Researchers at the University at Buffalo have found that the development of breast cancer appears to be influenced by how effectively the body breaks down estrogen.

In only the second prospective study to investigate the role of estrogen metabolism as a predictor of breast cancer, the researchers found that premenopausal women show a 40 percent lower risk of the disease if their predominant pathway of estrogen metabolism produces by-products with little biologic activity, rather than by-products that are highly reactive.

Estrogen must be eliminated from the body once it has performed its essential hormonal duties. High levels of estrogen are known to be a risk factor for cancer and can upset the body's delicate hormonal balance. In order to be eliminated from the body, estrogen undergoes a process called hydroxylation. These hydroxylated estrogens, called estrogen metabolites, can travel easily in the blood stream and are eliminated through the urine.

Estrogen hydroxylation takes place at two primary sites on the estrogen molecule, designated as the C-2 position and the C-16 position. Research has shown that hydroxylation at the C-2 position produces metabolites with little or no estrogenic activity and thus might be associated with decreased breast-cancer risk. Conversely, hydroxylation at the C-16 position produces metabolites with high estrogenic activity, and might be associated with increased breast-cancer risk.

Drs. Magaziner and Greenberg strongly recommend a diet rich in compounds known as indoles, found in cruciferous and green vegetables, to help promote healthy estrogen metabolism.  We also recommend that women with a personal or family history of breast cancer, those taking hormone replacement, or those concerned about developing the disease  have an evaluation of their own estrogen metabolism.  This test involves  a simple urinary collection and it is available at our office. 

If you would like to hear more about this topic, Dr. Greenberg will be the featured speaker at the Bosom Buddies nutritional conference on March 29, 2001 at 7:30 p,m.   Bosom buddies is a local support group aiding women afflicted with breast cancer which also provides relevant educational conferences.  For more information, contact the Magaziner Center for Wellness at 856-424-8222 or Bosom Buddies at 609-953-7996.

In September, a large-sample, long-term Canadian study demonstrated that an annual mammogram was no more effective in preventing deaths from breast cancer than periodic physical examinations for women in their 50s.

The study, which appeared in the Journal of the National Cancer Institute, examined almost 40,000 women ages 50 to 59. Half of the subjects received periodic breast examinations alone and the other half received breast examinations plus mammograms. All learned to examine their own breasts as well. By 1993, 13 years after the study began, there were 610 cases of invasive breast cancer and 105 deaths in the women who received only breast examinations, compared with 622 invasive breast cancers and 107 deaths in those who received breast examinations and mammograms.

"They found smaller cancers, but ultimately the mortality rate was the same," noted Dr.Suzanne Fletcher, a professor at Harvard Medical School. She added that cancer screening programs are built on the assumption that "finding it earlier is finding it better. . .  This study questions that assumption."

In fact, truly early detection would be better, but by the time a tumor has
grown to a sufficient size to be detectable by either a mammogram or a
physical examination, it has been growing for several years, and achieved
more than 25 doublings of the malignant cell colony.

The answer to true early detection may be thermography, a technique which can detect early stages of angiogenesis. Angiogenesis is the formation of a direct supply of blood to cancer cells, which is a necessary step before they can grow into tumors of size.

Thermographic breast screening is brilliantly simple. Thermography measures the radiation of infrared heat from our body and translates this information into anatomical images. Our normal blood circulation is under the control of our autonomic nervous system, which governs our body functions without our conscious will. To screen for breast cancer, a thermographer blows cool air over a woman's breasts. In response, our autonomic nervous system reduces the amount of blood going to the breast, as a temperature-regulating measure. However, the pool of blood and primitive blood vessels that cancer cells create is not under autonomic control and is unaffected by the cool air. It will therefore stand out clearly on the thermographic image as a "hot spot."

Perhaps the combination of thermography and evaluation of estrogen metabolism, as mentioned earlier, will truly be able to influence the mortality and morbidity of breast cancer in the 21st Century.