Nutrition for Breast Cancer Prevention and Management

Breast cancer is the world’s mostly commonly diagnosed cancer, according to statistics released by the International Agency for Research on Cancer (IARC) in December 2020.¹

However, the good news is that between 30 - 50% of cancer deaths could be prevented, simply by modifying or avoiding key risk factors, while executing evidence-based prevention strategies.²

Furthermore, a healthy dietary pattern, which is characterised by high intake of unrefined cereals, vegetables, fruit, nuts and olive oil and a moderate/low consumption of saturated fatty acids and red meat, may improve overall survival, before and after diagnosis of breast cancer.³

Doctor This is in line with the main recommendations from the World Health Organisation (WHO):²

Maintain a healthy weight
Eat a healthy diet with plenty of fruit & vegetables
Limit alcohol use

Decreasing breast cancer risk

Currently the most cost-effective, long-term approach for the control of cancer is the use of prevention strategies.²

Recent studies have delivered encouraging results, which confirm that breast cancer risk can be reduced, across genetic types and menopausal status, by following basic recommendations.⁴

Basic recommendations

Dietary:⁴

Low-energy dense (ED)
Low-glycaemic load (GL)
Nutritious & plant-based
Minimal intake of animal foods (red/processed meat)
Minimal intake of alcohol

Lifestyle:⁴

Physical activity
Management of body/abdominal fatness & adult weight gain
Extended breastfeeding duration

Reducing high energy dense foods & sugar:

By not limiting high-ED foods, the risk for breast cancer was almost double.⁵ Higher intake of refined sugar has shown an increased risk, through enhanced mammographic breast density.⁶

Ditching alcohol:

Alcohol is progressively associated with increased risk of breast cancer (≈35%) for both postmenopausal & premenopausal women. ⁴

Prevention strategies (diets)

The Mediterranean diet

This diet is plant rich and low-energy dense, providing high amounts of antioxidant flavonoids, carotenoids, and vitamins, plus phytoestrogens, fibre, folate and favourable fatty acids.⁴

The Okinawan diet

This diet is similar to the Mediterranean pattern, with very low-energy dense (ED), low-glycaemic load (GL) and low fat, is high in fibre, micronutrients, phytochemicals, prebiotic/probiotic, and n-3 polyunsaturated fatty acids.

This diet includes whole grains, beans, fruits, vegetables, fermented products and marine foods, eaten fresh/raw or lightly cooked, with minimal red meat intake.⁷ One of the longest-living populations in the world make use of this diet.⁷

Fibre

Fibre intake has been linked to a reduced risk of breast cancer, by 5% for every additional 10 g/day.⁸

Grain fibres (especially from rye), through gut fermentation, can reduce the toxicity of free bile acids & produce short-chain fatty acids such as butyrate, which yield anticancer effects.⁸

Vegetables

Total vegetable intake has been related inversely to breast cancer risk, especially:

Legumes/pulses
Allium ⁹
Vegetables
- Cruciferous ¹⁰
- Raw vegetables ¹¹
Mushrooms¹²

Fruits

No consistent association has been observed between total fruit intake & breast cancer. Although, high intake of specific fruits, such as citrus & raspberry, has shown an inverse association.⁹

Beyond their low ED & high nutritional density, they reduced craving for sweets.¹³

Nutritional education can reduce the risk of breast cancer

In sub-Saharan Africa (SSA), the diagnostic journeys of women with symptoms suspicious of breast cancer have been shown to be excessively long.¹⁴ Most breast cancer patients in SSA are diagnosed at advanced stages, after lengthy symptomatic periods.¹⁵

Priority should be given to promotion of breast cancer awareness among both women and front-line health-care workers and implementation of accelerated mechanisms for referral of women with suspicious abnormalities to specialised centres for early diagnosis and treatment.¹⁴

Food A recent study unpacked the adherence to the 2018 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) Cancer Prevention Recommendations in black urban women from Soweto, South Africa.¹⁵ Greater adherence to the adapted WCRF/AICR’s Cancer Prevention Recommendations was shown to be associated with a reduced breast cancer risk in this population.¹⁵

Additionally, higher consumption of fruit and vegetables and reduced consumption of fast/processed foods could play a key role in reducing breast cancer risk in this urban population.¹⁵

Complementary nutrition when undergoing treatment

During breast cancer treatment, nutritional counselling and supplementation, coupled with dietary constituents (such as omega-3 fatty acids), can be useful in reducing drug-induced side effects while boosting therapeutic success. ¹⁶

Nutritional intervention in breast cancer patients may be deemed as an essential part to the multimodal therapeutic strategy.¹⁶ Some evidence even suggests nutritional intervention as a key factor in defining cancer prognosis, patient quality of life and success of anti-tumour treatments.¹⁶

Reducing the risk of reoccurrence

Patients with breast cancer tend to be either overweight or obese at diagnosis and this is associated with heightened risk of mortality.¹⁶

arms crossed Women are affected by adverse changes in body composition, even without weight gain (with frequent sarcopenia, accompanied by fat gain). This represents a significant risk for the advancement of comorbidities (such as cardiovascular diseases and diabetes), which influences long-term survival.¹⁶

In these patients, nutritional intervention can be considered a necessity to reduce the risk of recurrence, mortality, and development of other chronic diseases.¹⁶

Current evidence proposes that greater adherence of breast cancer survivors to the Mediterranean diet pattern may reduce:¹⁶

Breast cancer recurrence
Overall cancer mortality
Other comorbidities

Conclusion

In aiming to reduce the risk of breast cancer and instances of reoccurrence, a healthy dietary pattern cannot be underestimated. It can also be used to complement cancer treatment.

In the East and South African Regions, the adapted WCRF/AICR’s Cancer Prevention Recommendations might be a great educational tool to help reduce risk of breast cancer.

References:

Who.int. 2021. Breast cancer now most common form of cancer: WHO taking action. [online] Available at: <https://www.who.int/news/item/03-02-2021-breast-cancer-now-most-common-form-of-cancer-who-taking-action> [Accessed 11 October 2021].
Who.int. 2021. Cancer. [online] Available at: <https://www.who.int/health-topics/cancer#tab=tab_2> [Accessed 11 October 2021].
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Foerster, M., McKenzie, F., Zietsman, A., Galukande, M., Anele, A., Adisa, C., Parham, G., Pinder, L., Schüz, J., McCormack, V. and dos‐Santos‐Silva, I., 2020. Dissecting the journey to breast cancer diagnosis in sub‐Saharan Africa: Findings from the multicountry ABC‐DO cohort study. International Journal of Cancer, 148(2), pp.340-351.
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