Reducing Breast Cancer Risk with an Integrative Approach
In 2016 the US Preventive Services Task Force (USPSTF) recommended that women receive biannual mammography screening starting at age 50 through age 74. Recently the USPSTF changed those recommendations to have women start biannual screening at age 40, which is consistent with a 2020 randomized controlled trial published in The Lancet. This is significant because although women age 40 to 49 have a lower risk of getting breast cancer, if they are diagnosed, it is often with a more aggressive type of breast cancer that has a poorer prognosis.
“Screening women aged 40 to 49 is associated with a 14 percent reduction in breast cancer mortality, which certainly justifies the revision of that portion of the guidelines,” explained naturopathic oncologist Lise Alschuler, ND, FABNO. “Unfortunately, the guidelines still do not address the issue of screening discontinuation at age 74. This is an area of concern because women are living longer, healthier lives, and it may, or may not, be prudent to stop screening.”
What about women with dense breasts? Alschuler explained that this is also a missing factor in the current USPSTF recommendations. “The importance of breast density as a risk factor for breast cancer is well recognized, and yet these new guidelines do not recommend additional screening in women with dense breast tissue,” said Alschuler.
In addition to the lack of guidance regarding women over age 74 and those with dense breast tissue, the USPSTF pointed out that racial disparity is present in the trials they evaluated with a significant underrepresentation of black women.
While questions, concerns, and conversations continue about screening, Alschuler explained that reducing breast cancer risk beyond screening is an area where integrative practitioners can excel.
Integrative Risk Reduction Strategies
“Integrative practitioners are well suited to address potential contributors that can increase the risk of breast cancer in their patients,” said Alschuler. She explained that risk factors include increased adiposity, increased breast density, chronic inflammation, insulin resistance, exposure to endocrine disruptors, and other factors. “I would argue that integrative medicine is perhaps best suited to address these factors because we focus on lifestyle optimization, specific and evidence-based anti-inflammatory strategies, and metabolic and detoxification support,” she said.
Specific to breast density, Alschuler said that women with dense breasts should be prioritized when creating an integrative breast cancer risk reduction protocol.
What about women who carry the BRCA genetic mutation? This is another patient population that can benefit from an integrative approach. For example, a 2023 review in Nature Reviews Cancer found that obesity is a promoter of breast cancer in women who carry the BRCA mutation. Despite being BRCA+, women who eat a Mediterranean diet may also reduce breast cancer risk because this eating style lowers IGF-I and other potential modulators of both BRCA 1 and 2 mutations.
“The incidence of breast cancer in women who carry the inherited genetic mutation is not 100 percent, which means the clinical penetrance of genetic mutations is influenced by the cellular environment,” explained Alschuler. “In fact, research has shown that BRCA+ women stand to gain even greater benefit from breast cancer reduction strategies such as eating more plants in the diet, regular exercise, and stress reduction.”
Going Beyond Screening
Breast cancer screening saves lives. However, to give patients the best chance of reducing their risk of breast cancer, an integrative approach provides proactive prevention while also optimizing health. Through a combination of diet, lifestyle, dietary supplements, and other integrative strategies, integrative practitioners can play a valuable role in a woman’s breast cancer reduction program.