Hope:
Lighting the Pathways to Prevention of Breast Cancer

By Laurine Brown, PhD, MPH

"You don't wait till people get cancer. You try to help them not get cancer." My six year old offers simple wisdom seemingly beyond her years. I wish the pink breast cancer awareness pamphlets distributed by our cancer leaders honored such common sense. But they begin narrating only with diagnosis, cheerfully reassuring me that "early detection is my best protection".

I am not reassured. I have walked the afterlife of detection, complete with its fear, surgery, chemotherapy and radiation. I want to prevent my own daughter's breast cancer (or at least help her minimize risks) not wait till she has cancer and then catch it early. Where is the public guidance?

Some statistics offer me hope. A Scandinavian study of 44,788 twins tells me that environmental factors play a much greater role than inherited genetics in susceptibility to most types of cancer. Consistent with this, we know only 5-10% of women with breast cancer inherit altered genes. Adding risks, like reproductive and family history, we account for less than 40% of this epidemic. And what of the majority of women with no "known" risk factors for breast cancer? If carcinogenic or hormone-disrupting chemicals, and ionizing radiation don't contribute, physician Janette Sherman challenges in "Life's Delicate Balance", what explains breast cancer's doubling (not attributable to mammography), since 1940, increasing in tandem with prostate and childhood cancers?

Scientists know our bodies contain remnants of modern life: vinyl siding, plastic wrap, weedkillers. Tissue tests reveal 200-500 synthetic foreigners. We're ignorant of how these unnatural materials interact in our cellular symphony. But strong animal and some human evidence suggests we should be very concerned.

So, if exposures are a problem, then eliminating exposures offers a solution. A light illuminates a pathway to prevention. I cannot change my daughter's or my genes, sex, or age. But I can do something about our exposures.

Yet public breast cancer guidance misses this opportunity to help me and others reduce our risks. Occasionally we are warned about harmful and helpful personal habits, like smoking, drinking and eating. But I find not a single caution about radiation (a proven cause of cancer) or any of the 80,000 post World War II synthetic chemicals dancing with our biology in the same half century we've seen breast cancer rates rise steadily by 1% per year. (The 1980s had a steeper rise, then fall, when screening through mammography became more widespread, then leveled off.) Also absent is any mention of 15,000 chemicals our Environmental Protection Agency is screening for hormone disruption, despite the fact hormones (like estrogen) are a prime suspect in breast cancer risk.

Sadly, the National Cancer Institute allocates a mere 5-10% budget slice for prevention. It's no wonder I've come up dry. Most funding goes for better treatment, cures, and genetics. Even in prevention's meager slice, quick-fix drugs dominate (like tamoxifen to high risk women), rather than true prevention (including identifying and eliminating environmental causes). If an ounce of prevention is worth a pound of cure, then we have it backwards.

"And me, Mommy. And I going to get breast cancer too?" my daughter asks. I want to reassure her that I hope she won't, and that we will do everything we can to help her not get cancer. Fortunately I find some visionary groups who are sifting through the tangle of research on breast cancer and a lifetime of exposures, ordering these findings into "better safe than sorry" pathways to prevention. I scan them for do-able actions and there are plenty. I am hopeful. It is a beginning…

1. Keep moving-- Exercising just 4 hours weekly may decrease a woman's chances of developing breast cancer by 1/3, perhaps by inhibiting cancer-promoting forms of estrogen. Additionally, physically active girls have later menarche, thus fewer years of exposure to menstrual estrogen.

2. Pass up smoking and alcohol-- Active and passive smoking increases breast cancer risk through an unknown effect on women's circulating estrogen. Alcohol may account for 4% of all breast cancers, perhaps by increasing the more potent, harmful form of estrogen (estradiol).

3. Eat-drink to be healthy-- Choose a plant-based diet, rich in vegetables, fruits, whole grains, legumes, and low in fat (but with healthy plant oils). Compounds in plant foods like green tea, cruciferous vegetables like broccoli, flax, soy, shiitake mushrooms, or garlic may boost immunity, protect against cell damage and promote healthy estrogen pathways. Choose organic foods to minimize pesticide exposure. Eating "low on the food chain" (more plants, less animals) also minimizes exposure to more highly concentrated chemical and hormonal residues in the flesh, fat and milk of animals.

Breastfeed your children. Among other benefits, a traditional pattern of breastfeeding (on-demand, night feeds, into toddlerhood) decreases a woman's risk of breast cancer, and that of her offspring.

Filter your water. We must work to clean up our earth's water from pollution. In the meantime, take precautions by identifying contaminants (see your local water report), and filtering them out.

4. Beware of bad chemistry-- Begin cutting exposures to toxins with some of these actions. Minimize dry cleaning which uses a probable carcinogen, perc. Avoid pesticides (insecticides/herbicides) in and outside your home, office, and school. Replace toxic cleaning products with safer ones like baking soda, vinegar, and borax. Ventilate your home and office. Take off your shoes inside to avoid tracking in outdoor chemicals. Avoid potentially carcinogenic black or dark brown semi- or permanent hair dyes. Don't heat food in plastic.

5. Avoid or minimize non-essential radiation-- Reconsider "routine" dental and chiropractic x-rays. If you choose to radiate request lead shield protection for the chest/pelvis/neck. Ask your doctor about the frequency of mammography for your reproductive age, breast density, and history that will minimize radiation while still assisting in early detection.

6. Beware of hormone hype-- Be informed on the risks/benefits of hormone therapies. Early (shortly after menarche) or prolonged use of birth control pills (> 5 years and before first pregnancy) slightly increases breast cancer risk. Long term use of hormone replacement therapy increases risk, but this may decrease after stopping.

7. Keep your distance from electromagnetic fields and honor cycles of darkness and light-- These effects cannot yet be ruled out. Keep your distance from clock radios, computers, televisions, microwaves, and refrigerators. Replace electric blankets and electrical appliances. Additionally, sleep in complete darkness at night to stimulate melatonin (which inhibits estrogen), and get at least 15 minutes of sunlight daily to stimulate the immune system.

8. Join the movement-- Speak out about the need for safe food (including safe breast milk), clean air, clean water, clean land, and non-toxic products. Talk with your grocers about carrying local organic foods, your doctor about supporting efforts to replace mammography with safer, more reliable screening technologies, your school and workplace and about using integrated pest management. Write to companies who use PVC plastic and ask them to replace it. Join forces with other local groups to help minimize pollution of your community's land, air and water. Tell your friends and family about what you've learned.

Support organizations that work upstream, investing in research into the true causes of breast cancer and real prevention (beyond early detection and pharmaceutical "prevention"). Examples are: Breast Cancer Fund, www.breastcancerfund.org; Breast Cancer Action, www.bcaction.org, and National Breast Cancer Coalition, www.stopcancer.org. Or ask your local cancer organizations to earmark your donation for true prevention. It's never to late to make a difference-- in our own lives and our daughters' lives.

October 2001