In terms of benefit or risk of specific food groups, unfortunately there is a lot of misinformation found on Dr Google. Dairy products and meats carry no extra risk beyond the calories they provide. And no, there are no hormones in chicken! Hormone supplementation has been banned in Australia for over 40 years. Specific dietary risks that are important include alcohol; three standard drinks per day will increase the risk of breast cancer by about 25 - 30%, similar to the risk of long term hormone replacement therapy. Although any amount of alcohol contributes to the risk, it is unreasonable to expect everyone to cut all alcohol out so a reasonable compromise is to have one to two standard drinks per day with a few alcohol-free days a week. Another important dietary factor appears to be vitamin D. Vitamin D can be found in fatty fish, eggs and mushrooms. In the body, conversion to active forms of vitamin D occur in the skin with sunlight exposure, and in the kidneys. Vitamin D appears to inhibit cancer pathways including cell proliferation and invasion. The importance of vitamin D in breast cancer is still debated but there is epidemiological evidence that low vitamin D increases the risk of breast cancer. It is also observed that more aggressive forms of breast cancer are associated with lower vitamin D levels and after diagnosis of breast cancer, correction of vitamin D insufficiency appears to improve breast cancer outcomes. Vitamin D supplementation is an easy way to correct any insufficiency. What about phytoestrogens? Phytoestrogens are plant products with oestrogen-like activity. Soy beans and tofu would be typical examples. This effect is one thousand to ten thousand times less than natural oestrogens and so in reality, there is probably little risk in consuming these foods in small to moderate amounts after one has been diagnosed with breast cancer. It would be sensible though not to over indulge with large amounts of phytoestrogens. For younger women, being diagnosed with breast cancer not uncommonly interrupts their plan to have a family. Chemotherapy can often further add to the problem by affecting their fertility subsequently. Women over 40 are more likely to be pushed into permanent menopause with chemotherapy. For those remaining fertile and wishing to have a family after diagnosis and treatment, there is no data to indicate that pregnancy will significantly affect their risk of recurrence. It is generally recommended to wait at least two years after treatment before getting pregnant. High-risk disease, particularly in the setting of an oestrogen dependant cancer, should really be advised on an individual level. The best approach is to discuss fertility issues at the time of diagnosis and include a fertility expert. It is important to remind women struggling through their stressful and often convoluted journey that there is life after breast cancer. They are able to make a number of lifestyle choices during this time that can be a powerful way of reducing further risk and as effective as, although complementary to, many of the conventional treatments we have to offer.
Pindara Private Hospital Magazine - Issue Eight
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