Breast Cancer

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Quick Reference

Updated March 2021: Open a 2-page quick reference summary of the therapies best supported by evidence for use with breast cancer:

quick reference document

Not only will conventional treatment vary from one person to the next, but integrative breast cancer care will vary and should be individualized.

Key Points

Blue icons beneath the page title are quick links to sections of this page.

Before investigating integrative care in breast cancer, we recommend reviewing integrative cancer care in general.

  • Integrative cancer care means skillful choices in both conventional and complementary cancer therapies.
  • Breast cancer is many different diseases. Not only will conventional treatment vary from one person to the next, but integrative breast cancer care will vary

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Authors

Laura Pole, RN, MSN, OCNS, BCCT Senior Researcher

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Nancy Hepp, MS, BCCT Project Manager

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Michael Lerner, PhD, BCCT Partner and Co-founder

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Reviewers

Ted Schettler, MD, MPH, BCCT Advisor

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Gwendolyn Stritter, MD, BCCT Advisor

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Last updated August 16, 2021.

Women with breast cancer use integrative therapies more often than any other group of people with cancer.

But despite the widespread use of integrative breast cancer therapies, informed guidance in integrating conventional and complementary breast cancer care is difficult if not impossible to find.

This summary of science-informed integrative breast cancer care is designed to provide that informed guidance.

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We do this for you. We hold you in our thoughts and prayers,

Michael Lerner

In early 2021, the World Health Organization announced that breast cancer is now the most common cancer diagnosis worldwide, overtaking lung cancer.2

Integrative Care in Breast Cancer

Breast cancer is actually many different diseases. Conventional treatments vary. Integrative care should also be individualized. For example, some complementary therapies that enhance immune function in some breast cancers may heighten cancer progression in others.

Getting your diagnosis right is critical to conventional treatment decisions. Unfortunately, accurate reading of pathology reports is often a weak link in cancer treatment, with unacceptably high error rates in some hospitals.

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Clinical Practice Guidelines

Further Clinical Practice Guidelines

The Society for Integrative Oncology (SIO), the leading organization of its kind, has conducted a monumental review of randomized control trials of complementary therapies in breast cancer care.3 From this review, SIO created integrative care guidelines.

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Highlighted Video

BCCT advisor Brian Bouch, MD, reviews the different therapies for breast cancer care. 

Integrative Programs, Protocols and Medical Systems

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Examples of Integrative Approaches

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Block Center Program Supplements

Supplements used in the 2009 study of advanced metastatic breast cancer patients:19

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The Block Center for Integrative Cancer Treatment (BCICT)

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Bastyr Integrative Oncology Care: A Naturopathic Oncology Approach

Bastyr Breast Cancer Study Supplements

No one "Bastyr protocol" exists, as researchers continue to investigate and refine approaches. Supplements used in one Bastyr protocol for breast cancer:22

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Dr. Kleef: Hyperthermia, Immunology and Integrative Oncology Program

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The Ecology of Breast Cancer

The Ecology of Breast Cancer: The Promise of Prevention and the Hope for Healing by BCCT advisor Ted Schettler, MD, MPH, is one of the best sources of information on lifestyle and environment in relation to breast cancer risk and outcomes.

Dr. Schettler proposes that individual body terrain is shaped across the lifespan by all levels, from individual to societal. “Efforts to change the design of that terrain can continue throughout life, so that breast cancer or its recurrence after initial treatment is less likely."26

The Ecology of Breast Cancer

Integrative Therapies in Breast Cancer

7 Healing Practices: The Foundation

Adding Up Benefits

Studies show that while a single lifestyle practice—such as a healthy diet or exercise—show benefit, combining practices is even more powerful.27

Breast cancer patients who adopted a healthier diet and regular exercise lowered their risk of relapse by nearly half, an effect seen in both obese and nonobese women.28

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The 7 Healing Practices listed here all promote wellness and tend to make your body terrain less hospitable to the development and progression of cancer. Some practices address cancer symptoms and side effects.

Eating Well

Dietary Fats: Healthier Choices

For most cancers, in general the recommendation is to eat a low-fat diet consisting of healthy fats (olive oil, nut oils, fish oils) and reduce the unhealthy fats (saturated fats found especially in red meat, trans-fats, and high amounts of omega-6 fatty acids). Limit total fat to 20 to 35 percent of dietary calories.

Different types of dietary fat have different health impacts:

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Moving More

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Managing Stress

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Sleeping Well

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Creating a Healing Environment

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Sharing Love and Support

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Exploring What Matters Now

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Beyond the 7 Healing Practices: Further Integrative Therapies

Complementary therapies and lifestyle practices can be useful to enhance treatment effects, improve quality of life and possibly even extend life for those with breast cancer.

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Therapies are grouped according to their effects:

  • Treating the cancer
  • Managing side effects and promoting wellness
  • Reducing risk
  • Optimizing your terrain

We present natural products in six groups:

  1. Good clinical evidence of efficacy & safety, easy access
  2. Good clinical evidence of efficacy & safety, limited access
  3. Limited clinical evidence of efficacy but good safety, used in leading integrative programs
  4. Limited clinical evidence of efficacy, or significant cautions, but potential significant benefit
  5. Especially promising preclinical or emerging clinical evidence of efficacy and safety
  6. Evidence of no efficacy or may be dangerous

Off-label, overlooked and novel cancer approaches (ONCAs) are grouped separately:

  • Group A: Good clinical evidence of efficacy
  • Group B: Limited clinical evidence of efficacy
  • Group C: Promising preclinical evidence only
  • Group D: Evidence of no efficacy or may be dangerous

Within each section, we list only groups containing applicable therapies.

Other integrative therapies and approaches are described but not categorized. See the full summaries as linked for more information on each of these therapies.

Cells, Animals and People

Studies on human cells can be helpful in finding effects of drugs, radiation, natural compounds and other potential therapies on tumors. However, isolated cells or tissues in a highly controlled lab may behave very differently from tumors and other cells in real human beings.

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We limit our presentation here to therapies with clinical evidence—studies involving cancer patients—and not solely cell or animal evidence (see at right). Preclinical evidence is included in therapy summaries on this site for those who wish to assess that.

Treating the Cancer

Working against cancer growth or spread, improving survival, or working with other treatments or therapies to improve their anticancer action

The role of each of the 7 Healing Practices in arresting or reducing breast cancer growth and spread is described above.

Conventional Breast Cancer Therapies

Conventional treatment for breast cancer is becoming more and more specific, depending on the type, stage and characteristics of a person’s cancer. For a growing number of women, treatment is effective or even curative, especially in the case of early-stage cancer.

Screening for Cancer in Dense Breasts

A large study in the Netherlands found that supplementing mammograms with  magnetic resonance imaging (MRI) for women with very dense breast tissue reduced missed cancers (called interval cancers) more than mammography alone.132

Pregnancy and Cancer Outcomes

Pregnancy after breast cancer was not associated with a negative impact on patients’ outcomes—including women with hormone-receptor positive disease—in a large meta-analysis.

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Breast Cancer and Pregnancy Outcomes

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Chemosensitivity Testing

Tests are available to identify which drugs and natural products are more likely to be active against your cancer. Breast cancer medical advocate and BCCT advisor Gwen Stritter, MD, offers several considerations if you are thinking about chemosensitivity testing for breast cancer.

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Conventional Treatment Interactions with Drugs and Natural Products

Commentary from BCCT advisor Jen Green, ND, FABNO, September 1, 2020: Arimidex generally has lower risk of drug interactions as compared to tamoxifen because it is metabolized by p glycoproteins and not CYP pathways in the liver. Tamoxifen, on the other hand, carries greater drug-drug and herb-drug interaction risks because it is extensively metabolized by the CYP2D6 pathway. Tamoxifen shouldn’t be combined with paroxetine/Paxil,137 fluoxetine/Prozac,138 diphenhydramine/Benadryl or cimetidine/Tagamet.139 Out of caution, it should not be combined with these natural substances:

Breast Cancer Conditional Outcome Calculator

An online tool allows patients to enter data about the type and status of her breast cancer to calculate expected cancer-related and overall life expectancy.

Natural Products

BCCT advisor Debu Tripathy, MD, writes that “herbal and botanical agents have significant potential as bioactive agents that can affect cellular pathways involved in breast cancer, but may also cause side effects and drug interactions. . . Caution should be exercised when used with other treatments.”142

Group 1: Good clinical evidence of efficacy & safety, easy access

These therapies may be widely used in integrative cancer protocols and traditional medical systems.

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Group 3: Limited clinical evidence of efficacy but good safety, used in leading integrative programs

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Group 4: Potential significant benefit, but either limited clinical evidence of efficacy or significant cautions

May be used in leading integrative oncology programs. Therapies in this group may need more medical oversight and surveillance.

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Group 5: Especially promising preclinical or emerging clinical evidence of efficacy and safety

Other therapies with preclinical evidence only for treating the cancer

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Group 6: Evidence of no efficacy or may be dangerous

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Off-label, Overlooked or Novel Cancer Approaches (ONCAs)

Off-label drug use involves a physician prescribing a drug for a disease or condition not approved by the FDA. Prescribing drugs off-label is legal if sufficient evidence indicates its usefulness for the condition or disease prescribed. However, different state medical boards have varying standards regarding off-label use of specific drugs.

These therapies have exciting potential and/or proven benefits. However, some carry higher risks of side effects, interactions with other treatments and other adverse medical events than other therapies we review. Cautions are noted with each therapy, and we strongly urge you consult your doctor before using these therapies—even over-the-counter drugs—for cancer treatment. We also note whether a prescription is needed or if a therapy is not widely available. 

Group A: Good clinical evidence of efficacy

May be used in integrative protocols and programs

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Group B: Limited clinical evidence of efficacy

May be used in integrative protocols and programs

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Group C: Promising preclinical evidence only

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Diets and Metabolic Therapies

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Therapies Using Heat, Cold, Sound, Light or Cutting-edge Radiotherapy

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Managing Side Effects and Promoting Wellness

Compelling evidence shows that stress reduction significantly improves quality of life after initial treatment of breast cancer and beyond.

Managing or relieving side effects or symptoms, reducing treatment toxicity, supporting quality of life or promoting general well-being

Wellness During Tamoxifen Treatment
Click the image to open this patient handout on wellness during tamoxifen treatment.

The role of each of the 7 Healing Practices in managing symptoms, improving quality of life and promoting wellness is described above.

Conventional Therapies

Vaginal moisturizers and vaginal rings supplying low-dose estrogen are used to address sexual discomfort and difficulties. Although these are conventional therapies, they may not be included in many conventional treatment programs unless or until a patient expresses a need.

A recent study (not yet published) found that "just about all (99%) of the postmenopausal women who took part in the study scored low on the Female Sexual Function Index (FSFI), indicating a high degree of sexual dysfunction, including vulvovaginal dryness and severe dyspareunia (painful intercourse)."333 In a discussion of the study, a recommendation was made to physicians to ask patients about sexual difficulties. However, BCCT encourages you to report symptoms and ask for help if your doctor doesn't ask.

Other conventional therapies for managing side effects are widely available. Ask your oncologist or primary care physician for recommendations.

Natural Products

Group 1: Good clinical evidence of efficacy & safety, easy access

These therapies may be widely used in integrative cancer protocols and traditional medical systems.

Read more

Group 2: Good clinical evidence of efficacy & safety, limited access

Some may require a prescription, for example.

Read more

Group 3: Limited clinical evidence of efficacy but good safety, used in leading integrative programs

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Group 4: Potential significant benefit, but either limited clinical evidence of efficacy or significant cautions

May be used in leading integrative oncology programs. Therapies in this group may need more medical oversight and surveillance.

Read more

Group 5: Especially promising preclinical or emerging clinical evidence of efficacy and safety

Other therapies with preclinical evidence only for managing side effects and promoting wellness

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Group 6: Evidence of no efficacy or may be dangerous

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Off-label, Overlooked or Novel Cancer Approaches (ONCAs)

These therapies have exciting potential and/or proven benefits. However, some carry higher risks of side effects, interactions with other treatments and other adverse medical events than other therapies we review. Cautions are noted with each therapy, and we strongly urge you consult your doctor before using these therapies—even over-the-counter drugs—for cancer treatment. We also note whether a prescription is needed or if a therapy is not widely available. 

Group A: Good clinical evidence of efficacy

May be used in integrative protocols and programs

Read more

Group B: Limited clinical evidence of efficacy

May be used in integrative protocols and programs

Read more

Group C: Promising preclinical evidence only

Read more

Diets and Metabolic Therapies

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Mind-Body Approaches

Mind-body approaches including music therapy, meditation and yoga have been shown to improve side effects and symptoms. Studies investigating the effects of cognitive-behavioral therapy and hypnosis have also found benefit. A 2017 study found that cognitive-behavioral therapy plus hypnosis reduced emotional distress in women with breast cancer undergoing radiotherapy.509 A 2018 non-randomized study of women undergoing breast surgery found shorter hospital stays; less anxiety; less weakness (asthenia) during follow-up chemotherapy; less radiodermatitis; and reduced incidence of hot flashes, joint and muscle pain and asthenia while on endocrine therapy in the group receiving hypnosis sedation compared to those receiving general anesthesia.510

More evidence is described in these summaries:

Energy Therapies

Energy therapies with evidence for improving side effects and symptoms include these:

Manipulative and Body-based Methods

Therapies Using Heat, Cold, Sound, Light or Cutting-edge Radiotherapy

Palliative Care

If you have advanced, incurable cancer that has stopped responding to conventional treatment, your oncologist, if pushed, will likely offer you more chemotherapy to try, even when it is unlikely to work and may worsen the quality of your life or even hasten death. This may be a time to push for your physician to be honest and to talk about realistic hope for quality of life, as so much more can be done for you with good palliative care. Furthermore, many patients receiving good palliative care as well as integrative approaches may actually live longer than expected. Such approaches described above include the Block Center for Integrative Cancer Treatment and the Bastyr Integrative Oncology Research Clinic approach.

See Palliative Care.

Reducing Risk

Reducing the risk of developing cancer or the risk of recurrence

Risk Factors

Hormone Replacement Therapy and Risk

A 2019 meta-analysis found an increased risk of breast cancer with all types of menopausal hormone replacement therapy except vaginally inserted estrogen.521 According to coauthor Gillian Reeves, PhD, use of menopausal hormone therapy for 10 years results in about twice the excess breast cancer risk associated with five years of use, but there appears to be little risk from use of menopausal hormone therapy for less than one year, or from topical use of vaginal estrogens that are applied locally as creams or pessaries and are not intended to reach the bloodstream.522

A 2020 study confirmed that use of hormone replacement therapy for more than five years is associated with greater risk in women genetically predisposed to breast cancer.523

Generally accepted individual risk factors for breast cancer include these, with varying levels of association:524

  • Genetic factors and family history of breast cancer
  • Pregnancy history (late age first pregnancy or no pregnancies)
  • Menstrual history (early age of puberty or later age of menopause)
  • Dense breast tissue
  • Chest radiation
  • Recent oral contraceptive use (increased risk may disappear within a few years after use is discontinued525 )
  • Combination hormone therapy (see also at right)
  • Cigarette smoking
  • Alcohol consumption

Lifestyle and environment influence the risks of developing breast cancer and of recurrence after treatment.

Although these risk factors are important, they do not fully explain why many people develop breast cancer. Lifestyle and environment influence the risks of developing breast cancer and of recurrence after treatment.

It Takes a Village (or a Whole Country) to Reduce the Risk of Breast Cancer

Reducing these risk factors “cannot be accomplished by individuals alone. Public health strategies to re-shape the terrain are essential.”526 Many of these can only partially be addressed by changes in individual behavior. Multi-level public-health and policy interventions at the population level are also necessary in order to re-design system conditions in more favorable ways.

Read more

From Dr. Ted Schettler's The Ecology of Breast Cancer527 and other sources as noted:

Breast cancer risk factors help shape conditions that foster vulnerability to the disease and less favorable outcomes. Risk factors for which the strength of evidence varies from strong to probable to plausible:

  • Certain kinds of diets (see Eating Well above)
  • Inadequate physical activity528
  • Exposures to certain environmental chemicals or contaminants, such as some hair products529
  • Body weight: even among people considered of normal weight and not overweight (BMI < 25), increased body fat was associated with increased risk of postmenopausal breast cancer.530  Higher BMI is also linked to higher risk of second primary cancers among breast cancer survivors.531
  • Non-ionizing radiation
  • Inadequate vitamin D status
  • Shift work
  • Light at night
  • Stress
  • Severe life events, anxiety, depression, perception of insufficient social support, or avoiding coping strategy532
  • Societal contributors to these factors, such as poverty, violence, racism or other marginalization

See Creating a Healing Environment.

The role of each of the 7 Healing Practices in reducing the risks of breast cancer development and recurrence is described above. Three further factors—alcohol use, breast feeding and adult body weight—are discussed here.


Alcohol Intake

Alcohol consumption is a recognized risk factor—among those with the strongest evidence—for developing breast cancer.533

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Breastfeeding

Breastfeeding brings many benefits to the mother as well as the infant, including reducing the mother’s risk of breast cancer.539

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Adult Body Weight

A lower body mass index is associated with a lower risk of breast cancer, even among women at higher genetic risk.541

In the Nurses' Health Study, a large, prospective cohort study spanning decades, weight gain after age 18 is associated with higher risk after menopause among women who have never used hormone therapy. Women who had lost more than 10 kilograms (22 pounds) since menopause and maintained their weight loss had a lower risk of breast cancer than women with stable weight since menopause.542 Even smaller amounts of weight loss—more than 4.4 pounds (2 kilograms)—can be beneficial, as long as the loss is sustained and not regained.543

See Creating Healthy Habits.

Therapies to Reduce Risk

Natural Products

Group 3: Limited clinical evidence of efficacy but good safety, used in leading integrative programs

Read more

Group 4: Potential significant benefit, but either limited clinical evidence of efficacy or significant cautions

May be used in leading integrative oncology programs. Therapies in this group may need more medical oversight and surveillance.

Read more

Group 5: Especially promising preclinical or emerging clinical evidence of efficacy and safety

Other therapies with preclinical evidence only for reducing risk

Read more

Read more

Group 6: Evidence of no efficacy or may be dangerous

Read more

Off-label, Overlooked and Novel Cancer Approaches (ONCAs)

These therapies have exciting potential and/or proven benefits. However, some carry higher risks of side effects, interactions with other treatments and other adverse medical events than other therapies we review. Cautions are noted with each therapy, and we strongly urge you consult your doctor before using these therapies—even over-the-counter drugs—for cancer treatment. We also note whether a prescription is needed or if a therapy is not widely available. 

Group A: Good clinical evidence of efficacy

May be used in integrative protocols and programs

Read more

Diets and Metabolic Therapies

Read more

Optimizing Your Terrain

Creating an environment within your body that does not support cancer development, growth or spread

Natural Products

  • Agaricales mushrooms
    • Increased number of natural killer (NK) cells and other biologic markers in breast cancer patients620
  • Astragalus
    • Anti-inflammatory;621 reduced inflammation in patients with advanced metastatic cancer622
    • Immune support or modulation623
    • Antioxidant624
  • Curcumin
    • Anti-inflammatory and antioxidant, interfering with known contributors to cancer development625
  • DIM (diindolylmethane)
    • Anti-inflammatory effects in lab and animal studies626
  • Ginseng (About Herbs)
    • Improved immunology among breast cancer patients when used in combination with red ginseng, lilyturf root, and magnolia vine fruit in a small clinical study627
  • Maitake mushroom
    • Modified immune response or functioning in patients with advanced breast, liver, or lung cancer628
    • Decreased inflammation in triple-negative human breast cancer cells629
  • Omega-3 fatty acids
    • Anti-inflammatory630
  • Reishi mushroom
    • Enhanced immunity in cancer patients631
  • Resveratrol
    • Inhibited obesity-associated inflammation in mice632
  • Shiitake mushroom
    • Improved natural killer (NK) cell activity and immunosuppressive acidic protein (IAP) levels in patients receiving chemotherapy (preliminary evidence)633

Off-label, Overlooked and Novel Cancer Approaches (ONCAs)

Breast Cancer and Surgery

Having breast cancer surgery and possible reconstruction may involve extra consideration and care. Planning ahead to minimize pain or discomfort and reduce the risk of infection can bring a happier experience and better clinical outcome.

Hormone Therapy before Surgery

From medical advocate, breast cancer survivor and BCCT advisor Gwendolyn Stritter, MD

Anti-estrogen therapy, typically started after surgery, prevents breast cancer relapse and death in ER+ cancers. However, some patients do not relapse even if they do not take anti-estrogen medication. Other patients will relapse despite taking them. This means a significant number of patients taking anti-estrogens suffer from the adverse effects of treatment without the benefit of improved outcomes. Taking anti-estrogens before surgery enables your healthcare team to determine if you would respond to such treatment. This can save five to 10 years of ineffective therapy for those who would not respond. Another benefit of neoadjuvant hormone therapy: good outcomes despite less aggressive surgery, such as lumpectomy instead of mastectomy.

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Breast Reconstruction: Now More Options


Dr. Deb's operating room flash mob before her double mastectomy

Two basic types of breast reconstruction are available after mastectomy:

  • Breast implants
  • Flap reconstruction using tissue from your own body to reconstruct the breast

Further options are available within those two categories. To learn more about the standard post-mastectomy breast reconstruction options, see an online decision aid called BRECONDA: Breast Reconstruction Decision Aid. Note that this aid does not mention prepectoral implants.

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Avoiding Complications after Breast Surgery

Surgery and Metastasis—and a Therapy That May Reduce Risk

Some studies in humans and animals suggest that surgery may be associated with metastasis638 —possibly from the inflammatory response of wound healing. Some researchers suggest that the flood of stress hormones associated with surgery may also contribute to the metastatic process following surgery.

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Why Is It Important (Besides the Obvious)?

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Patient Characteristics and Complication Rates

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Surgery Characteristics and Complication Rates

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Reducing the Risk of Complications: What You and Your Surgeon Can Do

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Post-surgical Pain Management 


Dr. Stritter's "pole dance" following her double mastectomy

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Reducing the Risk of Chronic Pain after Mastectomy or Breast Reconstruction

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Infection Response

Despite our best efforts, we can sometimes still get an infection after breast surgery. Fortunately, it is uncommon for a mild infection to cause a significant worsening of outcomes. But knowing what to do (and what not to do) will help prevent a mild infection from becoming a serious one. 

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Recovery and Remission Maintenance

BCCT does not recommend any particular remission maintenance approach. The strategies provided here are supported by evidence of improved outcomes.

Balancing Terrain

Several imbalances in your terrain can make the body more susceptible to infection, slower to heal wounds and/or more hospitable to cancer. Chronic inflammation, insulin resistance/glycemia, obesity and imbalanced stress chemistry may be particularly important to balance in relation to surgery, wound healing and reducing recurrence risk. For more information, see Body Terrain and the Tumor Microenvironment.

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Post-treatment Monitoring

When you have finished treatment, discuss and develop a survivorship plan with your cancer treatment team. Your survivorship plan includes instructions and a schedule for follow-up visits, plus testing and guidance on lifestyle and other self-care practices to help you recover and prevent recurrence. The type of testing and monitoring done to assess your response to treatment and pick up on recurrence depend on your specific cancer, treatment and risk for recurrence.

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DCIS Treatment

From medical advocate, breast cancer survivor and BCCT advisor Gwendolyn Stritter, MD

60 percent of the patients with DCIS would not progress to invasive breast cancer even without any treatment whatsoever.

De-escalation of DCIS Treatment

60 percent of the patients with ductal carcinoma in situ (DCIS) would not progress to invasive breast cancer even without any treatment whatsoever. But not knowing which patient will progress, combined with the potential for metastasis in those who do progress, has understandably led oncologists to overtreat everyone in the hopes of improving the survival of the 40 percent who are at risk.

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Low-dose Tamoxifen and DCIS

It turns out that the dose of tamoxifen you are taking may be much higher than needed. This research figured prominently at the December 2018 San Antonio Breast Cancer Symposium—for good reason. It was recently published in the Journal of Clinical Oncology.

First, some background. Conventional medical research, especially cancer research, has a notable deficiency: a strong tendency to test only the “maximally tolerated dose” of any given research drug. This approach is lots cheaper and lots easier than testing two to four other doses to find the sweet spot (maximal effectiveness, minimal side effects). Accordingly, it has been known for quite a while that the standard dose of tamoxifen—20 mg—may be much higher than that necessary to prevent non-invasive breast “pre-cancers” such as DCIS, LCIS and atypical ductal hyperplasia (ADH) from progressing to invasive breast cancer.

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Taking Care of Your Heart: Heart Health and Breast Cancer

With contributions from BCCT Advisor Jen Green, ND, FABNO

Caring for your heart is an important part of your wellness plan. The relationship between breast cancer and heart health may work both ways:

  • According to a 2018 review, following diagnosis, 35 percent of deaths in breast cancer patients are related not to breast cancer, but to cardiovascular disease.675
  • A heart attack raises the risk of death from recurrence.676

Fortunately, several actions are available to reduce the risk of heart damage and cardiovascular disease. Doctors should monitor women for early signs of heart disease and manage for risk factors—cholesterol levels, blood pressure and lifestyle.677 Cancer survivors can follow these approaches to reduce risks:

“Heart Healthy” Lifestyle Choices

Some complementary therapies may be helpful, starting with “heart healthy” lifestyle choices including the 7 Healing Practices of eating well, moving more, managing stress and sharing love and support (see also the descriptions above).

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Cardiac Toxicity and Breast Cancer Treatment

Click the image to open the brochure.

People with breast cancer who are undergoing chemotherapy such as anthracylines (including Adriamycin/doxorubicin), targeted agents such as Herceptin/trastuzumab, and radiation therapy to the chest are at risk for heart damage. Risk is even higher for those receiving anthracyclines plus Herceptin or anthracyclines plus chest radiation.

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Natural Therapies Protective during Adriamycin/Doxorubicin Treatment

Studies on herbs or natural supplements show how these have helped reduce heart damage from Adriamycin/doxorubicin. Please connect with an integrative oncology professional or naturopathic physician for specific guidance. Also see Quality and Sources of Herbs, Supplements and Other Natural Products.

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Natural Therapies Protective during Treatment with Herceptin/Trastuzumab, Perjeta/Pertuzumab or Kadcyla/Trastuzumab Emtansine

Studies of these herbs or natural supplements show improvements in heart strength/ejection fraction. These may be useful if heart strength is reduced from Herceptin or Kadcyla treatment. Please connect with an integrative oncology professional or naturopathic physician for specific guidance. Also see Quality and Sources of Herbs, Supplements and Other Natural Products.

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Commentary

BCCT advisor Gwen Stritter, MD, February 1, 2019: As a breast cancer medical advocate, I find there are certain areas that patients are really grateful to learn about. I have included a few in sections above: hormone therapy before surgery, regional anesthesia for mastectomy and de-escalation of DCIS treatment.

Naturopathic oncologist and BCCT advisor Lise Alschuler recommends overnight fasting for 13 hours, as this has been associated with improved survival after a diagnosis of breast cancer. For instance, you could finish dinner at 7pm and eat nothing else until 8am the next morning when you "break fast.” In addition, for people having significant side effects, especially gastrointestinal, from chemo, Dr. Alschuler may also recommend fasting for 48 hours—from after dinner on the day before chemo, through the day of chemo and the day following chemotherapy. The chemo fast can be a water fast (which includes coconut water and vegetable broths), or you can eat up to 600 calories per day of vegetable soup and/or low-carb vegetables. She stresses the importance of your being motivated to fast, and also that fasting during chemotherapy should be cleared with your treating oncologist. You should modify or stop the fast if you become dizzy or weak (try adding boiled eggs or nuts), or if you feel worse than if you had eaten.

BCCT advisors Gwen Stritter, MD, and Jen Green, ND, FABNO, May 9, 2019: Impact of curcumin on tamoxifen effectiveness

Many are aware that tamoxifen is what we call a pro-drug. A pro-drug is ineffective until specific enzymes in your body activate it. Tamoxifen is metabolized to endoxifen, the effective drug that prevents ER+ breast cancer patients from relapse.

An enzyme called CYP2D6 is responsible for the magic that changes tamoxifen to endoxifen. The activity of this enzyme varies from individual to individual. Part of the variance is due to genetics—some people are born with hyperactive CYP2D6; others have an enzyme that is very sluggish. Many medications—antidepressants like fluoxetine (Prozac), paroxetine (Paxil) and citalopram (Celexa) amongst a host of others—as well as assorted foods and dietary supplements can either activate or slow down CYP2D6.

When this information first started causing a stir in the breast cancer world roughly 10 years ago, researchers hypothesized that taking tamoxifen with a CYP2D6 inhibitor would cause a increase in breast cancer relapse. As it turned out, further clinical research did not bolster this theory,713 leading to a new one: genetics, drugs and dietary intake have complex interactions with the body’s enzyme system. They activate some enzymes and inhibit others. This results in a variable net effect on the concentration of important drugs. In a 2016 study, the cause of low endoxifen levels could not be identified over 50 percent of the time.714

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BCCT advisor Lise Alschuler, ND, FABNO, August 9, 2018: There are instances when I use specific mushrooms, for instance: Coriolus (or Trametes) versicolor (turkey tail) for breast cancer, Agaricus blazeii for ovarian cancer and chaga mushroom for melanoma. However, it is a very valuable and reasonable strategy to use a blend that includes mushrooms, each of which is standardized to its polysaccharides and beta-glucans. The key is to use a hot water extract of the fruiting bodies or a full-spectrum extract (includes mycelium) that clearly identifies on its label the quantity of mushroom extract.

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BCCT advisor Keith Block, MD, advises patients on heart-damaging medications to take 200 mg or even considerably more of CoQ10 per day.720 Many heart patients are also on statins. Block says, “Because statins deplete coenzyme Q10 from your muscle cells, particularly your heart, I advise patients on statins to take at least 30 mg of coQ10 per day.“721

BCCT advisor Ted Schettler, MD, March 4, 2019: Lavender oil (as with some other essential oils) has estrogenic properties at some concentrations.722 It might be wise to avoid skin application of lavender oil in the setting of an estrogen positive breast cancer diagnosis.

View All References

More Information

General Breast Cancer Resources

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Treatment Resources

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Financial / Support Resources

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Breast Cancer Treatment in Older Women

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Resources on Reconstruction Options and Risk of Infection

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Resources on Reducing Risk of Surgical Infection

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More from Our Resources Database

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