Breast Cancer Prevention Beyond Mammograms: Addressing Root Cause

Breast Cancer Prevention Beyond Mammograms: Addressing Root Cause

When Americans think of breast cancer, most consider it to be like a game of craps. If a woman is lucky she will avoid breast cancer during her lifetime, but if she is unlucky, then she may be diagnosed with this dreadful disease. This philosophy on breast cancer is unfortunately perpetuated in the United States health care system.

We doctors, nurses, and other health professionals learn early in our educations that breast cancer is virtually inevitable for many women. Currently, the lifetime risk of breast cancer in an American woman is about 12%. In other words,  a female born in the United States has about a 1 in 8 chance of developing breast cancer during her lifetime.1 This is one of the highest breast cancer rates in the entire world. It is well known that rates of breast cancer are substantially lower in many developing countries where diets consist of more plant-based whole foods (and less animal-based foods) and where lifestyles are generally less sedentary. For example, compared with a 12% lifetime breast cancer risk in the US, there is only a 3% lifetime risk in East Asia, Central and sub-Saharan Africa, and Western sub-Saharan Africa.

In the United States, our approach to breast cancer is tailored around its inevitability. As a result, instead of investing substantial research into dietary and lifestyle prevention of this disease, we prefer to focus instead upon early diagnosis and treatment. Techniques used for diagnosis most often include physical examination, mammography, ultrasound, and biopsy procedures. Such screening simply identifies cancers that have been around long enough that they have grown to where they can be detected. Breast cancer treatments often include surgery (e.g., mastectomy or lumpectomy), radiation, and chemotherapeutic agents. These approaches to breast cancer are unfortunately reactive, similar to how we typically approach many other diseases in our country, including heart disease, stroke, and hypertension.

“Wait until the disease is diagnosed. Then prescribe drugs and perform surgery.”

This approach ignores the root causes of these diseases, which is principally our diet and lifestyle.

Key risk factors for breast cancer include early age of menarche, late age of menopause, high levels of female hormones in blood, and high blood cholesterol. These were confirmed in the China Study and have been documented in many other research studies.2 With the exception of the blood cholesterol, these risk factors are all related to exposure to excess female hormones, such as estrogen and progesterone, which increases breast cancer risk. Women who consume diets rich in animal-based foods and relatively low in plant-based whole foods have menarche earlier and menopause later, resulting in greater lifetime exposures to estrogen. This explains why research has shown that lifetime exposure to estrogen is 2.5-3 times higher among Western women when compared with rural Chinese women.2 Estrogen is a direct participant in the breast cancer process.3 Its levels are a key determinant of breast cancer risk. High levels of estrogen and other female hormones result from consuming typical Western diets, high in fat and animal protein, but low in dietary fiber.4 This research strongly suggests that the risk of breast cancer can be markedly reduced simply by eating foods that keep estrogen levels at lower levels than is typical with the Standard American Diet (SAD).

Instead of addressing preventable dietary causes of breast cancer, we prefer to discuss other risk factors, including genes, hormone replacement, and environmental toxins. While it is true that genes play a role in breast cancer, it is wrong for women to feel that if they have a family history of breast cancer, there is nothing they can do to decrease their risk. This is simply untrue and it removes personal responsibility from the equation. In truth, most breast cancer is much more strongly tied to diet and lifestyle than to genes. Even in women who have so-called “breast cancer genes,” those genes would need to be expressed in order for breast cancer to manifest. Whether such genes are expressed is closely related to one’s diet and lifestyle.5 Hormone replacement therapy is considered a risk factor for breast cancer. As discussed previously, exposure to female reproductive hormones during the course of a woman’s life increases her breast cancer risk. Therefore, it is no surprise that administering these hormones as therapy in postmenopausal women would also increase breast cancer risk. The good news is that consuming a plant-based diet (as opposed to the typical American animal-based diet) reduces the abrupt hormone changes that typically cause menopausal symptoms and may make such hormonal therapy unnecessary in many women.5 Environmental chemicals such as dioxins, Polychlorinated Biphenyls (PCBs), and Polycyclic Aromatic Hydrocarbons (PAHs) have also been discussed as increasing a woman’s breast cancer risk. While such chemical exposures may contribute to carcinogenesis, it is important to realize that with similar chemical exposures, a plant-based diet has been shown to be protective against cancers, while an animal-based diet is more conducive to cancer cell growth.5

A review of more than sixty research studies suggests that premenopausal and postmenopausal women who exercise regularly may reduce their incidence of breast cancer by 20-40%.6 Also, a study of nearly 3,000 nurses with stages 1, 2, or 3 breast cancer published in The Journal of the American Medical Association indicated that simply walking three to five hours per week reduced the risk of breast cancer by 26 to 40%.7

Stress also seems to play a role in breast cancer. A study following nearly 60,000 African American women for six years found that women who reported feelings of racial discrimination were more likely to develop breast cancer than their peers.8

In summary, based on much research to date, there is reason to believe that the following may significantly reduce your risk of breast cancer … and that of your patients:

  1. Depart from the SAD, which is high in animal-based and processed foods, and instead adopt a plant-based, whole-food diet that is high in nutrients and fiber.
  2. Engage in regular exercise.
  3. Reduce your stress levels through prayer, yoga, meditation, and mutually supportive relationships.

Don’t sit back and let breast cancer find you. Be proactive and reduce your risk of this terrible disease in the first place. As health care providers, we can do more than merely suggest mammograms for our patients. We must educate them on dietary and lifestyle changes to prevent this terrible disease from happening in the first place.


  1. Forouzanfar MH, Foreman KJ, Delossantos AM, et al. Breast and cervical cancer in 187 countries between 1980 and 2010: A systematic analysis. Lancet. 2011 Oct 22;378(9801):1461-84.
  2. Junshi C, Campbell TC, Junyao L, Peto R, eds. Diet, Life-style and Mortality in China: A Study of the Characteristics of 65 Chinese Counties. Oxford, UK; Ithaca, NY; Beijing, PRC: Oxford University Press; Cornell University Press; People’s Medical Publishing House; 1990.
  3. Bocchinfuso WP, Lindzey JK, Hewitt SC, et al. Induction of mammary gland development in estrogen receptor-alpha knockout mice. Endocrinology. 2000 Aug;141(8):2982-94.
  4. Adlecreutz H. Western diet and Western diseases: some hormonal and biochemical mechanisms and associations. Scand J Clin Lab Invest Suppl. 1990;201:3-23.
  5. Campbell TC, Campbell TM II. The China Study. BenBella Books; 2006.
  6. Exercise and malignancy: Can you walk away from cancer? Harv Mens Health Watch. 2006 Nov;11(4):4-6.
  7. Holmes MD, Chen WY, Feskanich D, Kroenke CH, Colditz GA. Physical activity and survival after breast cancer diagnosis. JAMA. 2005 May 25;293(20):2479-86.
  8. Taylor TR, Williams CD, Makambi KH, et al. Racial discrimination and breast cancer incidence in U. S. black women: The Black Women’s Health Study. Am J Epidemiol. 2007;166(1):46-54.

Beating Diabetes

The American Diabetes Association (ADA) released new data regarding the mortality rate for those living with Type 1 Diabetes during their June annual meeting, highlighting a drop in deaths related to the disease. Analysis of data from the Allegheny County Type 1 Diabetes Registry, in Allegheny County, Pennsylvania, revealed a dip in the number of deaths for the 1,100 individuals diagnosed with the disease between 1965 and 1979.

Disparities were noted between gender and race. Presented findings said that women were still more likely to die from the disease than men–females were 13 times more likely to face mortality from type 1 diabetes than those without. Similarly, African American women were 30% more likely to die when compared to Caucasian women, perhaps connected to racial disparities facing the health care industry as a whole.

According to the ADA, those with type 1 diabetes account for 5-10% of the estimated 23.6 million people dealing with the disease, the vast majority of whom are diagnosed as children. Advances in insulin therapy treatments and early detection can be credited with the lower death rate.

Approaching cancer step-by-step

Researchers from the University of Michigan and Duke University seem to have found a preferable approach to discussing treatment options with cancer patients.

According to their findings, when deciding between treatment options, patients are more sensitive to the degree of risk reduction when making simpler decisions in a series, versus learning all of the information about different treatment methods at once and then making a final decision.

The study was conducted as an experimental survey administered over the Internet. It followed 1,781 demographically diverse women 40-74 years old through a hypothetical decision process for a breast cancer patient with a tumor. While some of the participants were presented with information about treatment options all at once, the rest were given decisions and information sequentially.

The women who participated in the step-by-step method were more likely to select the adjuvant therapy option that statistically had the best outcome of preventing cancer recurrence. The researchers suspect that these decisions, which are initially difficult because of patients’ sensitivities during this challenging time, are complicated by terminology and statistics that overwhelm patients when doctors present information about different treatments simultaneously.

Researchers argue that these findings should not increase the length of time in a doctor’s office, but should actually shorten visits because patients will absorb the information more effectively and efficiently, and doctors will not need to repeat themselves as often.

Antiretroviral drugs reducing the spread of HIV in heterosexuals

According to HealthDay News, two recent studies in Africa have shown antiretroviral drugs are effective in preventing the spread of HIV in heterosexuals. The trials were conducted by the U.S. Centers for Disease Control and Prevention (CDC), with the help of the Botswana Ministry of Health, and the University of Washington’s Partners PrEP study.

HealthDay News says the most recent study done by CDC involved 1,219 HIV-negative men and women who were given either a daily dose of Truvada (a pill that combines tenofovir disoproxil fumarate and emtricitabine) or a placebo pill for 30 days. Additionally, all participants were given HIV prevention resources such as free condoms and risk reduction counseling. Results showed that those taking Truvada had a 62.6% risk reduction rate, increasing to 77.9% if the participant continued taking the pill after the trial.

The Partners PrEP study, conducted by the University of Washington and funded by the Bill & Melinda Gates foundation, was put to a quick rest due to its early indications that the pill prevented the spread of HIV, HealthDay News reports. The study included 4,758 couples with one HIV-positive partner. At random assignment, each couple received Viread (single drug), Truvada (combination drug), or a placebo. Results proved those taking Viread had a risk reduction rate of 62%, while those taking Truvada had a 73% reduction, compared to the placebo.

Kevin Fenton, Director of the CDC’s National Center for HIV/AIDS, says there is strong evidence of this prevention strategy within these two new studies. HealthDay News says the CDC will continue the use of antiretroviral drugs for those at risk for HIV.

Mobility limitations in African Americans linked to depressive symptoms

The Johns Hopkins Bloomberg School of Public Health has led a study displaying a relation between demographic health issues and mobility limitation. Researchers found that depressed African American women had almost three times the odds of mobility limitations than those who are not depressed. Additionally, African Americans reporting multiple medical conditions tended to have a higher risk of mobility limitations than those with fewer medical conditions. The study can be found in a 2011 issue of the Journal of Gerontology.

The study was conducted with 602 African Americans, made up of men and women between the ages of 48 and 92. The participants previously reported having difficulties walking and climbing stairs. The researchers used logistic regression to measure how demographics and health independently affected mobility. Results proved that pre-existing medical conditions in African Americans were associated with mobility limitations; however, African American women with lower incomes were affected the most.

Roland Thorpe, assistant scientist with the Bloomberg School’s Department of Health Policy and Management, says depressive symptoms have not been labeled as a mobility limitation factor in the past, but the studies have begun to prove otherwise. Thorpe says the problem might have been a lack of motivation rather than a mobility limitation; therefore, in order to repair mobility, African Americans must tend to medical conditions right away and control their depressive symptoms.