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Breast Cancer and the BRCA genes, what you need to know....

In the UK and Australia, breast cancer is the most common cancer diagnosed in women and its incidence is on the increase. It is estimated that one in eight women will be diagnosed with breast cancer in their lifetime (Cancer Research UK, 2016, Cancer Australia, 2016). The number of men who get breast cancer is also on the increase although its occurrence is 100 times more common in women.

What causes breast cancer?

The cause of breast cancer is different for everyone and can not be attributed to just one thing. It is multifaceted, with many risk factors, for example:
  • Age – the risk increases as we get older
  • Genetics – the presence of certain genes
  • Race – risk is higher in white women than black, Hispanic or Asian women
  • High levels of oestrogen exposure and states of oestrogen dominance
  • Dietary factors like low intake of antioxidants, vitamin D and iodine
  • Smoking and high consumption of alcohol
  • Environmental exposure to xenoestrogens

The role of genes in breast cancer

The majority of people who develop breast cancer have no family history of the disease. However, where there is breast cancer in the family, it is possible that genes could have played a role.

Genes are the basic physical and functional unit of heredity. They carry the information that determines our traits, as passed on from our parents. Genes are made up of DNA and act as instructions to make molecules called proteins, which are the building blocks for everything in our body.

We are all born with changes or 'mutations' to certain genes, which are referred to as Single Nucleotide Polymorphisms (SNP's - pronounced 'snip's'). These SNP's occur normally through our DNA and create slight variations in our genetic makeup resulting in all of us being different and unique.

It is important to note that while these SNP's may allow us to predict specific genetic traits and to estimate predisposition to disease, they are rarely the ultimate cause of disease. In fact, many have no effect on either health or development (NIH, 2016).

So what are the BRCA genes?

BRCA stands for BReast CAncer susceptibility genes, referred to as BRCA 1 and BRCA 2. First of all, let's start by saying that everyone has the BRCA genes. When functioning normally, these genes produce tumour suppressor proteins, which prevent cells from growing and dividing too rapidly, or in an uncontrolled way. BRCA genes also have the ability to reduce the body's conversion of testosterone to oestrogen (Fitzgerald K, 2016).

When mutations, or SNP's, occur on the BRCA genes, this can affect their ability to function properly, increasing the risk of uncontrolled cell growth, breaks in cellular DNA and leading to higher levels of oxidative damage and oestrogen, all of which can play a role in cancer.

It is estimated that about 5-10% of breast cancers are hereditary in nature (Smith KL. 2011), with approximately 20% of these associated to the BRCA 1 and 2 gene mutations (Balmana J, et al. 2011).

Although there are other genes that are also associated to breast cancer, it is the BRCA genes that have the strongest association to breast cancer risk. Women who inherit a mutation in the BRCA genes also have a higher risk of developing other cancers like ovarian and pancreatic.

How do I know if I have mutations to the BRCA genes?

A predictive gene test can check if the BRCA genes mutations are present but is only recommended if there is a strong family history of breast cancer or if one of your relatives has previously tested positive.

If I test positive to BRCA gene mutations does this mean that I will get breast cancer?

The answer to this is no. Although having the BRCA gene mutations does increase breast cancer risk, it certainly does not mean that you will get breast cancer.

If we look at the history of breast cancer and the BRCA genes it becomes evident that there is more to it than just whether mutations to these genes are present. Prior to 1940, the lifetime risk of breast cancer was 24% if you had a mutation to the BRCA genes. Today, however, that figure is 70%, increased risk of breast cancer when the BRCA gene mutations are present (Fitzgerald K, 2016). Even with longer life expectancies accounted for, these figures clearly indicate that there is much more at play here than just whether the genes are there.

More and more research in the field of epigenetics, shows us that there are many factors that influence whether certain genes are expressed, and many of these factors are within our control. Amazingly, through dietary choices, our lifestyle and environment, we can to a large extent determine which genes are 'switched on' and 'switched off'. I think that this quote sums it all up, 'Genes load the gun but environment pulls the trigger'.

The key message here, is that although you are not able to control which genes you are born with, there is much you can do, to determine which of your genes are actually expressed.

So, if you do test positive for the BRCA gene mutations, you will know that you need to be extra diligent with preventative measures, regular screening and healthy diet and lifestyle choices in order to give yourself the best chance in preventing breast cancer.

Remember also, if you don't carry the BRCA gene variants, this doesn't mean that you won't get breast cancer and in fact, most cases of breast cancer occur in women without them.

What can I do to reduce my risk?

The main focus of a plan to support breast cancer prevention is aiming to reduce risk factors, while boosting diet and lifestyle elements that could have protective effects. These should form part of a holistic plan to prevent breast cancer and recent expert reports estimate they could help prevent 25% to 30% of cases (Harvie M, et al. 2015).
Here are 6 foods that we recommend be considered in a breast cancer prevention plan:

  1. Vegetables of the Brassica family like broccoli, cauliflower, cabbage and kale that contain glucosinolates like Indole-3-carbinol (I3C) which are antioxidants and support detoxification (Murray M & Pizzorno J. 2012).
  2. Brightly coloured fruits and vegetables which are high in antioxidants and flavonoids which have anticancer effects (Pozo-Guisado et al. 2002, Prakash et al. 2014, Hui C, et al. 2013)
  3. Turmeric, which contains curcumin, an active compound which is highly anti-inflammatory and has been seen to inhibit cell proliferation and induce cancer cell death (Liu Q et al. 2009)
  4. Flaxseed oil and ground flaxseed which contain omega 3 fats and plant compounds like lignans which can interfere with cancer promoting effects of oestrogen (Saarinen NM, et al. 2007).
  5. Green tea which is high in certain flavonoids that have been seen to have anticancer and anti-inflammatory effects (Ogunleye AA et al. 2010)
  6. Oily fish which is high in anti-inflammatory Omega 3, as well as maintaining a good Omega 6:3 ratio (Ju Sheng Z, et al. 2013, Bougnoux P, et al. 2005)
As part of a holistic approach, I would also consider optimising the following: gut health, liver function, body weight, exercise levels, stress and sleep routines. It is also important to reduce negative environmental and dietary factors like smoking, refined sugar, dairy and alcohol intake and exposure to environmental oestrogens and organochlorides.

In summary:

  • Breast cancer is the most diagnosed cancer for UK and Australian women and is on the increase.
  • There is no one cause, but rather many factors that increase the risk of breast cancer.
  • Genetics are just one risk factor with 5-10% breast cancer cases believed to be hereditary.
  • Variants of the BRCA 1 & 2 genes are associated with increased risk but do not mean that a person will get breast cancer. Studies show that through diet, lifestyle and environmental factors, we can influence which of our genes are actually expressed.
  • Those who test positive to BRCA 1 & 2 gene mutations, or those with a strong family history of breast cancer, should be extra diligent in their diet and lifestyle choices, preventative measures and regular screening for breast cancer.
  • There is much research to support specific foods and nutrients in breast cancer prevention and these should be considered as part of a holistic plan.
If you are concerned about breast cancer and are interested in making positive dietary and lifestyle changes, please contact us to develop a personalised plan for you.

Yours in good health, naturally! Victoria x

Sources:

Balmana J, Diez O, Rubio IT, Cardoso F. (2011). BRCA in breast cancer: ESMO Clinical Practice Guidelines. Annals of Oncology. Vol 22; Issue 6; pages 131-134. Available at: http://annonc.oxfordjournals.org/content/22/suppl_6/vi31.full. Accessed: 22nd May 2016

Breast Cancer.org. (2016). Genetic Testing. Available at: http://www.breastcancer.org/symptoms/testing/genetic. Accessed: 21st May 2016

Bougnoux P, Maillard V, Chajes V. (2005). Omega 6/Omega 3 Polyunsaturated Fatty Acids Ratio and Breast Cancer. Nutrition and Fitness. Vol 94; pg 158-165. Available at: http://www.karger.com/Article/Abstract/88235. Accessed: 21st May 2016

Cancer Australia. (2016). Breast Cancer in Australia. Available at: https://canceraustralia.gov.au/affected-cancer/cancer-types/breast-cancer/breast-cancer-statistics. Accessed: 21st May 2016

Cancer Research UK. (2016). Breast Cancer Statistics. Available at: http://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/breast-cancer#heading-Zero. Accessed: 22nd May 2016

Hui C, Qi X, Zhang Q, Peng X, Zhu J, Mi M. (2013). Flavonoids, Flavonoid Subclasses and Breast Cancer Risk: A Meta-Analysis of Epidemiologic Studies. PLOS. Jan 2013. Available at: http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0054318. Accessed: 21st May 2016

Fitzgerald K. (2016). Do BRCA Genes Determine Your Destiny? Institute of Functional Medicine. Available at: https://www.functionalmedicine.org/conference.aspx?id=2861&cid=39&section=t420. Accessed: 23rd May 2016

Garland CF, Gorham ED, Mohr SB, Grant WB, Giovannucci EL, Lipkin M, Newmark H, Holick MF, Garland FC. (2005). Vitamin D and prevention of Breast Cancer; Pooled analysis. The Journal of Steroid Biochemistry and Molecular Biology. Volume 103; Issues 3-5; pg 708-711. Available at: http://www.sciencedirect.com/science/article/pii/S0960076006003918. Accessed: 21st May 2016

Harvie M, Howell A & Evans DG. (2015). Can Diet and Lifestyle Prevent Breast Cancer: What is the Evidence? American Society of Clinical Oncology (ASC); 2015 Educational Book. ASC, Alexandria, VA

Know: BRCA. (2016). BRCA1 and BRCA2 Gene Mutations. Available at: https://www.knowbrca.org/Learn/brca1-and-brca2-gene-mutations. Accessed: 21th May 2016

Liu Q, Loo WT, Sze SC, Tong Y. (2009). 'Curcumin inhibits cell proliferation of MDA-MB-231 and BT-483 breast cancer cells mediated by down-regulation of NFkappaB, cyclinD and MMP-1 transcription'. Phytomedicine. Oct; 16; Vol 10; pg 916-922. Available at: http://www.ncbi.nlm.nih.gov/pubmed/19524420. Accessed: 20th May 2016

Murray M & Pizzorno J. (2012). The Encyclopedia of Natural Medicine. Third Edition. Atria Paperback. New York

National Breast and Ovarian Cancer Centre. (2009). Breast Cancer Risk Factors – a review of the evidence. National Breast and Ovarian Cancer Centre. NSW, Australia

Ogunleye AA, Xue F, Michels KB. (2010). 'Green tea consumption and breast cancer risk or recurrence: a meta-analysis'. Breast Cancer Research and Treatment. Jan; 119 (2); pg 477-484. Available at: http://www.ncbi.nlm.nih.gov/pubmed/19437116#. Accesessed: 20th May 2016

Pozo-Guisado E, Alvaros-Barrientos A, Mulero-Navarro S, Santiago-Josefat B, Fernandez-Salguero PM. (2002). The anti-proliferative effects of resveratrol results in apoptosis in MCF-7 but not in MDA-MB-231 human breast cancer cells: cell-specific alteration of the cell cycle. Biochemical Pharmacology. Nov; 64 (9); pg 1375-86

Prakash D & Sharma G. (2014). Phytochemicals of Nutraceutical Importance. CAB International. India. Pg 49-56.

Saarinen NM, Warri A, Airio M et al. (2007). 'Role of dietary lignans in the reduction of breast cancer risk'. Molecular Nutrition & Food Research. Jul; 51 (7); pg 857-866. Available at: http://www.ncbi.nlm.nih.gov/pubmed/17576639. Accessed: 20th June 2016

Sarris J & Wardle J. (2010). Clinical Naturopathy: An evidence-based guide to practice. Elsevier Australia

Smith KL & Isaacs C. (2011). BRCA Mutation Testing in Determining Breast Cancer Therapy. Cancer Journal. Nov; Vol 17; Issue 6; pages 492-499. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3240813/. Accessed: 22nd May 2016

Zheng JS, Hu XJ, Zhao YM, Yang J, Li D. (2013). Intake of fish and marine n-3 polyunsaturated fatty acids and risk of breast cancer: meta-analysis of data from 21 independent prospective cohort studies. British Medical Journal. 2013; 346; f3706. Available at: http://www.bmj.com/content/346/bmj.f3706. Accessed: 21st May 2016



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