Understanding Breast Cancer Risks, Prevention, and Treatment Choices

Jonathan Vellinga, MD -

Breast cancer, the second most common cancer in women, is a complex disease. The more you know about it, the healthier you can be. Whether you’re actively fighting breast cancer or just want to protect yourself and those you love, information is power.


Getting a breast cancer diagnosis can be an emotional and complicated time. At the Temecula Center for Integrative Medicine (TCIM), we understand those feelings. Our highly trained professionals, including our new provider Maggie Gama, MD, will help you every step of the way. Dr. Gama has a lifelong interest in health and healing. As a compassionate diagnostician, she can explain the many functional and integrative treatments available to you. Dr. Gama has an in-depth knowledge of clinical pathology, oncology, and functional medicine. This gives her a unique edge in treating difficult and challenging cases. Her goal for each patient is to restore and maintain their health, as well as empower them to develop a healthier lifestyle. Along with her respect for the important role of western medicine, Dr. Gama believes strongly in the synergy of other medical disciplines and holistic treatments to help restore mind, body, and spirit.


Understanding Breast Cancer Risks, Prevention, and Treatment Choices

What is breast cancer?


Breast cancer develops in the cells of the breasts, and it can occur in both women and men. Increasing patient awareness about breast cancer has improved screening and treatment rates, which is helping to provide a steadily declining death rate from breast cancer (1).


It begins when breast cells begin to grow abnormally and divide faster than healthy cells. As cells accumulate, they can form a lump or mass in the breast that can become cancerous. Breast cancer may also metastasize through the lymph system to other parts of the body (1).


Breast cancer is caused by a complex interaction of a patient’s genetics, hormone balance, lifestyle, and environmental exposures. About 10% of breast cancers are caused by inherited gene mutations such as BRCA1 or BRCA2, which substantially increase breast cancer risk (1).


Most women with breast cancer have no known risk factors, other than being female. Some risk factors you cannot change, but there are several important ones that you can change (1).


Risk factors you cannot change include:

  • Increasing age

  • Personal history of breast cancer or breast conditions

  • Family history of breast cancer in mother, sister, or daughter

  • Beginning menstruation before age 12

  • Beginning menopause at an older age

  • Never being pregnant

  • Having your first child after age 30

Risk factors you can control and moderate include:

  • Being seriously overweight

  • Not getting regular physical activity

  • Drinking alcohol

  • Having radiation exposure to the chest area

  • Not breastfeeding

  • Taking hormone therapy to treat menopause symptoms

  • Taking hormonal birth control methods

  • Having a long-term imbalance of hormones, especially estrogen


What are the symptoms of breast cancer?


  • A lump or thickening in a breast or underarm area that does not feel like surrounding tissue

  • Changes in the shape, size, or appearance of a breast, including the skin over the breast

  • Peeling, crusting, flaking of the nipple or breast skin

  • An inverted nipple that’s new


How is breast cancer diagnosed?


  • Both breasts and the lymph nodes in your armpits are examined for lumps.

  • Mammograms are used to screen for breast cancer and provide further evaluation of abnormal tissue.

  • Ultrasound provides more detailed images of deep breast tissue.

  • Tissue extracted during a biopsy is analyzed for cancer cells, their type and grade, and whether cells have hormone receptors, which help determine treatment options.

  • MRI can provide detailed images of the breast interior by using an injection of dye.

  • A blood test can identify BRCA1 or BRCA2 genes.


What are the standard treatments for breast cancer?


Treatment is determined by the type, stage, grade, size, and hormone sensitivity of the cancer. Conventional or standard treatments for breast cancer may include (1):


  • Surgery to remove the cancerous tumor (lumpectomy), the entire breast (mastectomy), or lymph nodes to determine if cancer has metastasized (sentinel node biopsy).

  • Chemotherapy, which may be used before surgery to shrink a tumor or after surgery to reduce the risk of recurring cancer, uses drugs to destroy aggressive cancer cells and decrease symptoms.

  • Hormone therapy can block the hormones that certain cancers depend on (estrogen receptor positive or progesterone receptor positive breast cancers). It can be used before or after surgery to reduce the chance of cancer recurring. If cancer has metastasized, it can help shrink and control it.

  • Radiation therapy can kill cancer cells.

  • Targeted therapy drugs attack abnormalities within breast cancer cells without harming healthy cells.

  • Immunotherapy uses the immune system to interfere with the process that lets cancer cells reproduce.

Many of these treatments do come with unpleasant side effects, most of which can be managed in various ways.


Can functional medicine help treat breast cancer?


While functional, integrative, and/or complementary therapies do not directly treat cancer, they are helpful in (1, 2, 3, 5, 7):


  • Reducing the severity of some of the side effects and symptoms of conventional treatment

  • Improving the effectiveness of conventional treatments

  • Enhancing wellness

  • Improving quality of life

  • Increasing adherence to treatment

  • Improving emotional and physical health both during and after treatment ends


As many as 75% of breast cancer patients use some type of integrative and complementary medicine (ICM). ICM considers the physical, mental, social, spiritual, and environmental influences on health, treating the whole person rather than just the disease.


As research is proving the benefit of many integrative medicine therapies, cancer-treatment centers are increasingly adding ICM and functional medicine methods to their treatment programs. Trained staff such as oncology nurses or social workers are available to provide mind-body therapies, making integrative methods more readily accessible to patients (7).


If you’re considering functional therapies, discuss them with your oncologist first. This includes taking vitamins and other supplements as some products can interfere with other cancer treatments. For example, St. John's wort can interfere with some cancer drugs (5).


Complementary Therapies


Functional medicine approaches can be used on a wide variety of physical and psychological problems that can occur during breast cancer treatment. Some of the most common approaches include:


Medicinal plants, and Nutrition supplements - Side effects of cancer treatment can be helped with diet and nutrition supplements including special diets, herbs (botanicals), probiotics, and vitamins and minerals (4, 6). Chemotherapy side effects can be helped with medicinal plants. They also have been shown to improve effectiveness, reduce toxicity, and manage pain (3). For example, ginger, mistletoe, and cannabis sativa have been used effectively in treating nausea and vomiting, radiotherapy-induced skin rashes, and stomach disorders. The flower Calendula officinalis helps radiotherapy-induced dermatitis. Arnica Montana is used for pain management (3). Cannabinoid use has been successful in relieving several types of pain: chronic neuropathic pain, mixed chronic pain, and generic pain. However, it has little or no effect on acute pain (3). Several studies report that cannabis may have a positive interaction with opioids in treating pain. This could help patients eliminate or reduce the dose of opioids, which are currently overused and the frequent cause of overdose deaths (3).

Acupuncture, Acupressure, and Massage - Side effects from conventional treatment can cause pain, fatigue, and problems with physical functioning, including sleep problems. These can be successfully addressed with acupuncture, acupressure, massage, spinal manipulation (7), and biofeedback (4, 5). Nausea and vomiting caused by chemotherapy were effectively treated by acupressure and electroacupuncture without interfering with conventional treatments (3, 5, 7). Persistent fatigue and weakness after conventional treatments were reduced with acupuncture and acupressure and acupressure produced significant improvement with sleep. Hot flashes were reduced more with acupuncture than medication and the benefits lasted up to six months (3, 5). Chronic and post-operative pain was reduced better with acupuncture when compared to pain medications. Finally, acupuncture and acupressure are effective in treating depression and anxiety and improving quality of life without side effects (3).


IV Therapies and Ozone - Improvements in healing were seen with the use of intravenous (IV) high-dose vitamin C and/or ozone. These IV therapies help the body heal by supplying extra oxygen, which boosts the immune system, red blood cell production, tissue healing, mitochondrial function, and decreasing inflammation and scar tissue (5). A growing number of preclinical studies show how high-dose vitamin C can benefit cancer patients. These studies are also providing guidance about which patients are most likely to respond to vitamin C (8). It is the IV administration of vitamin C (instead of oral) that provides significantly higher blood concentrations that are needed for improved healing. However, caution should be taken with cancer patients who have impaired kidney function because of their inability to clear high doses of vitamin C (10).


Intravenous therapies have been shown to help the body heal by:


  • Supplying extra oxygen, which boosts the immune system, red blood cell production, and tissue healing (5)

  • Reducing inflammation and scar tissue (5, 10)

  • Enhancing the immune system

  • Improving quality of life for cancer patients (8, 10)

  • Reducing pain (8)

  • Protecting normal tissue from the toxic effects of chemotherapy (8, 10, 11)

  • Improving the actions of radiation therapy and standard chemotherapies (8, 10, 11)

  • Improving symptoms that are related to antioxidant deficiency, disease processes, and the side effects of standard cancer treatment (9, 10, 11).


Fatigue can be a major problem for people undergoing cancer treatment and many therapies are available that lessen the effects of fatigue in addition to those mentioned above. These include gentle exercise (such as walking, swimming, yoga, or tai chi) (5, 6) and stress reduction techniques (muscle relaxation, visualization, spending time with family and friends).


Mental health concerns are another common struggle for those who have been diagnosed with cancer (mood disorders, depression, anxiety, and quality-of-life issues). These can be mitigated in a variety of ways including with the regular use of yoga, meditation, relaxation techniques, passive music therapy (4, 5, 7), and stress reduction techniques. Talk therapy, joining a support group, or journaling can help you express your emotions about having cancer. Keep your support system of family and friends close as they can provide important emotional and physical support (1).


Many of these therapies that are beneficial in addressing mental health concerns have proven to be effective in providing a range of benefits.


  • Mind-body therapies provide psychological benefits and improve health functioning, with fewer symptoms. They include mindfulness, Qi gong, yoga, tai-chi, and meditation (3). Tai chi also helps improve balance and stability, reduce back pain, and improve quality of life (6).

  • Stress-reduction techniques improve anxiety, depression, and overall quality of life (3) in addition to improving immune system function through reduced stress levels.

  • Meditation can significantly improve fatigue, inflammation, blood pressure, and physical functioning better than standard care. It also is effective in treating anxiety, depression, stress, sleep problems, quality-of-life (4, 6). Far more cost-effective than traditional counseling or psychotherapy, meditation can achieve similar results to psychotherapy and has good patient compliance. A study of women doing meditation, tai chi, and yoga also had a modest effect on reducing inflammation and boosting the immune system (3).

  • Massage improves mood (6).

  • Aromatherapy uses fragrant oils to improve mood and reduce pain, nausea, stress, and depression. Although generally safe, these oils can cause allergic reactions, headaches, and nausea in some people (5).

  • Passive music therapy is effective in reducing anxiety and depression during radiation therapy, chemotherapy sessions, and after surgery (5).


Many women undergoing breast cancer report feeling better and more empowered to fight their disease when they focus on improving their overall health by addressing the physical, emotional, social, spiritual, and environmental influences on their health (5).


Given the high level of evidence of benefits and the low level of risk, these therapies can be an important care option for many patients, especially when their symptoms are poorly controlled (7).


Unfortunately, there are many therapies that have not been scientifically evaluated, and some can actually do more harm than good. To help patients make good choices about ICM, the SIM has evaluated more than 80 ICM therapies and ranked them according to effectiveness with letter grades. You can get more information about specific treatments at breastcancer.org.


Can you reduce your risk of breast cancer?

Numerous studies have shown that making healthy choices about what you eat and drink, and how much physical activity you get, can reduce cancer risk (6). Lifestyle choices that can reduce your risk of developing breast cancer include (13):


  • Limit or eliminate alcohol; even small amounts increase your risk.

  • Eat a healthy diet that maximizes vegetables and fruits, whole grains, and limits red meat, processed foods, and soft drinks. The Mediterranean diet continues to be one of the healthiest and easiest to follow.

  • Get to and maintain a healthy weight.

  • Get regular exercise, which helps maintain a healthy weight. A good goal is to get at least 150 minutes of activity a week. You’ll probably need more than that to lose weight, but any physical activity helps prevent disease. It is even more beneficial to add strength training at least twice a week.

  • Breastfeed your infants; the longer you can, the greater your protection.

  • Avoid postmenopausal hormone therapy. If you must take it, use the lowest dose that works for you, and limit the length of time you take hormones. There’s also a slightly increased risk of cancer if you take birth control pills or use an IUD that releases hormones. Again, limit the length of time you use them.

  • Check your breasts and underarm area regularly for lumps, masses, or other changes. Ask your doctor when to start getting screening mammograms.

Many of the lifestyle choices you make every day can either increase or reduce your risk of developing breast cancer. If you have breast cancer, it is helpful to understand all your treatment options. The caring providers at TCIM will help you understand your options, and their risks and benefits. We are privileged to help you choose the best treatment for your individual needs.


 

Jonathan Vellinga, M.D.

Jonathan Vellinga, MD is an Internal Medicine practitioner with a broad interest in medicine. He graduated Summa cum laude from Weber State University in Clinical Laboratory Sciences and completed his medical degree from the Medical College of Wisconsin.​


Upon graduation from medical school, he completed his Internal Medicine residency at the University of Michigan. Dr. Vellinga is board-certified with the American Board of Internal Medicine and a member of the Institute for Functional Medicine.

info@tcimedicine.com

951-383-4333

www.tcimedicine.com


 

Sources:

1. Mayo Clinic. (2021, Oct) Breast cancer. {https://www.mayoclinic.org/diseases-conditions/breast-cancer/symptoms-causes/syc-20352470}

2. Taxman E.T., Conlon E.D., Speers A., et. al. (2016, March) Chemotherapy and Functional Medicine in a Patient with Metastatic Breast Cancer: A Case Report. National Institutes of Health. {https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4818066/}

3. Magno S., Filippone A., Scaldaferri A. (2018, April) Evidence-based usefulness of integrative therapies in breast cancer. Translational Cancer Research. {https://tcr.amegroups.com/article/view/19966/html}

4. BreastCancer.org (2017, April) Society of Integrative Oncology Updates Guidelines on Using Complementary Therapies During and After Breast Cancer Treatment. {https://www.breastcancer.org/research-news/guidelines-updated-for-complementary-tx}

5. MedlinePlus (2020, Feb.) Integrative medicine for cancer treatment. National Library of Medicine. {https://medlineplus.gov/ency/patientinstructions/000932.htm}

6. National Institutes of Health, National Center for Complementary and Integrative Health. (2021, April) Complementary, Alternative, and Integrative Health: What’s In a Name? {https://www.nccih.nih.gov/health/complementary-alternative-or-integrative-health-whats-in-a-name}

7. Greenlee H., DuPont-Reyes M.J., Baineaves L.G., et. al. (2017, April) Clinical practice guidelines on the evidence-based use of integrative therapies during and following breast cancer treatment. CA Cancer J. Clin. {https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5892208/}

8. Cantley L. & Yun J. (2020, Jan) Intravenous High-Dose Vitamin C in Cancer Therapy. National Cancer Institute. Retrieved 2-23-22, {https://www.cancer.gov/research/key-initiatives/ras/ras-central/blog/2020/yun-cantley-vitamin-c}

9. Klimant E., Wright H., Rubin D., et.al. (2018, April) Intravenous vitamin C in the supportive care of cancer patients: a review and rational approach. National Institutes of Health, National Library of Medicine. Retrieved 2-23-22, {https://pubmed.ncbi.nlm.nih.gov/29719430/}

10. Carr A.C. & Cook J. (2018, Aug) Intravenous Vitamin C for Cancer Therapy – Identifying the Current Gaps in Our Knowledge. Frontiers in Physiology. retrieved 2-23-22, {https://www.frontiersin.org/articles/10.3389/fphys.2018.01182/full}

11. Clavo B., Perez J.L., Lopez L., et.al. (2004, June) Ozone Therapy for Tumor Oxygenation: A Pilot Study. National Institutes of Health, National Library of Medicine. Retrieved 2-23-22, {https://www.ncbi.nlm.nih.gov/pmc/articles/PMC442111/}

12. Seymour T. (2020, May) What is ozone therapy? Benefits and risks. Medical News Today. Retrieved 2-23-22, {https://www.medicalnewstoday.com/articles/320759}

13. Mayo Clinic (n.d.) Breast cancer prevention: How to reduce your risk. Retrieved 2-23-22, {https://www.mayoclinic.org/healthy-lifestyle/womens-health/in-depth/breast-cancer-prevention/art-20044676#:~:text=Be%20physically%20active.,at%20least%20twice%20a%20week}