About 66% of breast cancer cases are diagnosed before the cancer spreads beyond the breast. Earlier detection and new treatments have boosted survival rates. But after receiving a breast cancer diagnosis, you may have more questions than answers.
In a WebMD Reddit AMA about early-stage breast cancer, oncologists Jane L. Meisel, MD, and Kathy D. Miller, MD, discussed various topics including what may help prevent breast cancer, which diets are best, and what’s linked to breast cancer returning.
Meisel is a professor at Emory School of Medicine at Emory University, specializing in women’s health with a focus in breast cancer. Miller is a leading expert in breast care at the Indiana University Health Simon Cancer Center.
Here are some questions and answers from the Reddit AMA event.
Are more women getting diagnosed with breast cancer, or does it just seem that way because of better screening and more breast cancer awareness?
Miller: We do see an increase in the overall diagnoses of breast cancer. There are many behavioral and lifestyle factors that contribute to this increase. Better nutrition and fewer childhood infections has added 10 to 12 years of reproductive life. We start having periods younger and continue having them longer than a century ago. Increased obesity, less physical activity, and having fewer children later in life all increase the risk. These changes don’t specifically affect young women: They affect all of us. I think greater willingness to share stories, use social media, etc., makes the problem more visible as well.
What kind of diet can benefit people with breast cancer? And can artificial intelligence, like generative AI models, help optimize diet for breast cancer?
Miller: Research has never found a benefit from specific foods or supplements. Rather, we see a benefit from a healthy diet. Many in the nutrition/alternative practitioner community make this really complicated, hard to follow, and not very compatible with real life.
My favorite food writer made healthy diet rules really easy:
- Eat real food. Fewer ingredients you can’t pronounce and less processed food.
- Eat mostly plants. Shrink the amount of your calories that come from animals.
- Don’t eat too much (portion size and weight control). A healthy diet can accommodate occasional treats (the key being occasional and in reasonable amounts).
ChatGPT and other large language models are powerful tools that can search and summarize information quickly. Like any tool, they’re only as good as the information input. If a suggestion seems strange or sketchy, look at the source. Food is needed to sustain and nourish us, but it should also bring joy and pleasure. If you aren’t enjoying what you eat, you’ve probably gone too far.
Are there vitamins, supplements, or alternative treatments that can help with endocrine therapy side effects, such as joint pain and hot flashes?
Meisel: I often recommend tart cherry, collagen, and coQ10 for joint pain. In general, drinking plenty of water and eating fruits and vegetables can also help you feel good. Acupuncture and acupressure, as well as yoga, can be helpful for hot flashes and joint pain, and regular exercise often makes joint pain better. For hot flashes, there are a number of medications you can discuss with your doctor, including venlafaxine, gabapentin, and oxybutynin.
Is it true that a mastectomy doesn’t offer better outcomes, especially when it comes to recurrence, compared to lumpectomy?
Meisel: Yes, this is true. Lumpectomy and radiation is felt to be equivalent to mastectomy in terms of local control for early-stage breast cancer.
Why isn’t there more research for men with breast cancer?
Miller: There’s some movement here to be excited about. The Komen Tissue Bank started collecting normal breast tissue samples from men. Early research on those samples finds differences in signaling pathways between men and women that could lead to different treatment approaches. We’re not there yet, but the topic is finally getting the attention it deserves.
Will governmental defunding of medical research at American universities set back breast cancer research and treatment development?
Meisel: It’s hard to know exactly how much recent political changes will alter the course of breast cancer research, especially since politics can be cyclical. All of us in breast cancer research hope funding won’t be as challenging forever as it is now. I think there’s no question it’ll impact progress, especially in early stages of research. It’ll mean government funding from other countries will be critical — especially since cancer research is now increasingly global in nature — and that funds from generous donors and industry will be more important to continuing our mission.
Are there any vaccines that look promising for hormone-positive breast cancers?
Meisel: There aren’t currently any approved vaccines for the treatment of breast cancer, though there are a number of them being studied in clinical trials. Approval of these vaccines will depend on results from these trials, and the impact they have on preventing recurrence is yet to be seen.
What’s the difference between distance recurrence and local recurrence?
Miller: We sometimes use those terms interchangeably and sometimes focus only on distant recurrence. They have very different implications for patients. Distant recurrence is generally not curable, while local recurrence/new primary is curable.
Does getting pregnant after hormone-positive breast cancer increase your risk of cancer recurrence?
Miller: Good news here: No.
Why don’t doctors recommend routine imaging after mastectomies?
Meisel: Generally, it’s because when your breasts have been removed, we don’t need to screen them for cancer. In other words, the organ in question is gone. However, we encourage you to be aware of your body and any changes that occur in the postoperative area. So if something does come up that’s new, you can have it evaluated. At follow-up visits with breast surgeons, medical oncologists, and radiation oncologists, clinical exams should be done to detect any changes.
In the absence of scans, how is it possible to monitor for recurrence when everything feels different after reconstruction?
Miller: This is a common challenge after initial surgery, whether lumpectomy or mastectomy, with or without radiation or reconstruction. Your body has changed. Give yourself some time to get to know what your new body feels like. You aren’t necessarily looking for lumps. You’re looking for anything that’s changed. If you notice something different, bring it to the attention of your doctor.
Does alcohol fuel breast cancer recurrence?
Meisel: This is a challenging question and the data we have keeps changing. In general, regular alcohol consumption can be associated with increased risk of breast cancer recurrence, particularly in people with overweight or obesity, and those in menopause.
The challenge in interpreting this data is there are many confounding factors. Meaning, you can’t ethically conduct a study where women are randomized to drinking or not drinking. So research is limited to observational studies, where we observe women in their natural environment. People who drink regularly may also have other risk factors for recurrence (such as smoking, lack of exercise, and poor diet). So, the results may be confounded by factors that are hard to control for.
What helps prevent recurrence after breast cancer treatment ends?
Miller: We know obesity increases the risk of developing breast cancer, and women with obesity have a higher risk of recurrence. This is true for both ER+ and ER- breast cancer. What we don’t know is whether losing weight after diagnosis changes your prognosis (regardless of how you lose the weight).
It could be that breast cancers that develop in an “obese environment” are more aggressive. If that’s the case, losing weight will not have an impact. But it may be that the environment around micrometastases has a big impact on your body’s ability to eliminate them or keep them from growing. If that’s the case, losing weight after diagnosis could reduce your chance of recurrence. We simply don’t know.
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Jane Meisel, MD
Kathy Miller, MD
