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The Good Fight
Being treated for breast cancer can wreak havoc on your body. Our writer — herself a breast cancer survivor — investigates the role that food and activity can play while undergoing a grueling treatment regimen.
The American Cancer Society estimates that in 2009, 192,370 new cases of invasive breast cancer will be diagnosed. And according to 2006 figures, 2.5 million women in the United States are living with a breast cancer history.
Though a bona fide cure is sorely lacking and too many lose their lives to this disease, progress is being made in treating it: Death rates from breast cancer have been slowly but steadily declining since 1990. Yet, approximately one women in eight in the US will receive a breast cancer diagnosis in her lifetime.
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Where to Find Support
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BreastCancer.org: Extensive source of information for the breast cancer community at large. Bulletin board includes sections for specific types and stages of breast cancer and a "healthy recipes" section.
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NetworkOfStrength.org: Offers a peer-counseling hotline, a free wig bank, and teleconferences.
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Csn.Cancer.org: Hosted through the American Cancer Society. "CSN" stands for "Cancer Survivors Network"; breast cancer is one of many cancers addressed here.
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YoungSurvival.org: The site of the Young Survival Coalition, addressing the needs of younger breast cancer survivors. Many cities have local group affiliates offering seminars, socials, and discussion groups.
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Her2Support.org: Offered for those with pathologies indicating overexpression of the Her2 gene.
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TnbcFoundation.org: Especially for those with the breast cancer pathology known as "triple negative" (that is, not candidates for the more targeted treatments currently available).
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FacingOurRisk.org: The website of FORCE (Facing Our Risk of Cancer Empowered), targeted to those with a genetic predisposition to breast cancer.
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BreastReconstruction.org: Featuring types of breast reconstruction available, related news, and personal stories.
Surgery (either a lumpectomy or a mastectomy), chemotherapy, and localized radiation are common breast cancer treatments. For women whose disease pathologies show a hormonal connection, years of hormone-related therapies follow after active treatment is over.
It can surely feel like insult added to injury, but many early-stage breast cancer patients will gain weight as a result of their treatments. “The body increases its metabolism in response to some cancers,” says Jennifer Crum, M.S., R.D., a nutritionist at New York University Langone Medical Center. “But breast cancer that has not spread — a preferable diagnosis to that of advanced disease, of course — doesn’t generate this response. Chemotherapy can cause losses of muscle mass and increases of fat mass. In addition, fatigue is a major aspect of chemo and radiation. When you're not moving as much, you're likely to gain weight. There can be a vulnerability to emotional eating during treatment, very understandably.” In addition, the steroids that are frequently prescribed to combat nausea can increase appetite.
Melissa Ackerman, MD, 45, an obstetrician/gynecologist on staff at the University Medical Center in Princeton, NJ, and a 3 1/2-year breast cancer survivor, points out that recovery times from surgeries limit a more active lifestyle.
“Obviously, in intensive cancer treatment, weight gain is not the primary concern,” says Crum. “Still, if you’re conscious about it, the gain can be less, and that’s for the best, healthwise. I tell patients to be aware of the potential for weight gain. Eat as healthily as you can, and stay active — that includes gardening, walking the dog, or raking leaves.”
Staying focused
“It’s hard to keep moving, with the fatigue inherent in all the treatment,” acknowledges Ackerman. “I wasn’t working out all the time while in chemo, but I kept riding my bike and walking regularly.” In addition to combating weight gain, regular activity, of a type and level that feel appropriate, can help increase a patient’s energy level and sense of strength during treatment.
And what constitutes healthy eating during this time? Fear of bacteria scares some away from their usual salads, but Ackerman quells this panic. “If your red and white blood-cell counts are OK,” she says, “eat raw fruits and vegetables. It’s best if you’ve prepared them at home, so you know that they’re well washed. If your counts are low, you should still eat them, but cooked.”
“You need to consume plenty of protein, to help repair your blood counts, which can be lowered by chemo,” adds Crum. “I recommend plant-based proteins like beans, lentils, nuts, nut butters and quinoa. It’s not so much about cutting out animal products as adding plant sources in.”
However, talk to your health professional before eating soy products in any great quantity. Soy foods contain isoflavones, or plant estrogens — and many breast cancers are fueled by estrogen. Medical opinion may differ on the relative safety of eating soy-heavy products at this time; there are studies that suggest that plant estrogens are nothing to fear and may in fact counteract excess hormonal estrogen in the body, while others suggest that consuming any extra estrogen can aggravate breast cancers.
Specific foods can address potential drug side effects: ginger often helps with nausea, as do blander foods like plain rice or potatoes. And high-fiber foods can help combat constipation, a common side effect of anti-nausea medications.
Reducing risk
After treatment, diet and activity continue to be key. “We clearly see that healthy weight, regular activity, and a plant-based diet are three big factors in lowering breast cancer rates overall,” says Crum. Furthermore, she cites a 2007 paper in the Journal of Clinical Oncology indicating that “physical activity and diet appeared to reduce risk, even if the women were overweight, which is great news for those who are struggling with that issue. And the study suggested women need about the equivalent of 30 minutes of daily walking, six days per week — it doesn’t have to be extreme.”
Some treatments can put a woman temporarily or permanently into menopause. In this case, Ackerman says, “She might look into calcium supplements to keep levels up, as menopause can lead to weaker bones.” She herself takes fish oil; some have found fish oil helpful in reducing the joint pain that can begin during cancer treatment and linger aggravatingly for years after. Make sure to talk to your doctor before taking any new dietary supplements.
A possible natural ally is flax. “We have seen good recent data looking at ground flax seeds,” says Crum. “One to two tablespoons per day, ground and mixed into food, might be a great idea.” The ability of flax seeds to decrease tumor-cell proliferation and thus help stave off an initial cancer diagnosis or recurrence is an exciting topic of current study, however a lot more research is needed in this area.
Strength in numbers
Many find that emotional support is a critical part of treatment. "Breast cancer can be a very isolating experience for many people, at precisely the time when we most need the support of others," says Bethany Aronow, MA, LPC, of Boulder, CO, a counselor specializing in the issues surrounding a cancer diagnosis or chronic illness — and herself a 10-year breast cancer survivor. "Many people hesitate to talk to friends and family because they don’t want to worry them by sharing their fears and concerns. Finding a support group, online or face-to-face, is one of the greatest gifts we can give ourselves, as talking to people who understand can be a huge component of healing from cancer."
As well as numerous online sources (see sidebar), the hospital where you're treated will probably have an ongoing in-person group as well, and independent support centers, with discussion groups and various educational programs, are available nationwide (SHARE in New York City, the Breast Cancer Resource Center in Princeton, NJ, and Breast Cancer Connections in Palo Alto, CA, are a few examples).
Online communities are often geared to specific needs or pathologies; the bigger ones have subcategories, to assist visitors and members in finding the help or information they need. Generally, the sites have active bulletin boards, allowing members to connect to one another and ask or answer questions; links to news relevant to their populations; and information on current clinical trials. Many also link to sources of financial support for patients and survivors or local community activities.
Dancing her way to happiness
Metabolic changes and hormonal interventions can, frustratingly, drive a woman’s weight up for years after her active treatment has ended. But Ackerman herself brings a story of triumph along these lines. She had loved ballet class as a child but, as a physician, mother, and wife, no longer made the time for them. “I always had an excuse to put off starting again,” she says. “But when treatment was done and I’d finished my reconstructive surgeries, there were no more excuses.”
She’s currently taking ballet classes — sometimes four a week.. “I understand a runner’s addiction now,” she laughs. “I get cranky if I don’t get to class. There’s something so joyous about moving to music.” Body-wise, as well as joy-wise, her results have been remarkable. A size 14 when her treatment ended, she has lost a significant amount of weight and recently bought pants in a size 4.
Her bottom-line advice on these issues: “Eat healthy, stay active in ways you enjoy, and don’t live in fear.” Words to thrive by.
About the writer
Pamela Grossman is a Brooklyn-based writer and editor whose work has been published in venues such as Ms., Salon.com, and the Village Voice. After a 2008 diagnosis of early-stage breast cancer, she is a survivor of the disease and an active member of the Young Survival Coalition.
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