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Breast Cancer Survival Vegetable

Simple changes in diet and lifestyle may quadruple a woman’s survival rate from breast cancer.

September 30, 2013 |
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Supplementary Info

Sources Cited

E. D. Paskett. The promise of a cancer-free world: Where are we? The presidential address from the 35th annual meeting of the American Society of Preventive Oncology (ASPO). Cancer Epidemiol. Biomarkers Prev. 2011 20(9):1982 - 1989.

L. S. Velentzis, M. R. Keshtgar, J. V. Woodside, A. J. Leathem, A. Titcomb, K. A. Perkins, M. Mazurowska, V. Anderson, K. Wardell, M. M. Cantwell. Significant changes in dietary intake and supplement use after breast cancer diagnosis in a UK multicentre study. Breast Cancer Res. Treat. 2011 128(2):473 - 482

C. A. Thomson, C. L. Rock, P. A. Thompson, B. J. Caan, E. Cussler, S. W. Flatt, J. P. Pierce. Vegetable intake is associated with reduced breast cancer recurrence in tamoxifen users: A secondary analysis from the Women's Healthy Eating and Living Study. Breast Cancer Res. Treat. 2011 125(2):519 - 527.

J. P. Pierce, M. L. Stefanick, S. W. Flatt, L. Natarajan, B. Sternfeld, L. Madlensky, W. K. Al-Delaimy, C. A. Thomson, S. Kealey, R. Hajek, B. A. Parker, V. A. Newman, B. Caan, C. L. Rock. Greater survival after breast cancer in physically active women with high vegetable-fruit intake regardless of obesity. J. Clin. Oncol. 2007 25(17):2345 - 2351.

D. M. Parkin, L. Boyd. 4. Cancers attributable to dietary factors in the UK in 2010. I. Low consumption of fruit and vegetables. Br. J. Cancer. 2011 105 (Suppl 2):S19 - S23.

L. M. Sánchez-Zamorano, L. Flores-Luna, A. Angeles-Llerenas, I. Romieu, E. Lazcano-Ponce, H. Miranda-Hernández, F. Mainero-Ratchelous, G. Torres-Mejía. Healthy lifestyle on the risk of breast cancer. Cancer Epidemiol. Biomarkers Prev. 2011 20(5):912 - 922.

C. Shufelt, C. N. B. Merz, Y. Yang, J. Kirschner, D. Polk, F. Stanczyk, M. Paul-Labrador, G. D. Braunstein. Red versus white wine as a nutritional aromatase inhibitor in premenopausal women: A pilot study. J Womens Health (Larchmt) 2012 21(3):281 - 284.

D. Romaguera, A.-C. Vergnaud, P. H. Peeters, C. H. van Gils, D. S. M. Chan, P. Ferrari, I. Romieu, M. Jenab, N. Slimani, F. Clavel-Chapelon, G. Fagherazzi, F. Perquier, R. Kaaks, B. Teucher, H. Boeing, A. von Rüsten, A. Tjonneland, A. Olsen, C. C. Dahm, K. Overvad, J. R. Quirós, C. A. Gonzalez, M. J. Sánchez, C. Navarro, A. Barricarte, M. Dorronsoro, K.-T. Khaw, N. J. Wareham, F. L. Crowe, T. J. Key, A. Trichopoulou, P. Lagiou, C. Bamia, G. Masala, P. Vineis, R. Tumino, S. Sieri, S. Panico, A. M. May, H. B. Bueno-de-Mesquita, F. L. Büchner, E. Wirfält, J. Manjer, I. Johansson, G. Hallmans, G. Skeie, K. B. Borch, C. L. Parr, E. Riboli, T. Norat. Is concordance with World Cancer Research Fund/American Institute for Cancer Research guidelines for cancer prevention related to subsequent risk of cancer? Results from the EPIC study. Am. J. Clin. Nutr. 2012 96(1):150 - 163.

C. A. Thomson, C. L. Rock, P. A. Thompson, B. J. Caan, E. Cussler, S. W. Flatt, J. P. Pierce. Vegetable intake is associated with reduced breast cancer recurrence in tamoxifen users: a secondary analysis from the Women's Healthy Eating and Living Study. Breast Cancer Res Treat. 2011 125(2):519-527

Acknowledgements

Images thanks to the National Cancer Institute and the U.S. Navy via Wikimedia Commons.

Transcript

A half million Americans are expected to die this year from cancer, equal to 5 jumbo jets crashing… every day. The number of Americans who die from cancer each year is more than all those who have died in all US wars combined. And this happens every single year.

After a cancer diagnosis people tend to clean up their diets. About a third to a half of breast cancer patients, for example, make healthy dietary changes following diagnosis, such as increasing in fruit and vegetable consumption and decreasing meat, fat and sugar intakes. Does it actually help that late in the game? Well, the Women’s Healthy Eating and Living Study was undertaken in few thousands breast cancer survivors to determine if a plant- based, low-fat, high-fiber diet could influence breast cancer recurrence rates and survival.

Previously they famously reported that simple changes—5 or more servings fruits and veggies a day and just like walking 30 minutes a day 6 days a week was associated with a significant survival advantage, cutting risk nearly in half. Note I said fruits and veggies and exercise. Here's the proportion of women with breast cancer surviving 9 years in the study if they had low fruit and vegetable consumption and low physical activity, or high in one and low in the other. But here's the survival curve, of those high in both.

And it worked just as well in women with estrogen receptor negative tumors, which normally have twice the mortality… unless, you eat a few fruits and veggies, and taking a few strolls. The "high" should really be in quotes, I mean you could eat 5 servings in a single meal and certainly walk more than like 2 miles a day.

Imagine, for a second, you have been diagnosed with breast cancer. Imagine sitting in that chair, in the doctor’s office, as your doctor gives you the news... But, there's a new experimental treatment that can cut your chances of dying in the next few years from like 16% down to just 4%. To quadruple their survival rate many women would re-mortgage their homes to fly to some quack clinic in Mexico, would lose all their hair to chemo, but most, apparently, couldn't stand the thought of eating broccoli.

And indeed that's what the latest report from the Women’s Healthy Eating and Living Study found, fruits and vegetables may be good, but cruciferous vegetables may be better. For women on tamoxifen, for example, if one of their 5 daily servings of fruits and veggies was broccoli or cauliflower/collards/cabbage or kale, the risk of cancer recurrence may be cut in half.

To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is just an approximation of the audio contributed by Ariel Levitsky.

To help out on the site please email volunteer@nutritionfacts.org.

Dr. Michael Greger

Doctor's Note

I recommend that all women with breast cancer eat broccoli sprouts. See my 8-part video series:

  1. DNA Protection from Broccoli
  2. Sulforaphane: From Broccoli to Breast
  3. Broccoli Versus Breast Cancer Stem Cells
  4. Liver Toxicity Due to Broccoli Juice?
  5. How Much Broccoli Is Too Much?
  6. The Best Detox
  7. Sometimes the Enzyme Myth Is True
  8. Biggest Nutrition Bang for Your Buck

They may also help out with other cancers (Lung Cancer Metastases and Broccoli and Raw Broccoli and Bladder Cancer Survival).

For more on breast cancer survival, see:

And even better, preventing it in the first place! Here are the last 10, but there are 81 other videos on breast cancer:

Some of this video may sound familiar—I included it in my 2013 live presentation, which you can watch here.

For more context, check out my associated blog post: Quadrupling Breast Cancer Survival.

If you haven't yet, you can subscribe to my videos for free by clicking here.

  • VegAtHeart

    The bar plot flashed at around 1:37 minutes through the video seems to show a much greater effect of high fruit and vegetable consumption or physical activity on reducing the mortality of patients who have estrogen-receptor negative breast tumours.
    Can anyone provide insights on why that might be the case?

    • Jen Drost, Physician Assi

      Hi VegAtHeart,
      Thanks for your thoughtful question. Based on the study mentioned at 1:37 minutes, risk of death (mortality) for women who follow a plant-based diet is similar (~3-4%) whether or not the breast cancer expresses the genes for estrogen receptivity. I am not sure, but I suspect that the reason for the relatively larger overall decrease in mortality in the estrogen-negative (ER-) receptor breast cancer is that ER- cancer may be less sensitive to circulating estrogen and more sensitive to the hormone IGF-1, which is triggered (or not) by the food we eat. Check out Dr. Greger’s video about this for more details:
      http://nutritionfacts.org/video/igf-1-as-one-stop-cancer-shop/
      I hope this helps. Love your pic, btw :)

      • VegAtHeart

        Thanks for your positive response. It is interesting how you look at this from an IGF-1 perspective. It seems that one of the challenges in interpreting research on whole foods is that there are so many possible mechanisms that could simultaneously be at work.

    • Darryl

      The unedited figure can be found as figure 3 Pierce et al, 2007. The ER-/PR- cancers demonstrated a better prognosis than ER+/PR- or ER-/PR+, not the expectation, so we may be seeing small sample size effects.

      Given only 75 patients had the ER-/PR+ tumor receptor status highlighted in the video, just one or two deaths (or their absence) would have changed the mortality (%) quite a bit. You’ll note that the four-fold larger (and hence more statistically reliable) cohort of ER-/PR- patients demonstrated an improvement from veggies and exercise, but less than the improvement seen in ER+/PR+ cases. This makes intuitive sense, too, given the importance of phytoestrogens in modulating estrogen & progesterone signalling.

      • VegAtHeart

        Thanks for pointing out the limitation of sample size.

        I am trying to understand your argument concerning phytoestrogenic modulation…Are you saying that the relatively higher quantity of phytoestrogens in the high fruit and vegetable group might diminish the negative effect of a person being ER+/PR+, which would in turn provide a relative reduction in mortality?

        • Darryl

          ER+ and PR+ tumors express receptors to normally occurring hormones for breast tissue growth, and this provides the therapeutic options of silencing that growth signalling with tamoxifen and aromatase inhibitors. The availabilty of these therapies have dramatically lowered mortality for ER+ and PR+ breast cancers, while outcomes with ER-/PR- and triple negative cancers haven’t improved as much.

          Common phytoestrogens like flax lignans and soy isoflavones bind estrogen receptors, and while there competitively block binding of native estrogen; but they don’t have quite the right shape to efficiently change the receptor conformation and send signals downstream. I visualize them as rubber keys: they can enter a lock (their receptor), perhaps turn it better than no key at all, but overall they largely block the effects of the correct brass keys, which can’t enter while the rubber key is stuck.

          So, diets high in fruits, vegetables and phytoestrogens like those in flax, soy and other vegetables can be expected to have a tamoxifen-like effect on ER+ cancers, in addition to their non-phytoestrogen effects. With ER- tumors, only the non-phytoestrogen effects of high fruit-vegetable diets would appear. This suggests to me that we might expect a larger reduction in mortality from high fruit & vegetable diets in ER+ tumors than in ER- tumors.

          In the study that was the case in comparing the two largest cohorts (ER+/PR+ vs. ER-/PR-), but wasn’t the case comparing ER+/PR+ with the smaller ER-/PR+ and ER+/PR- cohorts.

          • VegAtHeart

            Thank you so much for taking the time to answer; I think that this is an outstanding answer and really helps me appreciate the effects of phytoestrogens.

          • Darryl

            I came across a review that clarified my understanding of estrogen receptors, and owe you a revision to my explanation:

            There are (at least) two types of estrogen receptor, an alpha receptor responsible for both the feminizing effects of estrogen and promotion of breast and uterine cancers, and a beta receptor without feminizing effects that appears to suppress cancers of the breast, prostate and colon. Soy isoflavones in dietary amounts selectively activates the beta receptor (and hence one can eat soy without feminizing effects), but in a few animal studies, very high (non-dietary) doses of soy isoflavones can also activate alpha receptors. Another case of whole-plant food good, pill extract bad.

          • VegAtHeart

            Thank you for this information. That is extremely interesting and an excellent point to use to defend against some of the false claims we hear regarding soy and estrogen.
            Would you mind making the source of the review available (even citation would do)?

          • Darryl

            The review & hypothesis I read referenced Kuiper, George GJM, et al. “Interaction of estrogenic chemicals and phytoestrogens with estrogen receptor β.” Endocrinology 139.10 (1998): 4252-4263.

            The first citation is a weak one (comedy books have been written about the non peer reviewed journal Medical Hypothesis), but the Endrocrinology paper is one of the most cited papers in the phytochemical literature.

          • VegAtHeart

            Thanks again. I was trying to make sense of Table 2 from the Endocrinology paper and found this article which provides a breakdown of the specific phytoestrogen components in foods. I don’t know why the USDA data tables do not seem to provide food content of phytoestrogens, since they have gone to the trouble for micronutrients such as lycopene.

          • Paleo Huntress

            This guy wasn’t taking an extract, he was EATING soy.

            Endocr Pract. 2008 May-Jun;14(4):415-8.

            An unusual case of gynecomastia associated with soy product consumption.

            OBJECTIVE: To document a case of gynecomastia related to ingestion of soy products and review the literature.

            METHODS: We present the clinical course of a man with gynecomastia in relation to ingestion of 2 different soy products and review related literature.

            RESULTS: A 60-year-old man was referred to the endocrinology clinic for evaluation of bilateral gynecomastia of 6 months’ duration. He reported erectile dysfunction and decreased libido. On further review of systems, he reported no changes in testicular size, no history of testicular trauma, no sexually transmitted diseases, no headaches, no visual changes, and no change in muscular mass or strength. Initial laboratory assessment showed estrone and estradiol concentrations to be 4-fold increased above the upper limit of the reference range and he described a daily intake of 3 quarts of soy milk. After he discontinued drinking soy milk, his breast tenderness resolved and his estradiol concentration slowly returned to normal.

          • Toxins

            This is acknowledged paleo huntress, lets not misconstrue the science. The servings of this individual are far greater then any normal person.
            http://nutritionfacts.org/video/too-much-soy-may-neutralize-plant-based-benefits/

          • Paleo Huntress

            Either whole soy stimulates ONLY beta receptors or it doesn’t. Quantity shouldn’t be a factor.

          • Toxins

            Quantity is a factor, as shared by the video. We are talking in terms of IGF-1 which we can expect similar results with the receptors for the estrogenic effects..
            http://nutritionfacts.org/video/dairy-sexual-precocity/

          • Paleo Huntress

            100 grams of whole, steamed edamame contains almost 19 grams of isoflavones. Firm tofu contains 23 grams per 100 grams serving. Soy milk contains 2.5 grams per 100 gram serving. In other words, WHOLE soy sources are MUCH higher in isoflavones. An 8 oz cup of steamed edamame contains almost 45 grams of isoflavones. A cup of soymilk only contains 7.5.
            3 quarts (the amount consumed in the study) contains about 90 grams of isoflavones. So don’t suggest that the soy-milk consumption is an exceptionally excessive intake of soy, when 2 cups of whole food soy equals the very same level of isoflavones- and it isn’t unusual for a whole food vegan to eat that much soy.
            And even if you don’t eat THAT MUCH, clearly, if two cups can cause man-boobs, it’s having a significant overriding effect on a man’s testosterone. This means that even smaller quantities effect natural androgen levels.

          • OZ

            Just a quick question. Was the issue of other estrogen raising products out of his diet that might be enhancing this breast tissue growth. In Australia we have some research on alcohol and it enhancing gynecomastia.

          • Stewart

            Darryl, I don’t know if that “rubber key” metaphor is an original with you but I found it delightful and very enlightening. I will not forget that image.

          • Darryl

            Alas, in this case it was a bit of a naive take on the effects of phytoestrogens. My comments here and here offer a better read interpretation.

  • Broccoli

    Yay for Broccoli… my fav.

    But not for this cute little girl.

    • http://nutritionfacts.org/ Michael Greger M.D.

      She’s just upset that she only got one head of broccoli :)

  • Plantstrongdoc M.D.

    If broccoli were a drug, it would be really expensive……

  • Marty

    Dr. Gregor, I love all your work and am disappointed at your comment on this video, about the “Quack clinic in Mexico”. Do you know for sure that this clinic is Quack? If you are speaking of the Gerson institute then you are wrong! There are many people out there who have survived cancer and other diseases because of Max Gerson’s brilliant discovery.

    Check it out for yourself before you slander a clinic dedicated to helping people get their lives back form ravaging diseases.

    • Toxins

      Dr. Greger has covered gerson therapy here.
      http://nutritionfacts.org/topics/gerson-therapy/

    • HereHere

      He didn’t name any particular clinic. I’m pretty confident there are some quack clinics in Mexico. Certainly, I like the raw juice diet aspect of Gerson, and there is likely financial bias in many of the studies of Gerson patients, but perhaps a whole-foods, plant-based diet is superior to Gerson. Coffee enemas and injected calf liver from Gerson are two procedures that don’t seem to offer benefit, in my mind, unless they can publish their studies, ideally with peer review.

  • walk-veg

    Is there any information on whether broccoli or broccoli sprouts would be helpful with a diagnosis of Triple Negative Breast Cancer?

  • walk-veg

    Which do you think is better for a breast cancer diagnosis, raw broccoli and sprouts or cooked/lightly steamed?

    • Toxins

      Raw is typically best to preserve the sulforaphane. More info here.

      http://nutritionfacts.org/topics/broccoli/

      • walk-veg

        Thanks, Toxins!
        In your opinion what would a super smoothie made with a concoction of veggies to target breast cancer consist of.

      • Oz

        Nutritionist are selling powdered broccoli. How effective is it.

        • Toxins

          Typically you would find an extract of the broccoli, such as a component from the food to the pill. Although yes sulforaphane is a potent phytonutrient, there are thousands of other phytonutrients at play when eating the whole plant food. Isolating one component of that food and consuming it usually does not result in the same health benefits as eating the whole food would.

  • Coacervate

    Thanks for the positives in this and other vids. Lets encourage our friends and families to be healthy. Lets think before we speak…We can all improve and should try to do so. You might want to try to constrain the attitude. I’ve been in that chair, got some very bad news and hit rock bottom before slowly climbing out of the pit. The advice I got was all bad. Pure chance led me to Essy’s FOK and it all fell into place after that single lucky event. So you can believe me that I know whereof I speak. IF I had been aware of the power of this way of living I and most people would have made the changes early.

    I witnessed my mothers struggle with diabetes and her increasingly desperate efforts to “fix” her diet with various diets. She taught me what she believed was best for me. Then it was my turn. History repeats. We all get the same load of bull coming at us from all angles. It does no good to be superior… to berate people for their ignorance no matter how frustrated you may feel. When you do that you sound just like a …. doctor.

    When you score points by degrading peoples diet choices you risk losing them. When we lose them they die badly.

    You sound like you are pandering to your loyal groupies more than trying to reach people. You might benefit from considering reading a book about persuasion. Youre getting too full of yourself mate.

    • HereHere

      I have utmost respect for the doctor and his work, but I just couldn’t forward this on to my friend who was diagnosed two years ago. I do usually send her links to research showing improved breast cancer survival rates. I’m not sure I felt he was too full of himself, but I felt it might make her re-live the trauma of being told by the doc that her lump was cancerous.

      • Coacervate

        Yes exactly…thanks. In our case, our oldest dearest friends started referring to her in the past tense…in her presence! Cripes. Can’t people think a little before speaking?

  • HappyPBD

    Anyone care to share their recipe for a delish vegan broccoli soup? I’ve been try to concoct one, but have not found one that I really like yet.

    • VegAtHeart

      Try Brenda’s Queen of the Greens soup using broccoli.

      • Jen Drost, Physician Assi

        VegAtHeart,
        Super yum! Thanks for sharing :)

      • b00mer

        Looks good but boy so does that Ginger Squash soup! I think I might try that one first :)

        Here’s another blended green soup (can use any cruciferous green leafies or broccoli or both). I like to add a little rosemary to it. I also omit the oil and use regular ol brown rice. The rice blended into it gives it a wonderful thick and creamy texture.

        Also the directions as written are kind of involved, but I just caramelize the onions, then cook the crap out of everything else, then blend. I do it all in one pot and use an immersion blender.

        http://www.splendidtable.org/recipes/basic-green-soup

        • VegAtHeart

          Re: Brenda’s Ginger Squash soup, what would you suggest in place of coconut milk, which is high in saturated fat?
          Btw, thanks for your response and link.

          • b00mer

            In a couple Thai recipes, I’ve used soy or almond milk with 1/4 – 1/2 tsp coconut extract per cup milk. I got the suggestion from fatfreevegan or the Healthy Librarian, can’t remember which. And come to think of it I think they got it from Ann Esselstyn. Anyway I think it tastes great, plus once you have the little bottle of extract, as long as you have milk in the fridge you always have “coconut milk” on hand. Which otherwise for me would be a special trip to the store.

          • Thea

            b00mer: re:”coconut extract” Very interesting idea! I want to try that too.

            I also thought I would share my initial thoughts: The idea didn’t make sense to me initially, because most of the time when I am using coconut milk, it seems that the recipe is wanting the high-fat / saturated fat nature of the coconut milk. Especially for savory dishes, I thought the inclusion of coconut milk had more to do with tradition and texture than with taste.

            But then I thought about how Dr. Barnard talks about people’s natural adjustment from drinking say whole milk to 2% or from 2% to skim. It tastes watery at first, but then you get used to it. So, I imagine the same would be true with your/fatfreevegan/Healthy Librarian’s trick — with even less of an adjustment since the “milky” coconut milk that comes in cartons is not really any thicker than say soy milk I think. Also, I was thinking that adding some strong coconut flavor might make a difference taste-wise and really enhance a dish.

            Just sharing some thoughts with you. I appreciate the idea. I can see how it has potential!

  • Denis Spasyuk

    What about bitter Mellon?

  • Ronald Chavin

    Dr. Greger is making a mistake by linking cruciferous vegetables with the prevention of just one type of cancer (breast cancer) or with just one group of cancers (hormone-dependent cancers). The truth is that cruciferous vegetables prevent ALL cancers extremely well and they also prevent heart disease, stroke, brain diseases, bone diseases, lung diseases, kidney diseases, liver diseases, pancreatic diseases, intestinal diseases, vision loss, hearing loss, etc:
    http://www.ncbi.nlm.nih.gov/pubmed/16227704

    Just remember that cruciferous vegetables need to be eaten raw and that boiling them will destroy about half of the beneficial glucosinolates.
    Freezing them will also destroy about half. Freezing then boiling cruciferous vegetables will destroy about three-quarters of the beneficial glucosinolates. Fortunately, most other vegetables can be boiled or canned without too much destruction of their beneficial disease-preventing phytonutrients.

  • Tan

    Wonderful Dr. Greger.