Breast Cancer

Breast cancer, a common cancer in women, is a disease in which cancer (malignant) cells are found in the tissues of the breast. Each breast has 15- 20 sections called lobes, which have many smaller sections called lobules. The lobes and lobules are connected by thin tubes called ducts. The most common type of breast cancer is ductal cancer - it is found in the cells of the ducts. Cancer that begins in the lobes or lobules is called lobular carcinoma. Lobular carcinoma is more often found in both breasts than other types of breast cancer. Inflammatory breast cancer is an uncommon type of breast cancer. In this disease, the breast is warm, red, and swollen.

About 15%-20% of breast cancers are called carcinoma in situ. They may be either ductal carcinoma in situ (sometimes called intraductal carcinoma) or lobular carcinoma in situ. Sometimes lobular carcinoma in situ is found when a biopsy is done for another lump or when an abnormality is found on the mammogram. Even though it is referred to as a cancer, it is not a malignant cancer. However, patients with this condition have a 25% chance of developing breast cancer in either breast in the next 25 years. In situ carcinoma is contained entirely within the breast duct, with no invasion of adjacent normal tissues. Once fairly uncommon, it now accounts for > 15% of all breast cancers diagnosed in the USA, and the proportion is much higher in younger age groups. This increase may due to better screening and the increase of hormone replacement therapy.

Ductal carcinoma in situ (DCIS) accounts for 43% of breast cancers diagnosed in women aged 40 to 49 and 92% of cases diagnosed in women aged 30 to 39. DCIS occurs in premenopausal and postmenopausal women, forms a palpable mass, and is more commonly localized to one quadrant of a breast. DCIS is frequently the cause of microcalcifications seen on mammograms. Patients are likely to develop an invasive cancer if they are not treated. DCIS is considered a precursor of invasive cancer, but because it is localized, it can be totally removed surgically.

Lobular carcinoma in situ (LCIS), or lobular neoplasia, occurs predominantly in premenopausal women and is usually found incidentally because it does not form a palpable mass. Microscopically, LCIS appears distinctly different from DCIS. Between 25 to 35% of patients with LCIS develop invasive breast cancer after a latency period of up to 40 years. These invasive cancers occur with equal frequency bilaterally. Many specialists link LCIS with atypical hyperplasia, considering it indicative of a propensity for breast cancer rather than a true precursor. Invasive ductal and lobular tumors are the most common histologic types of invasive cancer (about 90%). Patients with less common histologic types (eg, medullary or tubular lesions) have a somewhat better prognosis.

Even with increased diagnostic capabilities and awareness, mortality rates have not changed in the last fifty years. Breast cancer still accounts for 17 percent of cancer deaths in females.

Risk Factors

In the USA, the cumulative risk of developing breast cancer is 12.64% (1 in 8) by age 95, and risk of dying of the disease is about 3.6%. Much of this risk is incurred after age 75. The risk rises with age, family history of breast cancer, early menarche or late menopause, age which the first child is born, not having children at all, obesity, oral contraceptives and possibly hormone replacement therapy. High fat diets may also increase the risks of getting breast cancer. Moderate drinking of alcohol has been linked to breast cancer in several studies. A family history of breast cancer in a first-degree relative (parent, sibling, child) doubles or triples a woman's risk of developing the disease, but a history in more distant relatives increases the risk only slightly. When two or more first-degree relatives have breast cancer, the risk may be 5 to 6 times higher.

A history of fibrocystic complex increases risk, but this condition is an imprecise histologic diagnosis, often assigned when a breast biopsy reveals a few cysts with normal breast tissue or very minimal proliferation; therefore, the diagnosis has little meaning. Among women who have had a biopsy for a benign breast disorder, the increased risk appears to be limited to those with ductal proliferation, and even then, the risk is moderate except for women with atypical hyperplasia. For those with atypical hyperplasia and a positive family history in a first-degree relative, the risk is increased nearly ninefold. Women with multiple breast lumps but no histologic confirmation of a high-risk pattern should not be considered at high risk.

Symptoms and Signs

More than 80% of breast cancers are discovered as a lump by the patient. Less commonly, patients present with a history of pain and no mass, with breast enlargement, or with a nondescript thickening in the breast. A typical finding during physical examination is a dominant mass - a lump distinctly different from the surrounding breast tissue. Diffuse fibrotic changes in a quadrant of the breast, usually the upper outer quadrant, are more characteristic of benign disorders, but a slightly firmer thickening not noted in the contralateral breast may be a sign of cancer. More advanced breast cancers are characterized by fixation of the mass to the chest wall or to overlying skin, by the presence of satellite nodules or ulcers in the skin, or by exaggeration of the usual skin markings resulting from lymphedema (peau d'orange). If matted or fixed axillary lymph nodes and/or supraclavicular or infraclavicular lymphadenopathy is present, surgery is unlikely to be curative. Inflammatory breast cancer is particularly virulent, characterized by diffuse inflammation and enlargement of the breast, often without a mass.

Naturopathic medicine addresses breast cancer in the following ways:

• Prevention of breast cancer.

• Complimentary treatment with conventional treatment.

• Promotes rapid healing before and after breast conservation surgery and mastectomy.

• Minimize the side effects of chemotherapy and radiation.

• Provide alternatives to estrogen replacement therapy in those women for whom estrogen may be contraindicated.

• Some women choose naturopathic medicine as their primary therapy to the exclusion of conventional therapies.

Nutritional Factors

There is strong evidence to support the role of a good diet in the prevention of breast cancer. A low fat, high fiber, and high complex carbohydrate diet is well documented in the prevention of cancer in general. Research shows that a diet high in saturated fats and possibly monounsaturated fat is linked to an increased risk of breast cancer.

Dietary fiber may be important in the prevention of breast cancer. Some breast cancer is estrogen sensitive and fiber may increase the excretion of estrogen in the digestive tract. Vegetarian women have been found to excrete 2-3 times as much estrogen as women who eat meat. Many red meats also contain synthetic hormones including estrogen.

A healthy, low fat, high fiber diet can decrease weight while protecting against breast cancer. High sugar intake is a major risk factor for the development of breast cancer in women over age 45. This may be due to the suppressive effects of sugar on the immune system and may be linked to a decreased intake of complex carbohydrates in the diet. Alcohol has been implicated in a 40 to 60% increase in the risk of breast cancer, even in moderation.

Women who are postmenopausal and overweight (especially in women with fat localized to the upper body) have higher levels of breast cancer, probably due to increased levels of estrogen from the adipose tissue. Long term oral contraceptive use from an early age increases the risk of breast cancer in pre-menopausal women. Estrogen replacement therapy has been implicated in the development of breast cancer during ERT. Having a longer reproductive life from age of onset of sense to age of menopause, results in higher estrogen levels for a longer time period and increases the risk of breast cancer. This suggests that artificially increasing estrogen levels may also be a risk factor. In addition, environmental toxins that act as estrogens in the body can add significantly to the estrogenic influence on breast tissue. Women with breast cancer had 10 times the amount of DDT breakdown products in their tissues as women without breast cancer. Many environmental toxins accumulate in breast and other fatty tissue.

Treatment Overview

Naturopathic medicine uses nutritional counseling, exercise, botanical medicines, homeopathy and hydrotherapy to help the body's immune response. A low fat, low sugar, no alcohol, high fiber and complex carbohydrate diet including fresh organic fruits and vegetables is recommended. Therapeutic doses of certain nutrients such as vitamin C, E, B complex, beta carotene, and selenium may be recommended as dietary supplements. Developing an individualized program of mild to moderate exercise can also assist immune stimulation and mental well being. Immune modulating herbs such as Echinacea, Glycerrhiza, Hydrastis, the Hoxsey formula, and Chinese herbs are used. Individual homeopathic prescriptions are used to stimulate the body's immune response and address mental and emotional wellness in addition to physical illness. Hydrotherapy techniques that detoxify and stimulate the body's natural immunity are also used.

It is also important to address the mental and emotional aspects of healing. Based on recent research, weekly breast cancer support groups are associated with a better prognosis. Individual counseling for stress reduction and support is also encouraged. Visualization, prayer or meditation may be utilized based on individual need and beliefs.

For more information, contact Dr. Ken Weizer at: