But that fear doesn't permeate other cultures the way it does ours.

A woman like Mariko Mori, for instance, 52 years old, Japanese, worries about intense pressures beginning to burden her toddler grandson. But worry about breast cancer? Hardly.

In Indiana, Mary Lou Marks, 50, has similar family frets, mulling over her 28-year-old daughter's career choice.

But on top of that, when Mary Lou tabulates her other worries, she recoils at the thought of breast cancer. She's heard about her lifetime risk: 1 in 8. Meanwhile, Mariko's is merely 1 in 40, according to Bob Arnot's Breast Cancer Prevention Diet (Little, Brown).

American Problem
Experts reporting in "Women at High Risk for Breast Cancer: A Primary Care Perspective" (Prim Care Update Ob/Gyns, vol. 5, no. 6, 1998, p. 269) say the risk of developing breast cancer for the average American woman during ages 40 to 59 is 3.9%; by 60 to 79 years of age that rises to 6.9%. A high-risk 40-year-old has a 20% chance of breast cancer in the next 20 years.

New studies have found the effect of carrying the gene linked to breast cancer, which is responsible for only 5 to 10% of breast cancer incidence, is not as great as first suspected. Earlier estimates that the gene reflects an 80% chance of incurring breast cancer by age 70 has been recalculated to be only 37% (The Lancet, 1998;352:1337-1339).

Complex Causesbr> Researchers agree: No one factor is solely responsible for breast cancer. Risk depends on many factors, including diet, weight, smoking, alcohol consumption, activity level and, of course, those genes.

Regardless of their actual chance of getting breast cancer, women worry. Mary Lou faces no factors that would place her in particular jeopardy. But her anxieties about radical therapies and medical expenses paralyze her: She forgets to visit her health care provider and skips her annual mammogram appointments. Mary Lou's daughter, perhaps in reaction to her mother's gripping fears, campaigns ardently for cancer prevention, educating herself and mobilizing against the cumulative effects of known cancer risks. Smart young woman: A malignancy, after all, can take years to develop. A tumor must swell to one billion cells before it is detectable by a mammogram.

Dietary Benefits
Of all the tactics for reducing the risk of breast cancer, diet ranks high on the list.

The soy-rich regimen of Japanese women like Mariko Mori, for example, helps to explain the low breast cancer rates in Asian countries (see box at center of the page).

Tomatoes, because of their high quotient of the carotenoid lycopene, have been found to protect cells from the corrosive clutches of oxidants that have been linked with cancer in 57 out of 72 studies (The Santa Rosa Press Democrat, February 17, 1999, page A6, reporting on a Harvard Medical School study). For more on tomatoes see page 16.

But there's no one magic anti-cancer food or diet. Eating to prevent breast cancer requires a balanced menu with fiber, healthy fats, phytoestrogens and antioxidants, all fresh and free of chemical additives.

Modifying the balance and type of estrogen, the female sex hormone produced by the ovaries, offers an important breast cancer safeguard. Fat cells, adrenal glands and, before menopause, the ovaries, produce three "flavors" of estrogen, the strongest of which, estradiol, is believed to be carcinogenic when too plentiful or persistent in the body.

Estrogen does its work by attaching to estrogen receptors. Receptors are particularly numerous in the epithelial cells that line milk sacs and ducts in the breasts.

A receptor site is like a designated parking spot: Once estrogen is parked there it triggers one of its 400 functions in the body, from preparation of the uterus for pregnancy to intensifying nerve synapses in the brain.

The food we eat can be a source of estrogen; plant estrogens, called phytoestrogens, are much weaker than the body's estrogens, but they fit the same receptors. Phytoestrogens exert a milder estrogenic effect than bodily estrogen and are capable of blocking the more potent, damaging versions.

Finding Phytoestrogens
Foods high in phytoestrogens include vegetables, soy, flaxseed and herbs such as black cohosh, chasteberry, red clover and turmeric. Soy is the darling of the day for good reason. Both soy and flaxseed can lengthen periods, reducing the body's overall exposure to estrogen.

Soy also contains genistein, an "isoflavone" very similar in molecular form to estrogen but only 1/100,000 as potent. Because of its structure, genistein can attach to cells just as estrogen does; it also helps build carriers needed for binding estrogen and removing it from the body (Journal of Nutrition 125, no.3 [1995]:757S-770S). It acts as an antioxidant to counteract free radicals.

Tumor Inhibition
Studies have demonstrated that genistein inhibits angiogenesis (new tumor growth), slowing the progression of existing cancer.

Soy is most protective for younger women. Postmenopausal women benefit from soy's ability to diminish hot flashes and for cardiovascular protection, especially in combination with vitamin E, fiber and carotene (Contemporary OB/GYN, September 1998, p57-58).

Experts don't know that much about the cumulative effect of combining hormone replacement with soy, herbs and a diet high in phytoestrogens. Menopausal women who boost their estrogen this way should work with their health care providers and monitor their hormonal levels every six to 12 months with salivary testing.

The Vegetable Cart
Some vegetables are particularly protective against breast cancer because they change the way the body processes estrogen. Indol-3-carbinol, found in the co-called cruciferous vegetables such as cauliflower, broccoli and cabbage, diminishes the potency of estrogen. (Broccoli also contains isothiocyanates that trigger anti-carcinogenic enzymes.) These vegetables supply fiber, beta-carotene, vitamin C as well as other vitamins and minerals (Proc of the National Academy of Science USA, 89:2399-2403, 1992).

Fiber from fruits, vegetables and whole grains reduces insulin levels and suppresses the appetite by making make us feel full, thus helping with weight control, so important to resisting cancer. Fiber also helps build estrogen carriers that keep unbound estrogen from being recirculated and reattached to the breast receptors.

Cellulose, the fruit and vegetable fiber most binding with estrogen, also rounds up free radicals that damage DNA within cells.,p> Feeding the Immune System
Despite heightened public awareness and efforts to stick to wholesome, healthful diets, experts increasingly link poor nutrition to depressed immune systems. Many Americans are at least marginally deficient in trace elements and vitamins despite their best attempts to eat well; that's why a good multivitamin/mineral is wise, even mandatory. Vitamins given to people undergoing cancer treatment stimulate greater response, fewer side effects, and increased survival (International Journal of Integrative Medicine, vol. 1, no. 1, January/February 1999).

Nutrients tend to work synergistically on the immune system. They should be taken in balanced proportions, and in consultation with your health care provider.

Immune Boosters
n Research links low levels of calcium and vitamin D, an inhibitor of cell division and growth, to higher breast cancer rates.

n Riboflavin (B2), pyridoxine (B6), pantothenic acid (B5), zinc and folate strengthen immunity. Selenium, in lab culture and animal studies, has helped kill tumors and protect normal tissues.

n Beta-carotene and vitamins A, E and C are antioxidants. Vitamin C enhances vitamin E's effects, boosting immunity and protecting against cell damage. The antioxidant isoflavones in green tea, with soy, convey the anticancer effects of the Asian diet. Research shows actions that discourage tumors and gene mutations.

The food you eat influences hormones. Excess sugar raises insulin, which acts as a growth factor for cancer and interferes with vitamin C's stimulation of white blood cells. It may contribute to obesity.

Alcohol is converted to acetaldehyde, which causes cancer in laboratory animals. It affects gene regulation by decreasing the body's ability to use folic acid. It increases estrogen and the amount of free estradiol in the blood. The liver damage that accompanies high alcohol consumption frequently reduces its capacity to filter carcinogenic products, regulate hormones and break down estrogen. Studies of alcohol consumption have caused experts to estimate that drinking more than two alcoholic beverages a day increases breast cancer risk by 63% (OB-GYN News, November 1, 1998, p. 12).

Fat Can be Phat
Fat conveys nutritional benefits. Not all fats are bad: we can't survive for very long without certain fats. Fat can turn you into a "well-oiled" machine. But the wrong kind of fat (the fatty acids in red meats and fatty poultry) is believed to be a major culprit in breast cancer.

Fat cells produce estrogen. Excess fat stores carcinogens and limits carriers that can move estrogen out of your system.

Once estrogen has attached itself to a receptor, the health result depends on the type of fat in the breast. Saturated fat, transfatty acids and omega-6 fat from polyunsaturated vegetable oils such as safflower oil, peanut, soybean oil, corn oil and in margarine can increase the estrogen effect and trigger a powerful signal to the breast cell to replicate.

Restraining Prostaglandins
Blood rich in the essential fatty acids omega-3 and omega-9 lowers cancer risk by driving down levels of prostaglandins, which promote tumor growth. The blood and tumors of women with breast cancer usually contain high levels of prostaglandins.

Breast tissue is protected by omega-3 fat chiefly from fish and flaxseed and by omega-9 from olive oil. Salmon once a week or water packed tuna three times a week are particularly beneficial. Fish oil supplements processed to reduce contaminates are available. Cod liver oil isn't recommended: its vitamin A and D levels are too high.

Flaxseed is the richest known plant source of omega-3. Use a coffee grinder to benefit from the seed and oil for the full estrogen effect; sprinkle ground flaxseed over cereal or fold into baked goods. Drizzle flaxseed oil, found in the refrigerator section of your health food store, over salads or cereal. (Store the oil in the refrigerator.)

Olive oil, especially in the context of the so-called Mediterranean diet of vegetables, omega-3-rich fish and fresh fruit (Menopause Management, January-February 1999, p. 16-19), lowers the risk of breast cancer (The Lancet, May 18, 1996;347:1351-1356).

Selecting Organic Food
Select organic foods for extra anticancer protection. Pesticides stimulate erratic cell action and often inhibit the estrogen carrier's ability to attach and remove estrogen from the body. Free floating estrogen then can attach to breast receptors and cause trouble.

Buy or grow fresh, organic foods whenever you can. When grilling meat, fish or poultry, reduce the area where carcinogens may accumulate by trimming fat. Charred, well-done meat is known to be carcinogenic. When grilling, marinate meat first and reduce the cooking time on the grill by slightly precooking.

Cancer prevention is an interlocking puzzle requiring the limitation of fat consumption, weight control, exercise, stress reduction and care for psychological and spiritual balance. Possessing more cancer fighting pieces makes you more likely to be able to complete the prevention picture.

Joseph L. Mayo, MD, FACOG and Mary Ann Mayo, MA, are the authors of The Menopause manager: A Safe Path for a Natural Change, an individualized program for managing menopause. The book's advice, in easy-to-understand portions, isolates in-depth explanations with unbiased reviews of conventional and alternative choices. A unique perspective for mid-life women who want to know all their options. At health food and book stores or call toll free 1-877-547-5499.

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