Breast Cancer and Diet: Not Just What, but When – David L. Katz, MD

Please read this article by Dr. Katz (Director, Yale University Prevention Research Center) and pass it on to any one you know with young daughters or sisters.

 ~ Be Well. 


My one time patient and student, Nicole Larizza, earned her MS degree in nutrition studying the effects of nutrition in childhood on breast cancer risk in adulthood. Her important insights have led her to establish an organization dedicated to the early prevention of breast cancer, Nourish Our Girls.

I found the information Nicole shared with me important and provocative- and felt it deserved to be shared. My questions and her answers follow to that end.

 Breast cancer typically presents during adulthood. Why is nutrition during childhood and adolescence important?

As women, we tend not to think about breast cancer until mid-life – our 40s, 50s, and beyond – when our friends, sisters, mothers, or coworkers are diagnosed with this dreaded disease. But adult breast health is largely determined much earlier in life when the breast tissue is developing. During this time, the breast is most vulnerable and sensitive to nutritional and environmental stimuli. Research shows us that consumption of certain foods during the breast development process may actually change the physiology of the breast, thereby making it more or less susceptible to future cancer.

One example of this is soy foods. Regular consumption of whole, traditional forms of soy during puberty is associated with the growth of fewer terminal ductal-lobular units (TDLUs) in the breast. These TDLUs are the end point of each mammary duct that extends out from the nipple, and are the site where the overwhelming majority of breast cancers originate. If we reduce the number of TDLUs in the fully-developed breast by altering a girl’s pubertal diet, then we reduce the opportunity for cancer to occur there.(Messina, 2009) This is just one of many examples about how diet during the breast development stage may affect physiology and influence risk as a result.


2. How does a girl’s nutrition during childhood and adolescence affect her risk of breast cancer later in life?

The development of cancer is a multi-step process at the cellular level. Very simply, it begins with initiation when a single cell is damaged. This is followed by promotion as the damaged cell replicates and makes more damaged cells, and finally culminates with progression as masses of damaged cells spread throughout the body, infiltrate other tissues, and affect function.

This process may take up to 35 years. (National Academy of Sciences, 1982) With women being diagnosed at earlier ages now – in their 40s, 30s, and even some in their 20s – think about when that disease process may have started! The food a young girl eats may directly affect her risk of breast cancer by intervening at the earliest points along the cancer continuum. The presence of antioxidants and other nutrients may protect cells from becoming damaged in the first place, and may slow down or prevent the promotion of cell damage thereafter.(Murillo, 2001) Conversely, toxins and anti-nutrients like sugar and synthetic fats may actually cause cell damage or create a cellular environment in which cancer grows and thrives.(Liu, 2010)

More indirectly, but just as important, certain dietary patterns and food intakes during childhood and adolescence are associated with the timing of menarche. Earlier menarche is an independent risk factor for adult breast cancer because it extends the window of exposure to estrogen. Estrogen has been implicated as a stimulus for cell division as well as a promoter of hormone-receptive breast tumors. As such, women with a higher lifetime exposure to estrogen have higher rates of breast cancer.(DeAssis, 2006) Any behaviors we can modify to delay that first period, and shorten the window of estrogen exposure, may therefore result in decreased cancer risk. These behaviors include eating a lower fat, lower protein, higher fiber diet, as well as being physically active and maintaining a lean body weight.


3. Which foods or dietary patterns during childhood/adolescence help to reduce risk of adult breast cancer?

Based upon available clinical evidence, there are essentially five dietary patterns that appear to be protective. The mechanisms of action are yet to be completely elucidated, but these patterns are associated with reduced risk of adult breast cancer and other breast cancer biomarkers… Read full article by clicking here.


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