Soy And Breast Cancer Recurrence

Written by Dr. Steve Chaney on . Posted in Food and Health, Issues

The Truth About Soy And Breast Cancer

 Author: Dr. Stephen Chaney

SoybeanYou’ve probably heard the warnings: “Soy may increase the risk of breast cancer!” “Women with breast cancer shouldn’t use soy!”

The first warning was never true. Numerous clinical studies have shown that consumption of soy protein is associated with a lower risk of developing breast cancer.

Furthermore, the science behind the second warning has never been very strong. The concerns that soy might stimulate the growth of breast cancer cells was based primarily on cell culture experiments and one experiment in mice – even though a second experiment in mice came to the exact opposite conclusion.

Was The Hypothesis That Soy Could Increase The Risk Of Breast Cancer Recurrence Plausible?

The possibility that soy isoflavones could stimulate the growth of estrogen- responsive breast cancer was biochemically plausible because soy isoflavones bind to the estrogen receptor and have a very weak stimulatory effect (much weaker than estrogen itself).

Even that evidence was not definitive because soy isoflavones also turn on several tumor suppressor pathways in breast cells and help strengthen the immune system – so they could just as easily inhibit the growth of breast cancer cells.

However, because the concerns were plausible and had not been definitively disproved, most experts, including me, recommended for several years that women with estrogen- responsive breast cancer might want to avoid soy protein.

Has The Hypothesis Been Rigorously Tested?

In fact, the definitive clinical studies have been performed, and it turns out for women who are breast cancer survivors, consumption of soy foods does not increase either the risk of breast cancer recurrence or of dying from breast cancer.

The first of these studies was reported in the December 2009 issue of the Journal of the American Medical Association by researchers at Vanderbilt University and Shanghai Institute of Preventive Medicine (Shu et al, JAMA, 302: 2437-2443, 2009).

It was a large, well designed, study that enrolled 5042 Chinese women aged 20 to 75 years old who had been diagnosed with breast cancer and followed them for an average period of 3.9 years.

The women were divided into four groups based on the soy content of their diet (ranging from 5 grams/day to 15 grams/day). The results were clear cut. Breast cancer survivors with the highest soy intake had 25% less chance of breast cancer recurrence and 25% less chance of dying from breast cancer than the women with the lowest soy intake.

The effect was equally strong for women with estrogen receptor-positive and estrogen receptor negative cancers, for early stage and late stage breast cancer and for pre- and post-menopausal women. In short this was a very robust study.

The study also showed that soy protein intake did not interfere with tamoxifen, a drug that blocks the binding of estrogen to its receptor on cancer cells. Tamoxifen is used for both for treating estrogen-responsive breast cancer and preventing its recurrence. In this study, the reduction in the risk of breast cancer recurrence & death was just as great whether the breast cancer survivors were taking tamoxifen or not.

In fact, tamoxifen was protective only for women with low soy intake. It conferred no extra protection for the women at the highest level of soy intake because the soy isoflavones were also blocking the binding of estrogen to its receptor.

Other Clinical Studies

If that were the only published clinical study to test the soy-breast cancer hypothesis, I and other experts would be very cautious about making definitive statements. However, at least four more clinical studies have been published since then, both in Chinese and American populations. The studies have either shown no significant effect of soy on breast cancer recurrence or a protective effect. None of them have shown any detrimental effects of soy consumption by breast cancer survivors.

A meta-analysis of all 5 studies was published earlier this year (Chi et al, Asian Pac J Cancer Prev., 14: 2407-2412, 2013). This study combined the data from 11,206 breast cancer survivors in the US and China. Those with the highest soy consumption had a 23% decrease in recurrence and a 15% decrease in mortality from breast cancer.

The Bottom Line:

What does this mean for you if you are a breast cancer survivor?

1)     There are many reasons to include soy protein foods as part of a healthy diet. Soy foods are one of the highest quality vegetable protein sources and provide a great alternative to many of the high fat, high cholesterol animal proteins in the American diet.

2)     I personally feel that these studies are clear cut enough that breast cancer survivors no longer need to fear soy protein as part of a healthy diet.

3)     The responsible websites agree with this assessment. For example, WebMD and the American Institute for Cancer Research (AICR) both say that breast cancer survivors need no longer worry about eating moderate amounts of soy foods.

4)     The irresponsible websites (I won’t name names, but you know who they are) are still warning breast cancer survivors to avoid soy completely. As a scientist I really have problem with people who are unwilling to change their opinions in the face of overwhelming scientific evidence to the contrary.

5)     Of course, some of those bloggers have now shifted their arguments to say that it is unfermented or genetically modified soy that causes breast cancer. Those statements are equally bogus – but that’s another story for another time.

6)     Finally, I want to emphasize that the published studies merely show that soy does not increase the risk of breast cancer and is safe to use for breast cancer survivors. None of those studies suggest that soy is an effective treatment for breast cancer. The protective effects of soy are modest at best. If you have breast cancer, consult with your physician about the best treatment options for you.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

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Comments (6)

  • Pam

    |

    Dr. Chaney — THANK YOU for the clarification!! I found this article easy to understand!

    Reply

  • Marie

    |

    This is fantastic information! I am wondering how estrogen plays a role in soy consumption for the average person. Many doctors claim that pumping estrogen (by means of soy consumption) into men or nursing babies through their mother’s milk is dangerous and can be harmful, possibly sterilizing, men. Do these claims hold any truth?

    Reply

    • sysadmin_htftp

      |

      Dear Stella,
      That information is also misleading. Look for an article in a few weeks summarizing the latest clinical studies on the effects of soy consumption on men.
      Dr. Chaney

      Reply

  • Susan

    |

    I am so glad to see this article and the timing is perfect for me. I have discussed with my Medical Oncologist, my soy protein shakes. I am in chemotherapy , my hormonal status is estrogen positive and she advised, she would prefer I did not have any soy products.

    I am going to take a copy of your email to my chemo appointment next Tuesday and see if she will change her mind.

    Thank you so much for this wonderful information.

    Reply

    • sysadmin_htftp

      |

      Dear Susan,
      You are doing exactly the right thing by discussing this information with your doctor. I can only report on the results of published clinical studies that represent the average effects of soy on breast cancer recurrence in a large group of breast cancer survivors. However, you are unique. What applies to the group as a whole, may not apply to you as an individual. That is why your oncologist is the best person to evaluate the data and give you the advice that best applies to you as an individual.
      Dr. Chaney

      Reply

  • Teresa Robinson

    |

    Thanks, Dr. Chaney. Several in my family and several friends have had breast cancer. The topic is one that is always top of mind.

    Reply

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Latest Article

Should We Use Supplements For Cardiovascular Health?

Posted July 10, 2018 by Dr. Steve Chaney

Are You Just Wasting Your Money On Supplements?

Author: Dr. Stephen Chaney

 

supplements for cardiovascular health wast moneyYou’ve seen the headlines. “Recent Study Finds Vitamin and Mineral Supplements Don’t Lower Heart Disease Risk.”  You are being told that supplements are of no benefit to you. They are a waste of money. You should follow a healthy diet instead. Is all of this true?

If I were like most bloggers, I would give you a simple yes or no answer that would be only partially correct. Instead, I am going to put the study behind these headlines into perspective. I am going to give you a deeper understanding of supplementation, so you can make better choices for your health.

 Should we use supplements for cardiovascular health?

In today’s article I will give you a brief overview of the subject. Here are the topics I will cover today:

  • Is this fake news?
  • Did the study ask the right questions?
  • Is this a question of “Garbage In – Garbage Out?
  • Reducing Heart Disease Risk. What you need to know.

All these topics are covered in much more detail (with references) in my book “Slaying The Supplement Myths”, which will be published this fall.

 

How Was This Study Done?

supplements for cardiovascular healthThis study (D.J.A. Jenkins et al, Journal of the American College Of Cardiology, 71: 2540-2584, 2018 ) was a meta-analysis. Simply put, that means the authors combined the results of many previous studies into a single database to increase the statistical power of their conclusions. This study included 127 randomized control trials published between 2012 and December 2017. These were all studies that included supplementation and looked at cardiovascular end points, cancer end points or overall mortality.

Before looking at the results, it is instructive to look at the strengths and weaknesses of the study. Rather than giving you my interpretation, let me summarize what the authors said about strengths and weaknesses of their own study.

The strengths are obvious. Randomized control trials are considered the gold standard of evidence-based medicine, but they have their weaknesses. Here is what the authors said about the limitations of their study:

  • “Randomized control trials are of shorter duration, whereas longer duration studies might be required to fully capture chronic disease risk.”
  • “Dose-response data were not usually available [from the randomized control studies included in their analysis]. However, larger studies would allow the effect of dose to be assessed.”

There are some other limitations of this study, which I will point out below.

Is This Fake News?

supplements for cardiovascular health fake newsWhen I talk about “fake news” I am referring to the headlines, not to the study behind the headlines. The headlines were definitive: “Vitamin and Mineral Supplements Don’t Lower Heart Disease Risk.” However, when you read the study the reality is quite different:

  • In contrast to the negative headlines, the study reported:
    • Folic acid supplementation decreased stroke risk by 20% and overall heart disease risk by 17%.
    • B complex supplements containing folic acid, B6, and B12 decreased stroke risk by 10%.
    • That’s a big deal, but somehow the headlines forgot to mention it.
  • The supplements that had no significant effect on heart disease risk (multivitamins, vitamin D, calcium, and vitamin C) were ones that would not be expected to lower heart disease risk. There was little evidence from previous studies of decreased risk. Furthermore, there is no plausible mechanism for supposing they might decrease heart disease risk.
  • The study did not include vitamin E or omega-3 supplements, which are the ones most likely to prove effective in decreasing heart disease risk when the studies are done properly (see below).

Did The Study Ask The Right Question?

Most of the studies included in this meta-analysis were asking whether a supplement decreased heart disease risk or mortality for everyone. Simply put, the studies started with a group of generally healthy Americans and asked whether supplementation had a significant effect on disease risk for everyone in that population.

That is the wrong question. We should not expect supplementation to benefit everyone equally. Instead, we should be asking who is most likely to benefit from supplementation and design our clinical studies to test whether those people benefit from supplementation.

supplements for cardiovascular health diagramI have created the graphic on the right as a guide to help answer the question of “Who is most likely to benefit from supplementation?”. Let me summarize each of the points using folic acid as the example.

 

Poor Diet: It only makes sense that those people who are deficient in folate from foods are the most likely to benefit from folic acid supplementation. Think about it for a minute. Would you really expect people who are already getting plenty of folate from their diet to obtain additional benefits from folic acid supplementation?

The NIH estimates that around 20% of US women of childbearing age are deficient in folic acid. For other segments of our population, dietary folate insufficiency ranges from 5-10%. Yet, most studies of folic acid supplementation lump everyone together – even though 80-95% of the US population is already getting enough folate through foods, food fortification, and supplementation. It is no wonder most studies fail to find a beneficial effect of folic acid supplementation.

The authors of the meta-analysis I discussed above said that the beneficial effects of folic acid they saw might have been influenced by a very large Chinese study, because a much higher percentage of Chinese are deficient in folic acid. They went on to say that the Chinese study needed to be repeated in this country.

In fact, the US study has already been done. A large study called “The Heart Outcomes Prevention Evaluation (HOPE)” study reported that folic acid supplementation did not reduce heart disease risk in the whole population. However, when the study focused on the subgroup of subjects who were folate-deficient at the beginning of the study, folic acid supplementation significantly decreased their risk of heart attack and cardiovascular death.  This would seem to suggest using supplements for cardiovascular health is a good idea.

Increased Need: There are many factors that increase the need for certain nutrients. However, for the sake of simplicity, let’s only focus on medications. Medications that interfere with folic acid metabolism include anticonvulsants, metformin (used to treat diabetes), methotrexate and sulfasalazine (used to treat severe inflammation), birth control pills, and some diuretics. Use of these medications is not a concern when the diet is adequate. However, when you combine medication use with a folate-deficient diet, health risks are increased and supplementation with folic acid is more likely to be beneficial.

Genetic Predisposition: The best known genetic defect affecting folic acid metabolism is MTHFR. MTHFR deficiency does not mean you have a specific need for methylfolate. However, it does increase your need for folic acid. Again, this is not a concern when the diet is adequate. However, when you combine MTHFR deficiency with a folate-deficient diet, health risks are increased and supplementation with folic acid is more likely to be beneficial. I cover this topic in great detail in my upcoming book, “Slaying The Supplement Myths”. In the meantime, you might wish to view my video, “The Truth About Methyl Folate.”

Diseases: An underlying disease or predisposition to disease often increases the need for one or more nutrients that help reduce disease risk. The best examples of this are two major studies on the effect of vitamin E on heart disease risk in women. Both studies found no effect of vitamin E on heart disease risk in the whole population. However, one study reported that vitamin E reduced heart disease risk in the subgroup of women who were post-menopausal (when the risk of heart disease skyrockets). The other study found that vitamin E reduced heart attack risk in the subgroup of women who had pre-existing heart disease at the beginning of the study.

Finally, if you look at the diagram closely, you will notice a red circle in the middle. When two or three of these factors overlap, that is the “sweet spot” where supplementation is almost certain to make a difference and it may be a good idea to use supplements for cardiovascular health.

Is This A Question Of “Garbage In, Garbage Out”?

supplements for cardiovascular health garbage in outUnfortunately, most clinical studies focus on the “Does everyone benefit from supplementation question?” rather than the “Who benefits from supplementation?” question.

In addition, most clinical studies of supplementation are based on the drug model. They are studying supplementation with a single vitamin or mineral, as if it were a drug. That’s unfortunate, because vitamins and minerals work together synergistically. What we need are more studies of holistic supplementation approaches.

Until these two things change, most supplement studies are doomed to failure. They are doomed to give negative results. In addition, meta-analyses based on these faulty supplement studies will fall victim to what computer programmers refer to as “Garbage In, Garbage Out”. If the data going into the analysis is faulty, the data coming out of the study will be equally faulty. It won’t be worth the paper it is written on. If you are looking for personal guidance on supplementation, this study falls into that category.

 

Should We Use Supplements For Cardiovascular Health?

 

If you want to know whether supplements decrease heart disease risk for everyone, this meta-analysis is clear. Folic acid may decrease the risk of stroke and heart disease. A B complex supplement may decrease the risk of stroke. All the other supplements they included in their analysis did not decrease heart disease risk, but the analysis did not include vitamin E and/or omega-3s.

However, if you want to know whether supplements decrease heart disease risk for you, this study provides no guidance. It did not ask the right questions.

I would be remiss, however, if I failed to point out that we know healthy diets can decrease heart disease risk. In the words of the authors: “The recent science-based report of the U.S. Dietary Guidelines Advisory Committee, also concerned with [heart disease] risk reduction, recommended 3 dietary patterns: 1) a healthy American diet low in saturated fat, trans fat, and meat, but high in fruits and vegetables; 2) a Mediterranean diet; and 3) a vegetarian diet. These diets, with their accompanying recommendations, continue the move towards more plant-based diets…” I cover the effect of diet on heart disease risk in detail in my book, “Slaying The Food Myths”.

 

The Bottom Line

 

You have probably seen the recent headlines proclaiming: “Vitamin and Mineral Supplements Don’t Lower Heart Disease Risk.” The study behind the headlines was a meta-analysis of 127 randomized control trials looking at the effect of supplementation on heart disease risk and mortality.

  • The headlines qualify as “fake news” because:
    • The study found that folic acid decreased stroke and heart disease risk, and B vitamins decreased stroke risk. Somehow the headlines forgot to mention that.
    • The study found that multivitamins, vitamin D, calcium, and vitamin C had no effect on heart disease risk. These are nutrients that were unlikely to decrease heart disease risk to begin with.
    • The study did not include vitamin E and omega-3s. These are nutrients that are likely to decrease heart disease risk when the studies are done properly.
  • The authors of the study stated that a major weakness of their study was that that randomized control studies included in their analysis were short term, whereas longer duration studies might be required to fully capture chronic disease risk.
  • The study behind the headlines is of little use for you as an individual because it asked the wrong question.
  • Most clinical studies focus on the “Does everyone benefit from supplementation question?” That is the wrong question. Instead we need more clinical studies focused on the “Who benefits from supplementation?” question. I discuss that question in more detail in the article above.
  • In addition, most clinical studies of supplementation are based on the drug model. They are studying supplementation with a single vitamin or mineral, as if it were a drug. That’s unfortunate, because vitamins and minerals work together synergistically. What we need are more studies of holistic supplementation approaches.
  • Until these two things change, most supplement studies are doomed to failure. They are doomed to give negative results. In addition, meta-analyses based on these faulty supplement studies will fall victim to what computer programmers refer to as “Garbage In, Garbage Out”. If the data going into the analysis is faulty, the data coming out of the study will be equally faulty. It won’t be worth the paper it is written on. If you are looking for personal guidance on supplementation, this study falls into that category.
  • If you want to know whether supplements decrease heart disease risk for everyone, this study is clear. Folic acid may decrease the risk of stroke and heart disease. A B-complex supplement may decrease the risk of stroke. All the other supplements they included in their analysis did not decrease heart disease risk, but they did not include vitamin E and/or omega-3s in their analysis.
  • If you want to know whether supplements decrease heart disease risk for you, this study provides no guidance. It did not ask the right questions.
  • However, we do know that healthy, plant-based diets can decrease heart disease risk. I cover heart healthy diets in detail in my book, “Slaying The Food Myths.”

 

For more details, read the article above.

 

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

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