How To Reduce the Risk of Breast Cancer Recurrence

Any woman who has had breast cancer is naturally concerned to avoid any future occurrence and nutritionist Patrick Holford has some practical suggestions on how to do that.


I have been fortunate enough to work with many experts in the field of women’s hormonal health and leading nutritionist Patrick Holford is someone I have known for many years.

His views on hormonal health are similar to those of the late John Lee, MD and he adds his own nutritional insight to dealing with cancer and its recurrence and he his happy for me to share his views with you.

What to do if you’ve been diagnosed with breast cancer, or want to decrease your chances of developing this disease.

There are many options that can help prevent a recurrence of breast cancer, and they are all things you can do without drugs. Lifestyle, dietary choices and hormone balance will all make a difference as will knowing what your options are.

Tamoxifen, Raloxifene, and Arimidex: The Anti-Oestrogens

Tamoxifen, the market leader, is potentially effective only for patients with oestrogen-positive breast cancer. It also does not appear to be effective when the cancer has spread to the lymph nodes.

Trials have shown that, with oestrogen-positive breast cancer, the longer a woman takes tamoxifen, the more she reduces her risk of a recurrence. Reviews typically report that 10% more women survive longer than ten years when they take tamoxifen for five years.

However, these reviews also indicate that tamoxifen significantly increases the incidence of endometrial cancer – quadrupling it after those same five years of use. This is because tamoxifen causes the uterus to quickly thicken in virtually all test subjects, doubling their risk of endometrial cancer in the first year or two of use.

Because the drug has anti-oestrogenic properties in some parts of the body and potent oestrogenic effects on others, it is known, along with raloxifene, as a selective oestrogen receptor modulator.

Other side effects of tamoxifen include a tripling of the risk for potentially fatal blood clots in the lungs, increased risk of stroke, blindness and liver dysfunction. In consideration of these potential problems, tamoxifen’s overall reduction in risk of mortality is considerably less than 10%.

The National Cancer Institute (NCI) admits that tamoxifen is indicated for preventive use only in women with increased risk of breast cancer, as determined primarily by family history.

NCI estimates that only about 0.3% of women age 39 or younger would be candidates for tamoxifen treatment, yet it used to be common practice to put most women with breast cancer on the medication.

Raloxifene is the major rival for tamoxifen. It hasn’t been so extensively studied in long-term trials, but the general consensus is that it reduces recurrence in oestrogen-positive breast cancer only slightly better than tamoxifen, but with less risk for endometrial cancer and no real difference in risk for stroke or cardiovascular problems. Some have claimed that raloxifene might reduce cardiovascular risk because, like tamoxifen, it appears to lower LDL (bad) cholesterol and raise HDL (good) cholesterol.

But a recent trial, which studied the effects of raloxifene in women who had a history of heart disease or who were at high risk for heart disease, showed that after more than five years of follow-up, participants experienced no real improvement in heart problems.

This trial also found that taking raloxifene put some women at greater risk for dangerous blood clots, though the risk of stroke was found to be the same in women taking raloxifene as those taking the placebo. However, among women who had strokes during the time of the study, more women in the raloxifene group had fatal strokes than in the placebo group.

A second rival to tamoxifen is Arimidex. Although the survival rates of patients taking Arimidex don’t appear to be any different from the survival rates of patients taking tamoxifen, there are quite a few studies that focus on symptoms affecting ‘quality of life’.

For example, one study says that women who took Arimidex reported less vaginal bleeding and thromboembolic events than women taking tamoxifen, but more hot flushes and vaginal dryness. Another reports more loss of libido with Arimidex, but less dizziness.

Natural Ways To Reduce Your Risk

To put natural solutions in perspective, a survey of more than 44,000 twins determined that no more than 15% of breast cancer cases are the result of genetic predisposition. Therefore, 85% of cases are likely a consequence of environmental factors, including diet and lifestyle. It makes sense to look at what these factors might be. One logical place to start is in China.

According to research quoted by Dr Jane Plant, cancer survivor and author of The Plant Diet, a woman living in rural China has a 1 in 9,000 chance of developing breast cancer, compared to a 1 in 9 chance for a woman living in the United States. Because Chinese women living in the United States have a risk comparable to other women in the United States, the difference must lie in a quality or practice in China that doesn’t exist in the United States (or vice versa). Two things come immediately to mind: the Chinese don’t consume dairy products, and they eat phytoestrogen-rich beans every day.

Natural Anti-Growth Foods

The drugs I’ve discussed work by blocking growth signals to breast cancer cells. Two key growth hormones for cancer cells are oestrogen and IGF-1 (insulin-like growth factor). IGF-1 is made in the body, but it is also found in milk.

A woman who drinks one pint of milk a day has substantially higher IGF-1 levels and a three times greater risk of breast cancer than a woman who drinks no milk. This is because IGF-1 stops ‘apoptosis’, which is the suicidal self-destruction that cells are programmed to do when they overgrow.

So, in an IGF-1-rich environment, cancer cells will keep growing. There’s no easy way to quantify the risk reduction you would realise by avoiding all dairy products containing IGF-1. IGF-1 is likely to be concentrated in a high-protein dairy product, such as cheese.

Hence, the odd bit of butter isn’t likely to stimulate cancer by itself, however, drinking milk and eating yoghurt and cheese on a regular basis might well do.

My advice is to avoid all dairy products except for unavoidable butter, for example, when eating out in a restaurant.

Phytoestrogens in beans, especially the soya bean, as well as in chickpeas, lentils, nuts, seeds and rye, help block oestrogen receptors from powerful hormone-disrupting chemicals that mimic oestrogen, such as PCBs, dioxins, and some pesticides. I wouldn’t rely only on soya, but generally make sure you eat at least some beans, lentils, raw nuts or seeds every day.

When you do have soya, have fermented soya products such as natto or tempeh, as the protective components are more active. In terms of seeds, flax and pumpkin are the best anti-cancer varieties. Broccoli is especially rich in di-indolylmethane (DIM), which mops up excess oestrogens.

All the cruciferous vegetables – including kale, cabbage, cauliflower and Brussel sprouts – are good sources of this. You can also get DIM supplements via a nutritional therapist (due to their potency, they are not readily available to the public in the UK).

One of the most potent anti-oestrogenic substances is the hormone progesterone.

If your progesterone level is low, taking it in amounts equivalent to what your body would naturally produce, is likely to greatly reduce your risk of cancer recurrence. You can do this with a transdermal progesterone cream; however, I strongly recommend that you also read Dr John Lee’s book, What Your Doctor May Not Tell You About Breast Cancer (Warner, 2002), to explore this approach fully.

Antioxidants Keep Your Immune System Strong

Researchers at the National Cancer Institute of Canada have found that diet and vitamin intake are key factors in surviving breast cancer. Their study analysed the dietary habits of 678 women who were diagnosed with breast cancer between January 1982 and June 1992, 76 of whom died from the cancer during the study period.

After reviewing the dietary habits of the women prior to their diagnosis, the researchers found that the women who had a relatively high intake of beta-carotene (greater than 4.6mg daily) had half the risk of dying from breast cancer compared to the women with a low intake of beta-carotene (less than 2.2mg daily).

Similar results were found for vitamin C. Women who consumed more than 210mg daily had a 57% lower risk of dying from breast cancer than women consuming less than 110mg daily.

Vitamin E also showed a slight protective effect, despite the fact that the amounts consumed by the women were very small (24 IU per day or less). Vitamin C has tremendous cancer-fighting properties, but less so for breast cancer. Even so, I’d recommend 4 grams a day in divided doses. Garlic has similar properties.

Reducing Saturated Fat Reduces Risk

The researchers also concluded that the risk of dying from breast cancer increases by 50% for every 5% increase in saturated fat in overall calories. Other studies have found that omega 3 fats – and fish consumption in general – reduce risk, but I would urge that you be extremely careful about the source of fish.

PCB contamination in the ocean is high. There’s less contamination in smaller fish from the Pacific, but I’d stick to, and possibly favour, supplementing purified fish oil instead and eating more protein from vegetables such as quinoa.

Other studies clearly show that reducing your intake of fat and increasing your intake of fibre cause substantial positive changes in many measures known to increase breast cancer risk, including reductions in IGF-1 levels.

Reducing your intake of sugar does the same thing. In reality, eating a low-GL (glycemic load) diet, which is the best way to lose fat, is also the best way to reduce your risk of breast cancer recurrence.

One of the simple reasons for this is that oestrogen is not only made in the ovaries. It’s also made in fat cells. The fewer fat cells you have, the less oestrogen you tend to make.

In post-menopausal women especially, losing weight and eating less sugar can make a big difference in cancer survival, as does taking regular exercise and staying relaxed.

Reducing stress has a profound effect on surviving cancer, which is itself a very stressful experience. So, it’s extremely important to know your priorities and to take care of yourself. I would recommend working with a psychotherapist if sorting them out seems too overwhelming.

Check Out Your H levels

Stress raises a substance in your blood called homocysteine – and this can promote cancer because high homocysteine is a marker of your inability to perform a vital biochemical process called methylation. One in four gene mutations is caused by faulty methylation.

So, check your homocysteine level (see for a home test kit), and supplement a cocktail of homocysteine-lowering nutrients – including vitamins B2, B6 and B12, folic acid, a nutrient called TMG, zinc and magnesium – to bring yours down to below 7 (ideally you want to achieve a homocysteine level of about one-tenth of your age).

I have seen this approach not only keep thousands of women free from breast cancer, but even reverse the cancer in women who have it. That’s what happened to Betty, who first consulted me in 1986. Here’s what she says:

“I feel moved to tell you that I consulted you in 1986 with a recurrence of breast cancer. Now, 13 years later, I am pleased to share that I have just celebrated my 75th birthday and am fit and well, taking no medication and attending no clinics. I am sure this is in large part due to the advice I received from you.”

Reduce your alcohol consumption

A 2011 study in the Journal of the American Medical Association reported that a low level of alcohol consumption (5.0 to 9.9 grams per day, equivalent to 3-6 glasses of wine per week) was modestly but statistically significantly associated with a 15 percent increased risk of breast cancer.

Also, women who consumed at least 30 grams of alcohol daily on average (at least 2 drinks per day) had a 51 percent increased risk of breast cancer compared with women who never consumed alcohol. The study authors suggested this may be due to alcohol’s effect on raising oestrogen levels in circulation, probably due to decreasing the liver’s capacity to detoxify oestrogens.

Follow a low GL diet and keep your insulin levels low

A study in 2009 by scientists from the Albert Einstein College of Medicine of Yeshiva University, published in the International Journal of Cancer, involving 5450 post-menopausal women followed over 8 years showed that those women in the top third for insulin levels had triple the risk of breast cancer.

The best way to balance your blood sugar and lose weight or maintain it, and so control insulin levels, is to follow a low glycemic load diet.

Keep this list handy to follow for breast health

* Follow a low-GL diet, emphasizing omega 3 fats instead of saturated, burned or fried fats.

* Avoid sugar and stimulants.

* Eat eight servings of fruit and vegetables a day, especially carrots, tomatoes and cruciferous vegetables such as broccoli.

* Supplement additional all-round antioxidants, plus 4 grams of vitamin C a day.

* Eat beans, lentils, nuts or seeds every day.

* Have fermented soya products.

* Have a tablespoon of flax or pumpkin seeds a day.

* Avoid dairy products and minimise red meat and burned meat or fish. Eat organic where possible and be very selective about the meat or fish you eat, choosing lean meat and fish from unpolluted waters.

* Supplement a high-strength multivitamin with plenty of B vitamins, plus vitamins A and D.

* Consult a nutritional therapist about supplementing DIM.

* Consider bioidentical natural progesterone.

* Have two cloves of garlic every day.

* Keep fit and active, but don’t over-stress yourself.

* Reduce your alcohol consumption

Helpful information:

Clearly lifestyle choices and good hormone balance are vital to reduce your risk. Progesterone can safely be used by women with a history of breast cancer and/or current treatment as well as helping reduce your vulnerability to breast cancer.

If you, or someone you know, is concerned about hair loss with cancer there is an excellent free online service offering support and expert advice on dealing with all aspects of hair loss from cancer treatment.