Our genes have possibilities for health and for disease. Most cases of cancer are not due to simply inheriting "a cancer gene". Even genes that have a strong association with cancer development are not usually a death sentence. For example, some women with a strong family history of breast cancer are so frightened to learn they have a BRCA gene mutation, which is associated with breast cancer risk, that they undergo a prophylactic mastectomy; they have their breasts removed even though they don't have a diagnosis of cancer. BRCA1 & BRCA2 are tumor suppressor genes. When these genes are mutated there is less tumor suppression, increasing breast cancer risk about five-fold. However, not all women with a BRCA1 or BRCA2 mutation will develop breast cancer.  Obviously, there are modifiable factors from diet, lifestyle and environment that interact with these genes to increase or decrease risk. The goal is to identify these factors. For example, a study of 1690 women with a BRCA1 or BRCA2 mutation found reduced incidence of breast cancer with increasing coffee consumption. Women who drank 6 or more cups of coffee a day had a 69% lower incidence of breast cancer. Another study found an interaction between another gene,  coffee consumption, and breast cancer risk. CYP1A2 is a detoxifying enzyme. Among other things, it helps breakdown caffeine and estrogen. Women with a certain genetic variant influencing the form of this enzyme, were found to have slower growth of estrogen receptor-positive breast tumors if they drank more coffee. Coffee consumption appeared to increase the activity of this enzyme, resulting in metabolism of estrogen to less cancer-promoting forms. CYP1A2 genetic make-up can be determined with a special lab test.
 
The other important mechanisms of cancer can be assessed with laboratory tests, as well. Methylation status is another gene-centered factor. Methylation is a process whereby methyl groups (a carbon with three hydrogen atoms) are transferred from one chemical to another. Methylation is involved with the metabolism of estrogens. It is involved with detoxification of a variety of chemicals. Methylation is involved with DNA repair. Very importantly, methylation regulates genetic expression. Methyl groups are placed over genes to silence them. When a methyl group is placed on a tumor-promoting gene, that's good. Methylation activity is influenced by genetics, nutritional status (methionine, vitamin B6, vitamin B12, and folate, in particular), and many other factors, including coffee (a negative, in this case), alcohol, fruits, vegetables, fish oil, creatine, insulin resistance, hypothyroidism, kidney function, toxins, smoking, menopause, inflammation, and certain medications, to name a few. It has been found that tumor cells are low on methylation. With inadequate methylation, tumor promoting genes are not silenced, as they should be. What's more, when methyl groups are in short supply, there is another surprising outcome: hyper-methylation of genes that should not be silenced- tumor-suppressor genes. One readily available test for methylation status is a blood test for homocysteine. This amino acid is metabolized by methylation. So, an elevated homocysteine is evidence of impaired methylation. About 1 in 3 Americans have a genetic variant in an enzyme important for methylation, MTHFR. Like homocysteine, this is something that can now be ordered from any major medical laboratory and is covered by insurance. If your blood test shows you have the C677T gene version of MTHFR then you may very well be able to reduce your cancer risk by supplementing a form of vitamin B9 that bypasses this genetic weakness: L-5-methyl tetrahydrofolate.

Chronic inflammation is an important factor influencing tumor development, growth, and metastasis or spread throughout the body. One valuable test for inflammation is a blood test called high sensitivity CRP. One study found this test for inflammation was a more accurate predictor of survival in cancer patients than any other measurements. If you have a high sensitivity CRP greater than 0.7 mg/dl on repeated tests, you might be at increased risk for cancer. This test is most commonly ordered because it is a recognized cardiovascular risk factor. In fact, chronic inflammation is a risk factor for all the chronic degenerative diseases of aging. There are a multitude of modifiable factors that produce chronic inflammation in the body. For example, you may develop cancer if you have poor dental hygiene habits. That's right. Chronic low-grade inflammation emanating from unhealthy gums can contribute to cancer. For more on inflammation see the September 2010 Nutritious Bytes .

Insulin resistance is another readily assessed mechanism of cancer development. Insulin is not a "bad" hormone. However, perhaps as many as 1 in 2 Americans have some impairment in how their insulin works. When cells develop an impairment in their ability to respond to insulin, the body compensates by producing more insulin. Insulin helps to transport sugar and other nutrients into cells. However, insulin does much more. Insulin is a growth factor. It spurs the growth of epithelial cells. These cells are found in the breast, colon, prostate, and  lung among others. If you have high levels of insulin, it will speed the growth of any cancers in the breast, colon, prostate, or lung. What's more, insulin contributes to inflammation, and vice versa. In fact, there are many vicious cycles involving the different mechanisms of cancer growth. They interact in a web-like fashion. An important study examined the connection between insulin resistance and degenerative diseases. Two hundred and eight healthy men were followed for an average of six years. The men were divided into three groups based on how well their insulin worked. During this study, nine men developed cancer. These were men with impaired insulin functioning; the men with normal insulin function remained free of cancer, hypertension, diabetes, heart disease, and stroke. A multitude of diet, lifestyle, and environmental factors contribute to insulin resistance. Natural approaches help to reverse it.

If you have blood that is prone to clotting, you may be more prone to cancer. Tumors spread more easily in blood that is prone to clots. Fibrinogen is a blood-clotting protein measured by any medical lab. Levels above 310 should prompt some intervention to lower this inflammatory chemical. The single most powerful natural substance to reduce fibrinogen may be the earth worm-derived enzyme, lumbrokinase.

Many nutrients influence the cancer process. Lack of certain nutrients contribute to impaired methylation. Inadequate levels of other nutrients, such as zinc, result in the same type of damage to DNA as results from radiation exposure! Vitamin K deficiency contributes to certain cancers, as does vitamin D deficiency. Vitamin D is a powerful growth suppressor. It helps to reduce inflammation and insulin resistance. A double-blind, placebo-controlled 4 year study of 1179 postmenopausal women found 1500 mg of calcium plus 1100 IU vitamin D reduced incidence of all cancers by 77%! I believe optimal blood levels of vitamin D are between 50-100 ng/ml. All of the nutrients involved in cancer protection can be measured with lab tests, although some are only available at specialty labs.

If an individual has been successfully treated for cancer, they are put on a schedule of examinations to check for return of the cancer. In some cases, medications are used to help reduce the risk of the cancer returning. However, using single medications as your only weapon against cancer is a rather limited approach and has side effects. Tamoxifen for preventing recurrence of breast cancer can increase risk of other cancers. I recommend a thorough metabolic evaluation to see if your physiology is one likely to foster the growth of cancer. If you are too acid that needs to be corrected. If you have insulin resistance, that needs to be corrected, and so on. You need the right testing. This then allows for a scientific, individually-tailored program of diet, lifestyle, and nutritional supplements to bring your body into balance and make it an unfriendly place for cancer. This approach applies to cancer prevention, adjunctive treatment, and to all the degenerative diseases of aging. Call my office if you would like to schedule an appointment to get started.

Int J Cancer. 2006 Jan 1;118(1):103-7.  Coffee consumption and breast cancer risk among BRCA1 and BRCA2 mutation carriers. Nkondjock A, Ghadirian P, Kotsopoulos J, Lubinski J, Lynch H, Kim-Sing C, Horsman D, Rosen B, Isaacs C, Weber B, Foulkes W, Ainsworth P, Tung N, Eisen A, Friedman E, Eng C, Sun P, Narod SA.

 

Facchini FS, Hua N, Abbasi F, Reaven GM. Insulin resistance as a predictor of age-related diseases. J ClinEndocinolMetab 2001 Aug;86(8):3574-8