Leadership Blog Series – In Honor of Breast Cancer Awareness Month

Welcome to our leadership blog series! This month,  Catherine Multari -the Chapter President of Canadian College of Naturopathic Medicine – discusses the risk factors associated with cancer, what we can do to protect ourselves, and what to expect as treatment for breast cancer.

In Honor of Breast Cancer Awareness Month

October marks breast cancer awareness month.  Excluding skin cancer, breast cancer is the most commonly diagnosed cancer in women in North America. (1)  In 2018, it is estimated that 25-30% of all newly diagnosed cancer in women will be breast cancer. (1,2)  Breast cancer can also affect men, but is far less common. (1)  Although breast cancer is one of the most commonly diagnosed cancers, treatment options are very effective with an 87% overall 5 year survival rate. (2)

As future primary health care providers it is important to understand that there are lifestyle changes that can reduce risk of occurrence in addition to non-modifiable factors to keep in mind for screening and prevention.

Non-modifiable risk factors (1,2,3)

  • Being a woman
    • The strongest risk factor for breast cancer, with more than 99% of newly diagnosed breast cancers occurring in women
  • Age
    • The risk of breast cancer increases with age, with 2/3 of invasive breast cancers occurring above the age of 55
  • Family history
    • Those with one first-degree female relative (sister, mother, daughter) with breast cancer have double the risk of being diagnosed themselves, and the risk is 5 times higher than average if there are two first-degree relatives that have been diagnosed
    • Mutations in genes such as the BRCA1 or BRCA2 may account for up to 10% of all breast cancers, however having a BRCA mutation does not always lead to breast cancer
  • Personal history
    • Being previously diagnosed with breast cancer infers a 3-4 times increased risk to develop a new cancer in a different part of the same breast or in the other breast
  • Race/ethnicity
    • Caucasian women are at an increased risk to develop breast cancer over African-American, Hispanic and Asian women.  African-American women are more likely to develop aggressive and advanced-stage breast cancer and are often diagnosed at a younger age

Although non-modifiable risk factors exist, diet and lifestyle remain within our patients’ control, and it is important to empower them to decrease their overall risk of developing breast cancer.

Modifiable risk factors: (1,2,3)

  • Being overweight
    • Elevated BMI increases the risk of being diagnosed with breast cancer
  • Pregnancy history
    • Pregnancy reduces the total number of lifetime menstrual cycles, decreasing hormonal exposure and the risk of breast cancer with each full-term pregnancy
  • Menstrual History
    • Reaching menarche before 12 years of age and menopause over the age of 55 also increases risk
  • Alcohol
    • Compared to non-drinkers, women who consume 3 alcoholic drinks a week have a 15% increased risk of breast cancer
  • Dense breasts
    • Dense breast tissue may make it more difficult to detect early stage breast cancer on screening mammography
  • Lack of exercise
    • Those who exercise regularly for 4-7 hours per week have a lower risk of breast cancer
  • Smoking
    • Smoking has been linked to a higher risk of breast cancer in young, premenopausal women
  • Vitamin D levels
    • Research has suggested that women with low levels of vitamin D have a higher risk of developing breast cancer
  • Shift work
    • Women working at night have a higher risk of developing breast cancer compared to those working during the day, which may be linked to low melatonin levels
  • Exposure to ionizing radiation
    • Radiation to the chest, neck and armpit areas puts women at an increased risk of developing breast cancer

In addition to the above, there may be other factors that increase the risk of developing breast cancer.  These can be discussed with patients at high-risk and include poor blood sugar regulation, exposure to xenoestrogens, hormone replacement therapy, oral contraceptives, atypical hyperplasia, breast implants and stress.  

Screening Guidelines:

Guidelines for screening vary between Canadian provinces, making it important to be familiar with the guidelines in the jurisdiction where you are practicing.  In the US screening guidelines are set yearly by the American Cancer Society (ACS).  

Breast cancer screening guidelines for Ontario can be found here:

https://archive.cancercare.on.ca/pcs/screening/breastscreening/breasthealth/

  • Recommends women ages 50-74 with average risk to be screened every other year with mammography

Breast cancer screening guidelines for British Columbia can be found here:

http://www.bccancer.bc.ca/screening/health-professionals/breast

  • Recommends women ages 50-74 with average risk to be screened every other year with mammography

Breast cancer screening guidelines for the USA can be found here:

https://www.cancer.org/content/dam/CRC/PDF/Public/8579.00.pdf

  • Recommends women with average risk of breast cancer to begin screening ages 45-54 yearly with mammography

Based on the detailed screening guidelines, patients with known risk factors will begin screening earlier than those with average risk.  It should be noted that mammography is not a perfect test. (4)  Mammograms may detect false positives that cause subsequent unnecessary treatment. (4)  Mammograms may also miss some cancers. (4)   

Conventional Care:

The stage of the cancer at diagnosis will determine conventional care.  Conventional care can include surgery, chemotherapy and radiation therapy.  In Canada the first-line chemotherapy regimens include FEC-D, Dose-dense AC-T and TC. (5)  More information on chemotherapeutic agents used for treating breast cancer in the US can be found here: https://www.cancer.org/cancer/breast-cancer/treatment/chemotherapy-for-breast-cancer.html.      

It is important to be familiar with the monographs of the chemotherapeutic agents your patient is taking to understand the side effects of treatment and support them as comprehensively as possible.   

Naturopathic Approach to Breast Cancer:

Note: The following is to be considered in conjunction with conventional care, not as a replacement to conventional treatment.

  1. Recognize you are treating a person, not a disease

“Treat the Whole Person” is one of the six fundamental principles of naturopathic medicine.  We must not forget that the body is an integrated whole both physically and spiritually.  Receiving a cancer diagnosis can be just as debilitating mentally as it is physically.  The type of person with the disease matters just as much as the type of disease a person has. Check-in with the patient and ask how they are mentally coping with the disease.

  1. Utilize the Therapeutic Order

Adapted by Yanez, J: AANMC with permission from: Zeff, J.L., Snider P., & Myers, S., DeGrandpre, Z., 2013. 1. http://www.foundationsproject.com/documents/Naturopathic-Therapeutic-Order.pdf.

While a patient receives high force interventions in chemotherapy, radiation and surgery, it is equally important to support the foundations of health in this process.  By increasing their vitality, you can improve their quality of life and decrease the risk of recurrence.  Our focus should be on treating the overall well-being of the patient, building a strong foundation of health that can withstand high force interventions.  

  1. Natural Therapies

Some well-researched natural therapies to consider include:

Melatonin

Melatonin has antioxidant and immunomodulatory properties that work to inhibit the growth of breast cancer cells. (6)  Melatonin has been studied demonstrating improvement in sleep parameters amongst breast cancer survivors and improvement in depressive symptoms for breast cancer patients undergoing surgery . (7,8)

Vitamin D

Improving vitamin D status should be considered in patients who are deficient at the time of diagnosis.  A study has shown improved survival rates in patients who had optimal vitamin D levels compared to those with chronic deficiency . (9)  Maintaining optimal vitamin D status at diagnosis is important for improving the survival rates of breast cancer patients. (9)

Additional naturopathic support to consider:

Indication
Ashwagandha Fatigue, Improving quality of life (10)
L-carnitine Improving tamoxifen related side effects (11)
L-glutamine Chemotherapy-induced mucositis (12)
Acupuncture Fatigue (13)
Exercise Fatigue, quality of life (14)

Note: These are general recommendations, for case specifics and dosing considering consulting with a naturopathic doctor who has a cancer practice or is a Fellow of the American Board of Naturopathic oncology (FABNO).  NDs who are board certified in naturopathic oncology, holding the FABNO designation, have completed minimum experience, cases and continuing medical education requirements as well as passed the board certification exam.

 

My hope is that this blog will give students a basic understanding of the risk factors, screening guidelines and naturopathic approach to breast cancer.  I am a 4th year naturopathic medical intern on the Integrative Cancer Centre shift at the Canadian College of Naturopathic Medicine in Toronto, Ontario.  If you would like to connect please reach me at cmultari.ccnm@gmail.com.   

Author: Catherine Multari

Chapter President of the Canadian College of Naturopathic Medicine

Catherine Multari is a 4th year clinical intern at the Canadian College of Naturopathic Medicine (CCNM) and the current NMSA Chapter President at CCNM.  She has held a position on her chapter’s executive board for two years.  Catherine served as the Education Chair and President-Elect prior to her current position.  She is particularly interested in empowering students to become involved, fostering a sense of community within the naturopathic medical schools and profession at large.

Outside of school Catherine is a group fitness instructor and barista, nurturing her love for both exercise and coffee.  She credits her time spent on the University of Virginia varsity rowing team for providing her with the drive to do more, be more and strive for uncompromised excellence.

 

Resources:

1) Breast Cancer Society, www.breastcancer.org

2) Canadian Cancer Society, www.cancer.ca

3) Centers for Disease Control and Prevention, https://www.cdc.gov/cancer/breast/basic_info/risk_factors.htm

4) Cancer Care Ontario- Breast Cancer Screening, https://www.cancercareontario.ca/en/types-of-cancer/breast-cancer/screening

5) BC Cancer- Chemotherapy Protocols, http://www.bccancer.bc.ca/health-professionals/clinical-resources/chemotherapy-protocols

6) https://www.ncbi.nlm.nih.gov/pubmed/25876649

7) https://www.ncbi.nlm.nih.gov/pubmed/24718775

8) https://www.ncbi.nlm.nih.gov/pubmed/24756186

9) https://www.ncbi.nlm.nih.gov/pubmed/25824788

10) https://www.ncbi.nlm.nih.gov/pubmed/23142798

11) https://www.ncbi.nlm.nih.gov/pubmed/24338689

12) https://www.ncbi.nlm.nih.gov/pubmed/25351453

13) https://www.ncbi.nlm.nih.gov/pubmed/23196311

14) https://www.ncbi.nlm.nih.gov/pubmed/25484317

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