Breasts: An Owner’s Manual: Every Woman’s Guide to Reducing Cancer Risk, Making Treatment Choices and Optimising Outcomes
Kristi Funk
A revolutionary and definitive new approach to preventing breast cancer, from Board-certified world authority on breast health Dr. Kristi Funk, co-founder of the renowned Pink Lotus Breast Centre, and surgeon to Angelina Jolie and Sheryl Crow.Breasts: An Owner’s Manual is a straight-talking, myth and misconception-busting, strategy-filled guide to breast health. Sharing the latest on lifestyle choices that impact your risk factor including food, supplements, hormones and exercise, Dr. Funk demonstrates that you are so much more in control of whether or not you get breast cancer than you could ever dare to think.In fact, unless you carry a genetic mutation associated with breast cancer, the choices you make in your-day-to-day life trumps genetics and family history when it comes to breast cancer risk, every time.Including a unique long-term risk reduction plan for every woman based on her needs, as well as the latest on diagnosis and treatment for women living with and surviving breast cancer, and with a heartfelt Foreword from longtime patient Sheryl Crow, this is a book with a life-saving message for the 1 in 8 women, at the time of writing, who are set to be diagnosed in their lifetime.
About the Author (#ulink_c1bfdf94-fcb0-592d-884f-fa22f6cc7571)
Dr. KRISTI FUNK, board-certified breast cancer surgeon and cofounder of the Pink Lotus Breast Center, is an expert in minimally invasive diagnostic and treatment methods for all types of breast disease. She has helped thousands of women through breast treatment, including well-known celebrities such as Angelina Jolie and Sheryl Crow, who have turned to her for her surgical expertise.
After graduating with distinction from Stanford University in 1991, Dr. Funk received her medical degree from the UC Davis School of Medicine. Following her surgical residency at Virginia Mason Medical Center in Seattle, Washington, she completed a surgical breast fellowship at Cedars-Sinai Medical Center in Los Angeles, where she then excelled as a surgeon and breast center director for seven years. In 2009, Dr. Funk, alongside her entrepreneurial husband, Andy Funk, opened the Pink Lotus Breast Center in Beverly Hills. The Pink Lotus Breast Center fuses state-of-the-art screening, genetic testing, diagnosis, and treatment with preventive strategies and holistic, compassionate care.
Dr. Funk is also the founding ambassador of the Pink Lotus Foundation, whose mission is to provide low-income, uninsured, and underinsured women free access to breast cancer screening and care.
When not appearing as a breast expert and TV personality in hundreds of television segments, documentaries, news articles, and stories, Dr. Funk enjoys Half Ironman triathlon races, vegan cooking, and card games. She resides with Andy and their three sons in Santa Monica, a peaceful suburb of Los Angeles.
Copyright (#ulink_ab8ae230-e814-5268-97f5-9600ba3890cf)
An imprint of HarperCollins Publishers Ltd
1 London Bridge Street
London SE1 9GF
First published in Great Britain by HQ in 2018
Copyright © Kristi Funk 2018
Kristi Funk asserts the moral right to be identified as the author of this work.
A catalogue record for this book is available from the British Library.
This novel is entirely a work of fiction. The names, characters and incidents portrayed in it are the work of the author’s imagination. Any resemblance to actual persons, living or dead, events or localities is entirely coincidental.
All rights reserved under International and Pan-American Copyright Conventions. By payment of the required fees, you have been granted the non-exclusive, non-transferable right to access and read the text of this e-book on-screen. No part of this text may be reproduced, transmitted, downloaded, decompiled, reverse engineered, or stored in or introduced into any information storage and retrieval system, in any form or by any means, whether electronic or mechanical, now known or hereinafter invented, without the express written permission of HarperCollins.
Ebook Edition © June 2018 ISBN: 9780008271398
Praise for Breasts: An Owner’s Manual (#ulink_de929ac2-56fa-5240-9461-96fcd11ea82b)
“I love this book! In Breasts: An Owner’s Manual, Dr. Kristi Funk’s evidence-based advice will have you kicking breast cancer—and all of life’s major killers—to the curb.”
—MICHAEL GREGER, MD, FACLM
Founder, Nutritionfacts.org
New York Times Bestselling Author
“Dr. Funk writes Breasts: An Owner’s Manual just like she talks: with conviction, passion, and a laser focus on you.”
—DR. MEHMET OZ
Host, The Dr. Oz Show
Professor of Surgery, New York Presbyterian Columbia University
Director, Integrative Medicine Center,
Columbia University Medical Center
New York Times Bestselling Author
“Breasts: An Owner’s Manual is an empowering guide to the latest life-saving information. It has everything you need for protecting and improving your health, tackling medical questions, planning health-supporting meals, and breaking through the myths that could hold you back, all in an easy-to-read format.”
—NEAL D. BARNARD, MD, FACC
Adjunct Associate Professor of Medicine,
George Washington University School of Medicine
President, Physicians Committee for Responsible Medicine
New York Times Bestselling Author
“Dr. Funk has written an incredibly detailed and carefully documented book on the very complex topics of breast health and breast cancer. She lays out a clear plan for breast health, cancer prevention, and, in reality, a lifestyle that we all could use to improve our health. Presented in an easily approachable manner, Breasts: An Owner’s Manual does not spare the science (in fact, it really ladles it on), but Dr. Funk makes the science readable in a conversational style that both calms and empowers the reader (exactly how I imagine she talks with her patients!). As she writes in the introduction, ‘Knowledge is power, and power replaces fear with confidence and joy, which motivates you to implement changes’—words that all patients (and all of us) can take to heart, making positive changes and taking control of our futures!”
—PETER D. BEITSCH, MD, FACS
Director, Dallas Breast Center
Past President, American Society of Breast Surgeons
“Dr. Funk uses scientific facts, complex theories, and clinical experience to artfully compose and communicate pearls of advice that are actionable and sensible. Breasts: An Owner’s Manual will become an indispensable and valued guide for women looking to optimize health and minimize breast illness.”
—DEBU TRIPATHY, MD
Professor and Chair, Department of Breast Medical Oncology,
University of Texas MD Anderson Cancer Center
Editor-in-Chief, CURE Magazine
“In Breasts: An Owner’s Manual, I can hear Dr. Funk’s straight-talking, witty voice as she debunks breast myths, simplifies complex choices, and inspires you to become your healthiest self. An important read for anyone looking to take charge of their health.”
—TRAVIS STORK, MD
Host, The Doctors
Emergency Medicine Physician
“Breasts: An Owner’s Manual not only provides a clear path to breast health, but a road that leads straight to your healthiest self. As someone who has faced breast cancer, I suggest you follow it.”
—ROBIN ROBERTS
Coanchor, Good Morning America
“Dr. Kristi Funk distills the complex topic of cancer causation and promotion down to practical, actionable advice and cutting-edge nutritional science. Breasts: An Owner’s Manual will become a cherished, life-saving manual shared among all generations of women throughout the world, for both breast health and breast illness. There’s simply no guide like it—and it’s so compelling to read!”
—CAROLYN “BO” ALDIGÉ
President and Founder, Prevent Cancer Foundation
“Breasts: An Owner’s Manual is highly readable, informative, and practical. Dr. Funk is a trustworthy and knowledgeable source of information. If you’re searching for the comprehensive book on breast health, look no further.”
—MIKE DOW, PSYD
Psychotherapist
New York Times Bestselling Author
“I believe that Breasts: An Owner’s Manual will change and save lives and serve as a gateway for many women to enter into a total health transformation: physical, mental, and spiritual. It is a comprehensive how-to, go-to book addressing the lifestyle issues of anyone with breasts. Somehow Dr. Funk has been able to neatly dissect, define, and package this explosive information. You now hold in your hands knowledge of revolutionary proportions. The light of this manual chases away the darkness that can be associated with breast health. Now sit back and enjoy the ride.”
—BEVERLY “BAM” CRAWFORD, DD
Chancellor, Bible Enrichment Fellowship International Church
“We all have (or had) breasts, but who has ever told us how to care for them? What should you eat, not eat, do, not do—and what about all those risk factors over which you have no control? There are so many mixed messages about screening and even about what to do after you’ve been diagnosed. In Breasts: An Owner’s Manual, Dr. Funk helps you sift through all the confusion as though you’re having coffee with a dear friend—a friend who just happens to know a lot about breast health and illness! So grab a cup and turn the page.”
—LISA LING
TV Journalist
Producer and Host of This Is Life with Lisa Ling
To the women and girls all over this wonderful world who have—or had—breasts.
Contents
Cover (#u8e02fce5-c719-5890-98e6-b81275f1e09d)
About the Author (#ulink_4905ddb9-a4dd-5c58-834a-ca8f72e7b85e)
Title Page (#udb3f86b0-a52d-54fb-b884-ae56897400f4)
Copyright (#ulink_c3e1c33f-47e5-5768-b7c7-4e575a9fb6c9)
Praise (#ulink_c0e090f8-9813-54a3-86f6-1122143477ec)
Dedication (#ude1e8e10-1e7b-507c-855a-976edce2b6d1)
Foreword by Sheryl Crow (#ulink_a144b263-60a6-525d-b345-d76d51771d44)
Author’s Note (#ulink_98d877a8-74f5-5022-b58e-3adfa9639267)
Introduction (#ulink_f08721be-91fa-522f-87f4-23ce8f5c53bf)
PART 1: Breast Health Basics (#ulink_30c6c67a-b53d-56d5-abe8-5292e962860d)
Chapter 1: Breast Care ABCs (#ulink_5df3a05a-bccb-53b6-8b60-98f752578f8d)
Chapter 2: Debunking Breast Cancer Myths (#ulink_9e505303-dbb9-5612-9d9b-36e725fe98ff)
PART 2: Reducing Cancer Risk
Chapter 3: Eat This
Chapter 4: Don’t Eat That
Chapter 5: Beyond Food: What You Should Do
PART 3: Learn Your Personal Risk Factors and Control What You Can
Chapter 6: Uncontrollable Risk Factors: Do You Have Them?
Chapter 7: Medications and Operations to Consider
PART 4: Making Medical Choices and Living with Risk
Chapter 8: Breast Cancer Screening and Detection
Chapter 9: Cancer Happens: A Newly Diagnosed Starter Kit
Chapter 10: Now What? Life After Diagnosis and Treatment
Acknowledgments
Appendix: Acronyms and Abbreviations
Notes
Index
About the Publisher
Foreword (#ulink_3599333d-41ad-50f9-b15a-4ce020bae670)
I’m embarrassed to say that when I first walked into my appointment with Dr. Kristi Funk, I wanted to turn around and leave. I thought, There’s no way this young woman whose beauty rivals Jessica Simpson’s can be the doctor I’ve heard so much about from my gynecologist and my internist as being someone who is widely known for her dedication and expertise to breast surgery. Boy, was I wrong! And furthermore, that appointment was one of the big blessings to come from my cancer experience. Not only was she then—and remains now—one of the finest breast surgeons a woman could have, but she also has been an inspiration and a friend to me ever since I walked into her office.
It was February 2006, and I was due to have my yearly mammogram. This one seemed to be more of a nuisance than ones in the past, because my engagement had just fallen apart five days before and I really didn’t want to be bothered with something I knew would be a waste of time. I was healthy and extremely fit, having spent the better part of the previous three years riding my bicycle up the sides of mountains—and I had no family history of breast cancer. I licked my wounds and went ahead and got it over with.
A few days after my mammogram, my gynecologist called me and suggested that I have two biopsies just to answer any questions that had shown up on the film, rather than waiting the recommended six months to view the areas again. She advised me to see Kristi Funk, who performed surgery a few days later.
I went through the painful process of a wire-localized open surgical biopsy and went home to resume the business of getting on with life. Four days later, I went in for my postoperative appointment with Dr. Funk. I will never forget the look on Kristi’s face when she told me that, although the odds of my having invasive cancer had been extremely minimal, mine was invasive, and I would need additional treatments. It was a blow of the first degree to someone who, until that point, had had complete and total control over every aspect of her life, or so I thought. And it seemed a blow to Kristi as well.
Now that I know Dr. Funk as I do, I believe each time she has had to deliver the outcome of a cancer screening that renders a malignant diagnosis, it has felt like a blow to her.
I got through my treatment uneventfully and went about rebuilding my life, personally and physically. Cancer was a game changer in the best and hardest of ways. I had to learn to put myself first, and I had to challenge what it means in a woman’s life to always nurture others but never to allow anyone to nurture her. I had to learn to say no and to be okay with not everyone liking or respecting me. I had to learn how symbolic breasts truly are and to accept that reality.
Accepting these truths seemed to be the lesson in the cancer experience for me—and from what I have heard from the countless women I have met in the most random of places who come up to me and share their cancer experiences, there is a lesson in it for everyone. Additionally, cancer changed my behavior; I had to learn about self-care and quality of living through nutrition and alleviating stress.
After some time passed, Kristi and her husband, Andy, and I met about their dream of opening a place that offered a “one-stop shop” where breast cancer screening, diagnosis, and treatment happened seamlessly and comfortably under one roof. I was all in. Their dream would eventually become Pink Lotus, including the free care they provide to underserved women via the Pink Lotus Foundation. The Pink Lotus Breast Center would offer the first contrast-enhanced digital mammograms in North America, combining Western medicine with complementary and alternative medicine, nutrition, psychology, physical therapy, genetics, and innovative technologies — and offering women holistic, whole-body view of health and wellness.
Over the years, I have learned so much about how to live a healthier life through diet and exercise and meditation. I wince every time I hear from someone I know or someone who is distantly connected that they’ve been diagnosed with breast cancer or cancer in general. The 1 out of 8 statistic seems to hold on, but we are learning more about prevention, and until there is a cure . . . well, early detection is a great help, but prevention is the greatest hope for us all.
Over a decade later, I remain grateful to Kristi for continuing to be driven to learn more about how to outsmart this insidious disease. Whether you live with or without breasts, there is so much to know and so many things one can do. Navigating it all can become confusing, especially with all the contradictory advice out there. Dr. Funk’s book is a gift to women everywhere looking for answers to breast issues and to health in general. Kristi shares what she learns in the hopes that eventually she will be out of a job as a breast cancer surgeon!
—Sheryl Crow
Author’s Note (#ulink_61c5ebb8-696f-58cc-8d6f-f758e63b2985)
My mom was thirty-six years old and had five children under the age of fourteen (I was two) in December 1971. She was in peak fitness as a competitive A-level tennis player who swam daily when she suffered a stroke and inexplicably fell into a coma that lasted three weeks. The UCLA doctors told my father on multiple occasions not to leave for home that night, for she would surely die by morning. A priest administered the sacrament of last rites, which I believe made heaven take notice: Oh heck no, we aren’t ready for that ornery MaryAnn; give her another fifty-plus. So she woke up! (If you ever meet me—and I hope you do—ask me how she woke up.) My mom remained in rehab for a year before returning home, relearning how to speak and how to walk, since she would never move her right side again (hemiparesis). All of my parents’ “friends” disappeared and my dad downsized the house, but his love for her never diminished; in fact, it grew. To this day, in their late eighties, he defends her fiercely and assists her tenderly. How could you not cherish a warrior who stared down death and won—without speaking a word?
That’s where I come from, and that’s what I offer you. I possess the dogged determination and tenacity of my mother, mixed with the empathy and compassion of my father. So when you fling excuses and hopelessness at me, I will whack you with a reality check. And when you come to me scared and broken, I will hug you until you’re whole again.
After my relationship with God, I only really care about two things in this life: loving family and killing cancer. You picked up this book. You’re family now, so let’s get going.
Introduction (#ulink_f423b3ce-565c-5901-a75a-8aab9c3b4396)
From the age of four, I wanted to be an actress. (Ha! You thought I was going to say I always wanted to be a doctor, didn’t you?) I performed in every school play, beginning with Sleeping Beauty in the second grade and continuing all the way through college, when I starred as Oedipus in an all-female production. Yet Hollywood was never my endgame. I actually pictured myself helping children heal from illness, using drama and imaginative play to explore the feelings and fears brought on by sickness.
Cut to my sophomore year as a psychology major at Stanford University, when I experienced an epiphany that would both change my course and guide it to this day. In the midst of studying for a neuropsychology final, painstakingly trying to memorize which neurotransmitters in the brain led to which functions of the body, I experienced an unmistakable and repetitive “interrupting thought” that made my own neurotransmitters buzz. It came from God.
You’re going to be a doctor, it said. Whoa.
Okay, that was interesting. Incorrect, but interesting. You see, my female role models married young, and all I wanted was to raise a family and work as a drama therapist. I traveled to Africa a week later on a summer missionary trip that had been planned for months. When I saw firsthand the health challenges that millions of men, women, and children face, my life’s purpose snapped into shape—and not in the form of theater or therapy. I felt newly inspired to care for people in the one way that matters most to them—by helping them maintain the very vessel that carries them around all day: their bodies. Disease robs far too many people of joy, replacing hope with chronic illness and death. It isn’t right. As I sat cross-legged in a dung hut, balancing potatoes on my head to make the tribal kids laugh, I decided to do something with my life to try to stop the killer of joy: I heeded God’s voice and resolved to become a doctor.
I went to medical school, did my residency in general surgery, and then completed a surgical breast fellowship at Cedars-Sinai Medical Center. I stayed on to become the director of patient education at their breast center, where I gave a number of community and physician lectures. Most women don’t want to hear about cancer unless they have it and need to make some decisions, so rather than bore them to tears with medical jargon, I challenged my audiences by discussing attention-grabbing studies that would incite them to alter their behavior. I delved into risk reduction and discovered all sorts of lifestyle game changers. I loved the work, and patients responded like crazy. I couldn’t wait to get to the office to spend all day examining and educating women, operating with curative intent, and becoming creative when a diagnosis or cosmetic issue became challenging. Everything I did back then and continue to do today—helping women boost their health, reduce their breast cancer risk, make sense of a diagnosis, or find their way after treatment—inspired the book you’re reading now.
A MULTILAYERED PROBLEM
Whether perky or droopy, full or flat, for two organs perched front and center on half the population’s chests, it is pretty crazy that breast health remains rather mysterious to many breast owners. Most women don’t know much about their breasts, what their purposes are, and how to keep them healthy so the rest of their bodies can thrive. Everyone knows that breasts can grow cancer, which is the number-one killer of women ages twenty to fifty-nine, yet there’s never been a solid and informed conversation about how to reduce our risk factors for this disease and why certain precautions might help.
Any breast health conversation needs to focus on two problems: numbers and knowledge. First and foremost, breast cancer is a pandemic concern, and the numbers sure prove it. In the United States alone, 1 in 8 women will be diagnosed with breast cancer at some point in their lives. Every year, we identify 1.7 million new breast cancer cases worldwide, with over 300,000 in the US. Interestingly, incidence rates vary fourfold across the globe, ranging from 27 per 100,000 in Middle Africa and Eastern Asia, to 93 in the US, to 112 in Belgium, and it’s not the weather that accounts for these global disparities. If this freaks you out, you’re not alone.
Based on my experience as a board-certified breast cancer surgeon who has helped tens of thousands of women navigate breast health issues, I know for a fact that we have the power to reduce our breast cancer risk in achievable and dramatic ways. Enter our second big problem with breast cancer awareness: erroneous public perception. Most women believe that family history and genetics determine who gets breast cancer, but for most people, they don’t. Inherited mutations, like BRCA, only cause 5 to 10 percent of breast cancer; in fact, 87 percent of women diagnosed with breast cancer do not have a single first-degree relative with breast cancer.
I’ll give you a minute to pick your jaw up off the floor.
For the last thirty years, the medical community has not corrected the false notions held by the majority of breast cancer survivors who attribute their breast cancer entirely to family history, environmental factors, stress, or fate—all factors predominantly not under their direct control.
Yet research tells us that if, before reaching menopause, women embrace a lifestyle that prioritizes exercise, not smoking, not drinking alcohol, and a diet shifted away from meat and dairy toward whole food, plant-based eating, their odds of getting breast cancer are slashed in half. And for older women, risk drops by 80 percent.
That’s right. You have the opportunity to impact the way you behave toward your breasts and how your breasts respond to that behavior. Rigorous science and firsthand experience in the trenches back up everything I know to be true about breast cancer risk reduction and care. The women I treat are exactly like you. They share your concerns about any new mammogram finding, pain, lump, itch, or discharge. They want to know if there’s anything new under the sun that they can do to ward off this disease. Most of the patients who heed my diet, lifestyle, and medical advice come away from our conversations feeling empowered and relieved, gaining clarity over “the right thing to do.” Depending on the changes they make, women might also notice that their fibrocystic lumps and pain disappear, their obesity or diabetes improves, or they find themselves cancer-free year after year.
I must mention here that having an unhealthy lifestyle doesn’t guarantee a future breast cancer diagnosis; similarly, we can never know with certainty that lifestyle choices caused the cancer you might have already had. Moreover, even women following an ideal lifestyle get breast cancer (although not as frequently, as we shall repeatedly see), and boy, are they upset. “I did everything right!”
That being said, the changes I’m about to suggest in this book don’t just serve your breasts well. Oh no, ladies. They also yield lower cholesterol, better triglycerides, perfect blood pressure, fewer heart attacks, a leaner body, less diabetes, painless joints, more energy, better sleep, a happier mood, an improved sex life, a sharper mind, less dementia, smoother skin, regular bowel movements, cleaner lungs, less cancer in every single organ in your body, a healthier planet, and a longer life. If you practice what I teach, you will radically reduce, if not completely prevent, many of the illnesses that ultimately lead to chronic and life-threatening diseases. You’ll feel a boost of happiness and satisfaction. You’ll implement your goals with ease—and never look back.
A PIONEERING APPROACH TO BREAST HEALTH
Since I founded the Pink Lotus Breast Center in Los Angeles in 2007 alongside my husband, Andy Funk, our mission has been to fuse state-of-the-art breast cancer screening, diagnosis, and treatment with preventive strategies and holistic, compassionate care. We’re out to save lives in a way that eliminates fear, instills confidence, and provides hope in a moment of panic. Pink Lotus aims to transform the delivery of breast health care in America and to help as many women as possible, regardless of their income or status in life. We see thousands of patients every year, with a wide range of concerns, and do our best to accept most insurances, including Medicare. For low-income uninsured or underinsured women, the Pink Lotus Foundation provides 100 percent free breast cancer screenings, diagnoses, treatment, and support to those who otherwise might not be able to receive any care at all.
I am incredibly grateful that occasionally working with prominent celebrity voices affords me the unique opportunity to get my message about breast health and risk reduction into the world. Three days after I removed Sheryl’s breast cancer, she arrived in my office with a paper in hand and revealed, “I want to go public about this. Can you please fact-check this press release?” And Angelina Jolie’s New York Times op-ed, “My Medical Choice,” led to a permanent increase in BRCA testing documented around the world.
I consider it an honor and duty to continue the conversations they started.
While I’m best known as a surgeon, my ultimate mission as a physician is to get to people before they need to go under the knife. I do everything I can to teach others about breast health—I appear on television, contribute to our Pink Lotus Power Up blog, give lectures, publish articles, perform research, and sponsor campaigns. I want to empower you with facts and arm you with strategies to help you understand your breasts, reduce your cancer risk, and open your eyes to life-changing interventions and treatments if you are diagnosed with the disease.
HOW TO USE THIS BOOK
Educating yourself on breast health simply requires a commitment to living your best life. We should never die from something we can largely control. Can we control breast cancer? Admittedly, a percentage of breast cancer occurs in women who seem to have mastered all the things that promise to maintain health and wellness throughout life. Until that elusive cure or prevention vaccine shows up, our best efforts will occasionally be thwarted by uncontrollable mutations and unrecognized causes. Nevertheless, you do have significant power over this disease—let’s use it. A solid 50 percent—and perhaps as much or more than 80 percent—of all breast cancer could be eliminated from planet Earth if women understood that daily choices like food, drink, exercise, weight, toxic exposures, and mind-set create the environment inside the very cells of our breasts, which either stay healthy or turn malignant.
Every single day, we make countless choices that bring us closer to cancer or move us farther away. The easiest cancer to cure is the one you never get.
Here’s what you can expect as you move through all these pages. I suggest reading the entire book to best comprehend all the important information it contains, but I certainly understand if you want to jump directly to the sections that apply to you and your interests. To that end, let me give you a little direction so you can navigate straight to the topics that intrigue you most.
In the first half of the book, I focus on boosting your breast savvy and teaching about lifestyle choices that reduce your breast cancer risk. In part 1 (#u6fa3b442-40e9-5537-bd64-d03651a6e332), you’ll learn how to care for your breasts and never again mind the myths surrounding breast cancer’s causes. I have spent much of the last two decades researching the connection between lifestyle and cancer, and many of the things you’ve heard cause breast cancer are false. In part 2 (#uf9ce9f1a-4d5d-50d4-8bd9-a470a2dcb1b5), we’ll discuss what else you can do besides showing up for your yearly mammogram and hoping that you don’t find a lump in the following 364 days. I’ll help you reduce your cancer risk based on food and lifestyle changes, particularly those that keep estrogen in check, since estrogen fuels 80 percent of all breast cancers. The healthiest meals are plant-based, low fat, and high fiber: an abundance of fresh fruits and vegetables (preferably organic), 100 percent whole grains like brown rice and oats, nonanimal proteins such as lentils, beans, and soy, with a cup of green tea on the side. I will also talk about choices like supplements, exercise habits, weight control, and hormones that can impact risk.
In the second half of the book, I’ll explore uncontrollable risk factors for breast cancer, plus outline your medical choices if you’re at elevated risk for, newly diagnosed with, living with, or navigating life after breast cancer. In part 3 (#u9220dde9-2c45-5362-b25d-84388a5beb12) specifically, I’ll detail the operations and medications that mitigate risk. I field a lot of questions from patients about genetics and BRCA mutations in particular, and will share the latest research on mutations and what they mean for you. The key with uncontrollable risks is to understand them and then to use them to inform controllable choices. And if you do have elevated risk, this doesn’t mean there is a one-size-fits-all protocol. Some patients choose prophylactic surgery. Others don’t want to go anywhere near the knife but take preventive medications. Still others decide to improve lifestyle factors combined with an aggressive screening regimen. If you’re struggling with medical choices, in part 4 (#uf71a9a22-88f4-5db6-a5e5-b8ad8239fd99) I’ll help you find a path that leaves you feeling confident and comfortable with your decisions. I will review surgical options, explain the differences between lumpectomy and mastectomy, endocrine and immunotherapy, radiation and chemotherapy, and address specific questions I repeatedly hear at my center.
It turns out acronyms abound in medicine, and in the interest of keeping you easily moving through our time together in this book, I use a number of them. To that end, please reference the appendix, a handy-dandy table that puts all those acronyms into a tidy little list. I’ve been sure to back up every claim I make with reference to a study, a paper, or a text. These endnotes are quite extensive, so I’ve placed them online for easy searching at pinklotus.com/drfunkendnotes (http://pinklotus.com/drfunkendnotes). Long quotes from studies or articles, and the endnotes attached to data in tables, have been retained at the back of the book.
So let’s get started! I firmly believe that knowledge is power, and power replaces fear with confidence and joy, which motivates you to implement changes—changes that I know could save your life, and in turn, make the lives of all those whom you love, and who love you in return, all the more joyful too.
PART 1 (#ulink_ebee4193-f818-5b3f-9f9f-f7e711c10df5)
BREAST HEALTH BASICS (#ulink_ebee4193-f818-5b3f-9f9f-f7e711c10df5)
CHAPTER 1 (#ulink_e9f7366a-9a42-5ecf-8914-e5ffc91c1f85)
Breast Care ABCs (#ulink_e9f7366a-9a42-5ecf-8914-e5ffc91c1f85)
Take it from someone who’s around breasts all day, every day, and has been known to dream of them at night—women can have very emotional associations with their breasts. It takes a strong sense of self, which I hope we all strive to achieve, to say, “I am not my breasts,” because breasts connect in undeniable ways to femininity, sexuality, body image, and womanhood. Our feelings about our breasts run the gamut from pride in their shape and size, to awe over their milk-producing and life-affirming function, to trepidation and dread that someday they may give us cancer. To this last point, despite our fears, there have been few solid guidelines on how to improve your breast health, lower your risk of getting cancer, optimize your outcomes if you’re faced with a diagnosis, and make informed medical choices after treatment—until now.
I’d like to start off here with a few basics about breast health: the parts and functions of your breasts, surprising facts about the “girls,” and how to take good care of them so you live a long, vibrant life. Understanding the breasts you’re caring for will ultimately go a long way to reducing their cancer risk. While you can’t control all your risk factors—some, like being a woman and getting older, are nonnegotiable—you can influence and reduce more than you may know by recognizing the factors that are under your control and then adjusting your life choices accordingly.
BREASTS 101
When it comes to your chest’s general anatomy, breasts remind me of a funky Jell-O fruit salad. Imagine one of your breasts as many bunches of grapes that you’re holding by the top of the largest stems (at the nipple). As you picture these bunches, see all the tiny connecting stems as the tubes that carry milk out of the nipple during lactation (they exist whether you ever get pregnant or not). The stems all connect to grapes, which represent the milk-producing lobules of your breast. The entire breast has fifteen to twenty lobes (grape bunches), and all the stems coalesce toward the nipple, with eight to twelve milk ducts opening on your nipple’s surface.
Patrick J. Lynch, medical illustrator; C. Carl Jaffe, MD, cardiologist. https://commons.wikimedia.org/wiki/File:Breast_anatomy_normal.jpg.
Now, push that entire bunch of grapes and stems, which together comprise what we call glandular tissue, into a mold of Jell-O that’s shaped like your breast and sits on top of your chest wall muscles. (By the way, imagine if Tupperware actually made breast molds. They’d make a killing at “bye-bye breast” parties—or as one of my patients called hers, “Ta-ta, ta-tas!”) The Jell-O represents the supportive structures that surround the breast gland, composed of stroma (a kind of connective tissue), adipose tissue (fat), ligaments, lymphatics, and blood vessels. The lobules and ducts, or grapes and stems, are usually what become cancerous (milk ducts alone are responsible for 75 percent of all breast cancers), but the Jell-O rarely does. For example, a Mayo Clinic review of all breast cancers in women over fifty-nine years old showed that a stromal-based breast cancer, called primary breast sarcoma, accounted for only 0.0006 percent of breast malignancies.
Breasts range in size from absent, as seen in a rare disease called Poland Syndrome, to ones that swing down to your knees. Cups go from AAA to L—with the average American cup size being a D; Russia, Sweden, Norway, and Finland have cup sizes larger than D; Australia, France, Italy, the UK, Canada, and South America average a C; in Africa and Asia, women are A/B. Few women have a perfect match. In most, the left breast is up to 20 percent larger than the right (sudden one-sided changes in size are not normal, so if that happens, see your doctor). Your breast size and “perkiness” mostly come from a genetic patchwork of markers handed down from both of your parents to you, plus nutrition and the influence of estrogen, progesterone, insulin, and growth factors during your early years, puberty, pregnancy, lactation, and menopause. Fatness, exercise, aging, skin quality, and hormone use also influence size and shape. Since your breasts contain a genetically predetermined amount of fat, your breasts expand when you do. And contrary to what you may have heard, there’s no direct connection between the size of your breasts and your risk of getting breast cancer.
Your actual breast takes up more space on your body than you probably realize—a point to keep in mind when you do your breast exam every month, as I’ll discuss next. The girls aren’t limited to the two fleshy mounds nestled into your bra. Each breast technically goes all the way up to your collarbone (the clavicle superiorly), centrally to your breastbone (the sternum medially), down to the curve you associate with being the bottom of your breast (the inframammary fold inferiorly), and off to the side of your chest wall (the anterior border of the latissimus dorsi muscle laterally). Another bit of breast tissue extends like the point of a teardrop toward the armpit, called the axillary tail, located just beneath the hair-bearing part of your axilla. Sometimes this tissue actually extends into the armpit itself, which is called axillary accessory breast tissue. When rather pronounced, it bulges out, covered by skin. Depending on whether this happens on one or both sides, you might feel as though you have three or four breasts. An axillary accessory nipple could even connect that breast tissue to your skin, and yes, this means you could actually breastfeed from your triple nipple one day.
All breasts are lumpy, not just cancerous ones. Who in the world ever referred to breasts as melons? Did that person ever feel a breast before? Melons are uniformly firm, round, and very smooth—and they don’t budge when you poke them. The natural terrain of the breast is more like a mountain range with peaks and valleys covered in a blanket of snow (fat) and then wrapped in skin. When you run your fingers across that skin, the snow feels soft until you push deep enough to feel a mountain peak, and with a valley on both sides, that peak sure feels like a lump. The only way to trust that that’s a mountain and not a malignant intruder is to either see a doctor, or to know that it’s been there forever and it’s just your normal anatomy. All breasts have lumps, breasts are lumps, and they feel lumpy. The denser your tissue, the lumpier you feel. Genetics determine breast density, as do the estrogen levels in your body.
Lastly, there’s the surface of the breast. Arteries and veins circulate blood flow to nourish the breast skin, and in lighter-skinned ladies, sometimes we can see the veins rather clearly; also, conditions that increase blood flow will dilate those veins, making them more apparent—especially after exercise, or during pregnancy, or in certain cancers. Nipples can be dark or light, smooth or textured, pointing out, level, or inward, and range in size from flat to a pencil eraser or sugar cubes—it’s all normal. The colored skin around the nipple base is called the areola, and its diameter varies from dimes to saucers, generally 1.5 inches to 4 inches (4–10 centimeters). Some people have additional nipples, called supernumerary nipples, located along two vertical “milk line” arcs from the armpits to the normal nipples to the left and right groin. Occurring in 1 per 8,000 people, these either look like flat moles or have a raised bump.
Celebs with extra nipples include Mark Wahlberg (three) and Harry Styles (four), so no shame there.
If you zoom in on the areola, there’s so much more to see. All women have hairs that grow at the areolar edge coming from hair follicles. We have fifty million follicles on our skin, so sometimes a few unwelcome strays grow right there. They usually show up in response to hormone changes: puberty, pregnancy, menstruation, menopause, or birth control pills. You can safely tweeze them out or get electrolysis. Tweezing sometimes leads to ingrown hairs, which then cause tiny raised pimples and white sebum to collect. Makes you wonder why you thought tweezing would make the area more attractive. Areolar bumps called Montgomery glands are tiny sebaceous glands whose function is to lubricate the nipple (per textbooks), but since that seems like a fairly useless function and doesn’t even make sense anatomically since they are not on the nipple, I just tell people they are normal and benign and won’t go away no matter how much you squeeze them. You can also get tiny blackheads at the edge of the areola; just wash the area and occasionally exfoliate as you would do to your face at night. If you notice an itchy, scaly, flaky rash on your nipple or areola, call your doctor.
MORE NIPPLE FUN FACTS!
• Some people are born without nipples, which is called athelia. There are about seven thousand diagnosed cases worldwide.
• Nipple stimulation and genital stimulation affect the same part of the brain. One-third of women can reach orgasm solely through having their nips caressed.
• If you use a magnifying glass to examine the areola, you will find hairs growing on the areolar border of all adult living human beings.
• When supernumerary nipples occur outside the milk line, they’re called ectopic, and can be as far from your chest as the sole of your foot.
• Why do men have nipples? Because we all start out as girls! Nipples show up in utero before sex organs do. And then they just stick around (and out).
GET HANDSY IN THE NAME OF HEALTH
Healthy breasts require regular at-home breast exams, but don’t let them stress you out. The goal here is to get a lay of the land and learn what all your lumps feel like. This way, if you develop something new or different, you’ll be the first to find it. Next to risk reduction, early detection ranks second as our best defense against cancer. I suggest starting a self-exam routine in your teens and doing one every month. Teenagers virtually never get breast cancer, but it helps them later to be familiar with their breasts now. Whatever your age, time exams to one week after your period since that’s when they’re the least lumpy, tender, and confusing. If you don’t menstruate anymore, make the first day of every month your exam day. The whole exam should take three minutes, and it may just be the most reassuring part of your day. If anything seems out of the ordinary, trust your intuition and see your doctor. Ready?
1. First, give your breasts a good stare. Disrobe from the waist up, stand in front of a mirror, and then scrutinize the breasts peering back at you. Visually scan them for shape, size, or contour changes, plus skin alterations like thickening, redness, dimpling, retraction, and bulging out. Your nipples should be pointing the way they always point—straight ahead, left, right, naturally inverted, or headed south checking for spare change on the floor.
2. Next, check to see if your breast tissue dimples or bulges out while watching your breasts in the mirror in two different positions. In the first posture, put your hands on your hips and push in so that you’re flexing your chest muscles. Any funny dents or bumps? In the second pose, raise both hands overhead like you’re getting arrested. All clear?
3. Exam time! Either reclining on your bed or standing in the shower—whatever is comfortable for you—put a little lotion or shower gel on your fingers to help them glide across the breast tissue. Pick one of the following four patterns to trace over your breast tissue: (1) up and down the length of the breast vertically, (2) left to right across the breast like words on a page, (3) concentrically in circles like a target sign, or (4) radially like spokes on a wheel. Whatever pattern you choose, the results will be the same—just be sure to use the same technique every month so your fingers develop an unconscious memory of the tissue.
4. Start with your left breast, and raise that left arm behind your head to flatten the tissue as much as you can (I know—some breasts are way too floppy to flatten). Use the fat pads of the three middle fingers on your right hand to do the exam. You’re feeling for a new lump or thickening. Start in your armpit, then transition to the upper outer part of your breast and make tiny circles gliding across the breast until you’ve evaluated the entire breast in whatever pattern you chose from number 3 above. Don’t ever lift your fingers off your breast skin as you do this. Repeat the entire exam three times—first with a light touch, then medium, then deeper still.
5. Gently squeeze your nipple a few seconds. At some point in your life, you will probably elicit discharge from your nipples due to tiny amounts of fluid always present in the breast ducts. It’s normal to have discharge when you squeeze or stimulate the nipples, but fluid should never come out by itself without touching the nipple (e.g., staining your bra cup or PJs). If you squeeze out bloody or clear-like-water fluid, or if discharge is spontaneous, see your doctor. I don’t care about nonspontaneous discharge that’s any color other than bloody or clear like water.
6. Repeat on your right breast. You’re done for the month!
7. Visit easybreastexam.com (http://www.easybreastexam.com) to watch a demonstration video.
WHAT TO LOOK FOR DURING A BREAST SELF-EXAM (BSE)
In 2017 an image from Worldwide Breast Cancer depicting bright, cheerful lemons in an egg carton went viral with the caption “What Breast Cancer Can Look & Feel Like.”
Worldwide Breast Cancer, “What Breast Cancer Can Look & Feel Like,” © Worldwide Breast Cancer, 2017. Used by permission. Knowyourlemons.org.
So smart. I love this! Certain signs of breast cancer are seen and not felt, so they should be seen. It’s said a picture is worth a thousand words. And looking at lemons, well . . . they don’t make you squirm or feel embarrassed, and it’s hard not to associate these yellow balls of fruit with sunshine and lemonade.
Here’s the list of signs shown in the picture:
• a thick area
• a dimple
• nipple with crusting, itching, pain, rash, cracks, peeling, flaking, scaly, or bleeding skin
• redness or heat
• new fluid from the nipple (especially bloody/brown or clear like water)
• skin sores (that are not typical skin conditions)
• a bump
• a growing vein
• a sunken nipple that is pointing in a new direction, getting flatter, or inverting (retracting inward)
• a change in size or shape (especially one side only)
• skin that looks like an orange peel (larger pores, orange/red discoloration)
• a hard lump deeper inside the breast
Also worth noting:
• swelling or lumps where lymph nodes are located: armpit, around the collarbone, in your neck
• pain or tenderness in one spot, constant, not changing with your periods
Any one of these findings is a good enough reason to check in with your doctor. No one will think you’re paranoid, and most times we discover a noncancerous reason behind the signs. So if your breast reminds you of one of those lemons in the egg carton, get it checked out. On the other hand, don’t fret that finding breast cancer is all up to you. That’s why you get breast imaging and annual breast exams with your doctor.
BREAST HEALTH BY THE DECADE
Though you can improve your breast health at any age, you’ll want to keep a certain level of vigilance in mind based on where you are in life. Let’s take a look at my recommendations for optimal breast health, based on the decades in life. The median age for breast cancer in the United States is sixty-two years old, so half of women are diagnosed at or after sixty-two, and half before sixty-two; so if you’re at, over, or under sixty-two, I want you to pay attention.
As a teenager, you’re in a sweet spot for breast health. With a lifetime of conscientious habits ahead, I don’t want you to worry about your breasts as they develop. Learn to do a breast self-exam (BSE) and do it every month, one week after your period starts, because the younger you learn to recognize lumps and bumps, the more familiar you will be with any changes that occur in the future. My unforgettable friend Mary Ann Wasil began the Get In Touch foundation to help young girls demystify and understand their breasts by teaching them the potentially lifesaving skill of breast self-exam. Check out their site, getintouchfoundation.org, to learn creative ways to spread knowledge and skill regarding BSE.
If you have a family history of breast cancer prior to age fifty, your mother or father (whoever is blood-related to the person with cancer) should schedule a genetic counseling and risk assessment visit for her/himself, the result of which will further inform you about your own risks. Know, though, that breast cancer as a teen is a reportable phenomenon, with chances being less than one in a million.
Women in their twenties and thirties need to take breast health more seriously than they did when they were younger. If this is you, do your BSE once a month, one week after your period starts or the first day of every month if you do not have a period. Visit the gynecologist for an in-office manual exam, called a clinical breast exam (CBE), every three years, plus schedule a genetic counseling and risk assessment visit if it’s appropriate due to family cancers. Women under the age of forty with breast cancer have more aggressive tumors, so it’s crucial to stay aware.
A decade or two later, in your forties, continue doing a BSE once a month, but start seeing your gynecologist annually for a CBE for the rest of your life. You’ll also need to add a mammogram once a year, and if your breasts are dense, get an ultrasound too. And from here on out, that’s the deal, ladies, whether you’re in your fifties, seventies, or nineties.
If you’re considered high risk, we layer a little extra on top of all this advice. Various factors determine what makes a woman high risk, with the most outstanding being whether any marker lesions have been identified in your own breast tissue, and how many of your relatives have had breast cancer, especially under age fifty. If this sounds like you, take our anonymous, free genetics quiz at pinklotus.com/genequiz (http://pinklotus.com/genequiz). Talk to your doctor about more frequent testing beginning ten years prior to the age of your youngest relative with cancer, and be sure to inquire about CBE twice a year, annual mammograms, and possibly ultrasound and/or breast MRI. You might also want to discuss the benefits of risk-reducing medications and operations. More on this in part 3 (#u9220dde9-2c45-5362-b25d-84388a5beb12).
WHAT IT MEANS TO LOWER YOUR RISK FACTORS
We’re going to spend a lot of time discussing risk factors for breast cancer in this book, so I want to be sure you understand what I’m talking about straight away. Simply put, a risk factor is anything that increases your chance of getting a disease, but does not definitely cause the disease. We don’t understand all of what causes breast cancer, so it’s impossible to eliminate every last variable and declare, “There, I prevented it!” with the same assurance that you could cry, “Five in a row. Bingo!” In that way, prevention doesn’t exist, but risk reduction does—and you, my friend, are in the driver’s seat.
Think of it this way: driving fast doesn’t automatically mean you will have a car accident, but it certainly increases the odds. Car accidents are caused by the collision of a vehicle with something else, and driving fast is just one risk factor for collisions. Deciding to drive fast backwards while also texting on a dark road in the rain combines multiple risk factors for a collision, but the actual cause would still be the undeniable imprint of that tree trunk smashed into your car trunk.
So how do you avoid colliding with breast cancer? Know your breasts, understand what they’re about, and take good care of them. This last point includes making the strategic and rather simple dietary and lifestyle improvements I outline in this book. After all, as I mentioned in my intro, researchers find that among women who, prior to menopause, (1) exercise, (2) don’t drink alcohol, (3) don’t smoke, and (4) shift their diet away from meat and dairy toward whole food, plant-based eating slash their odds of getting breast cancer in half. And postmenopausal women’s odds are sliced by 80 percent. In the medical world, this represents an incredible triumph when you consider that women endure chemotherapy for a mere 10 percent average improvement in survival over those skipping chemo.
How has all this powerful information eluded you so far? It’s hardly your fault. Evidence-based advice on breast health, particularly when it comes to cancer prevention, is publicly doled out in drips and drabs—a magazine article here, a brief morning show segment there. And when we do hear a tip, it’s often in isolation and gets lost in the shuffle of everyday life. So you might find out that consuming cinnamon improves breast health, but who, with so many spinning plates, remembers to make this part of her daily diet—and without guidance, who actually knows how? Our daily habits are set in stone or bring us comfort, so it’s hard to make changes to an established routine. But I will show you how.
I also need to point a manicured finger at our flawed educational system. During my four years of undergrad, four years of med school, five years of general surgery training, and my surgical breast fellowship, nutrition was a fleeting mention in the form of the Krebs cycle in the middle of one lecture—and for many of us physicians, that was twenty to forty years ago. Most doctors do not explore the science of eating or the impact of lifestyle choices to the degree that knowledge affects their own behavior, let alone yours. I know this is true because when I shared some of this book’s content with my cancer patients, countless times I heard, “Wow, I had no idea. You know, I asked my doctors what I should do and eat now that treatment has ended, and they just told me, ‘You did everything you were supposed to do. You’re fine; don’t worry about it. Live your life.’” Not so, my friend. You’re not done yet.
Even when doctors do recognize the nutrition–illness connection, part of the reason they don’t tell you much is a reimbursement issue. Just as insurance companies don’t pay for your gym membership, weight-loss program, or stress management course, they don’t reimburse us doctors to spend time detailing preventive strategies. Doctors already need to stay up-to-date on what you expect from them, like screening guidelines and the best treatments for all the diseases they handle, which leaves no time for researching and dispensing extra freebies like, “Hey, did you know that three cups of green tea a day cuts breast cancer risk in half?” (By the way, did you?)
So when you put all that together, the question isn’t how did you not know this—but how could you have possibly known at all? Nobody’s taught you to connect food and lifestyle to breast health the same way you might relate it to, say, the strength of your heart or brain. Which is funny, because your breasts coexist with the same body as these vital organs. The good news is that food science matters now more than ever, as the global health outlook becomes increasingly dismal. Both patients and doctors are becoming more interested in how nutrition and lifestyle affect risk reduction, causation, and reversal of disease processes.
Of course, my central concern right now is your breasts (well, and your heart, since the number-one killer of women is heart disease; lucky you, my advice helps both problems). Up to 90 percent of the risk factors that determine optimal breast health lie entirely in your hands—so you are in control of you. Not your doctors, genes, or fate. You are with your breasts all day long, every single day. If you spent that much time with anything or anyone—a child, a spouse, a pet, even a car—you’d make sure they were in good shape.
Why treat your breasts any differently?
TRUE, THAT’S FALSE
In coming chapters, we’ll discuss how to keep your breasts and body as healthy as they can be, but first let’s set the record straight on what does not cause breast cancer. Myths abound out there that puzzle my patients and the public, and they don’t hold up in studies. (Quoting studies is a theme you’ll find throughout this book because the pervasiveness of myths is such a peeve of mine.) If you’re aiming for optimal breast health, there’s no room for bogus claims.
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