Breast Cancer

Assessment and Plan: Breast Cancer

• Maintain a heightened sense of awareness for signs and symptoms of painless hard or irregular lumps, nipple discharge, breast swelling, skin ulcers, breast pains, skin irregularities, bone pain, redness of the skin, swelling under the armpits, and/or weight loss.

• To improve the risks of developing breast cancer, work to achieve ideal body weight, avoid use of hormone replacement therapy, avoid exposure to radiation when possible, do not drink any alcohol, plan pregnancy before age 30 if possible, and if there is a history of exposure to diethylstilbestrol (DES) from the mid-1900s, discuss with the gynecologist if more frequent screening for breast cancer is needed.

• Schedule regular gynecology visits to utilize their expertise in examinations for prevention of breast cancer. The USPSTF recommends against teaching breast self-examination since 2009 after concluding that breast self-exam does not save lives or detect breast cancer at an earlier stage. Breast self-exam is now promoted as optional by the USPSTF and Mayo Clinic because it does not affect mortality according to research.

• Discuss with the gynecologist whether there is higher density of breast tissue present which may require more frequent screening for breast cancer.

• In patients with family history of breast cancer, discuss with the gynecologist if more frequent screening for breast cancer is needed.

• According to the USPSTF, speak with the gynecologist about the benefits and harms of chemoprevention at high risk for breast cancer and who have a low risk of adverse effects of chemoprevention.

• According to the USPSTF, women with a family history with an increased risk for harmful mutations in BRCA1 or BRCA2 genes, which are associated with breast cancer, are recommended to be referred for genetic counseling and evaluation for BRCA (breast cancer susceptibility gene) testing. Genetic testing is not recommended by the USPSTF for women without increased risk of breast cancer.

• Avoid consumption of red meats and processed meats.

• Premenopausal women should eat at least 5 servings of fruits and vegetables per day to obtain a moderately reduced risk of breast cancer (those postmenopausal women that did had a significant reduction of breast cancer risk compared to women who had less than 2 servings per day).

• If one chooses to drink alcohol despite the increased risk of breast cancer, a higher intake of beta-carotene was associated with a moderately reduced risk of breast cancer among women consuming 15 grams per day of alcohol or more. Do not take beta carotene supplements. Please see the section on beta carotene to increase intake of this nutrient by eating fruits and vegetables.

• Based on a cohort study done on women with anorexia, caloric restriction may protect against breast cancer.

• A low-fat (10-15% kcal from fat), high-fiber (30-40 g per 1,000 kcal/d) diet, and participation in daily exercise was found to reduce several serum markers for breast cancer including estrogen, obesity, insulin and insulin-like growth factor-I (IGF-I).

• Lignan intake of over 318 mcg per day from dark bread, peaches, coffee, broccoli and winter squash was associated with the lowest risk of mortality in women with breast cancer. Lignan intake may be greatly enhanced by taking 1-2 tablespoons per day of ground flaxseed per day which contains over 80mg of lignans per ounce..

• Comparing the women who ate the most mushrooms against the women who ate the least mushrooms, a higher mushroom intake had a much lower risk of developing breast cancer especially in postmenopausal women.

• Green tea consumption was associated with a decrease in breast cancer risk in multiple studies, but with the lowest risk in one particular study in women who drank green tea made from 500-749 grams of green tea leaves per year.

• A study showed that women estimated to consume the largest amounts of the Chinese cabbage, Brassica showed an 18% lower risk of breast cancer, and a 32% lower risk of postmenopausal breast cancer.

• Breast cancer patients who performed yoga had a lesser amount of stress, anxiety, depression, fatigue. They also were found to have a better quality of life, emotional/social function, and functional well-being.

• Women who had the lowest levels of vitamin B12 in their blood had the highest rates of breast cancer mostly among postmenopausal women. Therefore, have the primary physician check your B12 level and please see the section on B12.

• Whey protein may reduce the concentration of glutathione in breast cancer tumor cells but more research is needed.

• More research is needed on the supplements curcumin (turmeric), resveratrol, and phyllanthus emblica (Indian gooseberry) which have promising effects on breast cancer cells in vitro (in a petri dish). Curcumin (turmeric) and phyllanthus emblica (Indian gooseberry) are used extensively in Asian Indian cooking but are not recommended as supplements due to safety concerns. Please see the respective sections on these supplements.

• Adequate calcium intake by premenopausal women was associated with a reduced risk of breast cancer. Please see the calcium section for the recommended intake of calcium.

• Research suggests that soy lowers the risk of breast cancer recurrence and increases the chances for survival. Among women with the top 25% of high soy intake, 4-year breast cancer mortality rate was 7.4 % verses 10.3% for the lowest soy intake. The breast cancer recurrence rate was 8.0% for high soy intake and 11.2 % for low soy intake. The inverse association of soy with breast cancer mortaliy and recurrence was seen regardless of estrogen receptor status and whether tamoxifen was taken or not.