BadasseryPublic Health Topics

Go Pink, and GREEN, for Breast Cancer Awareness Month

We all know that, with October, comes a massive pink ribbon explosion.  Advertisements on television and our favorite consumer products, races for the cure, and fundraisers for research are suddenly everywhere, aimed at raising awareness for breast cancer risks, the importance of early screening and detection, and treatment options for men and women who are diagnosed.  It is a month to come together and celebrate the lives of survivors, to remember those who have lost the fight, and to educate the public about what we can do to reduce our risk of this terrible disease — a disease that seemingly affects everyone in one way or another, whether personally or through someone we know. Approximately 12% (1 in 8) women will develop invasive breast cancer at some point in her life; a man’s lifetime risk is about 1 in 1000.

 

But is joining the sea of pink enough?

 

The American Cancer Society (ACS) attributes early detection, more awareness, and improved treatments to the 38% reduction in risk for dying from breast cancer between the 1980s and 2014.  They list the following as risk factors for developing the disease:

  • Smoking, particularly long-term and heavy
  • Obesity, which increases risk by 1.5-2 times in overweight and obese vs. lean women
  • Inactivity, which increases risk by 10-25% as compared to women who practice regular physical activity
  • Alcohol consumption, which increases risk by about 7-10% for each one alcoholic beverage consumed per day on average

 

What does the ACS say about nutrition?

On their website, the summary of the ACS Guidelines on Nutrition and Physical Activity for Cancer Prevention says to:

“Eat a healthy diet, with an emphasis on plant foods. Choose foods and drinks in amounts that help you get to and maintain a healthy weight. Limit how much processed meat and red meat you eat. Eat at least 2 1/2 cups of fruits and vegetables each day. Choose whole grains instead of refined grain products.”

 

Okay, so main takeaway = eat mostly plants and exercise.

What I find interesting about this is:

  1. There is an emphasis on eating plant foods with a minimum amount of fruits and vegetables to eat per day, yet when it mentions meat, the only advice is to limit it — aka there is no minimum amount of meat we should be eating to optimize our health, only a cautionary statement to not eat the subjective amount of “too much”.  On other pages of the ACS website, you will find statements like “A diet rich in vegetables, fruits, and other plant-based foods may reduce the risk of cancer”, and “Will eating vegetables and fruits lower cancer risk? Yes.” There is a lot of encouragement to eat more fiber, folate, and antioxidants like beta carotene, which are rich in plant foods.
  2. The ACS recipe tool does provide some vegetarian and vegan recipes, but the majority of recipes center around chicken, shrimp, crab, and eggs, and incorporate dairy products.

 

Let’s explore the stance of the other big name in breast cancer awareness, Susan G. Komen.

The Komen website notes significantly more factors affecting breast cancer risk, such as breastfeeding, bone density, height, and shift work, but as far as diet, it notes that eating vegetables and fruits reduce risk, especially those high in carotenoids (orange-red pigmented plants like carrots, melons, squash and sweet potatoes). In addition, it says to:

  • Eat at least 2 ½ cups of fruits and vegetables every day.
  • Limit red meat and processed meat. Choose chicken, fish or beans more often.
  • Limit “bad” fats (saturated and trans fats). These are found in foods such as red meat, fatty deli meats, poultry skin, full fat dairy, fried foods, margarine, donuts and microwave popcorn.
  • Eat “good” fats (polyunsaturated and monounsaturated fats). These are found in foods such as olive and canola oil, nuts and natural nut butters, avocado and olives.

 

Okay, so again with the limiting meats and an emphasis on eating plant foods.

The recipe tool linked on the Komen website is specifically introduced with the statement that “These recipes are provided by Natural Standard, the authority on complementary and integrative therapies. They are meant to encourage healthy (and delicious) food choices, not necessarily reduce your risk of breast cancer.”   

What? “Healthy and delicious”, but no emphasis on plant foods (and minimal animal products) that you just said could help reduce risk of breast cancer?

I would list some of the specific recipes they suggest, but the tool doesn’t work.

Below the link that is supposed to take you to the recipe tool, there is a section on “Healthy eating and breast cancer risk”. Here’s what they say:

“Eating fruits and vegetables may slightly lower the risk of some breast cancers.”

“A healthy diet promotes overall health and may help protect against other types of cancer and other diseases.”

“While we do not fully understand how diet affects breast cancer, body weight is related to breast cancer risk and overall survival.”

“Breast cancer survivors should follow the same healthy diet recommended for everyone. To promote overall health and possibly reduce the risk of breast cancer, everyone should try to:

  • Be physically active (get regular exercise).
  • Achieve and maintain a healthy weight. (Survivors who are overweight or obese should limit high-calorie foods and beverages and increase physical activity to help with weight loss.)
  • Eat at least 2 ½ cups of fruits and vegetables every day.
  • Choose 100 percent whole grain foods (such as 100 percent whole grain breads and cereals, brown rice, millet and quinoa).
  • Limit red meat and processed meat. Choose chicken, fish or beans more often.
  • Limit “bad” fats (saturated and trans fats). These are found in foods such as red meat, fatty deli meats, poultry skin, full fat dairy, fried foods, margarine, donuts and microwave popcorn.
  • Eat “good” fats (polyunsaturated and monounsaturated fats). These are found in foods such as olive and canola oil, nuts and natural nut butters, avocado and olives.
  • Limit alcohol intake to less than one drink of alcohol a day for women and fewer than two drinks a day for men.”

Okay, Susan G. Komen. We get it, you want to share some overall general recommendations and then be totally vague and not take a solid stance on how people should eat to reduce their risk of developing breast cancer.

 

Just eat a “healthy” diet, everyone likes to say. “Everything in moderation”, we’re taught. Leave the ownness on the consumer to determine what that even means, and then tell us you have no idea how people should specifically eat in attempt to reduce cancer risk.

Nobody wants the liability of taking a strong stance about the impacts our diet has on our health outcomes.

Out of curiosity (and because I know it’s out there), I took a look at some of studies available regarding diet and breast cancer risk. There are a ton, as you can imagine, but here are a few interesting ones from the past 3 decades.

 

Study: Is vegetarian diet associated with a lower risk of breast cancer in Taiwanese women? (2017)

Conclusions: Vegetarian diets show as protective role against breast cancer risk, while meat and processed meat dietary patterns are associated with a higher breast cancer risk.

 

Study: Adherence to the World Cancer Research Fund/American Institute for Cancer Research guidelines and risk of death in Europe: results from the European Prospective Investigation into Nutrition and Cancer cohort study. (2013)

Conclusions: Participants with the highest adherences to the lifestyle recommendations (below) had the lowest risk of death and cancer. Some had as much as a 60% lower risk in the development of breast cancer specifically. Lifestyle recommendations included:

  • Maintain a healthy weight for your body type.
  • Be physically active for at least 30 minutes every day. Limit sedentary habits.
  • Avoid sugary drinks.
  • Limit consumption of energy-dense foods.
  • Eat more of a variety of vegetables and whole grains such as whole wheat pasta, beans, peas, lentils, and fruits.
  • Limit or eliminate consumption of red meats to less than pound a week (such as beef, pork, and lamb), and avoid all processed meats.
  • If consumed at all, limit alcoholic drinks of all kinds to two for men and one for women a day.
  • Limit consumption of salty foods and foods processed with salt such as potato chips, cheese, and meatloaf (three of the top sources in the United States).
  • Don’t use supplements to protect against cancer, as they are of unproven benefit.
  • It is best for mothers to breastfeed exclusively for at least six months to reduce the chances of premenopausal breast cancer.

 

Study: Reduced cancer risk in vegetarians: an analysis of recent reports (2011)

Conclusions: Although plant-based diets including vegetarian and vegan diets are generally considered to be cancer protective, surprisingly very few studies have directly addressed this question. However, a broad body of evidence links specific plant foods such as fruits and vegetables, plant constituents such as fiber, anti-oxidants and other phytochemicals, and achieving and maintaining a healthy weight to reduced risk of cancer diagnosis and recurrence.10,13 And, research links meat, especially red and processed meats, consumption to increased risk of several types of cancer.2,10,22 Vegetarian and vegan diets increase beneficial plant foods and plant constituents,16,20,21,3032 eliminate the intake of red and processed meat by definition, and aid in achieving and maintaining a healthy weight.28 The few reports that have addressed whether vegetarian diets can be used for management or prevention of recurrence of cancer are positive. 41,42,45,46 The direct and indirect evidence taken together suggests that vegetarian diets are a useful strategy for cancer prevention.

 

Study: Vegetarian dietary patterns and the risk of breast cancer in a low-risk population (2016)

Conclusions: In conclusion, participants in this cohort who follow a vegetarian dietary pattern overall did not experience a lower risk of BC as compared with non-vegetarians. However, those adhering to a vegan dietary pattern showed consistently lower point estimates in various subgroups but these were not statistically significant. Numbers of cancers in vegans were relatively small, and these analyses should be repeated in the AHS-2 cohort after a longer follow-up to determine whether the same trends continue when power is greater.

 

Study: Vegetarian, vegan diets and multiple health outcomes: A systematic review with meta-analysis of observational studies. (2017)

Conclusions: This comprehensive meta-analysis reports a significant protective effect of a vegetarian diet versus the incidence and/or mortality from ischemic heart disease (-25%) and incidence from total cancer (-8%). Vegan diet conferred a significant reduced risk (-15%) of incidence from total cancer.

 

Study: Premenopausal Fat Intake and Risk of Breast Cancer (2003)

Conclusions: Intake of animal fat, mainly from red meat and high-fat dairy foods, during premenopausal years is associated with an increased risk of breast cancer

 

Study: Meta-analysis of studies on breast cancer risk and diet: the role of fruit and vegetable consumption and the intake of associated micronutrients. (2000)

Key notes: This analysis confirms the association between intake of vegetables and, to a lesser extent, fruits and breast cancer risk from published sources. Increasing vegetable consumption might reduce the risk of breast cancer.

 

Study: Dietary fat and mammary carcinogenesis (1984)

Key notes:  Epidemiological data show a positive correlation between dietary fat and mortality from cancer at various sites, and this is supported by results of animal experiments in the case of colon cancer and pancreatic cancer as well as breast cancer. In the epidemiological data, cancer mortality shows strong positive correlations with total dietary fat and with animal fat, but not with fat derived from plants.

 

Study: International comparisons of mortality rates for cancer of the breast, ovary, prostate, and colon, and per capita food consumption. (1986)

Key notes: The observed positive correlations between the four cancer mortality rates [breast, ovary, prostate, and colon] and caloric intake from animal sources, but negative correlations for vegetable-derived calories, suggest that, of the two, animal fat and not energy is the major dietary influence on cancer risk.

 

Study: Calorie-Providing Nutrients and Risk of Breast Cancer (1989)

Key notes: In summary, we found evidence that the intake of total fat, saturated fat, or proteins of animal origin is positively associated with the risk of breast cancer in women. Our findings suggest that during adult life, a reduction in total fat to <30% of calorie intake, of saturated fat to <10%, or of animal proteins to <6% may lead to a substantial reduction in the incidence of breast cancer in population subgroups with high intake of saturated fat and animal proteins, in agreement with some dietary recommendations that have been made.

 

Study: Meat intake, heterocyclic amines, and risk of breast cancer: a case-control study in Uruguay. (1997)

Key notes: According to these results, meat intake and chemicals formed during the cooking process appear to be strong risk factors in human breast carcinogenesis.

 

Am I claiming that if you go vegan you won’t get breast cancer? Of course not. Is meat consumption automatically going to give you cancer? Of course not. Cancer is a very complex disease and it would be naive to attribute its development or risk to one single factor in a person’s life.

I don’t expect ACS or Susan G. Komen to become pro-vegetarian or vegan. All I’m saying is that there is research available that should be taken a little more seriously than it appears to be by the organizations in place to educate us about chronic disease. Furthermore, there’s absolutely no research that tells us eating more plants is detrimental to our health, so why are large platforms like these so afraid to advocate the shit out of eating more of them when we’re talking about public health outcomes and chronic disease risk?  They clearly agree that eating plants are important based on their recommendations, but then seem to backtrack a little and say they’re not really sure what to tell us.  Are they not doing some sort of disservice by just lumping plant foods into the confusing message of general “healthy eating”, rather than emphasizing them as being super important?

IMHO, a lot of that has to do with industry bias and a corrupted food system, but at the risk of sounding like a total conspiracy theorist I will stick to the main goal of this post — which was to point out the recommendations being made by two major cancer organizations, alongside some of the research out there about plant-rich diets and breast cancer risk.

 

One last thing.

Breast cancer awareness month should be just as much about prevention as it is about education around screening, risk, and treatment options.  Whatever your diet looks like, just eat more plants; what on Earth do we have to lose by doing that?

Go pink, yes, but let’s also consider going green.

Leave a Reply

Your email address will not be published. Required fields are marked *