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Calico

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Reply with quote  #1 
Hey Constantine,

I feel like I am between a rock and a hard place.
DD has pretty bad acne and tried everything....now they want to put her on birthcontrol to get her on Accutane....don't know which one is worse.
She had PVNS, has a new hip joint, doing well.
With her bloodwork (new one being done) in the past she was fine except tending toward a higher platelet count (thick blood? tending toward blood clots??? when on the pill??) which she easily takes care of with Fish Oil Omega 3 so far.

How does the pill affect the bc risk overall?

Our family risk and genetics, sadly what we didn't know earlier but pass on to my daughter who already had her share of bad luck:

DH (adopted) had prostate cancer at 48 which is also hormone driven, possible link to BRCA 1 and 2 from what I read?
I had bc at 41 (or possibly 40)

My sis had colon cancer at 48
My mom had bc at 67 (probably earlier).
Her mom (my grandma) had kidney cancer.
Then I have a maternal aunt (my moms sister) with leukemia
uncle (my moms brother) with glioma

as well as a lot of female cancers and colon on great gand father's side (thinking he must have passed something like lynch syndrome/HNPCC) due to both of his wifes each having had kids with same cancers)...if it was one of the wifes, only one part of the family tree would have gotten it.

Sis is getting tested per my pushing for lynch syndrome, they/docs 'forgot' 2 yrs ago when she was dxed, they had to get tumor tissue now, but it takes a while....
Even if she doesn't have it (like with the wifes other kids, 2 out of 3 kids of each family got cancer)...meaning I could have it and pass it on?

If birthcontrol is okay with bc risk which I think DD really has, are there some that are better (estrogen wise) than others?
And what are your thoughts on Accutane? Is there any correlation with bc risk?
I feel like I am feeding my kid to the wolfes, one leg at the time....she's not dating but 18 and very responsible, maybe we should try Accutane without the pill?

Don't know where to turn but to you....docs say 'they 'always' prescribe these pills and accutane.
sigh....double sigh.......

Thank you

>^.^<


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edge

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Reply with quote  #2 

I can certainly appreciate your concerns and anxiety.  I would not be with the docs on this one.  Here's why:

 

Retinoids (and Accutane) and Breast Cancer

In a review by Pankaj Prakash and colleagues at Tufts of the differential effects of retinoids, carotenoids, and human breast cancer cell cultures, the authors concluded that "In general, the results of these studies demonstrate beneficial effects of all-trans-retinoic acid [which is the chemical name of Accutane/Isotretinoin] on different breast cancer cells".

 

Both naturally occurring and synthetic retinoids like Accutane (Isotretinoin, aka 13-cis-retinoic acid, better  known in the studies as "all-trans-retinoic acid", abbreviated "AtRA") have been shown to inhibit the growth of breast cancer cells, especially in younger / premenopausal women, and numerous studies attest to the chemotherapeutic, as well as chemopreventive, potential in breast cancer, typically limited solely by the potential adverse effects (hyperlipidemia and rare muco-cutaneous and liver toxicity).  And David Brown at California Polytechnic has just demonstrated that AtRA significantly inhibits breast cancer cell growth in vitro by 49.7% and by 73.4 % when combined with linolenic acid, so dietary linolenic acid appears to be a synergizer for AtRA.  My guidance therefore would be that it may be prudent to use a hepatoprotectant (like SAM-e) while on Accutane and have in addition close monitoring of liver profile, as well as lipid profile to guard against hyperlipidemia (which can if necessary be independently addressed (as with Red Yeast Rice standardized to 10+mg total monacolins content, comparable to and equipotent with (atorvastatin (Lipitor)).

 

The Latest - Surprising and Important - Findings on Oral Contraceptives and Breast Cancer

As to oral contraceptive (OC) use and breast cancer, this has been a tangled web, but recent results have clarified, by finally looking not at undifferentiatated breast cancer patients, but rather patients by subtype of tumor biology.  So Jessica Dolle and Kathleen Malone at the Fred Hutchinson Cancer Research Center have just (2009) established that oral contraceptive (OC) use ≥1 year was associated with a 2.7-fold increased risk for TNBC (triple-negative breast cancer), the risk in the TNBC  subgroup being further heightened in relation to longer oral contraceptive duration and fewer years since last use, and most importantly,  the strength of the oral contraceptive use association with TNBC being further magnified among women ≤40 years (indeed, among women ≤40 years, the relative risk for TNBC associated with oral contraceptive of one year or more was 4.2 fold).   And note that no similar relationships were observed in relation to non-TNBC subtypes, where OC use incurred no added breast cancer  risk. 

 

And although this study population was limited  to women under 45 years of age, it has been substantially confirmed (2010) by the study from Huiyan Ma and Leslie Bernstein and colleagues at the City of Hope Nation Medical Center who found that OC use was not associated with any breast cancer subtype as defined by ER/PR/HER2/p53 status, except for a 2.9-fold increased risk of triple-negative tumors among women of 45 to 64 years of age who started OC use before age 18.   So it would appear that the key determinant is not young age, which certainly is a factor, but rather the TNBC tumor biology itself, an extremely important result that segregates elevated risk from oral contraceptive use by TNBC status, with no observable heightened risk in any subtype except TNBC.  This is something of a clinical bombshell which very unfortunately has not received much attention and dissemination (I intend to do a separate posting on this to help try to get the word out).

 

Lessons - Not a Difficult Choice

Thus, given the considerations I brought forth above, the balance of benefit/harm would appear to be with the retinoid Accutane which may even have some positive BC risk-reductive activity, as opposed to OC use with its heightened association with an elevated risk and challenging prognosis subtype of breast cancer, namely TNBC. 





Constantine Kaniklidis

Breast Cancer Watch

edge@evidencewatch.com

Calico

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Reply with quote  #3 

Wow,
that is indeed a very interesting finding on TNBC.
I certainly would not want to chance it to have her go on a OC unless she totally needs something safe....one can't chose which breast cancer one gets....and so far it looks very promising for her that at some point she will get one ;(

I can't thank you enough to take the time to tell me all this in detail.
I was more worried about the Accutane initially.

The birth defect possibility is still causing me anxiety, this does totally go away after stopping it (after a month or so)??
Absolutely no longterm effect?

The book that DD received said also something about brain swelling and blindness as a possible side effect.....grrrr.....

She got her lipid values today and she's so good, they where taken without fasting in the afternoon about 4 hrs past her lunch which is usually a pepperoni pizza lol teen diet...don't grinch...I know...she's a pepperoni and cheese carnivore and hates greens with a vengance lol

cholesterol 125, triglycerides 60, HDL 46 (this used to be higher) and LDL 67.
AST 13, ALT 9 and ALK Phosp. 81 and her weight is good, 125 lbs with a height of 5'7"
Even if she goes up a little, she has room to expand in her values.

SAMe is a great suggestion, thank you.

Wow,
Consider yourself hugged

[[[Constantine]]]

Thank you so much!!


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Indigoblue

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Reply with quote  #4 

Cali,
(((hugs)))...family history, if & when we know it, is a genetic puzzle. a mystery, an enigma.  There are no guarantees on how the future health to offspring will, or will not be, affected.  Even when the DNA-RNA is mapped out, there are unpredictable factors. 
I know one thing, it would have broken my parent's heart had they known or thought they had passed on lethal genetic mayhem to their children.  This is where genetic counseling may (or may not) help, when planning genetic testing; fragile, emotional, sensitive, delicate, unpredictable...like a time bomb. 

One thing about Accutane; the reason the "Pill" is prescribed, is to avoid pregnancy, as Accutane causes birth defects.  Have you considered having your dd visit another Dermatologist ~ for a second opinion?    There are many new treatments that might be beneficial, and not so scary.  Also, have you considered taking your dd to an Endocrinologist, to test enzymes, hormones, thyroid, pituitary, and body chemistry for other possible causes?

The "Pill" and HRT are risky business.  The "Pill" can actually cause some women to develop Acne, gain weight, and a long list of other side effects.  Not enough is known about the long term side effects of the "Pill". Doctors rarely test patients to see if their body chemistry is compatible for introducing hormones, and/or other chemicals into a human being's physiology.  Since your daughter has experienced extraordinary issues with her health, wouldn't it be prudent to consult a specialist? 
 
Forgive me Cali, I feel awkward about commenting on this topic.  I care about you, so much, and I am trying to help...because I know how it feels to love, feel helpless, lost, and search for answers.   Your family tree reads like my family's long list of rare disorders, cancer, heart disease...and worse, thanks to modern science.  Prior to 1980, we thought we had a fairly healthful family genetic history, not including the skeletons hidden in the ancestral closet.

Please, never blame yourself for things beyond your control.  Environmental issues cannot be left out of the big equation.  I know people who smoked, drank, had horrific family histories, and lived to be 100.  I know people who lived perfectly healthful lives, never smoked, never drank alcohol, had healthy family members...and developed heart disease, lung, liver, brain cancers...etc., and died before they saw their 40th birthday.  Life doesn't make sense, it isn't fair, and sometimes it feels hopeless.  I remember, when I found my breast lump, my Surgeon told me all of the above advice...and said, don't worry about the family history...because every case is different, no matter how you look at it.  Didn't make sense to me in Dec., 2005...but it does now.  Long story, but made short...try not to worry (easier said than done, I know...)

Good luck, prayers, and faerie kisses.  You are a wonderful Mom!

Love,
Indi

Calico

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Reply with quote  #5 
Indi,
thank you for helping out.
The PCP thinks that the dermatologist is the 'specialist'. My question for more tests on hormones was just brushed away. But I have requested complete blood work on her before due to her hip replacement and it was all good, even cholesterol despite her not being active physically but me trying to have her be as healthy as can be during and after and her trying to get better....so...so far so good on 'normal' blood tests.

DD had failed minocycline, tetracycline, benzaclyn or even and topical retin A.
Naturally, one would think the pill is next but you know my reservation already.
Derma looked at her and said 'this' type of acne is only helped with Accutane.
Therefore the pill, due to the birth defects.
But smart as we are, we both had concerns


Now I am trying to get her to eat several servings of green stuff
Smarty pants she is she says 'look what it did to you' (meaning bc )

I have put her on a big berrie smoothie a day with a hand full of spinach, she loves it, told her about the spinach afterwards lol
We have a month until she gets the drug due to very carefull dispensing.
We have time to think and investigate.
Pill is out, Accutane possibly in.

I am so very glad to have the help, insight and expertise I can get on this board

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nosurrender

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Reply with quote  #6 
Hi there everyone,
I can only answer based on my own personal experience.
I started having ovarian cysts at the age of 15. Not just little ones that went away on their own, but 10-15 centimeter cysts. I had several laparascopies to remove them and had to have other ones to correct the scar tissue from them.
I was put on the pill at a young age. I think I was 19, to control the cysts. My sister the same thing. We BOTH developed TNBC before we were forty.
My doctors felt it was OK for me to STAY on the pill after my first dx because my cancer was TN. Then I got the lobular cancer.
Since then, I have seen studies that show the pill causes TNBC in young women and in older women it increases their risk of lobular.

Topical Retin A in the form of Refissa is not as drying as plain Retin A because it has emoilients in it to counteract the drying effects.

Please tell g1 that even though the oily skin/acne is terrible now, when she is older, she will look ten to twenty years younger than her "clear skin" counterparts at school. It is one payoff that she will be happy about in 30 years!


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WE WILL PREVAIL





ChrissieD

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Reply with quote  #7 
Hi Calico,
Has your DD tried eliminating dairy from her diet and increasing water intake?  I can only imagine this might be difficult to do but if you both are adverse to the pill or accutane / other meds you may want to give it a try.  If she has cereal she could use Rice Milk and you could also make smoothies with this.  I use the unsweetened because I also am limiting sugar.  I have yet to pour a glass and drink it but did get used to the taste in my food after a week.  I still have cheese on occasion and will break out after eating. 

Just a thought.  Tough decisions you have to be making.  Best of luck -

Chrissie
Calico

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Reply with quote  #8 
G,
thank you for your insight on the pill, so very scary!!!!
Will check on Refissa on DD's visit with the PCP on Monday! Especially good since she hates to use moisturizer in her face

Chrissie,
smoothies are done only with organic soymilk but cheese is part of her diet on a pizza, as I mentioned...the typical teen lunch I might be tortured taking away the only indulgance this girl has...she has utmost selfcontrol when it comes to Lindt chocolate, unlike her mom , other than that, she does not drink milk, I actually supplement calcium and vit. d due to her previous hip problem. I'll check this out, thank you for your help. I love Almond milk, it is just more expensive, might supplement that one for soy milk.

Not to scared about Accutane anymore due to it's bc killing ability

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Indigoblue

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Reply with quote  #9 
Gina,
That's wild & crazy...I too, suffered from Ovarian Cysts...the largest one was compared to a large Grapefruit.  Like you, I was given the pill to dissolve the Cysts, and later took it to keep them at bay. When I was utilizing the Pill, I developed complexion problems.  Around that time, I met my dh who had a beard.  I never had a pimple in my life.  Accutane was recommended...
As it turned out, I had a Staph Infection... it was not Acne, it was a nasty
horrific Staph Infection, which recurred because my dh was a carrier.  These organisms can hide anywhere, and look for "compromised immune systems", to attack.
Cali...ask someone to do a culture of your dd's abscesses...you might be surprised.  A cleanse, antiseptic helpers, and the "right" antibiotic...
I was never given the "right" antibiotic.
A PCP discovered what was causing my pimples...it was not Acne, not Rocacea, not zits from lack of cleansing the skin...it was a nasty Staph...and possibly Strep Infection. 
After taking the correct antibiotics, having my dh take the same antibiotics, it practically disappeared. 

I could be all wrong...but pimples are almost never cultured, or tested for invasive organisms...including fungus, mold, bacteria, and viruses...

Love you all,
Indi
edge

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Reply with quote  #10 

Calico:


Let me briefly take up your remaining concerns. 


It is now accepted that given the teratogenicity of  oral isotretinoin (Accutane) - topical forms have limited  such potential, although studies on this are still inconclusive - it's use should ideally be reserved for the treatment of severe, recalcitrant acne, and there is field experience  accumulating that a more prolonged course of therapy (16-20 weeks) with a relatively low dose of isotretinoin (≤ 1 mg/kg/day) may provide an optimal balance between long term outcomes and side effects.

 

As to the window of exposure, although the data show that isotretinoin and its metabolites are not stored in the body and are eliminated within a week of stopping therapy, the iPledge program, initiated in March 2006 as an effort to eliminate fetal exposure to isotretinoin in the United State, and which is binding, via requisite online registration in the program, on  all isotretinoin distributors, distributing pharmacies, prescribers and patients (both male and female), stipulates effective birth control to be necessary from one month before the start of treatment until one month after the end of treatment, via monthly monitoring in the form of  laboratory pregnancy testing, and also via using 2 approved forms of contraceptive  control to avoid pregnancy (one OC (primary form), and one barrier-type protection (secondary form)).  Women may instead choose complete abstinence for this time frame, although this typically (but not always) is an approved substitute at the discretion of the patient's prescribing  physician.  I  should note that in the field, the iPledge program is widely viewed as Draconian and in need of rational update and has been criticized for its excesses (including by me): for example despite not being of child-bearing potential, it imposes the same requirements on women with no ovarian potential who have had a hysterectomy, as well as all postmenopausal women, and this - correctly - is viewed as patient-blind and irrational, along with a vast unnecessarily intricate level of bureaucracy .  And because of this it is widely suspected - again including by me - that one uninvited consequence is to drive many women into obtaining the drug without a prescription over the Web, not to the women's own interest but predictable to a great extent, as is a high degree of non-compliance.

 

This is most unfortunate all around, since clinical data, as well as all systematic reviews and meta-analyses, have shown that  isotretinoin (Accutane) is our single most effective and consistent agent for the treatment of severe and/or refractory - and potentially disfiguring and psychologically adverse - cases of acne, given that isotretinoin (Accutane) can be a valuable, efficacious drug in the treatment of acne and can be safe for patients, with a favorable benefit/harm ration, if all procedures are followed appropriately and patients are monitored closely.  


Topical Nicotinamide and Tea Tree Oil

Let me close by adding, for your information, that there are two non-traditional anti-acne therapies that have robust evidence of efficacy (including randomized, double blind, placebo-controlled studies):  (1) topical nicotinamide gel (at 4%) - available generically as over-the-counter (one common OTC brand is Acnessential) and often referred to as "topical niacinamide", or under commercial brands such as Nicam gel, or Nicomide T Gel - which is at least non-inferior to clindamycin gel (82% of topical niacinamide patients showed improvement as compared to only 68% of topical clindamycin patients), but safer and without any potential for the development of antibiotic resistance which typically leads to resistant microorganisms.  (2) Tea Tree Oil (aka TTO, from Melaleuca) in 5% gel form, available  OTC (one common brand is DDF which combines it benzoyl peroxide, but other brands are available (such as Goddess Within in the form of a cream).  Both are effective, and field experience suggests additive value in combination, using a drop or two of the TTO first as an underlay, and then applying the topical nicotinamide on top, this two layer approach helping to avoid skin excess drying.   (Anecdotal evidence suggests that both of these, but especially TTO, may be of significant benefit in other inflammatory skin disorders including rosacea, although without benzoyl peroxide, and both remedies are  popular and widely deployed successfully outside the US).





Constantine Kaniklidis

Breast Cancer Watch

edge@evidencewatch.com

Calico

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Reply with quote  #11 

Gosh,
I am in awe of your knowledge again...still....always!
Thank you so much for going more into detail and exploring more options.
I will check out stores for these remedies, I really would like to try something else. Very interesting options, I am aware of tee tree oil but not as a gel.


The good information about Accutane the way I understand seems to be that it is a 'final' treatment? After that one is cured?

I suppose they cover their behinds from possible lawsuits with the ipledge , at least this way they cannot be blamed. For now DD has put down abstinence too, the doc is okay with it...and of course the obligatory waiting time....time to explore what you have found for us.

I'll check this out tomorrow asap.

Meanwhile spinach smoothies are still on (with berries so to not kill a teen with fright )

>^.^<

Kind appreciation for all you do Constantine!!!


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nosurrender

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Reply with quote  #12 
I just have to add I love how you quietly remind Edgy what team >^.^< you are on, Cali....hee hee hee

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diane

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Reply with quote  #13 
Hi Constatine,
I am new to this site. I was pointed in this direction by members on the TNBC  site.
I am almost finished my radiation and have just finished reading your Edge-CAM Regimen 3.4. You are a wealth of information as you know! I wish I had read this earlier in my treatment.

But I do have a question regarding using Boswellia extract and olive oil. I have been trying to follow a diet of 30g of fat per the Womens Intervention Nutrition Study results, which show that a diet limited to  30g fat in ER negative patients results in  a 40-50% reduced risk of recurrence.

So if I take the boswellia with even 2 Tbsp olive oil, I pretty much blow all of the fat for the day. Is there anything else that can help with this? Or is there a preparation that contains oil in the pill?

Thanks,
diane

edge

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Reply with quote  #14 

Diane:


Welcome to No Surrender, and thanks for the  kind words!  As you have probably seen already, in the No Surrender community that Gina has built, nurtured by so many wise and giving members, one of our goals is to be not only a breast cancer support site but also a unique evidence-based information site, subjecting questions and answers to rigorous evidence-based methodology, scrutiny and critical appraisal, and your excellent query will demonstrate this process, live. 

 


Let me first  give the short answer, then expand on the why of it.  The short  answer: (1) you should celebrate pushing olive oil consumption to at least 2 tablespoons daily, and (2)  the WINS trial, otherwise a landmark trial, is clinically irrelevant to the issue of monounsaturated fatty acids (MUFAs), in particular those derived exclusively  from olive oil.

 

Why?

 


First the fat-facts: olive oil typically delivers 14 grams of fat per tablespoon, although certain "lite" EVOO (extra virgin olive oil) can weigh in at a low of 11.5g.  The North American Diet contains inappreciable amounts of olive oil-derived MUFAs, and the WINS trial was one of exploring the effects of undifferentiated fat to breast cancer risk of recurrence; no analysis or data collection was specific to fat type, and based on the known composition of the American diet, one would not expect other than nutritionally minimal contribution from olive oil-based MUFAs, despite the fact that even the ultra-conservative FDA via their Qualified Health Claims Subject to Enforcement Discretion program, based on data from benefits to cardiovascular disease, advises and allows olive oil manufacturers to issue the same claim, that "scientific evidence suggests that eating about 2 tablespoons (23 grams) of olive oil daily may reduce the risk of coronary heart disease due to the monounsaturated fat in olive oil" [Enforcement Discretion Letter of 11/1/2004].  Regrettably, the  FDA restricted their advisory to CVD (cardiovascular disease), hence not addressing the anticancer benefit of substantial olive oil following the pattern stipulated and re-confirmed in the Cretan-Mediterranean Diet (CMD), where the evidence has spoken, loudly and now indisputably, which I will take up below.

 

Olives and olive oil contain acteosides, hydroxytyrosol, tyrosol and phenyl propionic acids, and extra-virgin olive oil (EVOO) in particular also contains secoiridoids and lignans in abundance with substantial amounts of other compounds deemed to be anticancer agents (such as squalene and terpenoids) as well as the peroxidation-resistant lipid oleic acid, and both experimental and human studies have shown that both the monounsaturated oleic acid (the major lipid in olive oil), and numerous minor olive oil components (including phenolic alcohols and acids, flavonoids, lignans and secoiridoids), exert an anticancer effect (particularly, but not only, on breast and colon cancer cells), involving numerous mechanisms including suppression of neoplastic transformation, cell growth inhibition, enhanced apoptosis, anti-angiogenic activity, COX-2 inhibition, anti-HER2 activity, and protection against oxidative damage, among others.  And animal studies have clarified that a high EVOO diet decreased RasRas/PI3K/Akt pathway, and up-regulated the Raf/ErkTNBC  disease), and via sustaining a more benign tumor phenotype of mammary cancer under the influence of EVOO with lower grade and proliferation (Montserratt Solanas and colleagues, Barcelona). activation, downregulated the pathway (all involved in malignant transformation, and most prominently so in TNBC  disease), and via sustaining a more benign tumor phenotype of mammary cancer under the influence of EVOO with lower grade and proliferation (Montserratt Solanas and colleagues, Barcelona).

 

The several robust and seminal studies of Dimitrios and Antonia Trichopoulou and colleagues at the University of Athens and Harvard have concluded that olive oil consumption does not in fact exhibit an adverse correlation with breast cancer incidence or mortality (as per also, Ross Prentice and colleagues, and CDC NHANES III findings, among others), as they do for consumption of saturated fat.  Indeed, Greek women with at least 42+% of energy intake from fat, almost exclusively from olive oil, have substantially lower mortality from breast cancer than U.S. women whose energy intake from fat is at present around 30+%, as these and other investigators have shown.  These results have been confirmed in multiple independent studies, including Jose Martin-Moreno's team in Madrid, with a higher consumption of olive oil being found significantly related to a lower risk of breast cancer and with a significant and continuous dose-response trend; in addition, numerous studies in other malignancies have confirmed that olive oil is inversely related to colorectal and upper digestive and respiratory tract cancers (Vecchia & Bosetti, among others).  And in the Swedish Women's Lifestyle and Health Cohort (SWLHC), compared to women > 50 years in the first quintile of MUFA / olive oil intake (at 10.6g/daily), women in the fifth quintile (26.5g/daily) had a statistically significant decreased breast cancer risk (with a hazard ratio (HR) of 0.45 for breast cancer).  Similarly, the study of Simonetta Salvini and colleagues in Italy further confirm that extra-virgin olive oils (EVOO) are at  least in major part responsible for the lower mortality and incidence of cancer and cardiovascular disease (CVD) in the Mediterranean region, and note with mean olive oil intake in that study being 53.3 grams/daily (~4 tablespoons). 

 

Indeed, Mary Flynn at Brown University found and reported at ASCO 2007 that weight loss can be achieved with a plant-based, higher-fat diet emphasizing extra virgin olive oil (EVOO), and that such a diet may have a metabolic advantage compared to the standard, lower-fat diet, in consequence of lower levels of insulin (lower-fat diets can adversely affect fasting blood levels of insulin, triglycerides and HDL-c, and independent data suggest that risk of breast cancer increases with increasing body weight, higher blood levels of fasting insulin and triglycerides, and lower HDL-c).  Likewise, in the population-based case control study of Purificación García-Segovia and colleagues in Spain of olive oil consumption and risk of breast cancer in the Canary Islands, the protective role of olive oil consumption on breast cancer was also confirmed, as it also was in the EURAMIC multi-center case–control study carried out in 11 European countries, which found  a strong and protective effect of oleic acid from olive oil intake against breast cancer.  And although in all these studies all tumor biologies (re ER/PR/HER2 status) were benefited, the E3N-EPIC prospective cohort study of 2,381 postmenopausal women with invasive breast cancer found that the greatest inverse association between components of the Cretan-Mediterranean Diet (CMD) and breast cancer were in the ER-negative/PR-negative subgroup (including TNBC). 

 

In addition, the meta-analysis of prospective cohort studies with an impressive total of 1,574,299 subjects conducted by Francesco Sofi and colleagues at the University of Florence to analyze the relation between adherence to a Mediterranean diet, mortality, and incidence of chronic diseases including cancer in a primary prevention setting concluded that the overwhelming evidence establishes that greater adherence to a Mediterranean diet is associated with an improvement in health status as evidenced by a reduction in mortality, cardiovascular mortality, incidence of or mortality from cancer, incidence of Parkinson's disease, Alzheimer's disease, cutaneous disease such as acne, and several types of inflammatory  disorders, and the metabolic syndrome and diabetes.  And the same researchers cited above (Trichopoulou) found from the seminal Greek EPIC prospective cohort study of  23,349 men and women that closer adherence to the traditional Mediterranean diet was associated with lower overall mortality (which of course included the contribution of the anti-oncogenic actions of the oleic acid in olive oil), with comparable positive findings from the NIH-AARP Diet and Health Study (population of ~380,000), among dozens of other confirming studies, trials, meta-analyses and systematic reviews.  And it is critical to inspect the raw data from the meta-analyses of multiple trials: for men the median daily consumption of olive oil in these multiple studies was ~56 grams , while for women daily consumption was ~47 grams (ranging up to 58g), these numbers representing 3.3 to 4 tablespoons median daily consumption.

 


Therefore, the weight of the evidence from multiple robust studies, meta-analyses and systematic reviews support a significant benefit of substantial olive oil consumption - at least 2 tablespoons daily (approx. 23 - 28 grams fat) - and this benefit extends to diet patterns in which the total fat contribution of olive oil intake ranges above the putative guidance level of 30%, even out to 42%, with daily total olive  oil fat contribution up to 50+ grams.  So one can read current guidance, regrettably naive as I have shown above, as stipulating only what the target proportion of non-olive-oil predominant diets should be, not what OA-dominant (almost to exclusivity) diets should target.  The evidence overwhelmingly continues to demonstrate through hundreds of studies to date that the diet of Greece (and especially the island of Crete) continues to be the foremost diet for anticancer and anti-cardiovascular disease (although India with its massive consumption of curcuminoids through the Turmeric spice comes close), and that diet does not even remotely approximate American standards of target fat proportions, yet exceeds the American diet  in all disease and mortality benefits (and this is with dozens of factors controlled such as physical exercise, sun exposure, etc., so the influence of confounding factors would be minimal and non-statistically significant, if any), and it is furthermore clear that the findings of the WINS trial is wholly elliptical to the issue of olive-oil-dominant diets, and hence clinically irrelevant to this issue, with its threshold fat target not being dispositive on OA-rich diets approximating CMD standards for olive oil consumption. 

 

So, back to  the beginning: two tablespoons of olive  oil - no cause for concern, on the contrary, time for celebration (gaining both anticancer and cardiovascular benefits)





Constantine Kaniklidis

Breast cancer Watch

edge@evidencewatch.com

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