Mutation in either the BRCA1 or the BRCA2 gene, excess estrogen levels in the body, diet, excess weight, alcohol consumption, and cigarette smoking are all risk factors for breast cancer. While there’s almost nothing we can do to change hereditary gene mutation, it is within our power to control the other factors and protect our breasts.

Maintain a Healthy Weight

A recent American Cancer Society study of more than 62,000 women found that the more weight women gain after age 18, the greater their risk of developing breast cancer during menopause. Extra pounds increase estrogen production, which can fuel cancer growth. On the other hand, even if you are heavier regular exercise will reduce your risk significantly.

“Physical activity is thought to lower the amount of estrogen in the body, thereby lowering your breast cancer,” explains Dr. Debbie Saslow, PhD, Director of Breast and Gynecologic Cancer at the American Cancer Society. So get moving. A brisk 30-minute walk five days a week can reduce breast cancer risk by 18 percent, according to a study of more than 74,000 women ages 50 to 79.

Eat Good Fats

High levels of polyunsaturated fat and saturated fat have been linked to breast cancer, so limit these fats in your diet. Opt for more monounsaturated fat, such as olive and canola oils. A study in Sweden of more than 61,000 women between the ages of 40 and 76 showed that consuming an additional 10 grams of monounsaturated fat reduces breast cancer risk by an estimated 45 percent. On the other hand, the study also showed that every extra 5 grams of polyunsaturated fat consumed, increased breast cancer risk by 69 percent. Breast cancer rates are low among women in Spain, Greece, and Italy, and the fact that people in these countries use olive oil as their primary source of fat undoubtedly is a factor in this beneficial result.

Eat Fruits and Vegetables

Carotenoids are powerful antioxidants that protect against cancer, and these are found in a wide variety of fruits and vegetables. Researchers at New York University compared blood samples from 270 women who subsequently developed breast cancer to samples taken from 270 women who did not. They found that women with the lowest levels of carotenoids had twice the risk of breast cancer as found in those with the highest levels. Try to eat five to nine servings (one-half- to one cup) daily of fruit and vegetables, especially carrots, tomatoes, watermelon, and spinach.

Add Flaxseed to Your Diet

These seeds are rich in omega-3 fatty acids, which support cardiovascular health as well as lowering the risk of all types of cancer. Flaxseed also contains high levels of a compound called lignans that may reduce estrogen activity in the body. Studies on rats show that lignans actually shrink breast tumors. To eat flaxseed, sprinkle two to three tablespoons of ground flaxseed on your cereal, add to smoothies, or use flaxseed oil in salad dressing.

Learn to Like Soy

Women in Asia have one-fifth the breast cancer rate of Western women. Scientists believe that the reason is their soy-rich diet. A Japanese study showed that women who ate three or more bowls of miso soup (made with fermented soybeans), reduced their risk by 50 percent over those who had less. Soy foods contain phytoestrogens, compounds that are weak forms of estrogen and may protect against breast cancer. Add one to two servings of soy foods daily to your diet - a cup of soy milk, a half cup of tofu, tempeh, or soy nuts.

Limit Alcohol Intake

Alcohol intake is linked to increased levels of estrogen which fuels cancer. It is recommended that if you drink alcohol occasionally, take 400 micrograms of daily folic acid (the amount found in most multivitamins). A Mayo Clinic study showed that women with the lowest folate (folic acid occurring in fruits and vegetables) intake who drank even a small amount of alcohol daily — even half a drink — had a 59 percent increased risk of breast cancer, but a high intake of folate cancelled out the increased risk among moderate drinkers. How folate reduces the risk is not clear, but experts agree that most Americans are not getting enough.

Quit Smoking

Studies show that the younger women are when they first start smoking, the greater their risk of developing breast cancer before menopause. Other studies suggest that women with a family history of breast and ovarian cancer may increase their risk if they smoke. Also current and past smokers who develop breast cancer are twice as likely to get an aggressive form of the disease that is not estrogen-dependent. Similar risk applies with second-hand smoke.

Limit Use of Antibiotics

New evidence suggests that the more often you take antibiotics, the higher your breast cancer risk. A study of more than 10,000 women revealed that the risk of breast cancer is doubled among those who took antibiotics for more than 500 cumulative days (the equivalent of about 25 prescriptions) over an average of 17 years compared with women who never took antibiotics. Researchers caution, however, that other factors, such as underlying illness, weakened immune system, or hormonal imbalance, could account for the increased risk.

Opt to Breast-Feed

Not only is it good for your infant, but lactation also suppresses ovulation and the production of estrogen. Researchers compared the birth rates and breast-feeding practices among women in developed countries with women in developing nations in Asia and Africa and found that the breast cancer risk in developed countries could be cut in half if women had as many babies and breast-fed each child for an average of 30 months per child as women in developing countries. Breast-feeding alone would reduce the risk by two-thirds. They also found that for each year a woman breast-feeds, her breast cancer risk dropped 4 percent.

Source:
American Breast Cancer Association
The Mayo Clinic

Syble James is President of Alpha Health Source, on the Internet at AlphaHealthSource.net AlphaHealthSource.net, where visitors can find diets, supplements, food & beverages, body care and request health & fitness consultations. Ms. James also researches, writes and consults within the investment and fitness community, focusing on VMS, nutraceutical, weight loss, health club, and MLM (VMS & body care). She can be reached at Syble.James@AlphaHealthSource.net or 1-800-899-0799.

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Tags: breast cancer, cancer risk, gynecologic cancer, ovarian cancer

If there is a diagnosis or strong suspicion of ovarian cancer, immediately go find a board certified gynecologic oncologist. This is a gynecologist who has undergone years of extra training and examinations to become board certified in the care of women with gynecologic cancers. This includes performing surgery, giving chemotherapy and recommending whether or not radiation is required. Note that radiation is rarely used in ovarian cancer treatment.

A board eligible oncologist who has completed fellowship training is an option as well. This means they have completed training, but are required to practice a few years before being allowed to take the final board certification exam. These energetic, recently trained oncologists are usually in practice with more senior physicians so you will often receive team based care in such private or University practices.

If you are under the care of a gynecologic oncologist who does not inspire confidence or does not present some kind of positive outlook, go find another one. This is not to say that they should be painting a rose garden picture. However, it is reasonable to expect your main physician to be objective but encouraging if at all possible. The treatment is hard and the outcome may not always be the best, but you do have a fighting chance and you should feel that your gynecologic oncologist is in your corner, providing personal attention and state-of-the-art information throughout.

Do not let anyone, including friends, family physicians, general gynecologists, surgical oncologists, medical oncologists, or any other doctor convince you that their team is just as good in the absence of a gynecologic oncologist. You absolutely, positively need a gynecologic oncologist as part of your team!! Again, do not let anyone convince you otherwise.

You can find help and a list of gynecologic oncologists in your area at sgo.org/” target=”_blank www.sgo.org (Society of Gynecologic Oncologists) or wcn.org/” target=”_blank www.wcn.org (Womens Cancer Network). To my knowledge there is no comprehensive and accurate international directory. However, you might try contacting the International Gynecologic Cancer Society at igcs.org/” target=”_blank www.igcs.org, who may be able to help you find a gynecologic oncologist in your country.

Your gynecologic oncologist may or may not work closely with a medical oncologist instead of administering chemotherapy his/her-self. A medical oncologist is a doctor who specializes in giving chemotherapy to patients with all different types of cancer, gynecologic or not. Most do not see as many patients with ovarian cancer as a gynecologic oncologist, but can be very important members of a team approach in treating your cancer. In centers or medical groups where treatment is regularly delivered by a multi-disciplinary team, medical oncologists play a critical role in administering the chemotherapy, working in conjunction with a gynecologic oncologist.

Who else do you need? First of all, don’t forget that YOU are a team member! The doctors you work with will give you options, opinion, information, treat you etc., but you must be an active decision-maker because we are talking about YOUR body here. You also have to be aware of what to look for in how your body responds, so that you can relay that information to your doctor(s). They cannot guess what might be going on with you. Make sure that you feel comfortable with your doctors. You should be able to ask questions, and relay fears and concerns.

When you visit your doctor(s), make sure you have all your questions lined up and write them down if you need to in order to stay organized. Some doctors will let you record your visits, others will prefer that you don’t. An alternative is to bring a family member or friend to help you hear everything.

Other members of the team might include:

Primary Care Doctor - Your Primary Care Doctor is hopefully the one you already know and trust for your basic medical care. Usually, this doctor is a Family Practitioner by training, but may be an Internal Medicine doctor or a Gynecologist. They will often stay involved to take care of your health beyond that of cancer care and help in situations where medical management is required around the time of surgery.

Surgical Oncologist - Surgical oncologists are surgeons who spend extra years training to surgically take care of cancer patients. They are not a substitute for a gynecologic oncologist, but may be very helpful when your surgical needs go beyond that of a gynecologic oncologist. For example, while gynecologic oncologists are trained to perform surgery in many areas of the body, a surgical oncologist may be involved when a large part of the liver needs to be removed or chest surgery needs to be done.

Nurse Practitioner - Nurse-practitioners are nurses who have gone beyond the basic RN degree and received extra training in healthcare. They may assist your doctors by performing examinations on you and may or may not be authorized to write prescriptions for medications you need. This depends upon the State you live in.

Oncology Nurse - Oncology nurses are RNs who have specialized, and are often specifically certified in, cancer care. Most often you may have oncology nurses helping administer chemotherapy to you; something that they are specially certified to do.

Social Worker - Licensed social workers are your connection to broad range of support networks in your medical facility and surrounding community. Social workers may intervene by providing individual, couple, or family counseling, offering group education or support, and by working with community groups in the development of resources to assist patients in meeting their own needs.

A psychosocial assessment provides the basis for the social worker intervention. This assessment includes evaluation of patient resources, strengths, and support systems, such as:

past coping behaviors family support living arrangements education level employment leisure interests financial situation The social worker also addresses the patient’s emotional response and reaction to the illness, the impact of the disease upon the family, the effect on the patient’s relationships and roles, and other personal or social problems. Alternative or Complementary Practitioners - Many centers have integrative medicine programs, or have at least some practitioners who represent alternative and complementary approaches to cancer care. The most proven options are those which help control your symptoms, help support your strength and possibly your immune system. These practitioners may have various degrees including PhD, naturopathy(ND), chiropractic (DC), or may have no degrees but with extensive experience in massage therapy, music therapy or accupuncture/accupressure. Rather than shopping for unknown practitioners with uncertain skills, the best strategy is to ask for a referral from an enlightened mainstream medicine practitioner. There is a lot of misinformation and misguided people out there, whose advice can harm you and cause you to lose your best chance of a cure.

Finally, the following are some general questions you might want to consider in setting up your team and selecting your main physicians.

Are you fellowship trained and board certified or board eligible? Who will be my main doctor in coordinating treatment? Do you believe in discussing options with me, including possible research alternatives? If I have problems during treatment who do I call and how do I reach them? Is this the same on weekends? What costs are covered by my insurance and who do I talk with about this? What kind of support services are available to me and where do I find them? If you are interested in complementary and natural aids, you may want to ask if your doctor would be willing to consider or discuss complementary and alternative options, or refer to a colleague who can.To your victory!!

Steven A. Vasilev MD,MBA,FACOG,FACS is a fellowship trained and board certified gynecologic oncologist, which means he is specially trained and certified to take care of women with gynecologic cancers using a broad spectrum of skills. He has practiced at academic as well as private centers, has been on the faculty of three universities and continues to be involved in research and education. You can visit gyncancerdoctor.com gyncancerdoctor.com to learn more about screening, prevention and treatment of gynecologic cancers.

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Tags: cancer patient, cancer treatment, chemotherapy, gynecologic cancer, ovarian cancer

In almost all cases, initial therapy should be a state of the art plan including one or several of the following options: surgery, chemotherapy, radiation. There are some research protocols which are available right up front, and you should inquire about this. However, in most cases,depending upon the tumor type, research medicines or therapies may be considered after the initial therapy and/or therapy after first recurrence fails. Research protocols are VERY specific about what types of tumors are included, their stage and what type of therapy has been given to date. It is never too early to inquire about research protocols and to look into where the options might take you. On the other hand you should know that research protocols open and close regularly when the desired number of patients on protocol has been reached. Therefore, a trial which is open today, may not be open tomorrow.

INVESTIGATIONAL TREATMENT or CLINICAL TRIALS
There are thousands of clinical trials available on any given day for various forms of cancer. For gynecologic cancers alone, there are hundreds across the country, usually, but not always, at designated larger research centers. They are further broken down by type of trial and type of cancer that is targeted. These studies can be divided into three general types.

In a Phase I trial a new treatment is being studied for the first time in humans, which has good laboratory and animal study evidence for efficacy. The primary purpose is to determine the dose levels that can be tolerated safely and side effects. Usually these are best suited for patients who have progression of their cancer despite use of all available standard therapy.

The next step is a Phase II trial, in which the treatment is offered to patients who have a variety of cancer types. These patients also have cancer which is progressing despite all standard therapies. Phase II trials are used to determine if the treatment has any benefit for each particular type of cancer.

If an agent/drug shows some good effect against a particular type of cancer, a Phase III study is initiated to see if the agent/drug is better than the known best treatment against that particular cancer. This requires something called “randomization”, which means that the patient will get either the standard therapy or the experimental therapy determined by chance. This is equivalent to the flip of a coin, but more sophisticated techniques are used. The goal for randomization is to have each treatment arm (experimental and standard) contain the same number and sort of patients with respect to extent of disease, age, past treatment, etc. This is crucial, because if this scientifically rigorous study method shows that the experimental treatment is better, it becomes the new standard therapy. Thus good scientific practice and study design is absolutely essential so that we have the best possible therapy available to patients.

So should you participate and when? Phase I trials have the most potential toxicity and side effects associated with them. But if everything else has failed, and you still want to give it a try, this offers a shot at the very newest drugs available. Phase II trials are the next in line and are a very reasonable alternative if standard therapy is not working very well, and you do not wish to risk the unknown levels of side effects inherent in Phase I trials. Phase III trials are made available when a very promising therapy (based on Phase I and Phase II information) is felt to be possibly better than the standard therapy. At the very least, when offered, it is felt that the Phase I and Phase II evidence suggests that the new agent/drug is not worse than the standard therapy. However, there is a risk that it might be worse. On the other hand, there is a good possibility that it might be better. It comes down to personal choice and a long risk/benefit discussion with your treating physician.

The best compendium of research trials can be found on the National Cancer Institute’s and the American Cancer Society’s websites. For additional information regarding Gynecologic Cancers be sure to also visit gyncancerdoctor.com/” target=”_blank www.gyncancerdoctor.com

Steven A. Vasilev MD,MBA,FACOG,FACS is a fellowship trained and board certified gynecologic oncologist, which means he is specially trained and certified to take care of women with gynecologic cancers. He has practiced at academic as well as private centers, has been on the faculty of three universities and continues to be involved in research and education. You can visit gyncancerdoctor.com gyncancerdoctor.com to learn more about screening, prevention and treatment of gynecologic cancers.

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Tags: chemotherapy, gynecologic cancer

We have all had friends get diagnosed with cancer. These are often friends who have lived the healthiest possible life, eating nothing but the best quality foods. We are talking about non-smoking, regularly exercising people who have lived the perfectly healthy lifestyle. Why did they get cancer?

The truth is that almost all cancers are caused by some genetic switch or another inside of us that flips on or off. Whether or not this occurs does depend to some degree on what we expose ourselves to, whether that be cigarette smoke, over exposure to the sun or some type of food additive. This is very over-simplified, but science is advancing rapidly and in the next five to ten years we may know exactly what the risk will be for any given environmental vice that we choose to engage in.

Until then, we do have knowledge about what kind of cancer we are most likely to come down with, and how effective cancer screening is against some of these. The point is that you have the power to take control and minimize the risk of cancer happening to you !!

The most common types of cancer in women living in the United States are:

breast (213,000 new cases, 40,970 deaths per year, with a 1 in 34 lifetime risk of dying from it),
lung (81,770 new cases, 72,130 deaths per year, with a 1 in 20 lifetime risk of dying from it),
colorectal (75,810 new cases, 27,300 deaths per year, with a 1 in 45 lifetime risk of dying from it),
endometrial (41,200 new cases, 7,350 deaths per year, with a 1 in 196 lifetime risk of dying from it),
skin (30,420 new cases, 3,720 deaths per year, with a 1 in 500 lifetime risk of dying from it),
ovarian (20,180 new cases, 15,310 deaths per year, with 1 in 95 lifetime risk of dying from it),
cervical (9,710 new cases, 3,700 deaths from year, with 1 in 385 lifetime risk of dying from it).

In general, in addition to taking care of yourself, a yearly examination with screening for cancer or precancerous conditions is highly recommended. Unfortunately, the cancers for which there are no effective screening tools are: endometrial, lung and ovarian.

The good news is that endometrial cancer tends to show itself early by abnormal bleeding, usually postmenopausal, which leads to a high cure rate. The additional good news for preventing endometrial cancer is that the vast majority occur in people who are overweight. So, paying attention to symptoms and keeping your weight in the normal range go a long way towards preventing endometrial cancer. Also, if you are taking estrogen, make sure you discuss the risk vs. the benefit with your physician.

Lung cancer is most often associated with smoking. Screening techniques have been ineffective in reducing mortality. Enough said. You know what to do for this one.

Ovarian cancer is a silent killer with no early symptoms and no reliable way to screen for it; at least not yet. There may be a blood test that is on the horizon that will change that in the near future. However, for today, the tests popularized in the lay literature as screening tools, particularly CA-125, are simply not effective. The best strategy is to pay close attention to persistent symptoms of increased bloating, indigestion, unexplained weight loss, pressure, abdominal or pelvic pain, or other intestinal symptoms. Having said that, these kind of symptoms are far more likely to be caused by something other than ovarian cancer, so don’t panic. Just be vigilant if these symptoms don’t go away. Also, although there are genetically predisposed women who get ovarian cancer in their reproductive years, the vast majority of ovarian cancers are diagnosed in the post-menopausal years. If you do have first degree relatives who have come down with breast or ovarian cancer, seek genetic counseling. Testing may be recommended.

Screening options do exist for cancers of the skin, cervix, colon-rectum and breast.

Women over the age of 40 should get mammograms every 1 to 2 years, and yearly after age 50. In addition, ask for a breast exam during your annual physical. Finally, although breast self-examination has not been proven to be effective, there is enough medical information to consider doing it regularly. You know your body best and may detect a lump earlier than anyone else. Finally, as far as preventive measures, a low fat diet , which you religiously adhere to may reduce your risk, especially if you have been on a high fat diet. Being overweight definitely increases your risk of cancer.

There has been a lot of press lately regarding cervical cancer screening. The best news here is that the combination of Pap smear and HPV testing is highly effective in detecting PRE-cancerous conditions of the cervix. This means that treatment can be effective very early and relatively non-invasive since the treatment is for pre-cancer rather than cancer. The recommendations are rather complex, vary with age and the details can be found on the American Cancer Society website. However, in general, make sure you are getting this combined test at least every 3 years.

After age 50, there are several options for colo-rectal cancer screening. Similar to cervical cancer screening, the most effective situation is detection of pre-cancerous polyps, but early cancer detection is also life-saving. The options include yearly testing of patient collected stool samples, sigmoidoscopy (examining the lower part of the colon) every 5 years, a special kind of x-ray study called a double-contrast barium enema every 5 years or colonoscopy (looking at the entire colon) every 10 years. Discuss these options with your doctor to determine what might work best for you.

Finally, especially if you are a sun-worshiper, ask your doctor to look at every inch of your body for signs of precancerous or cancerous skin changes. Make sure you use sun protection lotions which have a SPF (sun protection factor) rating of at least 15. Your risk will depend upon what type of skin you have, but these days you should pay attention to what the reported UV Index is wherever you live. This is a measure of the sun’s damaging ultraviolet radiation you are exposed to on any given day when you go outside.

It’s your life. Make sure you’re looking out for number one!

Steven A. Vasilev MD, FACOG, FACS is a fellowship trained and board certified gynecologic oncologist, which means he is specially trained and certified to take care of women with gynecologic cancers using a broad spectrum of skills. He has practiced at academic as well as private centers, has been on the faculty of three universities and continues to be involved in research and education. You can visit gyncancerdoctor.com gyncancerdoctor.com to learn more about screening, prevention and treatment of gynecologic cancers.

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Tags: cervical cancer, gynecologic cancer, lung cancer, ovarian cancer

A fairly stringent low-fat diet in women with early-stage breast cancer resulted in a very impressive 42% risk reduction in cancer recurrence or death in women with hormone receptor-negative tumors, according to the second follow-up data analysis from the Women’s Intervention Nutrition Study (WINS) presented at the December 2006 29th Annual Breast Cancer Symposium held in San Antonio.

The study was started in 1994 and is the first large scale randomized clinical trial which, so far, shows that dietary changes can strongly affect outcomes in women with breast cancer who also receive conventional treatment. The findings are very exciting, and are holding up through a second interim analysis, but plans call for three more years of follow-up to confirm the results. The next planned re-analysis of the data is scheduled towards the end of 2007. In addition, another confirmatory study is planned to start in early 2007 by the Canadian National Cancer Institute and other smaller studies are underway.

WINS was a multi-center trial involving almost 2500 women, ages 48 to 79, who were randomized either to a dietary intervention arm or a control group who ate their usual diet. The randomization was performed after patients underwent standard treatment for early-stage breast cancer. The intervention arm was closely directed by physicians and dieticians, and involved reducing fat consumption from about 57 grams per day in the regular diet control group to an average of 24 grams per day in the intervention arm. The intervention arm resulted in an average 6 pound weight loss after 5 years. Follow-up for this study is now approaching 6 years.

The recurrence and death rate amongst the entire group reached only borderline statistical significance with an approximate 15% risk reduction. However, among the 362 patients who had hormone receptor (estrogen and progesterone) negative breast cancer, the overall mortality was 6% in the intervention arm and 17% in the control group. Similarly, the combined death or recurrence rate was 9.8% in the intervention arm, compared to 24% in the control group. This represents a 42% risk reduction of recurrence or death.

Although the mechanism by which this occurs is not clear, the most likely reason is an effect on insulin, insulin-like growth factors and moderation of the inflammatory cascade. In other words, it is likely related to how sugars are processed and inflammation is handled by your body.

At this time, although confirmation of these results is pending, a motivated woman could consider following the WINS diet as published in J. Am. Diet. Assoc. 2004;104:551. It is not clear if partial benefit is derived from a low fat diet that is not quite as stringent as the one tested. Therefore, in order to approach the reported results, one has to be very committed to a very significant dietary modification.

If these results are confirmed in breast cancer, it is very tempting to speculate that this effect may be true in other cancers as well, especially hormonally related or mediated cancers like endometrial and ovarian cancer.

Steven A. Vasilev MD,MBA,FACOG,FACS is a fellowship trained and board certified gynecologic oncologist, which means he is specially trained and certified to take care of women with gynecologic cancers using a broad spectrum of skills. He has practiced at academic as well as private centers, has been on the faculty of three universities and continues to be involved in research and education. You can visit gyncancerdoctor.com gyncancerdoctor.com to learn more about screening, prevention and treatment of gynecologic cancers. You can also visit a one-of-a-kind site devoted to life, love and intimacy after cancer cancervival.com cancervival.com

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Tags: breast cancer, gynecologic cancer, ovarian cancer