how to reduce breast density to decrease risk of breast cancer by sat dharam kaur nd

How to Reduce Breast Density to Decrease Risk of Breast Cancer

by Sat Dharam Kaur ND

Breast Density and Cancer Risk

• Increased breast density causes a 4-5 fold greater risk of breast cancer in women who have increased density in > 75% of breast tissue

• 1/3 of all breast cancers are found in women who have increased density in > 50% of their breast tissue Lancet Oncol. 2005 Oct;6(10):798-808

Breast Density and Cancer Risk

• 43.3% of US women ages 40 to 74 years of age have heterogeneously or extremely dense breasts (about 27.6 million women) as determined by mammography

• Breast density is inversely associated with age and BMI

• Women aged 40 to 49 years account for 44.3% of this group J Natl Cancer Inst. 2014 Sep 12;106(10)

Detecting Increased Breast Density

Breast density can be evaluated using:

• Mammography

• MRI PLoS One. 2014;9(6): e99027

• Ultrasound AJR. Jul 2012; 199(1):224-235.

• Skilled Clinical Breast Exam - may not match mammographic exam - high and low densities were detected in 84.5% and 15.5% of clinical breast examinations and 59.7% and 40.3% of mammographies, respectively. There was a significant difference between breast tissue densities in breast examination with those in mammography Asian Pac J Cancer Prev. 2013;14(6):3685-8

Detecting Increased Breast Density

• Breast tissue is composed of fat, glandular tissue and fibrous tissue

• Fat is radiolucent and appears dark on a mammogram; glandular and fibrous tissue are radiodense and appear light.

• When more glandular and fibrous tissue are present, breast density is greater

Grading Breast Density

• the American College of Radiology developed a Mammography Breast Imaging Reporting and Data System scoring method using a 1-4 rating

• BI-RADS 1: less than 25% Dense Breast Tissue

• BI-RADS 2: 26-50% Dense Breast Tissue

• BI-RADS 3: 51-75% Dense Breast Tissue

• BI-RADS 4: more than 75% Dense Breast Tissue

Breast Density Comparison

Age and Breast Density

• ¾ of women in their 30’s have increased breast density

• ¼ of women in their 70’s have increased breast density

• Mammographic breast density can diminish over time

• Women whose breast density does not diminish over time are more likely to be diagnosed with breast cancer Int J Cancer. 2104 Oct 1;135(7):1740-4

Causes of Increased Breast Density

• Genetic

• Neonatal

• Reproductive

• Hormonal

• Lifestyle

• Dietary

• Nutritional

• Environmental

Genetic Factors

• density is influenced by age, parity, body mass index and menopause, but these factors account for only 20-30% of the variation in density

• twin studies show that mammographic density is highly heritable – inherited factors explain 63% of the variance  Methods Mol Biol 2009;472:343-60

• Ashkenazi Jews have breast density compared to other Caucasians Breast Cancer Res 2013 May 13;15(3)

Neonatal Factors

• higher birth weight (>4000 grams or 8 lb, 13 oz ) is correlated with premenopausal breast cancer, in comparison to lower birth weight (<2500 grams or 5 lb, 8 oz) Lancet. 1996 Dec 7;348(9041):1542-6.

Hormonal Factors

• increased estradiol, estrone, IGF-1, prolactin

• use of birth control pill

• use of hormone replacement therapy

• increased weight gain in adulthood

Menstrual and Reproductive Factors• earlier age at onset of menstruation (<11

yrs old)

• shorter menstrual cycle length (< 25 days)

• later age at menopause (>53 years)

• premenopausal women have increased density compared to postmenopausal women

• prior benign breast disease

Menstrual and Reproductive Factors• parity (not having children) is significantly

inversely associated with breast density

• mean percent dense breast volume (%DBV) decreases from 20.5 % in nulliparous women to 16.0 % in parous women. 

• breast density is inversely associated with the age women start using hormonal contraceptives

Menstrual and Reproductive Factors

• breast density increases the longer hormonal contraceptives are used

• mean %DBV decreases from 21.7 % in women who start using hormones at 12-17 years of age to 14.7 % in those who start using hormones at 22-28 years of age

• age at which women started using hormonal contraceptives and duration of hormone use are inversely correlated

• mean %DBV increased from 15.8 % in women who used hormones for not more than 2.0 years to 22.0 % in women who used hormones for more than 8 years

Dietary Factors

• increased red meat consumption, particularly in adolescence

• alcohol consumption

• saturated fats (meat, butter, ice cream)

• high glycemic load, from simple sugars and refined carbohydrates

Breast Density and Sweets

BMC Public Health. 2014 Jun 26;14:554

Environmental Factors

• Postmenopausal women with high serum levels of Bisphenol A (BPA) and mono-ethyl phthalate had elevated breast density Breast Cancer Res. 2013 may 27;15(3):R45

Ways to Reduce Breast Density and

Cancer Risk• have a child before age 24

• have three or more children

• breastfeed

Dietary Recommendations

• Decrease or eliminate red meat, transition towards a plant-based diet

• Decrease saturated fat (meat, butter, ice cream, fatty cheese)

• Decrease sugar, refined carbohydrates and high glycemic carbohydrates

• Avoid alcohol or limit to less than 3 alcoholic beverages per week

• Eliminate caffeine

• Decrease caloric intake

Consume Daily

• increase fiber to 45 mg/day - use chia, flax, legumes, psyllium, rice bran, wheat bran if tolerated

• use 2 or more Tbsp freshly ground flaxseed

• eat 1-2 cups of legumes daily (bean soup, bean dip, bean and grain casserole)

• eat 6 servings of vegetables daily (2 cups salad, 2 cups steamed vegetables)

• eat vegetables containing carotenoids (carrots, squash, sweet potato)

Consume Daily

• eat 2 Tbsp or 3000 mg of linolenic acid from flax and/or fish oil . Pour flaxseed oil over rice, pasta, baked potato; add to salad dressing, use in smoothies. Never heat it. Keep refrigerated.

• use 1 Tbsp olive oil daily in salad dressing

• use ½ cup organic tofu or 1 glass soymilk daily, or both. Avoid if allergic.

• drink green tea or take a green tea supplement

• use rosemary as a spice and as tea

Nutritional Factors to Decrease Breast

Density • vitamin D >1750 IU/day

• calcium >700 mg/day

Other Nutritional Factors to Prevent

Breast Cancer• inositol and alpha lipoic acid

• curcumin

• rosemary

• N-acetyl cysteine

• Coenzyme Q10

• Green tea extract

• Grape seed extract

Other Nutritional Factors to Prevent

Breast Cancer• B complex

• magnesium

• kelp

• indole-3-carbinol

• tocotrienols

Lifestyle Factors to Decrease Breast

Density• Exercise 40 minutes a day

• Spend more lifetime hours in the sun

• Avoid weight gain during adulthood and after menopause

• Avoid birth control pill and hormone replacement therapy

• Avoid plastics containing bisphenol-A and phthalates, especially during pregnancy

• Use organically grown food as often as possible