Take it or leave it.

Saturday, October 8, 2016

A HANDFUL IS MORE THAN ENOUGH


As the son of a former cancer survivor, I'd be remiss if now and then I didn't bring you news from the frontiers of medical research regarding this prevalent disease. As it stands breast cancer affects nearly 250,000 American women a year. On average, a woman has a 1-in-8 chance of developing breast cancer over an 80-year lifespan. (On a side note, heart disease, not cancer, is 
the leading cause of death for women in the United States, killing nearly 300,000 gals per year - which comes out to about 1 in every 4 female deaths.) 

But as TIME Magazine reports, new evidence suggests that treating breast cancer aggressively isn't always necessary. Throwing the works at a tumor - surgery, chemotherapy, radiation - has serious side effects and rarely extends a patient's life. This is because not all lesions in the breast tend to spread. Ductal carcinoma in situ, for example, is Stage 0 and remains where it is in the fatty tissue of the chest. In many cases it is better to live with breast cancer than treat it, especially since surgery itself can cause a tumor to metastasize. It seems that watchful waiting, once the exclusive domain of yogis and hippies (witness mindfulness meditation), is now de rigueur in teaching hospitals. It is also de rigueur for writers to lend color to their prose by including French terms such as, well, de rigeuer.

Of course the biggest obstacle to conservative treatment is the patient herself, since many females with noninvasive cancer refuse to accept the fact that their condition can be left alone. In an age of quick fixes and medical miracles, we have been conditioned to expect fast results. Isn't that what we go to the doctor for? Surely it is not merely to be told we have a tumor that nothing can be done about. For this reason many experts recommend starting mammograms not at the age of 40, as had been the common practice, but at the age of 50 instead. This decreases the likelihood of detecting a suspicious but non-cancerous lump (the infamous and harmless fibrocystic changes common to menstruating women) and also of jumping the gun to treat a growth that may be neoplastic but poses no threat to one's survival or quality of life. 


Yes we should avail ourselves of technological breakthroughs. More sophisticated tests, including 3-D mammography and MRIs, provide a more detailed depiction of the breast tissue's topography and play a part in risk assessment. Genetic testing can in some cases predict the course of some cancers, guide medical treatment, and even indicate the likelihood that a particular patient will get cancer herself. But it must be remembered that even in patients with the BRCA mutation - which increases a person's risk for breast cancer and in the media as well as in some scientific circles has become practically synonymous with cancer - the likelihood of developing neoplastic disease is not 100 percent and in many cases isn't even 50 percent. In other words, even if you are genetically predisposed to developing a tumor in your breast, chances are you will not get breast cancer - even if you do nothing to reduce your risk!


Of course there are lifestyle changes that reduce one's risk of all types of cancer, particularly neoplasms of the girlie parts. When you consider that as many as 80% of breast cancers are tied to lifestyle and environment, it is in your best interest to take proactive measures to safeguard yourself from this notorious disease. These include maintaining a healthy weight, eating nutritious foods, getting regular exercise, as well as refraining from smoking and minimizing alcohol consumption. 


A plant-based diet that is low in fat has been shown to cut your breast cancer risk in half. Why is this? Simply because the more fat you eat, the more fat you store, and fat cells secrete more estrogen than virtually any other cells in the body. Since many breast cancers, such as the one that plagued my mother, are what's known as hormone receptor positive (HRT) and therefore fed by estrogen, it is wise to limit weight gain and to reduce consumption of foods not only high in fat but also high in estrogen. Particularly dairy products, which are loaded with hormones. Even organic varieties! 


Exercising an hour each day can further reduce your risk by as much as 30%. Math was never my favorite subject, but does this mean that by eating fruits and veggies and breaking a sweat you have essentially immunized yourself from cancer? It's like a vaccine without the controversy (or risk of autism, don't get me started). Oh, and there are also environmental factors at play (or at work, choose your pet expression), and these are often but not always out of our control. Limiting exposure to X-rays especially in adolescence is a wise choice, as well as avoiding plastics. Plastics are high in BPA which can mimic the cancer-causing effects of estrogen. Of course there are also toxins present in the air, household cleaners and pesticides which are invisible and harder to avoid. Call it a drawback of modern living. But if you're post-menopausal and thinking of hormone replacement therapy (HRT) to combat the symptoms of the change of life, limit estrogen therapy to as short a time frame as you can. Otherwise you may wind up to be merely a youthful-looking corpse.


So, remember the KISS rule and keep it simple, sweetheart. Yes, we all want to be stars and celebrities. So we buy their perfumes and wear their clothes. We purchase the overpriced and outrageous lifestyle brands of the likes of Paltrow and Lively and Jay Z. But I say draw the line at getting their surgeries! Yes, Angelina Jolie brought double mastectomy into the vernacular, mainstreaming a procedure which prior to her surgery had been relegated to the fringes of medical treatment. While it is true that this extreme approach has prevented cancer in some patients, particularly those like Jolie with a family history of breast cancer who themselves have a genetic predisposition to the disease, there are an increasing number of women who undergo this surgery unnecessarily. The vast majority of women with breast cancer opt for surgery, despite the fact that 25% of diagnoses are stage 0 and unlikely to metastasize. Even in aggressive cancers, radical measures are not always the safest bet. If you are considering eradicating your boobs, you should know that the increased survival rate for women who choose a mastectomy over a lumpectomy is a paltry 1%. Since Ms. Jolie underwent her procedure in 2013, the incidence of this aggressive procedure in one study has gone from 4% of women with aggressive cancer in one breast to 13%. In other words double mastectomies have more than tripled. And whether you get a mastectomy, lumpectomy, or lumpectomy with radiation, your probability of disease-free survival after treatment is the same!


It would therefore seem far more judicious, even if you have the BRCA mutation, to adopt a healthier lifestyle rather than going under the knife. Because modest changes in how you live can all but immunize you from cancer, and you get to keep your tatas. Of course if you are small-breasted, or large-breasted and approaching middle age, you may jump at the opportunity to remove your tiny/sagging mounds and replace them with synthetic perky ones and brag that you are serving the best interest of your health. I'm not saying this was Ms. Jolie's MO, only that it must be tempting for a person to use this excuse, and I have met more than one young lady with no genetic predisposition to cancer who is determined to remove her B cups for big ones in order to reduce her risk to zero. Give up cheese, is what I advise. And stop being so body conscious. What usually follows is a lesson in vanity versus confidence. Hint: breast size aside, attractiveness always lies in the latter!


So you see, even in the technological age of fancy tests and extreme procedures, the old-fashioned approach involving moving and eating better serves your overall health. In breast cancer as in life, it's not too late and you're never to old to take the matter into your own hand. And as every guy knows, a handful is more than enough.

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