HealthCare

A comprehensive overview of 10 cohort studies and 43 case-control studies of alcohol and breast cancer found a 7% increase in relative risk of breast cancer per 10 g of alcohol per day, approximately, per drink per day. However, in the prospective cohort studies only, the overall result was the slightly lower figure of 5% increase per 10 g of alcohol per day.

In recent years there have been a number of studies investigating physical activity and breast cancer risk. Physical activity in early life is inversely related to breast cancer risk.  This is consistent with the hormonal etiology, as such activity may delay puberty or reduce ovulation. Exercise later in life has also been found to have a protective effect, with a 6% reduction in relative risk per additional hour of exercise per week.  As with the predisposing effect of obesity, the influence appears to be stronger in postmenopausal women.

Thus it seems that there is a potential to prevent a substantial number of breast cancers by lifestyle changes. These include increased physical activity, weight loss, a diet lower in animal products, and reductions in alcohol consumption.

The increased risk of breast cancer with late age at first pregnancy, nulliparity or low parity, late menarche, and early menopause all suggest an increased likelihood of breast cancer as a result of proliferative stimulus by cumulative exposure of the breast to ovarian estrogens. The associations of age at menopause, age at first birth  and breast feeding with breast cancer risk are well documented.

Breast cancer rates tend to be highest in Western Europe and North America, where lifetime risk of the disease is slightly higher than 10%. In some African countries, the lifetime risk is only 1%. In East Asian countries, risk has been low in the past but is increasing now toward western rates. The other most important risk factor is age. The disease is almost unheard of in childhood and adolescence, and incidence gradually increases with age. Around the time of the menopause, there is a hiatus in the trend of increasing incidence, and in western populations incidence continues to increase thereafter at a slower rate. For some far eastern and other populations, incidence falls after the menopause. It is not clear to what extent this is because of biological differences or cohort-specific risk factors.

Since the early twentieth century a large evidence and knowledge base of risk factors for breast cancer has developed. The seminal study of breast cancer epidemiology was the Lane–Claypon report in 1926. This study was important not only in the etiology of breast cancer but also in the development of epidemiological methods, being arguably the first systematic case-control study. Before reviewing the epidemiological research, some important terms are defined. The two most common study designs in epidemiological research are the cohort study and the case-control study. In the cohort study, a group of subjects free of disease are recruited, and their status with respect to potential risk factors is ascertained. The subjects are followed up for the disease in question, to ascertain which factors are predictive of future disease. For example, in a cohort of nurses in the United States, it was found that women with high consumption of red meat were more likely to develop breast cancer. In a case-control study, subjects with the disease in question (cases) are recruited, together with a group of comparable subjects who do not have the disease (controls). Risk factor status of cases and controls is ascertained retrospectively. A notable example is the international series of case-control studies carried out in the 1960s and 1970s by McMahon and colleagues, which among other findings firmly established the association of late age at first childbirth with increased risk of breast cancer. It should be remarked that the case-control design is subject to a number of potential biases, such as differential recall of risk behavior between cases and controls, and therefore their results must be interpreted with caution. Findings from the prospective cohort design are regarded as more definitive.

Osteoporosis
Osteoporosis is a progressive disease in which the bones become weak and
lead to an increase risk of fractures. Any bone can be affected by osteoporosis, but the most common bones that break are in the hip, back, and wrist. Often people don’t know that they have osteoporosis until a bone actually breaks and further evaluation reveals poor bone density. Osteoporosis affects more than 75 million men and women worldwide.

Understanding risks of Osteoporosis
 Gender: Women are four times more likely to have osteoporosis than
men. Women’s bones are thinner and less dense than men’s, and in addition,
men tend to have more muscle, which serves to protect the bone.

 Smoking: The role of smoking and osteoporosis isn’t clearly understood,
but smoking is thought to decrease the amount of calcium absorbed
from food as well as reduce the production of bone cells (osteoblasts).
 Nutrition: People with a very low calcium intake have a higher risk of
developing osteoporosis because calcium plays such a vital role in bone
development.

 Physical activity: Bone remodeling (new bone formation) occurs in
response to activity. Weight bearing exercises are the best form of activity
to improve lean muscle mass and strengthen your bones (see Chapter 10
for strength-training tips).

Preventing Cancer
Study after study after study proves that Vitamin C can help protect you against cancer. People with high levels of Vitamin C and other antioxidants are markedly less likely to get cancer of the lung, cervix, colon, pancreas, esophagus, mouth, and stomach. Why? We're still not sure, but it's very
likely that the antioxidants gobble up free radicals and damaging toxins before they can damage your cells and trigger cancer.

In the case of stomach cancer, Vitamin C blocks the formation of
cancer-causing nitrosamines from the nitrates and nitrites found in bacon, hot dogs, and other cured meats.
A study by Dr. Linus Pauling in 1976 showed that some terminally ill cancer patients lived as much as a year longer if they took megadoses (over 10,000 mg) of Vitamin C. A later study backed this up. In both studies, though, all the patients eventually died—none was cured. No study since then
has ever shown that megadoses of Vitamin C (or any other vitamin, for that matter) cure cancer.

If you're being treated for cancer, there's no question that Vitamin C can really help you get through this difficult time. As mentioned previously, Vitamin C could help you bounce back from surgery more quickly. Many people getting radiation treatment or chemotherapy have low Vitamin C levels. Part of the reason is that the treatment can make you tired and nauseous, as well as giving you diarrhea.

The other part is that the treatment is making you produce huge amounts of free radicals, so any Vitamin C you get from your food is going to mop them up. Unless you take supplements, you won't have any left over for other things, like keeping your immune system active. Cancer
treatment lowers your immunity, making you more likely to get sick or pick up an infection.
Discuss nutrition and supplements, especially Vitamin C, with your doctor before you start your cancer treatment. They could make a big difference in how well you do.

Diabetes and Vitamin C
Diabetics, especially those with non-insulin dependent, adult-onset (Type II or NIDDM) diabetes, often have low Vitamin C levels. Diabetics also often have gum disease, slow wound healing, frequent infections, and problems with the tiny blood vessels of the circulatory system. Sounds a little
like scurvy, doesn't it? In a way, it is—and Vitamin C can help.
The hormone insulin, which is made in your pancreas, carries glucose into your cells, where you use it for energy. Insulin also carries Vitamin C into your cells. People with Type II diabetes, however,
are resistant to their own insulin. Not enough insulin enters their cells, so not much Vitamin C does either. Diabetics need to take in much more than the RDA to be sure enough reaches their cells. If you have diabetes, your doctor will probably recommend that you take 500 or 1,000 mg a day of
extra Vitamin C. Some diabetics say that their circulatory problems and other complications get a lot better when they take larger doses, as high as 3,000 mg a day or even more. They also say that they
can control their blood sugar better when they take large doses. It's also possible that extra Vitamin C could help prevent diabetic cataracts.

Breast cancer is classified in different ways according to its location and
whether it’s metastasized.
 Adenocarcinoma: Most breast cancers start in the glandular tissue
(lobes and ducts) of the breast; cancers of glandular tissue are called
adenocarcinoma. There are two types of adenocarcinoma:
• Ductal carcinoma in situ (DCIS): DCIS means the cancer is contained
within the walls of the ducts and hasn’t spread to other
breast tissue or metastasized. This is the most common type of
noninvasive breast cancer, accounting for around 20 percent of
newly diagnosed cases. Almost all women diagnosed at this stage
can be cured.
• Lobular carcinoma in situ (LCIS): LCIS begins in the lobules of the
breast but hasn’t invaded through to surrounding breast tissue.
LCIS isn’t a true cancer; it may be the early stage of cancer or may
simply increase a woman’s risk of getting cancer later. Everyone
agrees that at a minimum having LCIS increases your risk and that
it’s important to follow the screening guidelines for breast cancer
closely if you have LCIS.
 Invasive ductal carcinoma (IDC): IDC, which starts in a duct and then
breaks through to the fatty part of the breast, accounts for 80 percent
of all invasive breast cancers. After the cancer breaks through, it can
metastasize through your blood stream or lymphatics.
 Invasive lobular carcinoma (ILC): Ten percent of invasive breast cancers
are ILC, which begins in the lobules (milk producing glands). ILC is
harder to feel on examinations and harder to detect on mammograms
than IDC, but can metastasize in the same way, through lymphatics and
blood vessels.
 Inflammatory breast cancer (IBC): This cancer is an uncommon type of
breast cancer accounting for only 1 to 3 percent of cases. Instead of containing a single lump or tumor, the entire breast becomes warm and red,
with the skin taking on the appearance of an orange peel. This condition
occurs because the cancer cells are blocking the lymph vessels in the
skin. IBC is more likely to spread (metastasize) than ductal or lobular
cancers (see previous bullets).
 Paget disease of the nipple: This cancer is rare and accounts for only 1
percent of all breast cancers. The upside of this cancer is that it has an
excellent prognosis (meaning that there are good cure rates) in most
cases. The disease starts in the breast ducts and then spreads to the
skin of the nipple and then to the areola, the dark circle around the
nipple. You may feel itching or burning and notice crusted, scaly, and
red areas, which may ooze or bleed.

Many young women state that their biggest health fear when growing older
is breast cancer. Even though lung cancer has a higher mortality rate and
heart disease is a greater health risk (see respective sections in this chapter),
breast cancer is still what many women worry most about. On the flip side,
many women don’t worry about breast cancer because it doesn’t run in their
families. This false sense of security can be a costly mistake if it keeps you
from having preventative testing.
Consider the following breast cancer facts:
 Globally, breast cancer is the most commonly diagnosed cancer among
women and is the second leading cause of cancer death for women.
 About 1.2 million people worldwide are diagnosed with the disease each
year with approximately 502,000 global deaths.
 Breast cancer also affects about 1,600 men worldwide each year.
 Breast cancer is more common among women over the age of 40 and is
rare in women under age 25.
 Fifty percent of diagnosed breast cancer is in women over age 65.

You can’t completely prevent breast cancer — everyone is at risk. Great
strides have been made in breast cancer awareness in recent years, with
more women aware of the symptoms and utilizing self-exam and diagnostic
techniques regularly.
Differentiating types of breast cancer
Breast cancer is classified in different ways according to its location and
whether it’s metastasized.