Breast Cancer: a Functional Medicine approach
Full disclosure, I am NOT an endocrinologist. I have no expertise in the arena of cancer diagnosis, nor treatment. However, I do have some general knowledge on the topic as it relates to hormones and with it being October, Breast Cancer Awareness Month, I feel compelled to share. May this information serve as a beacon of hope, a glimpse into integrative and alternative methods of care, and a spark of empowerment to all who read--because chances are, you are personally connected to someone who has/had breast cancer.
According to The National Breast Cancer Foundation, 1 in every 7 women will be diagnosed with breast cancer in her lifetime. It is the most common type of cancer in women with risk increasing after age 30. In fact, over 20,000 cases of breast cancer reported annually occur in women under the age of 40. This demographic is severely neglected by current routine screening protocols.
But before we get into screening, let's lay the ground work. What is cancer? Failure of the Immune System to rid the body of abnormal cells before they take root and grow. You see, every cell in our bodies is encoded with a "suicide" feature. When the cell becomes unhealthy, it is expected to terminate itself (apoptosis). When this process fails, the once oxygen metabolizing cell becomes anaerobic and instead survives by stealing glucose and blood supply from surrounding tissues. With the resources to grow, this "sick" cell becomes a cluster of cells--a tumor. If said tumor continues to grow, spread, damage DNA, and starve surrounding tissues, we call it cancer.
How do hormones play a role in breast cancer? The simplest and most straight-forward explanation boils down to estrogen and progesterone imbalance. The most common depiction is estrogen dominance. Basically, estrogen promotes cell proliferation while progesterone inhibits cell growth. So, an excess/dominance of estrogen can be a driving force in DNA damage and uncontrolled growth of tumor cells.
In women, estrogen is produced mainly in the ovaries. During the follicular phase of the menstrual cycle, follicle stimulating hormone (FSH) stimulates the ovary to develop the egg (follicle) which produces estrogen. Men produce estrogen as well, but at lower levels than women. Males secrete estrogen from the adrenal glands and the testes. These forms of estrogen are referred to as endogenous, meaning they are made in the body.
However, "wether you make it (endogenous), or you take it (exogenous), you have to get rid of it." So it is important to also consider outside, or exogenous, sources of estrogen. Unfortunately, there are many substances in our modern environment that mimic estrogen (usually referred to as xenoestrogens). Preservatives, pesticides, additives, plastics, chemicals--found in our food, water, personal care products. Hormone replacement therapy (HRT), bio-identical hormones and oral contraception pills (as well as all other forms of hormonal birth control) are also examples of exogenous hormones that often times drive estrogen dominance. If each estrogen where a vehicle, this would be rush hour traffic on the roads. And the xenoestrogens would be "vehicles" that typically don't belong on the highway--bicycles, mopeds, rollerbladers, etc.
Now, remember the last part of that quote? You have to get rid of it. This means it is crucial to also evaluate estrogen detoxification pathways. In this example, the highway is three lanes. The three lanes, or estrogen detox pathways are: CYP1B1, CYP3A4, and CYP1A1. If any one of these pathways is suffering, estrogen is shunted down the other two and we have a traffic jam. Furthermore, some of these lanes are safer than others. For instance, CYP1B1, aka the 4-OH pathway, leads to Quinone production. When Quinones are not neutralized they cause DNA damage and have high potential for becoming carcinogenic (cancer causing). Some people have a genetic predisposition to metabolizing estrogen via this pathway, which puts them at greater risk for estrogen-driven cancer.
If we take it a step further, there are three types of estrogen too.
Estradiol: this form is the highest during ovulation as it is made from the developing egg. it is the strongest form and is good for the heart and bones.
Estriol: this form is present during pregnancy, or when estrone is broken down. It is the weakest form, and is good for your skin.
Estrone: this form is predominate during menopause. It has an affinity for breast tissue and in the wrong quantity and environment, it is dangerous.
The body has two estrogen receptors. Alpha and beta. Alpha receptors lead to breast cell proliferation and beta receptors prevent breast cancer. Unfortunately, estrone (predominate during menopause and potentially dangerous) has a 5:1 favorability to bind to alpha (proliferation) receptors--two factors leading to multiplication of breast cells. Beta cells (breast cancer preventing) are favored by estriol (the weakest form of estrogen). These characteristics makes it so vitally important that, when breast cancer is a concern, complete hormone panels are obtained--panels that look at all the forms of estrogen, and progesterone as well as the three pathways of metabolism (and really, DHEA, testosterone, cortisol).
This brings us full circle, back to the topic of screening according to the American Cancer Society, when breast cancer is detected early, the 5 year survival rate is 99 percent. Unfortunately, current screening guidelines are confined to mammograms (sometimes with adjunct MRI) starting at 45. As state previously, over 20,000 cases of breast cancer reported annually occur in women under the age of 40. That is not the only limitation to mammograms. They also have a high rate of false positives, causing undue stress and unnecessary invasive cancer treatments while subjecting patients to pain and considerable cumulative radiation exposure. The New England Journal of Medicine published a recent study reporting that 1.3 million US women have received unnecessary and invasive cancer treatments over the last 30 years. Not only that, but the physical aggressiveness of the mammogram itself can stimulate growth and metastasis of any present cancer. Undoubtedly, there are situations in which mammograms are necessary. However, early detection measures can be better had via other screenings. There ARE non-invasive, pain-free, and effective forms of screening available.
One form is laboratory screening. Hormone testing (via saliva, serum, and--my personal favorite: dried urine) is an effective way to uncover hormone imbalances and track progress. As we covered, a balance in estrogen and progesterone is key to controlling cell proliferation. It is highly likely for hormone imbalance to proceed cancer formation. Furthermore, the test itself will no exacerbate any issues that may be present (saliva and dried urine testing does not even require a blood draw, so fear of needles is covered as well).
Another safe, adjunctive screening method that is helpful in the diagnosis and tracking of response to various health care approaches is thermography. Thermography is a radiation-free, contact-free procedure with greater than 97% sensitivity. A University of Wisconsin study shows 70% of tumors can be identified via thermogram 8-10 years PRIOR to that of a mammogram! Thermography can determine whether or not a tumor is metabolically active, and can actually detect the growth of cancer cells BEFORE a tumor is even formed (thanks to visibility of vascular activity and measures of inflammation).
If breast cancer runs in your family, you know you have a genetic predisposition to breast cancer, or you simply want to be as proactive in preventative care as you can, I would love to visit with you and further explore a plan that is ideal for you :)
Sources: National Breast Cancer Foundation, Breast Thermography International, An Integrative Approach to Breast Cancer Precision Analytical Inc