An integrative approach to breast cancer

Breast cancer is being diagnosed earlier and earlier, said Tara Scott, MD, FACOG, FAAFM, ABOIM, CNMP, at the 2022 Integrative Healthcare Symposium in New York City.

In this session, Scott, founder of her medical practice, Revitalize, in Fairlawn, Ohio, reviewed hormone physiology as it pertains to cancer; discussed different types of testing to assess estrogen load at the tissue levels; talked about estrogen metabolism and how it relates to cancer; and reviewed evidence about hormone-replacement therapy (HRT).

Estrogen is related to the pathology of breast cancer in most cases not all, Scott said, adding she is seeing more premenopausal breast cancer in her practice.

Breast cancer risk factors include age, BRCA1 & BRCA2, gene mutations, family history, reproductive history, radiation history, elevated endogenous estrogen levels, hormone therapy, obesity, and alcohol use.

She defined cancer as the failure of the immune system to get rid of abnormal cells before they take root and become full blown cancer.

Scott gave a brief overview of the phases of the menstrual cycle and steroidogenic pathways before talking about the many functions of estrogen.

Estrogen promotes growth, body development, and slows bone loss. There are three types, according to Scott. Estradiol is good for heart and bones; estriol is good for skin; and estrone, which was described as the “sort of the bad” estrogen.

Not all estrogens act the same, shared Scott. There are alpha and beta estrogen receptors in every cell of the body. For example, according to Scott, in terms of breast cancer, activation of estrogen receptor‐alpha is associated with breast cell proliferation, while activation of estrogen receptor‐beta prevents breast cancer development. Estrone favorably binds the alpha receptor with a five to one ratio, while estriol favors the beta receptor.

Estrogen can also come from preservatives, additives, chemicals, and Bisphenol A (BPA). High estrogens stem from a variety of reasons: an individual’s body makes a large amount; environment or diet; genetics; or an individual has had a hysterectomy and is only taking estrogen, not progesterone.

Scott said you need a healthy liver to have estrogen metabolism.

While progesterone gets bodies ready for pregnancy and helps with mood, it also protects against breast and endometrial cancer. Testosterone has many functions including boosting strength, stamina, and bone density.

As an integrative gynecologist, Scott said there are several ways to check hormone levels and they all have validity.

It’s necessary to know what you are looking for and when, she said.

There are four types of testing, according to Scott, stool, blood or serum, urine, and saliva. Serum testing tells practitioners what is in the patient’s blood in real time. In saliva tests, hormones are released from binding proteins, and she described them as the gold standard for measuring cortisol. Urine testing is new, according to Scott and evaluates metabolites and provides insight into what an individual’s body does with hormones.

“This is a really good option to look at your receipts and how your body is breaking down estrogen,” she said.  

Scott shared ways to promote healthy estrogen metabolism that include a specific diet with cruciferous vegetables and omega-3; supplements such as magnesium and selenium; correct insulin resistance; specific phytonutrients including curcumin, vitamin A and vitamin C; and a healthy intestine.

To prevent negative estrogen burden and promote DNA repair, Scott said 2-HydroxyE pathway activity needs to be increased while 4-HydroxyE pathway activity needs to be decreased.

Iodine supplementation was found to be effective at diminishing ductal hyperplasia in rats. Bifidobacterium significantly decreases glucuronidase activity.

For breast cancer, Scott said MTHFR C677T, COMT, CYP 2D6, CYP 1B1, CYP 19A1 are the single nucleotide polymorphisms (SNPs) that are significant.

The biggest one I see is COMT, she said, adding CYP 2D6 is the other SNP that is important. She also said if CYP 19A1 is fast, it will make estrogen dominance worse.

Scott also addressed the question of whether HRT contributes to or causes breast cancer.

We all hear about how hormones cause cancer, she said. We can’t extrapolate this for every case of hormone therapy, she said.

Scott said this conflict typically catch headlines and people always fear getting cancer. In my opinion they don’t have the same risk, she said. The type, the dose, the duration, and the patient matter.

In addition, she discussed whether hormone levels matter after a breast cancer diagnosis. Scott said hormones do matter.

“Not only are we not looking at hormones in people who are high risk, but we are not tracking hormones,” she said. 

She said we know that the breasts have alpha and beta receptors, and that progesterone inhibits estradiol induced proliferation in the breast. Perhaps we should be testing hormone levels in patients, she said.