Breast Cancer in the News - Summer 2008
Breast Cancer Alliance Medical Advisory Board members Dr. K.M. Steve Lo of the Bennett Cancer Center, Dr. Barbara Ward of Greenwich Hospital and Dr. Alison Estabrook of Beth Israel Hospital offer their comments on this quarter’s breast cancer news:
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Dr. KM Steve Lo |
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Dr. Barbara Ward 
Dr. Alison Estabrook
A new study by the German Cancer Research Center, in collaboration with the University Hospitals in Hamburg-Eppendorf, suggests that high levels of Vitamin D can protect against breast cancer
Dr. Lo: I think that the Vitamin D issue is very interesting, but we need more data to confirm it and understand why. These retrospective studies can be very wrong sometimes. I would not recommend that all women take extra Vitamin D specifically for breast cancer prevention. I do recommend it for women with osteopenia/osteoporosis or those at risk for osteoporosis (women with low body weight, a family history of osteoporosis, a history of bone fractures, smokers).
A new study by Jasmine Q. Lew, a fourth-year medical student at the University of Chicago working with the National Cancer Institute, goes further on the subject of alcohol, saying that alcohol fuels ER+/PR+ breast cancer. Can women ever enjoy a drink?
Dr. Estabrook: Drinking too much causes cirrhosis of the liver which increases estrogen levels. Women can certainly enjoy one drink a day without fearing higher estrogen levels.
Dr. Lo: It is clear from many past and recent studies that the risk of breast cancer increases with the amount of alcohol consumed. But, alcohol also has a benefit in terms of lowering the risk of cardiac disease. There is also data from the Mayo clinic and other institutions that indicate high folate intake (about 400 micrograms per day) appears to negate the effects of alcohol on breast cancer. So I've also advised my patients to drink alcohol in moderation (no more that 3-4 drinks per week) and to take at least 400 micrograms of folate per day (found in most multivitamins).
Is benign proliferative breast disease the next thing to worry about? As part of the Women’s Health Initiative study, Dr. Tom Rohan of the Albert Einstein College of Medicine has identified long term estrogen-only hormone therapy as a possible precursor of breast cancer 10 years down the road.
Dr. Estabrook: Proliferative Disease can be a precursor to breast cancer, and it can be linked to estrogen usage, but, as with all things in medicine, one has to weigh the benefits of the estrogen use and the risk of breast cancer. So, if the hot flashes and sleeplessness and lack of concentration are overwhelming, then the woman can stay on estrogen and get frequent breast checkups.
Are we worried about too many things?
Dr. Estabrook: It depends on the person. I think we should worry about real stuff: weight gain, hormones and antibiotics in foods; smoking…
Dr. Ward: The advice and study findings can all get a bit overwhelming and at the end of the day, “balance” appears to be the answer. Because calcium and Vitamin D are important anyway, it is an easy addition if not already being taken. Regarding alcohol, it appears clear that the more we drink, the higher the risk, so we need to make choices. At the same time, moderation is the key. A person cannot necessarily alter her propensity to develop benign proliferative disease, and I think we should have a good reason to be on HRT in the first place, recognizing that severe hot flashes and sleeplessness can be good reasons. Because this epidemiologic information comes in waves and even fads, maintaining a balanced, healthy diet with regular exercise and some alcohol, if desired, is what I discuss with patients.
