Dr Kristi Funk, An­gelina Jolie’s can­cer doc­tor, on the big­gest life­style risk fac­tor for breast can­cer

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most women ig­nore their breasts. We know they may kill us one day – breast can­cer is the lead­ing cause of death in women aged 35 to 50 – but why dwell? We stuff them into a bad bra, like be­ing forced into wear­ing an un­der­wired ver­sion of a ter­ror­ist bomb vest, and get on with it.

Breast can­cer: act of fate! It never once oc­curred to me it was the other way round. That I was re­spon­si­ble. That I was poi­son­ing my boobs daily, or at al­most ev­ery meal.

That is un­til my au­di­ence with An­gelina Jolie’s breast sur­geon. Dr Kristi Funk’s es­teemed breast can­cer cen­tre is in Bev­erly Hills and has the Bar­bie-ish name of Pink Lo­tus. She be­came the most fa­mous breast can­cer doc­tor in the world when Jolie cred­ited her in her de­ci­sion to have a pre­ven­ta­tive dou­ble mas­tec­tomy. When I call Dr Funk she’s just wo­ken up in her Santa Mon­ica home, with her triplet boys head­ing out past the swim­ming pool to sum­mer camp, and she still has the big hair and power smile of the ra­dioac­tively glam­orous.

Yet there is a rea­son Jolie, Sh­eryl Crow and more pow­er­ful women than can be dis­closed trust Dr Funk. At 48, she’s been at the fore­front of breast can­cer treat­ment for decades, in­clud­ing a long stint as the di­rec­tor of the breast can­cer cen­tre at the Cedars-Si­nai hos­pi­tal in Los An­ge­les. When the call came for her to write a book, Breasts: An Owner’s Man­ual, Dr Funk had a life­time’s ex­pe­ri­ence to draw on. How­ever, she wanted the book to be metic­u­lous and de­fin­i­tive, so she im­mersed her­self in the lat­est re­search. She felt a slightly sick­en­ing shock.

‘I felt be­trayed by my own med­i­cal ed­u­ca­tion.’

Pretty much overnight she changed her fam­ily’s diet to avoid dairy and meat, and pre­scribes food for her pa­tients as if it is medicine. All you need now, I say, is for some­one with the star power of An­gelina Jolie to tell the world she went ve­gan for her boobs.

‘I know, right? That would be fab­u­lous. It will come. I don’t know if you know who Ellen Pom­peo is, the lead ac­tress on Grey’s Anatomy? She saw me the other month. That same day her whole fam­ily went ve­gan, then she told Peo­ple mag­a­zine why. So I just need a few more peo­ple like Ellen to come out with the news.’

This isn’t ex­actly what I want to hear. I mean, I like my breasts fine, but I re­ally love ice cream. Dr Funk al­ready knew that women get com­pla­cent. When polled, most say that breast can­cer is down to ge­net­ics, when in fact 87% of women di­ag­nosed do not have an im­me­di­ate rel­a­tive with the dis­ease. Dr Funk says that up to 90% of the risk fac­tors for the dis­ease lie in our con­trol, ‘not your doc­tor’s, genes or fate’. She as­sumed that they were the usual com­mand­ments to ex­er­cise and avoid ‘chub’ and al­co­hol, but she was sur­prised to see study af­ter study prov­ing how much diet plays a role.

What is the big­gest life­style risk fac­tor for breast can­cer? ‘Def­i­nitely nu­tri­tion. Then obe­sity, al­co­hol, ex­er­cise, hor­mone re­place­ment ther­apy (HRT), stress.’

What is the big­gest life­style risk fac­tor for breast can­cer? ‘Def­i­nitely nu­tri­tion. Then obe­sity, al­co­hol, ex­er­cise, hor­mone re­place­ment ther­apy (HRT), stress.’

That is as­tound­ing to me. The only con­nec­tion I made be­tween food and my breasts was when I spilt sauce down my front. The Can­cer Re­search UK web­site ad­vises women that re­search on the link be­tween diet and can­cer is ‘in­con­clu­sive and in­con­sis­tent’. The med­i­cal es­tab­lish­ment be­lieves it’s too soon to ad­vise women on meat or dairy. Dr Funk be­lieves it’s al­ready too late, a gross be­trayal of women’s in­tel­li­gence.

‘If you had asked me this ques­tion a lit­tle over a year ago, I would have ranked ev­ery­thing the same, but put diet some­where around fourth. Even af­ter 17 years of be­ing a laser-fo­cus breast can­cer sur­geon, I had no idea. But when I delved into the lit­er­a­ture re­gard­ing food, I was lit­er­ally shocked. It’s crys­tal clear that the body’s cel­lu­lar re­sponse to an­i­mal pro­tein and fat is noth­ing but dan­ger­ous.’

Breast can­cer sur­vivors are sent home with­out a word about diet, she says. Why? ‘Oh, doc­tors don’t tell them be­cause they don’t know. They eat cake and ice cream; they had a turkey sand­wich for lunch. I didn’t have a nu­tri­tion class in med­i­cal school.’

When re­search does come up with strik­ing find­ings, doc­tors al­ways urge cau­tion, she says.

‘I’m opin­ion­ated in the book be­cause I feel like we’re pa­tro­n­ised as peo­ple con­sum­ing med­i­cal in­for­ma­tion. They feel you’re too en­trenched in your ways to make a dra­matic change. So they spread this false mes­sage that mod­er­a­tion is the key. And it’s not.’

Or, as she says in the book about pro­cessed meats such as sausage, ba­con and ham that are car­cino­gens: ‘The ev­ery­thing-in-mod­er­a­tion mantra rubs me up the wrong way… Why con­sume can­cer-caus­ing meats in mod­er­a­tion? So that maybe I can re­move a mod­er­ate part of your breast?’

sO, what to eat? Let’s back up a lit­tle. Her book is full of facts I didn’t know. If you’re tall you should be aware that you’re more likely to get breast can­cer. This means that the na­tions with the tallest women, such as Den­mark and the Nether­lands, over­lap pretty heav­ily with the na­tions with the high­est breast can­cer rates (and the re­verse goes for coun­tries where the women are short, such as Ja­pan). Why? The­o­ries abound, but for Dr Funk the clue is in the growth fac­tors in dairy and meat, which are loved by the tallest na­tions.

The stud­ies on ve­g­ans and breast can­cer risk are, she con­cedes, some­what muddy. The num­bers of ve­g­ans have just been too low in the West, although it’s worth not­ing that pop­u­la­tions with low breast can­cer rates typ­i­cally eat lit­tle meat or dairy. The

‘The ev­ery­thing-in-mod­er­a­tion mantra rubs me up the wrong way… Why con­sume can­cer­caus­ing meats in mod­er­a­tion? So that maybe I can re­move a mod­er­ate part of your breast?’

largest study on ve­g­ans and breast can­cer is the Ad­ven­tist Health Study, in which ve­g­ans (as op­posed to veg­e­tar­i­ans) showed a 44% drop in breast can­cer rates com­pared with meat eaters. Or, as re­searchers wrote in the jour­nal Can­cer Epi­demi­ol­ogy, ‘A ve­gan diet seems to con­fer lower risk for… fe­male-spe­cific can­cer than other di­etary pat­terns.’

Dr Funk is con­fi­dent that fu­ture stud­ies will prove more con­clu­sive be­cause of other re­search done on the ef­fects of an­i­mal fat and pro­tein. Essen­tially, this is where the hor­mones and ‘growth fac­tors’ that make West­ern­ers so big, tall and pos­si­bly can­cer­ous are stored. So, in the case of dairy, stud­ies show no breast can­cer risk when it comes to con­sum­ing low fat.

Yet a study of breast can­cer sur­vivors showed that those eat­ing one or more daily serv­ing of high-fat dairy (cheese, for ex­am­ple) were 50% more likely to die early. An­other study that fol­lowed post-menopausal women showed that their in­take of sat­u­rated fat, like but­ter and meat, was ‘di­rectly as­so­ci­ated’ with the risk of breast can­cer. Women eat­ing like typ­i­cal West­ern­ers had their blood taken, were put on a low-fat vege­tar­ian diet for two weeks and had their blood taken again. The sec­ond batch of blood sup­pressed more breast can­cer growth in petri dishes.

‘If I had a big salad, I used to dump a bunch of feta on top. My break­fast was a big plop of Greek yo­ghurt. I thought that was healthy,’ Dr Funk says. ‘But I be­came so over­whelmed by the rock-solid ev­i­dence that my three sons, my hus­band and I all be­came 100% ve­gan and never looked back.’

Af­ter this, my mind wan­ders to my ado­les­cent daugh­ter, who likes to drink a glass of full-fat milk a day be­cause the ev­i­dence shows that this boosts height. A pre­lim­i­nary study by Michi­gan State Univer­sity showed that a high-sat­u­rated fat diet in pu­berty sped up breast can­cer in adult women.

‘If she drinks milk she’ll grow, be­cause her body’s re­sponse to that is to spike her in­sulin-like growth fac­tor, but she will also be set­ting the stage for ill­ness. So I’d rather her be a lit­tle shorter,’ says Dr Funk.

She is not un­re­al­is­tic. Yes, any al­co­hol con­sump­tion in­creases breast can­cer risk, but be­cause of al­co­hol’s heart-healthy ben­e­fits she com­pro­mises on about one glass a day – and stud­ies sug­gest that red wine may be the least dam­ag­ing to breasts. Also, you know that thing peo­ple do when they eat a big salad to ‘trade off’ their drink? It’s not ridicu­lous – it ac­tu­ally works. In the Nurses’ Health Study, among those drink­ing at least one glass of wine a day, those who also ate a few serv­ings of green veg­eta­bles (adding up to 600 mi­cro­grams of fo­late) were 89% less likely to de­velop breast can­cer than drinkers who did not.

what pro­tects? Dr Funk is a fan of veg­gies, ob­vi­ously, as well as green tea, olive oil (one study showed that those adding it to their diet were 68% less likely to get breast can­cer) and ground flaxseed. Those eat­ing one tea­spoon a day of ground flaxseed for a year showed, in a biopsy on their breasts, a re­duc­tion of biomark­ers for can­cer of 80%. Dr Funk has at least one tea­spoon a day in her smoothie or on a salad. She’s also in­ter­ested in the re­search show­ing that a reg­u­lar aspirin re­duces breast can­cer cases by as much as 20%.

I’m sort of reel­ing. I con­sider my­self rea­son­ably in­formed, yet I didn’t know any of this. Who is re­spon­si­ble? Me? I’m still pon­der­ing when we di­gress a lit­tle to dis­cuss Jolie’s de­ci­sion in 2013 to have her breasts re­moved. Since then, Dr Funk says, the num­ber of peo­ple get­ting ge­netic test­ing for breast can­cer has ‘sky-rock­eted, with tremen­dous ser­vice to peo­ple’s health’, and ‘with­out a doubt the pro­phy­lac­tic mas­tec­tomy rates have in­creased since then’.

Also, she says, a woman’s fam­ily used to try to talk them out of do­ing some­thing so dras­tic, but with Jolie’s ex­am­ple they feel they have a ‘com­rade in arms’, a ‘phil­an­thropic ser­vice to women ev­ery­where’.

‘I have coun­selled count­less women prior to 2013 in the de­ci­sion to do a pro­phy­lac­tic mas­tec­tomy. They felt iso­lated and os­tracised – their fam­i­lies thought they were los­ing their minds to do some­thing self-de­struc­tive. But now they can point to An­gelina’s ex­pe­ri­ence, and their fam­i­lies bet­ter un­der­stand that dilemma.’

I guess the theme run­ning through all this is re­spon­si­bil­ity. If the med­i­cal es­tab­lish­ment feels the case on diet and life­style is still too un­proven to ad­vise women, who is left? Us?

A study of breast can­cer sur­vivors showed that those eat­ing one or more daily serv­ing of high-fat dairy (cheese, for ex­am­ple) were 50% more likely to die early.

An­gelina Jolie (above left) and Sh­eryl Crow have both been pa­tients of Dr Kristi Funk.


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