For example, there is insufficient evidence to support that green tea reduces the risk of breast cancer and there is limited evidence that the consumption of foods containing carotenoids as well as foods rich in calcium reduce the risk of breast cancer.
As for soy, as a source of isoflavones, it has components with weak estrogenic activity, “which leads to controversy about its effects, given the relationship between estrogens and breast cancer.”
All these observations are included in the Manual of Breast Pathology for Primary Care, powered by Spanish Association of Surgeons (AEC), la Spanish Society of General and Family Physicians (SEMG) y la Spanish Society of Primary Care Physicians (Semerging).
In the work, which seeks, among other things, to improve training in breast pathology at both levels of care and to coordinate patient care more effectively, 23 specialists in Surgery, 23 specialists in Primary Care, 4 specialists in Gynecology, two Nursing professionals and a specialist in Radiology.
EFEsalud collects here part of the chapter dedicated to the modifiable factors of breast cancer, prepared by the specialists Ana Patricia ArlandisIsabel Sierra Fernandez and Isabel Sanchez Clarosthe three from the Breast Pathology Unit of Arnau de Vilanova University Hospital (Lleida).
Breast cancer: modifiable risk factors
According to the authors, factors such as overweight and obesity, alcohol, physical inactivity and inadequate diet will increase or decrease the risk of cancer depending on the woman’s hormonal moment.
These are some of the key ideas in relation to obesity and diet:
Obesity/muscle mass index
Industrial foods have induced a change in diet in developed countries, which has caused an increase in the rate of overweight.
Muscle mass index (BMI) is an independent risk factor for breast cancer, especially in Caucasian patients. For every 5 kg/m2 increase in BMI, the risk of breast cancer increases by 12%.
In the postmenopausethe sex hormone binding globulin (SHBG) is decreased, so free estrogens are increased by 50-100% due to increased activity of aromatase, responsible for transforming fatty tissue into estrogens.
This leads to an increased risk of breast cancer in postmenopausal women who did not receive hormone therapy, which is 1.5 times greater than in women of normal weight.
Those who have experienced a weight gain of 25 kg or more since the age of 18 have an increased risk of breast cancer compared to those who have maintained the weight.
Likewise, those who have not used hormonal treatment, who lose 10 kg or more of weight since menopause, and who maintain this loss, have a significantly reduced risk of breast cancer.
Diet
The diet of industrialized society is characterized by the excessive consumption of hyper-transformed foods, which, together with a sedentary lifestyle, causes overweight that induces many chronic and neoplastic diseases.
There are not many studies that compare the incidence of breast cancer with different types of diet and most are observational, so they are subject to biases that make it difficult to interpret the observation.
In any case, it is known that weight gain and obesity, which are usually directly related to diet, increase the risk of breast cancer.
On the other hand, the composition of the diet could have a greater influence during adolescence and early adulthood.
Thus they highlight that:
– There is a relationship between consumption of animal fats and breast cancer: more than five intakes of red meat per week in youth is associated with a relative increase in breast cancer of 1.22 in premenopause and postmenopause, compared with the intake of poultry, fish, legumes and nuts .
– It has not been shown that a strict Mediterranean diet influences the risk of breast cancer, although some studies affirm that such a diet characterized by the use of oils of vegetable origin (such as extra virgin olive oil EVOO), intake of fruits, vegetables, monounsaturated fats, omega 3 fats, sugars from fiber and cereals, in which the proteins come from fish and legumes, causes a 15% decrease in the incidence of breast cancer.
This benefit could be included in women with less physical activity.
– There are very limited data to suggest that the consumption of non-starchy vegetables (tomato, lettuce, onion, spinach, cucumber, broccoli, cauliflower, cabbage, mushrooms, etc.) decrease breast cancer RH-.
Some studies suggest that women with low levels of vitamin D have a higher risk of developing breast cancer.
They also note:
– There is insufficient evidence to support that the green tea reduce the risk of breast cancer.
– There is limited evidence that the consumption of foods containing carotenoids as well as foods rich in calcium decrease the risk of breast cancer.
– The soyas a source of isoflavones, has components with weak estrogenic activity, which leads to controversy about its effects, given the relationship between estrogens and breast cancer.
However, it has been proven that it can have an anticancer and antioxidant effect, that it induces apoptosis and decreases angiogenesis.
Studies are underway to elucidate this aspect.
Healthy life style
The three specialists recommend a healthy life style Passing by:
– Maintain a healthy body mass index (BMI) and prevent weight gain after menopause.
– In women who are overweight or obese, it is recommended to lose weight.
– Limit sedentary behaviors.
– Carry out moderate-intense physical exercise spread over 3-5 days a week (150 minutes a week of moderate exercise, 75 minutes a week intense, or both).
– Limit the alcohol consumption and avoid it especially in young women before the first pregnancy.
– In smokers, it is recommended reduce or eliminate smokingof particular importance in young people before the first pregnancy, as in the case of alcohol.
– It is recommended the Breastfeeding as far as possible.
– Limit the use of hormone replacement therapy.
– Avoid processed meats, limit the consumption of red meat and foods with high salt content. Promote protein intake from poultry, oily fish, legumes and nuts.
– Limit food high calorie and avoid sugary drinks.
– A Mediterranean diet is recommended, rich in fruits, non-starchy vegetables, cereals, legumes and extra virgin olive oil.
Manual of Breast Pathology for Primary Care
In the Western world, breast cancer is the most common cancer among women. Its incidence grows every year and its age of onset is advanced. In addition, benign breast disease is very common in our population.
Currently, and as indicated in the introduction to the manual, this type of cancer has a great social relevance thanks to public awareness campaigns on the importance of early diagnosis and screening programs, which entails a greater commitment on the part of patients in the active search for signs and symptoms of the disease and, consequently, the demand for early health care before its appearance.
The manual, so, propose a change of roles in these two care levels, in which both the new information technologies as the healthcare information play an important rolein order to improve the accessibility of patients to the health system, reduce waiting times in all phases of the process, provide comprehensive management of breast pathology taking into account the psychological and socio-family aspects, and facilitate complete rehabilitation and the return to normal life of patients after treatment.
On the occasion of its publication, the coordinator of the Breast Section of the AEC, Sonia Rivas-Fidalgo has considered that the Primary Care doctor «plays a fundamental role not only in the early diagnosis of breast pathology, but also in the follow-up once the oncological treatments have finished, in the identification of social or psychological needs, in the identification of high-risk women and in promoting healthy lifestyles.
Also the doctor Fatima Santolaya Sardineroof the Oncology Working Group of the Spanish Society of General and Family Physicians, SEMG has reported that one of the fundamental actions of Primary Care is to carry out a set of preventive, diagnostic, therapeutic, follow-up and care activities, aimed at Comprehensive management of people who present clinical signs/symptoms or diagnostic imaging test findings suspicious for malignancy, or in whom an increased risk for breast cancer is detected.
Finally, the coordinator of the Semergen Women’s Care working group, the Dr. Ana Rosa Jurado has pointed out that once again, and at a time of unprecedented care overload, the Primary Care professionals who have participated in the preparation of this Manual «have shown that the priority is the quality of care for users of the National Health System, on this occasion from the training, the advice and the work of consensus that have made the elaboration of this work possible».
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