An (Extreme) Ounce of Prevention

The danger of preventive cancer interventions

Benjamin Franklin once said, “An ounce of prevention is worth a pound of cure.” While there is sound wisdom to this phrase, life-threatening diseases present a conundrum when it comes to prevention. Our culture’s ever-growing need for instant gratification, and an institutionalized lack of patience, affects all aspects of life, including cancer treatment and other interventions. Each year, 7.6 million people worldwide die from cancer, and one of the most deadly forms is breast cancer. In 2009—the most recent breast canceryear the Centers for Disease Control and Prevention has data available—40,676 women died from breast cancer in the United States and 211,731 women were diagnosed with the disease.

In the past 15 years, there has been a significant increase in the number of women opting to have bilateral prophylactic, or double preventive, mastectomies. This extreme extra ounce of prevention in women with a high risk of or early stage breast cancer leapt 150 percent between 1998 and 2003, according to a study presented by Kelly Hunt, M.D., at the American Society of Clinical Oncology’s annual conference. This surgery hasn’t only gained popularity in women who already have breast cancer, however. In 1996, genetic screening became available, and since then nearly 1 million people have been screened for BRCA1 and BRCA2, the genetic mutations associated with increasing the lifetime risk of developing breast cancer by as much as 87 percent. For women who test positive for these mutations, bilateral mastectomy has become a common choice in the prevention of breast cancer.

There have been numerous studies done on the effectiveness of these extreme preventive therapies, and some say its increased popularity is largely an American phenomenon. In March, Deanna Attai, M.D., a board member at the American Society of Breast Surgeons, told CNN, “This is the American culture. We want quick solutions, and we expect there’s an answer to every problem.” Doctors and surgeons are seeing as much as a 20 percent increase in the number of women who are high-risk, yet cancer-free, who have already researched mastectomies and made up their minds to have them.

This reactionary mindset that leads to drastic interventions disconnects us from our bodies and interferes with natural healing processes. Rather than aggressively altering the body for fear of potentially developing a disease, a more vitalistic mindset toward cancer prevention may offer effective alternatives.

Overestimating the Risk

While any amount of risk, no matter how marginal, is enough to inspire drastic measures for some, researchers on the subject of breast cancer risk believe it is easy to emotionally miscalculate that risk. Oncologists generally consider factors such as a family history of breast cancer, presence of specific genes, personal history of endometriosis or fibroids and/or a social history of smoking and drinking alcohol when calculating a patient’s risk of contracting the disease. A study published in the Journal of Clinical Oncology in 2007 looked at nearly 3,000 families, 300 of whom had breast cancer susceptibility gene mutations present. What they found directly countered earlier studies from the same year, that women who had first-degree relatives (such as mothers, daughters or sisters) with BRCA1 or BRCA2 mutations but themselves tested negative for it had the same risk of developing breast cancer as the average woman. Doctors are generally hesitant to recommend more aggressive preventive options, such as mastectomies, to women without known breast cancer genes.

What remains to be seen is the effectiveness of these preventive surgeries in both women who have tested positive or negative for the BRCA1 and BRCA2 mutations. Because a surgeon can never be certain that he or she has removed all of a patient’s breast tissue, cancer can still develop even after bilateral mastectomies. A major myth surrounding drastic cancer preventive surgeries is that you cannot get breast cancer after a mastectomy. While there’s a lessened chance of it happening, women who are at high risk of breast cancer who opt to have their breasts removed can still develop the disease, most often at the site of the scar.

There are several potential side effects that go hand-in-hand with preventive mastectomies, including typical surgical complications such as infections and bleeding. More severe, potentially, is the risk of negative psychological effects; because these surgeries are irreversible, they can potentially change body image and also result in a loss of normal breast functions. Women who make the decision for aggressive surgery before being diagnosed with cancer and before having children will never be able to breast-feed.

For Angelina Mehta, N.D., a board-certified naturopathic medical doctor with two years experience in private practice focusing on women’s health, the controversy in the wake of the growing popularity of aggressive preventive therapies has patients overlooking more natural approaches to preventing disease. “Preventive care is defined as the measures taken to prevent disease. However, there are multiple approaches to preventing disease, just as there are multiple approaches to treating disease,” she says. “With the research of natural therapies accumulating, there may be just as much—if not more—interest rising about how diet, lifestyle, chemicals, emotional well-being and more can impact the likelihood of developing a disease or condition.” As a start, the National Cancer Institute recommends women with a high risk of developing the disease limit their consumption of alcohol, eat a low-fat diet, exercise regularly and avoid using hormone replacement therapy.

Creating Risk

According to Mehta, the concept of preventive therapies originated with the American Board of Medical Specialties and American Osteopathic Association Bureau of Osteopathic Specialists—groups that take a more prophylactic approach to disease management. Bilateral prophylactic mastectomy, along with birth control medications and vaccinations, were born of this paradigm: Measures are taken in advance to assuage people concerned with unwanted complications and illnesses. Rather than aggressive surgical preventions, the naturopathic approach to preventive therapy includes healthy lifestyle and diet choices as well as stress-relieving techniques and optimizing immune, liver and hormone functions in natural ways.

Altering the body in more unnatural ways has shown adverse results in other areas besides the breasts. For years, research has been conducted in an effort to establish a potential link between tonsillectomies and Hodgkin’s lymphoma. One nationwide cohort study conducted by Hanne Vestergaard published in the International Journal of Cancer in August 2010 concluded that tonsillectomy was associated with an increased risk of Hodgkin’s lymphoma among persons younger than 15 years, whereas those aged 15 years or older had a significantly increased Hodgkin’s lymphoma risk 14 years after tonsillitis. Because tonsillitis most often precedes a tonsillectomy, it cannot be ruled out that severe tonsillitis, rather than removal of the tonsils, is the cause of the correlation.

Causation and correlation remain difficult to prove, regardless of the medical issue at hand. “Removing both breasts is a preventive measure, which, inherently, will not allow accurate reflections of how many lives might be saved. This is the same reason that natural preventive therapies have been scrutinized,” says Mehta. “Time will reveal more information about the effectiveness of preventive therapies, but early studies are showing a higher quality of life and satisfaction rate with natural therapies to decrease risk than the removal of the breasts prophylactically. Just as hysterectomies are shown to contribute to hormone imbalance, the prophylactic removal of breast tissue may interrupt hormonal balance as well.”

Dennis Citrin, M.D., Ph.D., medical oncologist at Cancer Treatment Centers of America in Illinois, warns that, “Before any woman decides to have both breasts removed, she should carefully consider the effects on her body image, her sex life and her overall emotional health.” With more than 30 years experience treating women with breast cancer, he says, “I only recommend prophylactic removal of the opposite breast where the risk of future development of second cancer is close to 50 percent or higher. In practice, this really means a woman with a BRCA gene mutation or a woman who received radiation to both breasts as part of prior treatment for a disease such as Hodgkin’s disease.”

Adopting a Mindset of Vitalism

Vitalistic alternatives to aggressive treatments for diseases like breast cancer are gaining popularity among those concerned with contracting the disease as well as increasing their overall health and wellness. According to Mehta, removing the obstacles to a cure is the vitalistic approach to prevention. “Rather than avoiding the underlying issues, healing the whole person and fully engaging in taking the steps to make responsible choices in life yields greater results for quality of life and future generations,” she says. “The toxic attitudes, lifestyle, emotions and spiritual degradation can paralyze the body’s innate ability to heal itself.”

As in Chiropractic, naturopathic principles include an emphasis on balance and trusting the body’s innate intelligence. “Any type of exogenous or invasive insult adds to trauma and disharmony in the body, which needs to be addressed through balance,” says Mehta. “In order to safely address this shift in paradigm, consulting with a naturopathic physician licensed and trained to integrate the best of conventional and traditional medicine is recommended.”

Citrin advises that women modify their lifestyles to help reduce their risk of breast cancer. “Regular physical exercise, limiting alcohol intake and avoiding cigarettes will all help to reduce breast cancer risk as well as promote good general health,” he says. When the body as a whole is functioning well and getting what it needs to operate at a higher level, immunity is supported, as is the body’s inherent ability to heal itself. When you naturally support the body’s ability to be well, that respect of the inner intelligence of the body is its own effective form of preventive therapy.