Women with Breast Cancer Can Modify Their Lifestyle to Improve Prognosis

Sunrise at the World's Tallest Tepee, Medicine Hat, Alberta. (Dr. Noorali Bharwani)
Sunrise at the World's Tallest Tepee, Medicine Hat, Alberta. (Dr. Noorali Bharwani)

“Although more than 90 per cent of patients with breast cancer have early stage disease at diagnosis, about 25 per cent will eventually die of distant metastasis,” says an article in the Canadian Medical Association Journal (CMAJ February 21, 2017).

Women with breast cancer would like to improve their prognosis and live long. Making positive lifestyle changes can improve long-term prognosis and be psychologically beneficial, since the feeling of loss of control is one of the biggest challenges of a cancer diagnosis.

So which lifestyle changes can be recommended to patients in addition to standard breast cancer treatments?

The CMAJ article reviews the role of lifestyle factors, particularly weight management, exercise, diet, smoking, alcohol intake and vitamin supplementation, on the prognosis of patients with breast cancer. Here is the summary.

Weight management

Weight gain during or after breast cancer treatment increases the risk of recurrence and reduces survival, irrespective of baseline body mass index (BMI). Patients who are obese or overweight at breast cancer diagnosis have a poorer prognosis. So lose weight.

Physical activity

Physical activity can reduce breast cancer mortality by about 40 per cent and has the most powerful effect of any lifestyle factor on breast cancer outcomes. At least 150 minutes per week (about 30 minutes a day) of physical activity is recommended, but less than 13 per cent of patients with breast cancer attain this. So exercise more.

Diet

Western-style diets (high in processed grains, processed meats and red meat) and prudent diets (high in fruits, vegetables, whole grains and chicken) have similar rates of breast cancer recurrence. Diets rich in saturated fat, especially from high-fat dairy products, may be associated with increased breast cancer deaths. Soy products have not been found to increase breast cancer recurrence and may actually reduce it. Eat less and stop eating fatty food.

Smoking

Recent evidence has shown a strong association between a history of smoking and breast cancer mortality. Women who quit smoking after diagnosis of breast cancer have higher overall survival and possibly better breast cancer–specific survival. So quit smoking.

Alcohol intake

Findings are too inconsistent to conclude that alcohol consumption affects breast cancer outcomes. However, limiting alcohol consumption to one or fewer drinks per day reduces the risk of a second primary breast cancer.

Vitamin supplementation

Moderate increases in dietary vitamin C or oral supplementation may reduce breast cancer mortality, but randomized trials are needed to confirm these findings. Vitamin E supplementation is not associated with breast cancer outcomes. Low levels of vitamin D at diagnosis have been associated with an increased risk of breast cancer deaths. However, randomized trials are needed to determine whether supplementation improves prognosis. One multivitamin a day and Vitamin D 2000 units a day is good for your health.

So the message is clear – make positive life-style changes like exercise more, lose weight and eat healthy. And keep smiling.

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Detecting Breast Cancer in Women with Dense Breasts Made Easier

Valley of the Kings, located on the west bank of the Nile, Egypt. (Dr. Noorali Bharwani)
Valley of the Kings, located on the west bank of the Nile, Egypt. (Dr. Noorali Bharwani)

The Canadian Cancer Society recommends that all women 50 to 69 years of age be screened for breast cancer every two years, using mammography. But mammography is less useful in identifying cancerous tissue in women with dense breasts; that is, women whose breasts have less fatty tissue but have more fibrous tissue.

In Canada, more than one million women (that is 50 per cent of women) who are 50 to 69 years old have dense breasts. Mammography is not a good test for picking up breast cancer in women with dense breasts. These women are being offered an additional test in the U.S. at a cost of about U.S. $2000 (two thousand). This test is called molecular breast imaging (MBI). This is not the first line of investigation for breast lumps. All women who are eligible for breast screening first undergo mammography and if necessary ultrasound to see if a lump is solid or cystic. Women with dense breasts then can be offered MBI if the mammogram is negative.

In a study from Mayo Clinic, 2600 women with dense breasts underwent mammogram and then MBI. Thirty two per cent of women were found to have breast cancer. Of these only eight breast cancers were picked-up by mammogram alone but 29 breast cancers were picked up by mammography plus MBI. This test is four times better than mammogram alone, is less painful and gives better pictures. However, this is not the final answer. More research is in progress to see how the results can be improved.

MBI is not going to replace mammography. Mammograms will remain the gold standard in breast cancer screening and will continue to be the standard first step in breast cancer detection. Use of MBI, MRI (magnetic resonance imaging) and ultrasound will continue to serve special populations of patients who need tests beyond a mammography.

Breast MRI is not recommended as a screening tool for women who are at average risk of developing breast cancer. It is better than mammogram but a major disadvantage is that breast MRI screening results in more false positives. In other words, the test finds something that initially looks suspicious but turns out not to be cancer. To avoid unnecessary biopsies MRI screening is reserved for high-risk women only. MRI is also more expensive and not widely available.

In conclusion, mammograms are probably the most important tool doctors have, not only to screen for breast cancer, but also to diagnose, evaluate, and follow people who’ve had breast cancer. It is safe and reasonably accurate. The technique has been in use for more than 50 years. MBI is still being tested, but it appears to hold promise for detecting breast cancer in women who are at higher-than-average risk for the disease and have dense breasts. Ultrasound and MRI is used for special cases.

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Should You be Worried About Nipple Discharge?

To drink or not to drink - Cordoba, Spain. (Dr. Noorali Bharwani)
To drink or not to drink - Cordoba, Spain. (Dr. Noorali Bharwani)

“Nipple discharge is benign in most instances and is the third most common breast-related complaint, after breast pain and breast mass,” says an article in the Canadian Medical Association Journal (CMAJ May 19, 2015).

About 50 per cent of women in their reproductive years have nipple discharge, which are physiological. This kind of discharge is usually from both breasts, milky, green or yellow fluid expressed from multiple nipple duct openings and often associated with nipple stimulation. Usually these patients do not require surgery if the ultrasound and mammogram is normal. Discharge may spontaneously disappear.

Nipple discharge you should be worried about are spontaneous and often from one breast. It may arise from a single duct or be associated with a breast lump or new skin changes. It can be bloody, serous (clear thin plasma fluid), green or black.

About 15 per cent of these patients will have breast cancer. About 50 per cent of these patients will have benign intraductal papilloma (benign growth in the duct), and 20 per cent will have ductal ectasia.

Ductal ectasia of the breast (also known as mammary duct ectasia or plasma cell mastitis) is a condition in which the lactiferous breast duct becomes blocked or clogged. This is the most common cause of greenish discharge. Mammary duct ectasia can mimic breast cancer. It is a disorder of peri- or post-menopausal women.

Intraductal papillomas are benign growths of the nipples in women close to menopause. They are usually single. Generally they are not seen on mammography. Surgical excision is indicated to rule out malignancy. These papillomas are the most common cause of bloody nipple discharge.

What can be done for women with nipple discharge?

Women with nipple discharge should be investigated. Mammography (sensitivity may be decreased in younger patients) and retroareolar ultrasonography should be performed in all cases of pathologic nipple discharge. Galactography, and more recently, magnetic resonance imaging, can be helpful in identifying an involved duct or papilloma. Patients with a palpable mass or a mass identified on imaging should undergo needle biopsy to exclude carcinoma, says the CMAJ article.

Milky discharge in patients who are not pregnant or lactating (galactorrhea) is often due to medications. Milky nipple discharge from both breasts is appropriate during pregnancy and lactation, and it can last up to one year after delivery or after breast-feeding has stopped.

In patients who are not pregnant but are lactating should have prolactin levels checked to exclude endocrine disorder (> 20 ng/mL). Medications such as:

  • Psychotropics, antihypertensives (e.g., reserpine, methyldopa, verapamil),
  • Opiates, prokinetics (e.g., metoclopramide) and
  • H2-blockers (e.g., cimetidine) can cause galactorrhea.

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Cancer Drugs are Being Abused by Bodybuilders

Kin Coulee Park, Medicine Hat: A beautiful mild evening look in January. (Dr. Noorali Bharwani)
Kin Coulee Park, Medicine Hat: A beautiful mild evening look in January. (Dr. Noorali Bharwani)

I was surprised when my attention was drawn to an article in MedPage Today titled “Bodybuilders Bulk Up Using… Cancer Drugs.” Should I be surprised?

“The only thing that should surprise us is that there are still some things that can surprise us,” said Francois de La Rochefoucauld (1613 – 1680). He was a noted French author with a clear-eyed, worldly view of human conduct that indulges in neither condemnation nor sentimentality.

Abusing cancer drugs to muscle up your body does call for condemnation. As we know, performance-enhancing drugs are substances used by athletes to improve their performances.

The phrase has been used to refer to several distinct classes of drugs: steroids, human growth hormone, stimulants (caffeine, amphetamine, methamphetamine), painkillers (simple analgesics to narcotics), sedatives, diuretics, blood boosters and others.

What about abuse of cancer drugs?

“Arimidex, also known by its chemical name anastrozole, is an aromatase inhibitor – a breast cancer drug. While steroids and growth hormone make headlines when athletes abuse them, breast cancer drugs are a lesser-known staple of doping regimens, for athletes and ‘weekend warriors’ alike,” says the article. Even common anti-estrogen breast cancer drugs like tamoxifen and exemestane are abused.

The article says these breast cancer drugs are on the prohibited performance-enhancing drugs lists from the U.S. Anti-Doping Agency and the World Anti-Doping Agency. But somehow some athletes manage to find them. How can this be stopped? A difficult question to answer.

Those athletes who abuse performance-enhancing drugs do eventually suffer from side effects. Hopefully, they will learn early in their lives that the best way to improve your health is by exercising regularly, eating healthy and not abusing performance-enhancing drugs. I hope somebody is listening.

Talk to you again soon. Keep smiling.

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