Dr James Schaller
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Breast and Prostate Cancer
Prevention Basics

I am writing to both women and men because many of these principles apply to both genders. Let’s protect our health and our loved ones.

Why bother to read these few pages? Simple, you may literally save your life, or the life of a family member or friend. Much fatal illness is preventable--I believe these two cancers are samples. Some of this material will be new. But we are trying to offer the most up-to-date medicine.

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Estrogen causes cell replication in men and women. It causes all the changes to female anatomy during puberty, and makes the uterine lining grow in the first two weeks after a period. Yet, excess estrogen without the protective effects of bio-identical natural progesterone promotes cancer–breast cancer in women. Excess estrogen promotes prostate cancer in men. Some estrogen is needed for male libido, but excess estrogen from belly fat promotes prostate cancer in men and breast cancer in women. We have had success with new treatments targeting belly fat.

Recently there have been a series of commercials with popular actresses and singers promoting " HRT," one form is Premarin (a collection of 200 miscellaneous hormones from pregnant horse urine), and Prempro (the horse urine hormones with synthetic eccentric progestins that are falsely called "progesterone.") Your body makes progesterone. A drug company makes a patented synthetic progestin. Unfortunately, the commercials only discuss preventing height loss and hot flashes, and not the other changes that occur during menopause. Men have yet to get any commercials for their andropause–the decline of free testosterone.

The buzzword "HRT" has finally become meaningless. Why? It is used in many contexts regarding profoundly different treatments with opposite effects. You will understand as you read. When many women see their doctor they may think of HRT as the synthetic the powerful estrogen(s) (with, or without synthetic progesterone) that often gives them weight gain. Why? Estrogen retains fluid! Let's forget the shallow commercials and start from scratch for ten minutes. It may save your life, or at least improve your feelings and energy.

Basic Principles on Hormones

  1. Estrogen is like cellular globs of paint on an artist’s canvas. Your own natural Progesterone makes the painting. It makes the globs less primitive and cancerous. Estrogen makes a breast. Progesterone makes the breast cells more specialized. Estrogen makes a lining for the uterus and progesterone makes it more developed, so that it can grow a fertilized egg.


  2. Abdominal obesity increases cancer by many mechanisms. Please see my Patient Friendly Obesity Solutions handout. You may be encouraged. Fat makes estrone (E1), which can become two cancerous metabolites that increase both prostate and breast cancer.


  3. Female ovarian progesterone peaks roughly at age 32-35 according to Dr. David Zava, a veteran breast cancer researcher. Most breast cancers take ten years to be discovered. Breast cancer is the #1 killer of women age 45-50. I believe it is amazing that most breast cancers take ten years to grow, even if doubling every three months, and seem to peak 10 plus years after progesterone has started to decline. To me, this is very important. Specifically, age 35 plus 10 years equals a 45 year old. It seems clear progesterone is protective. Lots more evidence below.


  4. Women should check their breasts carefully once a month. If you check them before your period they may be tender from excess estrogen and the absence of progesterone. Any lumps you note before a period may go away just after your period. Consider checking at both times and note any lumps and their development. Busy mothers and career women who put everyone or everything before themselves should be careful--do not cut corners on this one. New lumps that do not resolve with natural progesterone when checked throughout the cycle should be evaluated by your Gyn (or a breast cancer specialist). Mammograms are not a substitute for self-exams.


  5. Typically breast cancer lumps are painless and hard.

    So what should men do while the women are checking their breasts? Men must have a free and total PSA and a digital exam done by your family doctor or urologist every year. After feeling 10,000 prostates they get pretty good at sensing abnormalities. Both are important. By the way, simple cholesterol tests are old 1980’s medicine–new subtypes and newer more important tests are in my obesity hand out.

  6. Low dose Estrogen has some benefits, e.g., it prevents bones from dissolving in skinny 18 year old girls with no fat, and during perimenopause. However, you probably can grow bone with bio-identical progesterone and, if needed, low dose natural testosterone. (Testosterone levels in most women decline 50% from age 20 to 50 years of age and this may increase diabetes according to pending research by Gyn researcher). Estrogen primarily prevents bone loss and does very little to grow bone.


  7. The real danger for most American women is excess estrogen/low progesterone. Or lots of estrogen to make primitive tissue but little to make it safely specialized, i.e., globs of paint but no artwork. These two hormones are like a right and left hand–they are meant to be in balance.


  8. Basically, excess estrogen causes many forms of cancer in both sexes. If you have a waist that is bigger than your hips, you clearly have excess fat estrogen.


    1. Estrogen speeds up breast cell proliferation and progesterone calms it down. Dr. Zava has even found that some malignant tumors are "calmed down" with progesterone and are not growing. (This view is new to many Breast Cancer teachers who say progesterone is very bad for breast cancer because the cancer has some progesterone receptors).


    2. Breast tumors with lots of receptors for progesterone may be the safest (Dr. Zava).


    3. Estrogen turns on a cancer-promoting gene (Bcl-2). Progesterone decreases and calms down this gene.


    4. Pregnancy floods the body with progesterone. The progesterone develops and matures the breast-decreasing cancer rates. Nuns have increased breast cancer likely because they never have surges of the HCG detected in pregnancy tests, pregnancy estrogen (E3) or estriol, and progesterone surges.


    5. During breast surgery for benign lump removal, smearing low dose bio-identical progesterone on the breast’s before surgery decreased lump cell divisions by 400%! Estrogen increased cell proliferation 230% (K.J. Change, 1995).


    Prevention

  9. Read my handout on decreasing abdominal obesity. Excess belly fat creates carcinogenic estrogen in both sexes. I am not merely going to yell and say "diet and exercise." I want to teach you how insulin works. Insulin is quite tricky and most of us do not know its games. If you get heavy, you will make more and more insulin and this will grow more ovarian cysts (from a stimulating messenger in the brain-LH) and these cysts may make excess testosterone in some women—acne and unwanted facial hair (found in some menopausal women). You will, however, be able to beat up your husband or boyfriend…. So perhaps this is something you will want left untreated?


  10. While it is hard for 25-50 year old mothers or fathers doing 80 things to exercise, please consider a physical sport for both your girls and boys. Fat makes estrogen. If they are slim it will delay puberty and their first menses and decrease breast cancer risk. It is hard for kids to have increasingly early sexual feelings and not be able to marry till they are 30 years old.


  11. If you get any "PMS" signs, e.g. bloating, irritability, decreased coping, headaches, sore breasts, it is usually a sign of low progesterone when it occurs in the 1-2 weeks before your period–treat with bio-identical progesterone in the a.m. and at bedtime. Discomfort during your period may have another cause.


  12. Re-marketed Prozac in the form of Sarafem or Zoloft does not work as well as bio-identical progesterone for PMS, despite the advertisement claims, in my experience and other’s I discuss these issues with in this field.

    Journal articles show some benefit in some people, but the results do not touch our success rate--95-99%. I often have to adjust the dose to get benefit, because each person’s liver and receptor sites are different. This is achieved by providing me with feedback: "no benefit, some benefit, great benefit, or too sleepy"–and we adjust the dose. (The goal is a nice even amount throughout the day. Doses and delivery forms vary a great deal and may be covered by insurance. If you overdue it, natural progesterone may make you feel sedated or a bit too happy.

  13. 85% of women over 40 years old in my practice have low "normal" thyroid. In psychiatry, we have used strong bio-identical thyroid for decades to help fatigue, mild depression and boredom. So what does this have to do with cancer–breast or prostate? Glad you asked. If thyroid is low, a binding protein that carries hormones is low. The result? More estrogen is free to increase cell division and growth in the breast, uterus and prostate. Also, excess estrogen inhibits thyroid, so your "low thyroid" may become even worse with excess estrogen.


  14. Standard TSH and other "routine" thyroid tests are not useful. In 2001, the National Endocrine Society said TSH levels are not useful to determine thyroid’s effects. Also, antibodies against your own thyroid are now common and are not routinely checked–if you have antibodies against your own thyroid it will make the thyroid useless, but it will not show up in "full thyroid panels." Again, a TSH test too simple. Take home message: keep Free T3 blood levels (or 24 hour urine levels) in top third of normal, but do not go over "normal." Have yourself checked for antibodies against your own thyroid. If positive, some of your thyroid is bound up with the antibodies and useless. Men or women with anxiety disorders may be best in the middle range on normal free T3.

    Synthroid is the most prescribed "synthetic thyroid." Synthroid is weak thyroid (T4). This hormone has four bits of the element iodine, and is fairly useless until it converts to T3. The enzyme that rips off the iodine of T4 to make potent T3 requires about 20-30 things to be working in order to convert to T3. New published research shows having T3 added helps people in many ways. They have better concentration, joy, better memory and overall health. We customize doses to fit your unique body, since drug company options are too limited.

  15. Melatonin is the hormone that controls sleep. It is also a potent anti-oxidant. Women with breast cancer have low melatonin (Zava). Also, the gland that makes melatonin is more likely calcified in breast cancer patients. Melatonin lowers both estrogen and progesterone. In people with excess estrogen, perhaps this may help. Perhaps a low dose SWISS or GERMAN form (the purest) of melatonin may be of use.


  16. Very low estrogen is not the solution to preventing cancer. If your estrogen is too low because you are very thin with low body fat you will lose bone fast. Only a little will be needed to prevent bone loss and mood changes while you bleed. You have to find an estrogen balance you feel comfortable living with. No estrogen, a little estrogen and normal estrogen ranges all have different issues associated with them. After breast cancer, most physicians want estrogen very low.


  17. In Perimenopause you may also have intermittent low estrogen. (Perimenopause is before 40 years of age in 5% of women). In perimenopause, your estrogen level is rebounding up and down like a basketball, which is a terrible sensation. Why? Because water follows estrogen. If in the morning your estrogen is 20 you will have low water in your brain, breasts, belly and ankles. At dinnertime, if you are in perimenopause, your estrogen may be 150 and now you suddenly have water in all those body areas. It can be a roller coaster ride from Hell.

    One common option you might consider if you need a dash of estrogen, is estriol (E3) or pregnancy estrogen. It does not increase prolactin, which can swell breasts. And it is believed by some researchers to not increase breast cancer risk and perhaps even be protective.

    Low dose fermented or non-fermented plant estrogens may be very helpful–the issue of fermentation and ideal dose is outside our scope. Standardized German Black Cohosh (up to 4 capsules/day) may be a benefit. Both often take up to three months to work. Natural progesterone also helps hot flashes. DIM is a plant derived compound with good research that may also settle down estrogen lability.

  18. Birth control pill use in women under 21 increases breast cancer risk. The younger the girl’s age the worse the risk. So why does the FDA allow birth control pill advertising in teen magazines to control acne? Some artificial progestins in these pills actually act like estrogens and persistently stimulate the undeveloped young breast cells. Birth control pills also deplete nutrients, e.g., Vitamin 6 and folic acid–essential for DNA protection. Deficiency in these vitamins increases cervical hyperplasia risk.


  19. Certainly there may be times when young people are struggling with how to handle their sexuality and a pregnancy is more of a problem than using the pill for a few years. Lets face it, some youth of both sex’s act out sexually–and it only takes one "slip." Nevertheless, parents and youth need to know the risks and benefits to either road.

    According to leading pharmacy textbooks, "the pill" can be affected by other medications, so make sure you have a full list of drug interactions. The FDA reports most prescriptions are written by pressured doctors, flying from room-to-room to please the HMO's and PPO’s, with no discussion of side effects. Interaction data is even harder to explain. You will likely have to get the information off the Internet yourself. Drug store computer print outs are only fair.

    The risk/benefit of mature women using the pill is left between you and your Gynecologist. Here I only want to point out the breast cancer risk is clear for young teenagers.

  20. One critical way to prevent breast cancer in all women is to address anovulation. This is when no egg is released from the ovary, i.e., there is lack of ovulation. The more anovulation the greater the cancer risk. Ovulation or egg release occurs in the middle of your cycle. If an egg is released, it triggers the message "an egg has been released, so make more progesterone to prepare the uterus for possible implantation." One reason for irregular short cycles is that if no egg is released, the uterus may simply shed the lining–no point to progesterone preparing for a fertilized egg if no egg was released. And no natural progesterone means higher breast cancer risk.


  21. Sample Treatment Options:

    1. Progesterone can be given just before the middle of the cycle to smooth out irregular cycles.


    2. Prevent early puberty because early puberty increases breast cancer. Early puberty causes more anovulatory periods.


  22. Ever go into a school cafeteria or see the food served at a hospital? Studies show they rarely even meet the very low RDA's of essential nutrients. Kids are eating worse, not better and safer food. So why does this matter? I cannot easily show you early cancer effects in young children. But I can show you what trash food does to the heart and blood vessels. The New England Journal of Medicine reported that 100% of small children had early coronary artery disease--either fat in the huge hose coming off the heart (aorta) or the essential coronary arteries themselves. In WWII they did not find this in the young men who perished.


  23. Sample Options for Cancer Prevention:

    1. Milk and meat products should be organic whenever possible. Estrogen-like hormones fed to these animals cause earlier puberty and sexual feelings that youth are not equipped to handle.


    2. Avoid excess foreign Xenoestrogens. There are thousands of these estrogen-like chemicals. They are in every person’s body and are very carcinogenic, e.g. pesticides, plastics.


        1. Avoid synthetic pesticides on all fruits and vegetables.


        2. Avoid excess plastics, especially thin wraps in the microwave.


        3. Men might consider a tiny dash of progesterone to prevent prostate cancer.


        4. All women with "PMS," over 35 years old, or with a first full-term baby after 24 should be on natural progesterone. My father, a Gyn writer, also feels any women having any type of elective or spontaneous abortion also should consider natural progesterone. He feels HCG stimulates the breast cells to start dividing, and then if the fetus is suddenly lost and multiple protective hormones quickly fall off, you might be more likely to have eccentric cell divisions.


        5. I published on the use of progesterone in girls as early as 12 years old. Mothers can see the estrogen dominance--irritability and bloating--from estrogen retaining fluid. They can see mood and behavioral cycling before some girls have their first period.


        6. Progesterone decreases four catechol--a metabolite of fat estrogen implicated as a cause of breast and prostate cancer.


        7. Testosterone in men may be needed as early as 40 to prevent prostate cancer. The messengers from the brain to the testes start to decline roughly in the 40's. In very rare cases even earlier. You have to decide if you want to be in the top half of the normal range or in the bottom half. Most traditional physicians will not give you any testosterone unless your levels are clearly very low and below "normal." The problem with "normal" is that your past normal may have been quite high and it is too low for you. Also, the reference ranges can be for men 20-49 years old, which means men with age related declines are included in the "normal" range, i.e., men 40-49 years old.


        8. Once you already have prostate cancer you cannot use testosterone. Some men with no libido have low testosterone and/or estrogen (E2). If checked you must have the free testosterone checked and not merely the total.


        9. Make sure any water you drink is treated. Chlorine is a chemical war agent that makes multiple carcinogens–if you can smell it; you are getting "a dose." Multiple wells and bottled water companies report their water is "fine and tested." Much testing is fair. Research testing finds many impurities in bottled water, which varies by brand. "Doctor’s Data" has a nice $99 pre-paid test kit, which allows you to take any water site and have it tested, e.g., for heavy metals. They have an Internet site. Another new kit is $17 and uses a mere dipstick.


        10. If you want a home water purification unit, it should be more than mere charcoal. The filter should remove chlorine, heavy metals, benzene, PCB's and bacteria. Even modest filters can do a reasonable job.


        11. Get on a good vitamin and mineral supplement. One-a-Day or Centrum nutrients are junk. One nutrient pill or capsule per day is sold as "all you need." They need to be sober when they produce and write such commercials. They are already made under tons of pressure and are entirely incomplete--buyer beware. Generally, anything less than 3 capsules a day is too minimal.


        12. Selenium 200mg chelated decreases prostate cancer 300% in some research.


        13. Zinc and magnesium are used in 300 enzymes of the body, including ones that remove toxins and helps the immune system fight cancer. If the form in your supplement is a solid oxide or chloride, place it in the circular file. Chelated Zinc and Magnesium is best absorbed.


        14. Enjoy olive oil and butter-put the margarine and hydrogenated fats in the trash.


        15. Consider Indole 3 Carbinol or DIM which some experts feel decrease carcinogenic 16-El (a fat estrogen metabolite). Both decrease breast and prostate cancer. Both women and men can use it. Ever wonder why smokers have less breast cancer? Smoking kills but it actually increases good 2-E1 fat estrogen--protective of the breast, and lowers 16-E1 fat–a cancer promoter.


        16. If you have allergies, are "sensitive" to drugs, get tiny colds if stressed, or want to increase your bodies ability to remove toxic substances, consider taking glutathione (and glucarate/glucaric acid). Glutathione easily gets used up. Glutathione removes carcinogens from inside cells and prevents them from binding to and damaging DNA. The best forms have other anti-oxidants with it.


        17. Fiber binds excess estrogens which the liver expels into the gut and prevents re-absorption. If you use psyllum or other fibers, do not get ones with 50 pounds of sugar, eccentric colorings and preservatives.


         

        A FINAL COMMENT ON BREAST CANCER POLITICS

        Drugs like tamoxifen (Nolvadex) are preached as the great savior pill for breast cancer. The National Women’s Health Network has petitioned Zeneca and the FDA to stop false exaggerated claims. The Public Citizen Health Research Group petitioned the FDA complaining that while the drug decreases breast cancer in 2.9/1,000 women per year, it increases potential death in 2.8/1,000 by uterine cancer, blood clots and stroke. My father mentioned that rare cases of blindness and cataracts also exist. I will leave the use of this drug between you and your oncologist. ( In Lee and Zava book below)

        Breast Cancer and Mood

        We are exploring the use of custom-made low dose hormones, such as bio-identical thyroid and very low dose bio-identical testosterone (used with a medication to prevent conversion into estrogen which promotes cancer in some survivors), or pure DHT (actual usable form of testosterone) to help very depressed cancer survivors unresponsive to other common mood treatments. Cancer treatment depletes the body of many things and increases stress on the body, making biological depression more common.

        Also, cancer treatments profoundly deplete your nutritional state and probably special nutrients the liver uses to remove hormones, drugs and environmental toxins. Personally, I would get a consult with a very progressive nutritionist. If they recommend merely a one-a-day vitamin, I would run. Most cancer treatment depletes your body profoundly of nutrients. Some benefit from short term IV nutrients. Do not expect this to be a familiar option with many physicians, i.e., after chemotherapy you get aggressive nutrition by mouth and/or IV.

         

        LISTED BELOW ARE A FEW FINAL QUALIFIERS FOR ANYTHING "MEDICAL."

        1. Nothing I wrote above claims to be FDA "approved" or proven.


        2. You may not use this document to self-treat.


        3. This article is not a peer-reviewed publication.


        4. I am not an expert on anything and I do not claim any expertise in anything I have written above. Do not confuse passion with mathematical certainly.


        5. I do not claim any of my statements above is the "standard of care."


        6. According to JAMA and the New England Journal of Medicine, routine care is profoundly biased by drug company influence. This influence is in drug representatives updating M.D.’s, controlling most patented new treatments, funding journals, and government money to research pharmaceutical company drugs. Some of my comments are not easy to research because they lack government funding.


        7. Please assume the CDC, FDA, EPA, NIH, NIMH and any state board have members that do not agree with me.


    Hoping you and your loved one’s have a healthy decade!

    Enjoy Today but Let’s Live For Another Decade

     

    For Further Reading:

    What Your Doctor May Not Tell You About Breast Cancer: How Hormone Balance Can Help Save Your Life by J. Lee, D. Zava, V. Hopkins which is receiving praise from Ivy League Teachers, Cancer expert clinicians and general gynecologists working in cancer prevention. (Warner Books, 2002, 416 pages).

    My appreciation to my father, James A. Schaller, MD, Fellow of the Academy of Obstetrics and Gynecology and a physician who cared for women for 35 challenging years in a very difficult field of medicine.

    I appreciate he taught me about the utility of progesterone and hormone physiology as a youth. What is better understood now, he was discussing and implementing many decades ago. Planting the seeds for my current successful service in this field.

    Now it is my turn. I pass on some of what I know so you can wrestle with it, discuss it and read about it, and come to your own healthy conclusions.

    James L. Schaller, MD, MAR

    President

    Chester County Research Center (PA)


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