Judy Siegel Itzkovitz
Cancer is the most frightening disease for most people, and among women, it is breast cancer that terrorizes them the most. In Western countries, one out of every eight or nine women will contract the tumor in some form during her lifetime, and one out of 100 breast cancer cases occur in men.
But there is good news. In about a third of cases, breast cancer and other tumors can be prevented by adopting healthful lifestyles. And in Israel, the mortality rate from breast cancer has been declining by 2% every year – and 25% since 2005. Better treatments have turned the cancer for many into a chronic illness rather than a fatal one.
As October is Breast Cancer Awareness Month, the non-profit Israel Cancer Association (ICA, www.cancer.org.il) recently held a press conference to mark the event. Established in 1952, the nationwide organization has significantly reduced the prevalence of cancer and increased the rate of survival, thanks to research, encouragement of early detection, public information campaigns and support for cancer patients. It also represents Israel in international organizations that fight cancer.
The ICA has saved many lives by getting many women to get a subsidized biennial mammogram. The age for going for a first breast scan and every two years until they are 74 is 50 for most women. For women at high risk because they have or had a first-degree relative who took sick or because they themselves contracted the cancer – the age to start getting a mammogram every year is from 40.
When well-known women make public the fact that they were diagnosed with breast cancer, they increase awareness and early detection by other women. Among such personalities have been Australian singer and actress Olivia Newton John; singers Kylie Minogue, Marianne Faithfull and Sheryl Crow, actresses Maggie Smith, Suzanne Somers, Julia Louis-Dreyfus, Christina Applegate, Cynthia Nixon and Jane Fonda; tennis player Martina Navratilova; journalist and activist Gloria Steinem; and many others
Healthful lifestyles may not only prevent breast cancer but also increase recovery rates. The ICA quotes scientific studies that show avoiding obesity and maintaining a healthy body weight; doing regular exercise; drinking little or no alcohol; and not smoking significantly reduce the risk. Avoid processed, fried, salted, canned and smoked foods. Women who give birth can also cut their risk by breastfeeding their babies.
New research at Harvard University and the Dana-Farber Cancer Center in Boston shows that eating a lot of vegetables and fruits can reduce the risk of breast cancer significantly. A total of 182,145 American women aged 27 to 59 from the Nurses’ Study (one of the most extensive studies ever conducted on risk factors of chronic diseases) completed questionnaires about their eating habits. Among the vegetables that were most protective were broccoli, green beans, cabbage, cauliflower, Brussels sprouts, carrots, spinach and sweet potatoes. Among the beneficial fruits were apples, pears, oranges, peaches, apricots, plums, bananas, grapes, grapefruit, strawberries and blueberries.
Cruciferous vegetables (such as cabbage, broccoli and cauliflower, arugula, collard greens, kale, kohlrabi, turnips, watercress, and mustard greens), as well as orange and yellow veggies, are very healthful, reducing the breast cancer rate by 11%. “Our study highlights the importance of consuming fruits and vegetables to reduce the risk of breast cancer, especially aggressive breast tumors,” wrote the researchers in the International Journal of Cancer in June 2018.
Researchers from Scientists in Spain and Austria who examined the relationship between eating times and taking into account people’s sleep and lifestyle – as well as classifying men and women according to whether they were “morning” or “evening” people – found that those who didn’t work night shifts and slept well at night were less likely to get breast or prostate cancer or to develop cardiovascular disease, diabetes and obesity.
Patients who went to bed two hours after dinner were 26% less likely to contract prostate cancer and 16% had lower breast cancer risk than those who went to bed right after dinner. “This study demonstrates the importance of the biological clock in nutrition and cancer studies, and their possible contribution to cancer prevention recommendations,” the authors wrote. Breast cancer was found to be lower among those who regularly ate dinner before 9 p.m. than in those who ate supper after 10 p.m.
Researchers have also found that there is a link between obesity in boys and an increased risk of breast cancer at a later age. Because it is harder to diagnose breast cancer in men, it is found in older men and at more- advanced stages.
Recovery rates of breast cancer patients here are among the highest in the OECD. Survival rates in Israel reach 89.7% among Jewish women and 84.4% among Arab women. Other countries around the world can learn from Israel on how to prevent and deal with the malignancy.
Seventy-eight percent of patients are diagnosed over the age of 50, even though Jewish women of Ashkenazi (Western) origin are at higher risk of having the BRCA genetic mutation that can cause the tumor to erupt at a younger age.
A total of 22,481 women diagnosed with breast cancer who have either recovered or are still coping with the disease live in Israel today; 19,889 were diagnosed with the invasive disease.
ICA director-general Miri Ziv, said that today, “the most effective way to fight breast cancer is early detection. When it is diagnosed at an early stage, the chances of healing increase to 90% or more. I call upon all women to take responsibility for their health and to adopt a healthful lifestyle, which has been scientifically proven to significantly reduce the risk of disease.” In addition, women need to undergo physical examinations by their doctor and mammograms, as well as an ultrasound exam if possible and be familial with their body so as to catch any changes and report them immediately.
Prof. Lital Keinan Boker, deputy director of Israel’s Center for Disease Control in the Health Ministry, noted that 4,846 new patients with invasive breast cancer are diagnosed in a year, of whom 4,140 on average are Jewish (85%), 470 Arab (10%) and 236 of other ethnic or religious background.
In 2015, about 1,000 Israeli women – Jewish, Arab and others – died of invasive breast cancer, which causes about a sixth of all cancer deaths in Jewish women and about a quarter of cancer deaths among Arab women.
According to the OECD data for 2013, the number of new cases in Israeli women in 2012 was slightly higher than the average of 34 countries in the OECD, putting Israel in 16th place. But more Israeli women survive the tumor, and the rising survival rates are very encouraging.
More than 71% of Israeli women aged 50 to 74 go for mammograms when called in by their health maintenance organization (HMO), which is much higher than the OECD average of 60.8%. Early detection through screening programs has been shown to reduce breast cancer mortality and to change the course of the disease.
In addition to the possibility of having a mammogram at one’s HMO clinic, the ICA set up a special team of women who perform the scans for free in mobile vans that travel around the country, especially to the periphery.
The fully equipped vans offer women – including those who are religiously observant and especially insistent on modesty – complete privacy. Since the beginning of the mobile activity, the vans have been able to significantly reduce the gaps between the various sectors and to provide mammography screening for women of low socioeconomic status and women living in the periphery.
Already in 2011, the gaps between Jewish and Arab women were narrowed. In the ultra-Orthodox Jewish sector, the proportion of female examinees is on the rise but still 10% lower than the national average. The ICA mammography unit continues to make early diagnosis possible for women, leading to a reduction in mortality due to breast cancer in Israel.
On average, about 50 Israeli men are diagnosed with the tumor per year. The cause is not yet clear, but some men seem to have a higher-than-average risk due to being over 60 years of age and having first-degree relatives (men or women) who have or have had breast cancer.