also been shown to prevent metastasis.
• Iodine: There is an association between iodine deficiency and fibrocystic breasts. Since certain types of fibrocystic changes are associated with a higher risk of breast cancer, raising iodine levels can have a protective effect. Furthermore, iodine is naturally found in the epithelial cells lining the ducts and lobules of the breast and reduces their sensitivity to estrogen.
• Magnesium: Use of this mineral reduced the incidence of malignant breast tumors in rats by 50%.
• Melatonin: Down-regulates estrogen receptors, reduces circulating levels of estrogen and prolactin, blocks estrogen and epidermal growth factors and suppresses tumor fatty acid uptake. Very effective in ER+ breast cancer. 
• Milk Thistle: Helps detoxify the liver and inhibits or modulates epidermal growth factor, which may make it useful in modulating estrogen receptors. 
• Mistletoe: Main properties include DNA stabilization and protection, cytotoxic killing of cancer cells, immune modulating and anti-inflammatory. Mistletoe stimulates the immune system to remove cancer.
• Modified Citrus Pectin (MCP): This is essential for patients undergoing tumor biopsy, surgery or any therapy  that may cause the tumor to shed cells.  MCP helps to prevent metastasis by inhibiting the clumping of cancer cells together, as well as their adhesion to normal cells.
• N-Acetyle Cysteine (NAC):  An essential antioxidant that helps clear the cells of toxins, increase glutathione production and reduce the toxicity of chemotherapy. This should not be used during the active phase of our conventional medical treatments, but during the detoxification and recovery phase.
• Quercitin: An aromatase inhibitor. Use with bromelain for better absorption.
• Resveratrol: Has several anti-cancer properties, including being anti-inflammatory, an antioxidant, and inhibits BRCA-1 mutant cancer cells. It is a phytoestrogen so caution must be used in certain cases as with all phytoestrogens.
• Selenium: Deficiencies of this mineral are linked to higher breast cancer rates. 
• Therapeutic Mushrooms (Reishi, Maitake, Coriolus): All of these mushrooms have properties that are shown to have significant anti-cancer effects, mostly through their ability to activate the immune system in unique ways. 
• Tumeric (Curcumin): Has a number of anti-cancer properties, including being an antioxidant, pro-apoptotic, immune modulator, and anti-angiogenic.  Must be used with bromelain or black pepper to ensure absorption.
• Zinc: Angiogenesis, or the formation of a blood supply to tumor cells, is dependent upon copper. Copper levels can be reduced by taking higher levels of zinc. Therefore, zinc is important in the regulation of angiogenesis and tumor growth.

Supplements to Avoid With Breast Cancer:

• DHEA: Boost IGF-1 and sex hormones.  

Other Considerations: 

• Acupuncture, Ozone Therapy, Nutritional Interventions, Mind-Body Medicine, Meditation, Yoga (Kundalini in particular), Counseling

Your Naturopathic Doctor will work closely with you to determine which supplements would be best for you and your type of breast cancer, as well as what can be done to help you through conventional treatments such as chemotherapy and radiation. 

References:

Berek & Novak's Gynecology; Berek 
Institute of Women's Health and Integrative Medicine- Women and Cancer; Dr. Tori Hudson
Naturopathic Oncology- An Encyclopedic Guide for Patients and Physicians; Dr.Neil McKinney 

The Breast Cancer Companion; Dr.Barbara MacDonald and Dr. Kelly Jennings
The Complete Natural Medicine Guide to Breast Cancer; Dr. Sat Dharam Kaur 

www.hopkinsmedicine.org

www.mayoclinic.com

www.medicinenet.com