Strategies to Reduce the Risk of Hormonally-Related Cancers
Read the section on the Foundations of Health and Healing. These principles apply to every aspect of our health and the issue of cancer prevention is no exception. Then consider the section on the Fundamental Functions of Health and Healing. This section speaks to the background processes that support optimal health, the symptoms, signs and tests that detect dysfunction, and the strategies to restore optimal function. These include gastrointestinal function, hepatic function, reduction of toxic load, hormonal balance, glucose metabolism, single carbon metabolism and immunologic function, oxidative stress and inflammation.
When Considering Hormonal Therapy:
Consider the use of natural hormones. This means hormones that are chemically identical to the hormones your own body makes.
Use transdermal estrogens when possible. This avoids the first pass through the liver that can have adverse metabolic, endocrine and hematologic effects.
Transdermal estradiol is the preferred form of estrogen. This can be prepared individually by a compounding pharmacist or it can be obtained in a commercially prepared patch (Vivelle) or a commercially prepared cream.
I strongly recommend avoiding artificial progesterone like drugs (progestins) and using natural progesterone. The dose is adjusted on an individual basis. (Read the Chapter on Progesterone)
Use the lowest dose possible to achieve symptom control and or the desired metabolic effects.
Reevaluate the dose you are taking and the need for continuation of HRT on a regular basis.
Measure and replace the anabolic hormone DHEA if the level is low. It appears that DHEA has breast protective effects. I do not advocate the use of DHEA without measuring levels prior to use to determine the need or measuring levels during use to determine the appropriate dosing.
Optimizing the Metabolism of Hormones:
The strategies outlined here are valuable for all women. There is value for the woman who is still menstruating, the post-menopausal woman using HRT and the post-menopausal woman who chooses not to use HRT.
The metabolism of estrogen yields secondary molecules, which are called estrogen metabolites. The quantity of the individual metabolites you produce may tell us something about your risk of developing cancer. This work is preliminary but useful.
There are tests that reveal the way you are metabolizing estrogen. Some estrogen metabolites are considered favorable and associated with a decreased incidence of breast cancer (2-alpha-hydroxyestrone). Other metabolites are considered undesirable and associated with an increased incidence of breast cancer (16-alpha-hydroxyestrone). The ratio of 2/16 alpha hydroxyestrone may be useful in predicting risk and guiding prevention strategies. This is a urine test that is now commercially available. It is not precise and I do not recommend it at this time.
Another estrogen metabolite that may be significant is 4-hydroxyestrone. When this metabolite is oxidized it can produce damage to DNA (our genetic material). At this time the research implicating this molecule and its oxidized by-product is preliminary. There are no commercially available tests to measure it. I think the concept of oxidized metabolites causing DNA damage is intriguing. It speaks to the potential value of measuring for oxidative stress and correcting it with avoidance, dietary change and supplementation. There is now a test to measure oxidative stress available through our practice. Again, fruits and vegetables are important in minimizing oxidative damage in our bodies.
Estriol is one of the three molecular forms of estrogen in humans (estrone, estradiol and estriol). It is the least potent form of estrogen. Asian women eating a traditional diet have lower rates of breast cancer. They also have higher levels of Estriol compared to North American women where the breast cancer rates are significantly higher. Estriol may be a marker for the transformation of 16-alpha-hydroxyestrone (a less favorable estrogen metabolite) into a more benign form of estrogen.
In women who have a particular vulnerability to Hormone Related Cancer we can use Estriol as the sole form of replacement therapy to relieve symptoms. The dose range is 0.5-4 mgs given by mouth, applied to the skin or applied as a vaginal suppository. The dose is adjusted to provide control of disabling symptoms related to menopause. This is commonly used in other countries as a form of HRT. We have had excellent results with a dose as low as 0.5 mg of Estriol applied vaginally three times per week. This is equivalent to 1% of the dose of Premarin or Estradiol used in conventional hormone replacement therapy.
Maintaining a reasonable body weight and exercising regularly will improve the way in which your body handles the metabolism of the hormones you make and the hormones you take. Five to six servings of fresh fruits and vegetables per day really make a difference in risk to breast cancer and other cancers; JUST DO IT!
The Brassica family (cruciferous) vegetables include cauliflower, broccoli, brussel sprouts and cabbage. Three to four servings per week have been shown to decrease the risk of sex hormone related cancers. They contain many protective chemicals. Indole-3-carbinol is one that has been studied and shown to be beneficial. One can supplement with indole-3-carbinol or its derivative di-indolylmethane. There is a product called ONCOPLEX, which can be purchased without a prescription. Oncoplex supports the hepatic transformation of estrogen by the liver. It helps create a favorable balance of the estrogen metabolites or by-products. The recommended dose is on capsule per day.
Flaxseed can be incorporated into the diet and may be protective against the hormonal cancers. Supplementation improves the 2/16-alphahydroxyestrone ratios. I suggest using 1-2 tsp ground and placed in a health drink or sprinkled on a salad. Organic flaxseed can be purchased in many health food stores.
Soy Isoflavones can be obtained by eating soy-based food or from supplements. The best types of soy-based foods are the traditional ones such as tofu, miso soup and tempeh. There are people who do not find these foods palatable. In that case isoflavones can be obtained as supplements. Isoflavones provide protection from breast cancer by reducing the stimulatory effect of estrogen on the estrogen receptor and by improving the metabolism and excretion of estrogen and its metabolites. I recommend a dose of 30-60 mgs of isoflavones per day. This mimics the dose in the Asian diet and is safe. The effect and safety of higher doses is not known. I have used a variety of supplement sources. The ones that I favor are: A soy based health drink such as Ultranutrient 360.
There are observations that iodine may be useful in promoting the metabolism of 16-alpha-hydroxyestrone to a more benign molecule (estriol). Sea Kelp is a readily available food product and supplement. A concentrated iodine supplement called Iodorol can be taken in a dose of 1 tablet three times per week.
Reducing Oxidative Stress:
We think that oxidative damage to the DNA of normal breast cell genetic material is one of the causal factors in breast cancer. A balanced antioxidant supplement is valuable in preventing oxidative damage.
The general supplement I recommend is Multi t/d in a dose of 1 capsule two times per day. This provided an excellent multi-vitamin with a balanced antioxidant supplement profile.
Green tea is readily available. It is rich in antioxidants and may be useful in preventing hormonal cancers. Green tea extract can be used as a substitute for those who do not like green tea or are interested in avoiding caffeine.
Lycopene is a carotenoid found in tomato products, watermelon and red grapefruit. It has been shown to provide protection from prostate cancer. There have been no studies in women. Nevertheless, I believe that supplementing with Lycopene is another safe and inexpensive strategy for minimizing risk.
Pycnogenol is a powerful antioxidant derived Pine Bark extract. The recommended dose is 50 mg capsules, two in the morning and one in the afternoon.
Excess alcohol ingestion is associated with an increased risk to breast cancer. Alcohol should be limited to 3-4 servings per week. A serving size is 3-4 ounces of wine, 8 ounces of beer or 1 ounce of whiskey.
Supplements that have a unique effect:
There is an inverse relationship between Vitamin D blood levels and hormonal cancers. The greater the Vitamin D blood levels the lower the incidence of cancer. Since we have become phobic about being in the sun, it is wise to use a supplement of about 1,000-2,000 units per day.
Strategies for Preventing Injury to our Genetic Material:
Our genetic material is undergoing damage all the time. We have mechanisms to repair the genetic damage. One theory of cancer induction is that genetic damage that goes unrepaired can lead to abnormal cell activity. We think that injury to our DNA is one of the mechanisms that is involved in hormonally related cancers. There is marker for DNA damage and adequacy of DNA repair that is used by researchers. They study the size of the nuclei of one type of our white blood cells, the lymphocyte. When the nuclei are smaller than expected this is referred to as micronucleation. This has become a fairly standard way to study the phenomena of DNA injury and the substances that enhance DNA repair. There are good studies relating Homocysteine levels to genetic injury and repair. Please read the section on Homocysteine.
Optimizing Metabolic Function:
Optimal metabolism refers to the way in which we metabolize glucose, our major energy source. The efficiency with which we metabolize glucose effects our hormonal balance, our immune function, the rate at which we age and our risk to chronic diseases such as cancer. Please read the section on Optimal Glucose Metabolism.
Optimizing Immune Function:
Our immunologic system is important in prevention of cancer development and in survival once a cancer has developed. This is a very complex system. One area of study is the function of Natural Killer Cells. There is growing scientific evidence that there is an inverse relationship between the amount and the quality of Natural Killer cell function and cancer risk. Our section on optimizing immunologic function addresses this issue and includes strategies for improving NK cell quantity and quality.
Simple actions to take include:
- Reducing intake of sugar and other refined food products in your diet
- Emphasize a diet that is high in fresh unprocessed fruits and vegetables, the more colorful and varied the better.
- High-risk people should consider Natural Killer Cell count and function tests. Special therapies to improve NK count and function include Immucare I, two capsules twice daily between meals.
It is important to remember that adequate sleep is an important factor in immunologic function. Sleep deprivation results in compromised immune function. Read the section on Restorative Sleep and Rest. Use the information if it applies to you.
Reducing the Toxic Burden:
Our bodies make hormones and metabolites of hormones that can increase our risk of hormonally related cancers. This issue has already been discussed. There are xenobiotics (contaminants from our environment) that increase our risk of cancer. Some of these products are the artificial hormones we ingest as prescribed medications. Others are the artificial hormones we ingest with the food that we eat. Still others chemicals are not hormones but may look like hormones to our body and stimulate hormone receptors, thus increasing cancer risk. There are chemicals that induce cancer by promoting injury to our genetic material. This makes our cells more vulnerable to cancerous transformation. These issues are discussed in the sections on Detoxification and Cleansing and Reducing Toxic Load.
Simple actions to take include:
- Use a good water filtration system
- Emphasize foods that are produced by organic methods
- Reduce or eliminate the toxic substances used in the house, lawn and garden.
- Consider supplements that enhance hepatic function such as Ultra Clear Plus, UltraInflammex, LVR, Multi t/d and Milk Thistle.
There are toxic materials that seem to have an increased association with breast cancer. Cadmium is a heavy metal and a common environmental pollutant. It stimulates the estrogen receptors, acting as an estrogen mimetic. The toxic burden of cadmium and other heavy metals can be measured by doing a Heavy Metal Challenge Test. Industrial materials such as Bisphenol A and Phthalates can act as estrogen mimetics as well. We can measure for a burden of these and other industrial pollutants with a Urinary Industrial Pollutant Assay. Once identified, these products can be avoided and removed from the body.
Tests to Consider:
- Standard hormone measurements: Estradiol, Progesterone, DHEA-s, Sex Hormone Binding Globulin, Testosterone.
- Urine test of Estrogen Metabolites; 2-alpho hydroxyl estrone: 16-alpha hydroxyl estrone ratio
- Estriol serum level
- Tests for oxidative stress
- Glucose/Insulin ratios
Supplements to consider:
- Multi t/d: an enhanced multivitamin to prevent oxidative damage in a dose of 1 capsule two times per day with meals.
- Pycnogenol a product that has strong antioxidant and anti-inflammatory activity, (50 mgs, two in the morning and one in the afternoon), and Green Tea Extract in a dose of one capsule two times per day with meals.
- Oncoplex; one daily to optimize the metabolism of estrogen