In March last year, 34-year-old lawyer Samantha James found a small lump in her breast. She went to her doctor and was immediately scheduled for surgery to remove a cancerous growth. Within weeks, she was operated on and started chemotherapy and radiation. Since then, "fingers crossed," she has been given the all-clear.
During her treatment, James was invited to join the Diet and Lifestyle Study being undertaken by Against Breast Cancer (ABC), a research charity headed by Dr Anthony Leathem, based at University College London Hospital.
A report issued last year by Cornell University found that "some foods or nutrients are associated with as much as a 50 per cent decrease in the risk of death." The findings of two published studies,including the landmark Nurses Health Study, that looked specifically at breast cancer survival emphasize the benefits of eating fibre, fish and vegetables, while poultry and dairy products were credited with increasing survival rates by up to 35 percent. Beyond that, it is difficult to get any health professionals to go on record as to which nutritional elements might be beneficial -- although a deficiency in iron causes problems with women's immunity.
It's an important area of work, not least because, as Dr Janet Reibstein, psychologist and author of Staying Alive, points out: "In the face of a disease over which sufferers feel they have little control, diet is one area where they can take charge." Indeed, many women, says Leathem, "have very strong ideas about what caused their breast cancer and most change their diets considerably after diagnosis."
After reading Dr Jane Plant's book, Your Life in Your Hands, a controversial account of how the author was "cured" of breast cancer after adopting a radical diet banning all dairy products, Samantha James came to feel that dairy had to be a contributory factor in her illness. She promptly gave up "virtually everything" for a strict vegan diet before settling into what she calls a more "common-sense approach."
Many breast cancers are influenced by estrogen. Factors such as starting periods early, having a first child late, taking the pill or HRT, can all contribute to an excess of the hormone in the system that might trigger cancer or cause it to recur. James believes alcohol compounded the factors that were applicable to her. "While your liver's processing alcohol, it can't process estrogen properly," she explains, "and I had been a bit of a party girl."
For their study, ABC aims to collect and analyse information from 1,200 breast cancer survivors across the UK. Participants join one year after diagnosis, once their treatment is complete. Blood and urine samples support a variety of questionnaires, which incorporate medical and antibiotic histories with food diaries, in the hope of understanding why UK mortality rates from the disease are among the highest in the developed world.
Asian countries have some of the lowest breast cancer mortality rates worldwide (28.4 deaths per 100,000 in England and Wales, compared to 5.8 in Japan). Taking early diagnosis or treatment in those places into account, says Leathem, the differences in mortality rates -- even within Europe -- seemed so great (only seven deaths per 100,000 in southern Italy, for example) that he felt sure environment must play an important role. And women who move from a country with a low incidence of the disease to one with a high incidence apparently acquire the higher risk of their adopted country "within one generation," so such a link could not be ignored.
The key, Leathem believes, is phyto-estrogens -- plant chemicals that mimic the hormone estrogen, and which are widely present in our diet in beans, seeds and grains. They are only about one-thousandth of the strength of the body's own estrogen, but, he says, "are present in such large amounts in our diet that they can have an effect."
But it is the context in which phyto-estrogens are ingested that Leathem believes is important. There are at least 400 different types of bacteria in the human gut, each of which is altered radically by the foods we eat. "There is a huge difference in the gut bacteria between different populations," Leathem notes, and this influences how different phyto-estrogens may react in our systems. What proves beneficial to one population could cause damage to another.
Soya, for instance, is a diet staple in many of the countries with decreased mortality rates. It contains high levels of phyto-estrogens. It has been used in Western trials to measure its effectiveness in controlling the disease, but was found in some studies to oppose the effect of tamoxifen, a treatment that suppresses estrogen, mimicking the hormone in the breast and increasing the risk of cancer cells growing.
The point Leathem makes is that taking individual phyto-estrogens out of context may negate the benefits they appear to bring to countries with low breast cancer mortality rates. What he hopes to uncover is how volatile phyto-estrogens like soya work with or against other dietary factors to decrease a population's overall risk -- and how they can be used to reduce the risk in our own. "Our approach may not destroy the breast cancers," he admits, but "the aim really is to slow down their growth. If we can halve the growth time," Leathem says quite simply, "then patients will live twice as long."
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