Life Over Cancer Blog

Breast Cancer and Cholesterol

One of the most important strategies for treating women with estrogen-positive breast cancer is to block the action of estrogen. In estrogen positive (ER+) breast cancers, the natural estrogen in the body attaches to the estrogen receptors on cancer cells and stimulates them to divide, which makes breast tumors grow. 

Once the initial treatment of breast cancer is completed, (surgery, chemotherapy, radiation), it is usually recommended that patients with ER+ tumors undergo long-term treatment with drugs like tamoxifen, which blocks estrogen activity, and aromatase inhibitors – Aromasin, Arimidex and Femara – which block the synthesis of estrogen in fat tissue in the body. These estrogen-blocking drugs work well for most women, but unfortunately, not all women respond to them, and it is not unusual for tumors to develop resistance to these drugs. 

We are now learning more about why estrogen-blocking drugs may not work all the time, and one of the mechanisms comes from a surprising source:  cholesterol! Like most molecules in the body, cholesterol gets metabolically transformed into other molecules by various enzymes in our body. One of the molecules that is derived from cholesterol, and which is present in fairly high levels in the body, is 27-hydroxycholesterol (27-HC). This interesting molecule can attach to and actually stimulate estrogen receptors in the body. Patients with ER+ breast cancer have higher amounts of 27-HC in the normal tissue in their breasts than women who have not been diagnosed with ER+ breast cancer. And the amount of 27-HC in breast tumors is even higher. This is because the enzyme that converts cholesterol to 27-HC is found in high levels in some breast cancer cells, especially in higher-grade tumors (higher grade tumors tend to grow rapidly and spread faster than lower grade tumors), and also in immune cells called macrophages, that sometimes infiltrate breast tumors. 

Fruit-Nut Wild Rice

Serves 6

Ingredients:

4 scallions

1 tablespoon extra-virgin olive oil

Coarse salt and ground pepper

1 1/4 cup wild rice or wild rice blend (any seasoning packet discarded)

2 tablespoons red-wine vinegar

1/2 cup dried cherries or cranberries

1/2 cup pecans, toasted and chopped

1 orange, diced, zest optional 

 

Jalapeño Cornbread

Serves 12

Qigong Fatigue Study

Qigong is a traditional Chinese exercise modality. It aligns breathing, mental focus (or awareness) and movement for purposes of exercise, meditation and balancing of the “qi,” or life energy, in healing. It emphasizes and cultivates a calm and relaxing state of mind. At the Block Center, qigong exercises are often integrated into the physical activity component of our patients’ individualized treatment plans.  

A study recently published in the Journal of Cancer Survivorship compared qigong with stretching classes in the framework of a randomized, controlled trial. The main goal of the study was to evaluate whether qigong helps with fatigue – a common problem for many cancer patients, both during and after treatment – in prostate cancer survivors. Many studies have been done on ways to address this fatigue; of special interest to our clinicians are non-drug interventions that may be helpful. 

This study was designed especially well, which makes its conclusions even stronger than most of the previous studies that have looked at exercise for cancer patients. 40 men (average age 74) with prostate cancer were randomized to take either qigong classes or controlled stretching classes twice a week for 12 weeks. Both types of classes were an hour long, included sitting and standing exercises, and had DVDs to encourage participants to practice at home. One particular strength of the study was the fact that the control group was doing an exercise intervention at the same time as the qigong group. This ensures that it is not simply an increase in activity that would cause any beneficial effects from the qigong classes, but rather something unique about the qigong itself as an exercise system.

Antioxidants as Pro-oxidants

When is an antioxidant not an antioxidant?  This curious question was explored in a scientific poster that Dr. Block presented at the 10th International Conference of the Society for Integrative Oncology (SIO), held October 20-22 of this year. The answer to the question was suggested in the title of the poster, “Antioxidants as pro-oxidants in cancer cells.”  What, you might ask, is a pro-oxidant?  As the name suggests, it’s the opposite of an antioxidant!  Antioxidants neutralize free radicals, while pro-oxidants stimulate and produce free radicals, or, in scientific jargon, reactive oxygen species (ROS).

Why are we interested in producing free radicals in cancer cells?  Isn’t this the opposite of what we want to do?  And why would an antioxidant suddenly turn into a pro-oxidant when you put it into a cancer cell?  Actually, it’s well known that many antioxidants can act as pro-oxidants – this fact even appears in Wikipedia!  However, the Wikipedia discussion of antioxidants overlooks some new data that are coming to light about pro-oxidants and antioxidants as they relate to cancer treatment. 

Barley Bean Pilaf

A hearty pilaf for fall makes great leftovers for lunch when you're on the go!

Ingredients:

2 tsp canola oil (organic)
1 medium yellow onion, peeled and diced
1 celery stalk, diced
1 medium carrot, peeled and diced
1 ½ cups pearled barley
2-inch piece of fresh orange peel
1 whole cinnamon stick
3 cups vegetable stock or broth
2 cups cooked white or navy beans (or 1 15-ounce can, drained)
¼ cup finely chopped dill

Instructions:

1. Heat oil in a large saucepan and add onion, celery, and carrot when hot.   Sauté over medium heat for 7-8 minutes.  Add water as needed if veg are sticking to the pan. 
2. Add barley, orange peel, cinnamon and vegetable stock to the pan and bring to a boil over high heat.  Reduce heat to medium and cook for 35 minutes.
3. Add beans and cook for an additional 10 minutes, until barley is tender.  Remove from heat and stir in the dill. 

For more information on The Block Center for Integrative Cancer Treatment, call (847) 230-9107 or visit BlockMD.com.

Dr. Block Delivered a Presentation on Fish Oil at the Society for Integrative Oncology Meeting

What cancer-related uses of fish oil have the best scientific evidence behind them? Dr. Block presented on this topic at the 10th International Society for Integrative Oncology in Vancouver, British Columbia on Sunday, October 20. 

Laboratory studies of fish oil show that it has many effects on cancer, from modifying blood viscosity to modulating treatment resistance. It has beneficial effects on the important processes of apoptosis and angiogenesis. EPA and DHA, the major omega-3 fatty acids in fish oil, diminish inflammation, a critical driver of many cancer processes.

Besides lab studies, several important recent observational and clinical studies have shown the benefits of fish oil on different cancers. Breast cancer patients whose diets included the most EPA and DHA had 28% less risk of recurrence or metastasis, and 41% lower risk of mortality than those with the least. A randomized study of fish oil taken during chemotherapy for lung cancer found that patients had improved rates of tumor shrinkage, less weight loss and better retention of muscle mass. Prostate cancer patients who were given fish oil and a low fat diet before surgical removal of the prostate were found to have tumors with lower rates of cancer cell proliferation than those who ate typical Western diets. Fish oil also helped to maintain weight and immune function in gastrointestinal cancer patients who were receiving chemotherapy.  

There are very few side effects from taking fish oil. Gastrointestinal side effects, such as belching or stomach upset, can be minimized by taking enterically coated fish oil capsules. We recommend fish oil that contains added vitamin E to reduce oxidation, which fish oil is prone to.  Finally, fish oil has blood thinning effects and should be used cautiously with medications that thin the blood, and during times when blood platelets are low due to chemotherapy. If your doctor tells you, for instance, that you should not take aspirin due to low platelet counts, it is prudent to ask her/him if you should also stop fish oil supplements.

Dr. Block also discussed the study on omega-3 blood levels of prostate cancer patients by Brasky and colleagues that was discussed in this blog a few weeks ago, concluding that the results of this study did not offer any conclusive evidence of harm from taking fish oil. With the basis of randomized trials and observational studies of solid design showing benefit from taking fish oil, we continue to feel that this source of essential omega-3 fats is a healthful supplement for cancer patients.

For more information on The Block Center for Integrative Cancer Treatment, call (847) 230-9107 or visit BlockMD.com.

DIM and Breast Cancer

By Dr. Keith Block

Evidence-based medicine is an important precept throughout healthcare today. Evidence-based medicine relies on the best scientific evidence available at any particular time to help clinicians make decision in caring for patients, although it should never replace clinical judgment. In using evidence-based medicine, we look at randomized trials, laboratory results and systematic literature reviews to decide which medications and lab tests to use – or not to use.

A 2013 article that appeared in the Townsend Report – “Estrogen Metabolite Ratios: Time For Us To Let Go,” written by Jacob Schor – alerted us to a change in the status of evidence regarding one of the laboratory tests that we use. Along with many other practitioners, we have been using a test that measures two different metabolites, or breakdown products, of estrogen in the body to measure risk for breast cancer. Estrogen, specifically the molecule estradiol, is transformed in the body by different enzymes into other molecules. The particular molecules in question in the estrogen metabolite ratio test are 2-hydroxyestrone and 16α-hydroxyestrone. A series of studies dating back to the 1980’s had indicated that 2-hydroxyestrone had a relatively inhibiting effect on estrogen receptors, which modulate the effect of estrogen on breast cancer cells and other cells in the body. 16 α-hydroxyestrone, on the other hand, binds strongly to estrogen receptors on breast cancer cells, where it is thought to cause a long-lasting stimulation of the estrogen receptors. This might increase breast cancer risk or promote breast cancer growth. Because of the interest in predicting breast cancer risk, a lab test was developed that measured the ratio of “good” 2-hydroxyestrone to “bad” 16 α-hydroxyestrone. In this lab test, women with higher ratios of “good” estrogen to “bad” estrogen were thought to have less risk of breast cancer than women with low ratios (i.e., more “bad” estrogen). 

Resveratrol and Radiation

Resveratrol is a phytochemical found in high levels in grape skins. Not only is resveratrol an antioxidant, it has some cancer preventive properties as well. In addition, there’s increasing interest in its potential use in cancer treatment. Since it’s an antioxidant, and since many chemotherapies as well as radiation act by producing free radicals that can damage cellular DNA, researchers and clinicians have been cautious about combining resveratrol with conventional treatment. Dr. Block and his research team have reviewed the clinical literature on antioxidants and chemotherapy and feel this concern is misplaced. Randomized clinical trials in which antioxidants were given with chemotherapy did not show any reduction in anticancer effects compared to chemotherapy given with no antioxidants. In addition, a new paper published in the Journal of Surgical Research recently suggested that concern about combining resveratrol with radiation therapy is similarly misplaced.

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