Surgeon to the stars reveals secrets of keeping your breasts healthy
I can help you beat breast cancer: Angelina Jolie’s surgeon reveals the simple secrets of keeping your breasts healthy for life
As a breast cancer surgeon, who has helped tens of thousands of women navigate breast health issues – including stars like Angelina Jolie and Sheryl Crow – I have seen that we can reduce our breast cancer risk in achievable and dramatic ways
You have the power to change your body’s future. I know this for a fact. How? Because as a breast cancer surgeon, who has helped tens of thousands of women navigate breast health issues – including stars like Angelina Jolie and Sheryl Crow – I have seen that we can reduce our breast cancer risk in achievable and dramatic ways.
Up to 90 per cent of the risk factors that determine optimal breast health lie in your hands. So you are in control – not your doctors, genes or fate. You are with your breasts all day long, every day. If you spent that much time with anything or anyone – a child, spouse, pet, even a car – you’d make sure they were in good shape. Why treat your breasts differently?
These two organs are perched front and centre on half the population’s chests; yet breast health remains mysterious. Everyone knows that breasts can grow cancer – it’s the No 1 killer of women aged 20 to 59 – yet there’s never been an informed conversation about how to reduce risk factors and why certain precautions might help.
That’s why I’ve written my book – Breasts: An Owner’s Manual. Rigorous science and first-hand experience back up everything I know to be true about breast cancer risk reduction and care.
I’ve operated on breasts for 22 years and was Director of Patient Education at the Breast Center at Cedars-Sinai Medical Center in Los Angeles for seven years. In that time I delved into risk reduction and discovered all sorts of lifestyle game changers.
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In 2007, I founded the Pink Lotus Breast Center, fusing cancer screening and diagnosis with preventative strategies and holistic care.
The women I treat are like you. They share your concerns about any new mammogram finding, pain, lump, itch or discharge.
They want to know if there’s anything they can do to ward off this disease.
I tell them 50 per cent – and perhaps more – of all breast cancer could be eliminated if women understood that lifestyle choices create the environment inside the very cells of our breasts which stay healthy or turn malignant. Every day, those choices bring us closer to cancer or move us farther away.
You are with your breasts all day long, every day. If you spent that much time with anything or anyone – a child, spouse, pet, even a car – you’d make sure they were in good shape. Why treat your breasts differently?
Research tells us that if, before reaching menopause, women embrace a lifestyle that prioritises exercise, not smoking, not drinking alcohol and a balanced diet that keeps them a healthy weight, their odds of getting breast cancer are reduced.
Depending on the changes they make, women improve their breast health: they might also notice that any lumps and pain disappear and that their obesity or diabetes improves. Some cancers outwit the best army, but others can be halted or reversed. Our bodies are not defenceless. So here is some of my best advice to keep you – and your breasts – healthy.
Top 10 facts and myths
The truth about cancer risk
Most women believe that family history determines who gets breast cancer, but for most, it doesn’t. Inherited genetic mutations, such as a faulty BRCA gene, only cause five to ten per cent of breast cancer: 87 per cent of women diagnosed with breast cancer do not have a first-degree relative with breast cancer.
The identical twin sister of a woman with breast cancer has only a 20 per cent chance of getting breast cancer – which is the same risk as anyone with an affected sister. Since these twins share the same DNA, if heredity called all the cancer shots, risk should approach 100 per cent but it doesn’t, because genes aren’t the be-all and end-all.
Also, a woman’s lifetime risk of getting breast cancer is one in eight, but your risk right now, today, this minute, is not one in eight. That’s the lifetime roll of the dice to a newborn.
One in 68 women will get breast cancer in their 40s. But if you’re 42, the chance is one in 680. That’s a far cry from one in eight, isn’t it?
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Why diet is important
Imagine a normal cell happily humming along when, unexpectedly, in a matter of days, what was normal becomes mutated by factors such as the sun’s UV rays, cigarette smoke, or other carcinogens. This mutated cell turns into a cancer seed. Whether or not that seed takes root and blooms into a full-blown cancer capable of destroying your life depends on the micro-environment, the soil in which cancer seeds either flourish or fail.
How do we make this soil? Nutrition is infinitely more important in controlling cancer growth (the soil) than the dose of whatever caused the cancer. Powerful plant compounds that could reduce your risk of cancer are found in broccoli and kale, soy, garlic, berries and walnuts. The ideal meal is plant-based, low fat and high fibre, with fresh fruits and vegetables, whole grains, lentils and beans, with a cup of green tea – or sometimes wine – on the side.
You know your breasts best
Healthy breasts require regular at-home breast examinations, in my opinion, but don’t let them stress you out. Breasts are naturally lumpy, and can change through your menstrual cycle, so the goal here is to get a lay of the land and learn what all your lumps feel like. This way, if you develop something new or different, you’ll be the first to find it. Trace your fingers over your breasts the same way every time. If anything seems out of the ordinary, trust your intuition and see your doctor.
Most lumps ARE benign
You feel a lump and your mind likely unravels. Yet 95 per cent of palpable breast masses in women under 40 are not cancer, and in women of any age who get a biopsy for a palpable mass, over 80 per cent are benign.
So when’s a girl to panic? OK, never panic. Anxiety adds nothing useful. But see your doctor if a mass persists throughout your menstrual cycle, feels gritty and firm, doesn’t hurt, can’t be defined at the edges because it blends into the surrounding tissue, or it has no matching lump in the same place in the opposite breast. Even then, it’s more likely to be benign.
Cancer can vanish
Some women live and die with, but not from, cancers they never knew they had. Other cancers might disappear on their own. How do I know this? From autopsies on women without known breast cancer who died from something else, such as an accident.
A survey of 852 post-mortems on women showed that 39 per cent of those aged 40 to 49 had early stage breast cancer and only ten per cent aged 50-70 had the same. Could this mean that cancer regresses? Similarly, researchers in Norway and Sweden think some of the cancers detected through mammograms may spontaneously regress. Don’t misunderstand: once you’re diagnosed with cancer, we aren’t smart enough (yet) to know which ones will regress with no treatment at all, so ‘better safe than sorry’ is the best course of action.
These things don’t cause it
Deep breath… breast cancer is not conclusively linked to any of the following: coffee, dairy, bras, antiperspirants or deodorants, relaxing lotions for hair, nipple piercings, tattoos, mobiles, power lines, contraceptive pills, IVF, abortions or stillbirths, or even implants. And relax.
Scans are a pain but worth it
Sometimes patients decline mammography, fearful that radiation exposure from the X-rays involved causes breast cancer. You know what I tell them? They’re right. In a lifetime’s worth of mammogram screening, 8.6 out of 10,000 women will get a radiation – induced breast cancer. However, screening finds about one hundred times more cancers than it causes. If you’re hesitant to get a mammogram because it hurts, sometimes in life, the pain is worth the gain. Taking ibuprofen 30 minutes before the scan might help.
Think yourself healthy
When I ask a patient newly diagnosed with breast cancer if she faced a stressful or heart-breaking situation five to ten years ago, she all too often responds, ‘Yes, how did you know?’ Loss, disappointment, emotional pain, regret, illness, suffering – life happens, and everyone passes through difficult times. But it’s tragic when that ‘something’ occurred during the five- to ten-year window when cancer cells were too few to detect, but ready to gain momentum. Not all stress announces itself like a massive earthquake; chronic stress results from the cumulative effect of tiny shocks. It sets off a chain reaction, elevating hormone levels and decreasing the number of natural killer cells. Smile, and make it a point to forgive those who hurt and upset you. Do it for your health.
TEN BREAST SUPERFOODS TO PREVENT CANCER
1 Leafy greens, broccoli and cauliflower
2 Dietary fibre in whole grains and beans
3 Berries
4 Apples
5 Tomatoes
6 Mushrooms
7 Garlic, onions and leeks
8 Turmeric
9 Seaweed
10 Cacao
Don’t panic about soreness
Nearly 70 per cent of pre-menopausal women complain of breast pain but the good news is, it doesn’t always mean cancer. If it’s the only symptom, it’s likely to be benign in 90 per cent of cases. In fact, two-thirds of breast pain is cyclical – monthly hormonal changes in a woman’s menstrual cycle cause breast tissue to swell and hurt for a few days before menstruation and mid-cycle at ovulation. The other third can be linked to stress, HRT, ill-fitting bras, weight gain and myriad other causes.
Most leaks can be ignored
Breast ducts naturally contain tiny amounts of fluid and discharge is so common that I can squeeze drops of fluid from 50 per cent of nipples. You can ignore the discharge (other than bloody, red, brown, or clear, like water) as long as it only happens when you squeeze around your nipples. It can be (honestly) amber, yellow, green, blue, grey, white and black. These colours, when associated with discharge only elicited by squeezing, come from benign conditions like cysts and hormone imbalances. You only need a check if discharge emerges spontaneously.
Lose the fat, slash your risk
Being overweight or obese is the single most preventable contribution to breast cancer. Let’s work out your risk of post-menopausal breast cancer. What was your weight in high school? Now subtract that from your current weight. If you gained less than 8 lb, there is no increased risk; a 9 lb to 14 lb gain yields a 25 per cent increase in risk; a 14 lb to 29 lb gain 60 per cent; and over 21 lb nearly doubles your risk, with a 90 per cent increase in breast cancer. If you lose fat, you will lose your risk. It’s that simple.
© Dr Kristi Funk
Breasts: An Owner’s Manual, by Dr Kristi Funk, is published by HQ, priced £14.99. Offer price £11.24 until July 15. Order at mailshop.co.uk/books or call 0844 5710640; p&p free on orders over £15.
THE DOUBLE MASTECTOMY THAT SAVED ANGELINA JOLIE
Angelina Jolie carried a faulty gene, BRCA1, which sharply increased her risk of developing breast and ovarian cancer.
Her mother had breast cancer, and sadly passed away, aged 53, from ovarian cancer. Her maternal grandmother was also diagnosed with ovarian cancer.
Angelina wanted to be proactive and minimise her risks, so made a decision to have a preventative double mastectomy – which involves the surgical removal of both breasts.
Angelina Jolie carried a faulty gene, BRCA1, which sharply increased her risk of developing breast and ovarian cancer
But it is important to emphasise that each woman’s case is different. Surgery will not necessarily be the right choice for everyone: alternatives include taking anti-oestrogen chemo-preventive drugs which can reduce the risk of breast cancer, or a rigorous programme of surveillance, including imaging and regular breast exams.
Just because you have an elevated risk doesn’t mean you follow a one-size-fits-all protocol.
On February 2, 2013, Angelina had her first operation, a procedure known as nipple delay, which rules out disease in the breast ducts behind the nipple and draws extra blood flow to the area, increasing the chance of saving the nipple.
Angelina’s skin was slightly bruised but soon returned to normal.
Two days later, great news arrived: the tissue behind both nipples came back completely normal.
On February 16 she had the main surgery, which can last up to eight hours, and it went smoothly.
After the mastectomies, the plastic surgeon performed the first-stage breast reconstruction by placing tissue expanders with allograft – creating a hammock into which the implant fits.
When the pathology results returned, all of the breast tissue was benign.
I believe that recovery reflects expectation. Angelina expected to feel well, to be active. On day four after her mastectomies she was not only in good spirits, with bountiful energy, but with two walls in her house covered with freshly assembled story boards for the next project she was directing.
All the while she spoke, six drains dangled from her chest, three on each side, fastened to an elastic belt around her waist.
The next day she had her first injection of saline into the expanders, beginning the process that would gradually prepare the tissues for the final reconstruction stage.
Then four of the six drains were removed. Four days after that, on post-operative day nine, the last two drains were removed.
A second saline fill occurred on March 4. Over the next four weeks she was hard at work.
The final operation occurred on April 27, 2013, ten weeks after the mastectomies: reconstruction of the breasts with implants, which went extremely well, bringing an end to her surgical journey.
I would urge women like Angelina – who feel they might be at risk of a BRCA gene mutation – to seek medical advice and to take control of their futures.
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