How to Reduce Breast Density to Decrease Risk of Breast Cancer

by Sat Dharam Kaur ND

Breast Density and Cancer Risk

• Increased breast density causes a 4-5 fold greater risk of breast cancer in women who have increased density in > 75% of breast tissue

• 1/3 of all breast cancers are found in women who have increased density in > 50% of their breast tissue Lancet Oncol. 2005 Oct;6(10):798-808

Breast Density and Cancer Risk

• 43.3% of US women ages 40 to 74 years of age have heterogeneously or extremely dense breasts (about 27.6 million women) as determined by mammography

• Breast density is inversely associated with age and BMI

• Women aged 40 to 49 years account for 44.3% of this group J Natl Cancer Inst. 2014 Sep 12;106(10)

Detecting Increased Breast Density

Breast density can be evaluated using:

• Mammography

• MRI PLoS One. 2014;9(6): e99027

• Ultrasound AJR. Jul 2012; 199(1):224-235.

• Skilled Clinical Breast Exam - may not match mammographic exam - high and low densities were detected in 84.5% and 15.5% of clinical breast examinations and 59.7% and 40.3% of mammographies, respectively. There was a significant difference between breast tissue densities in breast examination with those in mammography Asian Pac J Cancer Prev. 2013;14(6):3685-8

Detecting Increased Breast Density

• Breast tissue is composed of fat, glandular tissue and fibrous tissue

• Fat is radiolucent and appears dark on a mammogram; glandular and fibrous tissue are radiodense and appear light.

• When more glandular and fibrous tissue are present, breast density is greater

Grading Breast Density

• the American College of Radiology developed a Mammography Breast Imaging Reporting and Data System scoring method using a 1-4 rating

• BI-RADS 1: less than 25% Dense Breast Tissue

• BI-RADS 2: 26-50% Dense Breast Tissue

• BI-RADS 3: 51-75% Dense Breast Tissue

• BI-RADS 4: more than 75% Dense Breast Tissue

Breast Density Comparison

Age and Breast Density

• ¾ of women in their 30’s have increased breast density

• ¼ of women in their 70’s have increased breast density

• Mammographic breast density can diminish over time

• Women whose breast density does not diminish over time are more likely to be diagnosed with breast cancer Int J Cancer. 2104 Oct 1;135(7):1740-4

Causes of Increased Breast Density

• Genetic

• Neonatal

• Reproductive

• Hormonal

• Lifestyle

• Dietary

• Nutritional

• Environmental

Genetic Factors

• density is influenced by age, parity, body mass index and menopause, but these factors account for only 20-30% of the variation in density

• twin studies show that mammographic density is highly heritable – inherited factors explain 63% of the variance  Methods Mol Biol 2009;472:343-60

• Ashkenazi Jews have breast density compared to other Caucasians Breast Cancer Res 2013 May 13;15(3)

Neonatal Factors

• higher birth weight (>4000 grams or 8 lb, 13 oz ) is correlated with premenopausal breast cancer, in comparison to lower birth weight (<2500 grams or 5 lb, 8 oz) Lancet. 1996 Dec 7;348(9041):1542-6.

Hormonal Factors

• increased estradiol, estrone, IGF-1, prolactin

• use of birth control pill

• use of hormone replacement therapy

• increased weight gain in adulthood

Menstrual and Reproductive Factors• earlier age at onset of menstruation (<11

yrs old)

• shorter menstrual cycle length (< 25 days)

• later age at menopause (>53 years)

• premenopausal women have increased density compared to postmenopausal women

• prior benign breast disease

Menstrual and Reproductive Factors• parity (not having children) is significantly

inversely associated with breast density

• mean percent dense breast volume (%DBV) decreases from 20.5 % in nulliparous women to 16.0 % in parous women. 

• breast density is inversely associated with the age women start using hormonal contraceptives

Menstrual and Reproductive Factors

• breast density increases the longer hormonal contraceptives are used

• mean %DBV decreases from 21.7 % in women who start using hormones at 12-17 years of age to 14.7 % in those who start using hormones at 22-28 years of age

• age at which women started using hormonal contraceptives and duration of hormone use are inversely correlated

• mean %DBV increased from 15.8 % in women who used hormones for not more than 2.0 years to 22.0 % in women who used hormones for more than 8 years

Dietary Factors

• increased red meat consumption, particularly in adolescence

• alcohol consumption

• saturated fats (meat, butter, ice cream)

• high glycemic load, from simple sugars and refined carbohydrates

Breast Density and Sweets

BMC Public Health. 2014 Jun 26;14:554

Environmental Factors

• Postmenopausal women with high serum levels of Bisphenol A (BPA) and mono-ethyl phthalate had elevated breast density Breast Cancer Res. 2013 may 27;15(3):R45

Ways to Reduce Breast Density and

Cancer Risk• have a child before age 24

• have three or more children

• breastfeed

Dietary Recommendations

• Decrease or eliminate red meat, transition towards a plant-based diet

• Decrease saturated fat (meat, butter, ice cream, fatty cheese)

• Decrease sugar, refined carbohydrates and high glycemic carbohydrates

• Avoid alcohol or limit to less than 3 alcoholic beverages per week

• Eliminate caffeine

• Decrease caloric intake

Consume Daily

• increase fiber to 45 mg/day - use chia, flax, legumes, psyllium, rice bran, wheat bran if tolerated

• use 2 or more Tbsp freshly ground flaxseed

• eat 1-2 cups of legumes daily (bean soup, bean dip, bean and grain casserole)

• eat 6 servings of vegetables daily (2 cups salad, 2 cups steamed vegetables)

• eat vegetables containing carotenoids (carrots, squash, sweet potato)

Consume Daily

• eat 2 Tbsp or 3000 mg of linolenic acid from flax and/or fish oil . Pour flaxseed oil over rice, pasta, baked potato; add to salad dressing, use in smoothies. Never heat it. Keep refrigerated.

• use 1 Tbsp olive oil daily in salad dressing

• use ½ cup organic tofu or 1 glass soymilk daily, or both. Avoid if allergic.

• drink green tea or take a green tea supplement

• use rosemary as a spice and as tea

Nutritional Factors to Decrease Breast

Density • vitamin D >1750 IU/day

• calcium >700 mg/day

Other Nutritional Factors to Prevent

Breast Cancer• inositol and alpha lipoic acid

• curcumin

• rosemary

• N-acetyl cysteine

• Coenzyme Q10

• Green tea extract

• Grape seed extract

Other Nutritional Factors to Prevent

Breast Cancer• B complex

• magnesium

• kelp

• indole-3-carbinol

• tocotrienols

Lifestyle Factors to Decrease Breast

Density• Exercise 40 minutes a day

• Spend more lifetime hours in the sun

• Avoid weight gain during adulthood and after menopause

• Avoid birth control pill and hormone replacement therapy

• Avoid plastics containing bisphenol-A and phthalates, especially during pregnancy

• Use organically grown food as often as possible