November 21, 2007

After Breast Cancer

I was diagnosed with and treated in the standard way for breast cancer. My friends have given me a lot of advice, which has varied from the standard medical approach to the exotic. What can you tell me that can assist me in the posttreatment phase of my breast cancer?

We are very pleased that you have undergone standard treatment for your breast cancer. Large studies have confirmed the benefits of treatments that have been standardized and tailored to the specific forms of breast cancer. Today, a cancer can be studied to identify whether it has estrogen receptors and is accurately staged, and treatment protocols are designed specifically to match the situation.

A good oncologist will organize an appropriate regimen of treatment. It is true that mistakes can be made, as occurred recently in Newfoundland—where a laboratory was found to be incorrectly diagnosing estrogen receptors—but in the vast majority of situations such mistakes are extremely unlikely.
As Adventists, we are very aware of the general benefits and lowering of risk that occur with a lifestyle calculated to increase our exercise, as well as our fruit, vegetable, whole grain, and nut consumption, with a reduction in flesh food intake.
2007 1533 page22One of the common misconceptions is that such risk-reducing methods should be able to treat cancers. We need to remember that the most conscientious lifestyle does not eliminate risk, it only lowers it, and that modern treatments have been intensively studied and documented during a long time period and with thousands of patients.
With breast cancer it has been difficult to tease out specific protective lifestyle elements, though a report by D. Ingram in the British Journal of Cancer in 1994 (69[3]:592-595) suggested a diet high in vegetables and fruit may decrease risk of breast cancer, while one high in total fat possibly increases risk. Your question, though, comes to the point of whether such diets help after a diagnosis has been made. We do know obesity also contributes to cancer formation—but once again little data exists regarding the effects of weight loss on cancer outcomes once the disease is present.
In 2006, a study by R. T. Chlebowski, et al., reported on reduction of dietary fats and suggested a possible benefit to breast cancer patients (Journal of the National Cancer Institute, 2006; 98[24]:1767-1776), but this was marginally significant.
The most recent report we have read was reported in the Journal of the American Medical Association by the Women’s Healthy Eating and Living Randomized Trial (JAMA, July 18, 2007; vol. 298, no. 3, p. 289), which did not show improved survival with dietary improvements.
This does not mean that diet is unimportant. Persons who develop one type of cancer may be at risk for others. The benefits of a diet high in fruits and vegetables and lower in fat have been well documented as an excellent preventive strategy. Prevention is not the same as cure, though more valuable to those who escape a cancer.
Additionally, breast cancers differ. More work will be required, however, before a definitive answer can be given to you. In the meantime, a good diet lowers the risk of many other types of cancer.


Is it true that drinking wine may lead to an increased risk of breast cancer?

Many factors are associated with breast cancer. The older a woman is, the greater the chance of exposure to potential cancer-promoting agents, and so age is clearly a factor. Genetics play an important role; in the United States approximately 10 percent of the breast cancer cases are a result of inherited genetic mutations in the BRCA1 or BRCA2 genes.

This links directly, then, to the hereditary, or familial, relationships to breast cancer. If a woman has two or more first-degree relatives (mother, sister) who have had breast cancer, this should alert her to increased vigilance and care because of the increased risk of this disease. Diet has been discussed in the preceding question.
Despite the purported (and disputed) so-called benefits of wine to cardiovascular health, the effects of alcohol and breast cancer, especially in postmenopausal women, are seldom discussed simultaneously. Wine consumption has been shown to increase the risk of breast cancer. A recent paper cited in the European Journal of Cancer Supplements (vol. 5, no. 4, p. 161) confirms that not only wine but all forms of alcoholic beverages relate to increased risk of breast cancer.
True temperance teaches us to use all things good in moderation and avoid entirely that which is harmful. How true this is of alcohol!  

My cholesterols have always been normal, so you can imagine my surprise when I was told I had some plaque in my carotid arteries. How can I raise my HDL and lower my LDL—or, perhaps more important, does it really make much difference?

The cholesterol story is a long one, and though we have come a long way in our understanding, we can say unequivocally that there is a lot more to learn.

The cholesterol story began with concern with total cholesterol. We remember well the unraveling of cholesterol into the various categories of low-density, lipoprotein-bound cholesterol; high-density, lipoprotein-bound; ultra-low; and so forth.
Today, most laypeople know high density, lipoprotein (HDL)-bound cholesterols are “Healthy” or “Happy”; and low-density, lipoprotein (LDL)-bound cholesterols are “Lethal” or “Lousy”—but there is far more to it.
The ratio between these two is somewhat predictive of atheroma, but often more cases exist for which we just have no explanation. For about one third of individuals, sudden death is the first manifestation of heart disease. Obviously, we need better predictors of coronary heart disease that can be used—cost-effectively—in screening large populations.
HDL and LDL continue to be useful indicators, though not definitive. More than just the buildup of plaque in the arteries can cause heart attacks. Usually a “rupture,” or breakup of the plaque, precipitates the attack.
Much attention is being given to HDL. We know exercise raises HDL. Fiber from grains such as oats may lower LDL. Cholesterol-lowering medications reduce the risk of heart attack. Smoking more than doubles the risk.
Recently, a trial of a medication (torcetrapib) that raised HDL was abandoned after millions of dollars were spent on its development because Pfizer, Inc., a research-based pharmaceutical company, detected an increase in deaths and heart problems. Why would an elevated HDL be associated with such problems?
Research is now probing the complex nature of HDL. By breaking it into smaller fragments, numerous functions are being discovered. Not only may it wash LDL out of cells and plaque, but it may have anti-inflammatory effects. Besides its lipid metabolic effects, researchers have found it has an enzyme that may block the breakup of plaque (protease inhibitors). Additionally, it has regulatory enzymes involved in the inflammation reaction that may modify the response in the heart to dying muscle.
Differences between the HDL of healthy people and those who have heart attacks were also found. A protein (ApoE) involved in lipoprotein transport was found in higher concentrations in patients than healthy controls.
We still have a lot to learn. It seems our understanding of these cholesterols is just beginning. The more deeply the complexity of creation is explored, the more reverent we become in the presence of such an awesome Creator. We will be wise to live as naturally as we can, and to walk humbly before such majesty.
Allan R. Handysides, M.B., Ch.B., FRCPC, FRCSC, FACOG, is director of the General Conference Health Ministries Department; Peter N. Landless, M.B., B.Ch., M.Med., F.C.P.(SA), F.A.C.C., is ICPA executive director and associate director of Health Ministries.
Send your questions to: Ask the Doctors, Adventist Review, 12501 Old Columbia Pike, Silver Spring, Maryland, 20904. Or you may send your questions via e-mail to [email protected]. While this column is provided as a service to our readers, Drs. Landless and Handysides unfortunately cannot enter into personal and private communication with our readers. We recommend that you consult with your personal physician on all matters of your health.