Marys Medicine

Issue 115 • June/July 2014 Upfront U Kaiora
• Lifestyle, Obesity and Breast Cancer page 8 • Annual Report page 9 • Lisa's Story part 2 page 10
Fabulous Lineup for Seminar 2014
Breast Cancer Network will be holding a day-long seminar – Reducing breast cancer risk – on the 30th of August, with five superb speakers.
We are thrilled to welcome back Professor Ian Shaw, who will be joined by Dr Peter Tunbridge, Dr Helen Smith, Sue Dykes and Liz Hart. In this edition we profile three of our speakers; in the next edition we will profile Dr Helen Smith on an integrative nutritional doctor's approach to healthy breasts, and Sue Dykes on mindfulness based stress reduction.
Professor Ian Shaw: Breast cancer – nature or nurture?
Ian Shaw is the Professor of Toxicology in the As we begin to understand the causes of cancer – including breast cancer – it is
Department of Chemistry, at the University of becoming clearer that there are a number of risk factors; the more of these risk Canterbury in Christchurch. He studied bio- factors you are exposed to the greater the risk of cancer. In the case of breast chemistry at the universities of Bath and cancer, there are three distinct risk factor groups; the first – somewhat surpris- Birmingham, going on to lecture in toxicology and work on the ing perhaps – is the female hormone 17_-estradiol; the second is a complex toxicity of anti-cancer drugs, subsequently working in food analy- array of breast cancer genes; and the third comprises environmental contami- sis and doing research on toxic chemicals in food. He held appoint- nants and food chemicals. In his talk, Ian will explore these risk factors and ments in various tertiary institutions in the United Kingdom. focus on environmental and food contaminant risk factors, and show how they In 2000 Prof. Shaw moved to New Zealand to take up leader- might affect gene expression in a breast cancer context. The genes you are born ship of the Food Safety Group at the Institute of Environmental with determine part of your risk of contracting breast cancer, but the environ- Science & Research (ESR). From there he went to the University ment you are nurtured in probably contributes significantly to the risk.
of Canterbury as Pro Vice-Chancellor (Science) and in February2009 returned to academic life at Canterbury University. CONTINUED ON PAGE 2 Upfront U Kaiora
CONTINUED FROM PAGE 1 Dr Peter Tunbridge:
There is more to cancer than genes and The role of the MTHFR gene
Dr Peter Tunbridge is a medical doctor
There is more to cancer than genes: Much has been made of the risk of getting breast cancer when you
with a special interest in diseases carry certain gene mutations. However, 30% of people who carry the ‘at risk' genes do not develop can- caused by defects in oestrogen metabo- cer. Why? This is the group we should be looking at to understand how to prevent the disease.
lism (including breast cancer), thyroid This presentation will look at the current model of cancer and its shortcomings, and the role of sugar disease and metabolic disorders relat- in the development of inflammation (the precursor to cancer). It will look at environmental and ing to insulin and diet. nutritional factors, and how stress causes the biochemistry of the body to change. It will also exam- He is in private practice in Adelaide, ine the "Golden Triangle" of hormones that control wellness in the body – thyroid hormones, sex South Australia, and is a lecturer in hormones and insulin /carbohydrate metabolism – and how these have to work in absolute harmony clinical medicine at the University of for the body to work optimally.
Adelaide. He lectures internationally in The role of the MTHFR gene: Some 20% of the total population (more than 90% in indigenous popu-
all of the above topics, has several pub- lations) carry the MTHFR gene mutation. It is part of how the B group vitamins work and if present, lished papers and is the author of "The causes defects in the way in which the body handles oestrogen. An excess of oestrogen is known to be one Human Code". of the major causes of breast cancer. This presentation will focus on how it causes changes in the body's Dr Tunbridge has an interest in physics metabolism and how, in both men and women, it makes the body act as though it was pregnant and breast and is submitting a paper for publica- feeding at the same time; and how and why it causes: tion on "The Quantum Mechanical • central weight gain •diabetes •cancer Basis of Life". His first work of fiction, a How does one prevent this gene from causing these conditions through dietary manipulation? This is is collection of short stories titled "Short not calorie restriction, but a way to permanently change your metabolism and eating patterns: to regain Pants", is also soon to be published. your energy, lose weight, sleep better, help protect against cancer and give back the control over your ownlife through wellness.
Liz Hart: Emotional Freedom Techniques
Liz has a BA in Education and Psychology
EFT tapping – Emotional Freedom Techniques is a healing modality that works
and completed her MA in Metaphysics in from an energetic level, from which springs all our physical-mental-emotional- 1990. She has worked variously as a coun- spiritual experiences. EFT tapping influences all of our experience simultane- selor, trainer, teacher, parent educator, pris- ously for a truly holistic, integrated outcome.
oner meditation program co-ordinator and parenting skill EFT is simple enough for anyone to learn, and sophisticated enough in the hands researcher, and since 2000 has been focused on sharing of an expert to handle powerful and difficult experiences with great sensitivity, Emotional Freedom Techniques, a highly effective tool for reliev- creating lasting transformations. Nothing promises a cure, but EFT can offer heal- ing pain and distress, and creating more positive life outcomes. ing. Emotional distress, bad memories, physical pain and discomfort, fears for the In 2007, Liz gained international certification as an EFT Trainer future and any underlying emotional contributors to health issues can be effec- and has gone on to design and deliver many workshops to the tively neutralised with EFT.
public and therapeutic community. Her enthusiasm for the heal- The best treatment for breast cancer is prevention and that begins with managing ing possibilities with EFT burgeoned through her own experience wellbeing through a self-care program. Tapping is often used by those with cancer, of recovery from a serious back injury that still has her their families and support people, as well as medical and health care professionals for orthopaedic surgeon shaking his head in wonder. Liz shares her self-care and therapeutically with others. EFT is easy to learn and it is safe and gentle enthusiasm with a deep compassion and wicked sense of humour. to use, with a reputation for often working where other approaches have failed.
Breast Cancer Network invites you to:
9am to 4:30 pm, Saturday 30 August 2014 King's School Auditorium, Remuera Rd, Remuera.
$60 per person ($40 paying members) including lunch and morning and afternoon teas.
Newcomb, Peter McInnes Pty Ltd (for Kitchen Aid Appliances), Lion Foundation, Marion Morris, Manning Funerals,
Julie Lamb & Associates, Gibbs Foundation, Trillian Trust, New Zealand Chefs Association, Archetype Ltd.
Upfront U Kaiora
June/July 2014 • Issue 115 The idea that the incidence of breast cancer is influ-
government to take action (see page 5). Sadly I have to enced by lifestyle and environmental exposures has been report that, despite the enormous efforts of our organi- a core belief of the Breast Cancer Network for many sation, in particular the dedication of past Committee years. BCN firmly believes that in order to reduce the toll members, Gillian Woods and Barbara Mason, the govern- BCN VITAL STATS
that this disease takes on whole communities, we must ment has done nothing. Not a thing! Breast Cancer Network (NZ) – seek to prevent it.
As New Zealanders affected by breast cancer (whether it established in 1993 is an It has been an uphill battle to get any traction on this be as patient, family member, friend, colleague or just organisation for women with topic in the mainstream media, or for that matter with member of our national community) we must ask our- breast cancer and their our government. Our belief in the role of environmental selves if this lack of action is what we deserve? In the friends and families. It aims and lifestyle factors as contributors to breast cancer, and face of mounting evidence that environmental exposures to promote increased efforts our determination to discuss this in the public arena and contribute to the increasing burden of breast cancer in to prevent and cure breast take action, has been steadfastly ignored by those agen- this country, have successive New Zealand governments cancer – by advocacy, cies best placed to bring this to public attention.
education, information In the week that I wrote this editorial, the New Zealand No! No! And again, no! And we must shout this from the and networking.
Herald published two articles on recent research which streets, from the rooftops, from the factories, the super- addressed the issue of environmental and lifestyle influ- markets, the hospitals, petrol stations, workplaces and ences on breast cancer (see page 8). At last! New our kitchens – anywhere that we are exposed to unsafe, Zealand's mainstream media has finally seen fit to cover cancer-causing chemicals, and we must demand that our a major health issue that has been pretty much ignored government put in place measures to protect us, our for so long.
children and all the unborn children who will inherit a In light of this and our upcoming seminar, it seemed modern life that causes so timely to produce an edition of Upfront U Kaiora that much dis-ease.
focused on breast cancer risk reduction. As part of that Ihave revisited BCN's 2006 petition which appealed to the PATRON
Dame Lois Muir
Fat Intake Linked to Breast Cancer Subtypes Barbara Holt, WendySteenstra-Bloomfield, Research has shown that the role a high intake
might have a causative effect on breast cancer was Dell Gee, Jenny Clark, of dietary fat plays in breast cancer risk appears based on feeding fat to lab animals – such as Gillian Woods and to vary by cancer subtype. A high intake of total rodents – and noting the development of mam- Barbara Mason.
fat was associated with a greater risk of estrogen mary tumors, said Dr Ambrosone.
receptor-positive and progesterone receptor- "And there was an ecological study where they positive breast cancer.
charted out breast cancer rates in all different The risk of ER+ and PR+ disease was also parts of the world and also charted out per-capita Keith Clark, Anne Iosefa, highest for saturated fat intake, according to Dr fat intake, and there was a perfect slope," she said, Sabina Sieri Fondazione IRCCS Istituto meaning that breast cancer rates appeared to rise Robyn Kingdon-Mason, Nazionale dei Tumori in Milan and her co- with dietary fat consumption.
Bonnie Reid, Louise Bobbit authors. Women in the highest quintile con- This research, she said, was followed by a BCN gratefully accepts any sumed an estimated 47.5 g per day of saturated number of cohort and case control studies, the bequests. For more information fat, compared with 15.4 g per day for women in conclusion of which "was pretty much that fat please contact the office. the lowest quintile.
was not associated with breast cancer, or if it was, The opinions expressed in the various Her2 positive breast cancer was not associated we weren't getting the data well enough from the UPFRONT U KAIORA articles are with fat intake, and there was also no link questionnaires or maybe there wasn't enough not necessarily those of the Breast between ER- and PR- disease and fat intake.
variability in the population." Cancer Network (NZ) Inc. One of the main strengths of the study is that The current study is an expanded follow-up of Copyright 2014 it took into account breast cancer subtypes, said one published by the same authors in 2008, which Breast Cancer Network (NZ) Inc Dr Christine Ambrosone of the Roswell Park found a weak but statistically significant associa- Cancer Center in Buffalo, New York tion between fat intake and breast cancer risk.
Kindly contact us for "There are different types of breast cancer, all The purpose of current study, the authors said, permission before using of which have different prognoses, and a growing was to investigate whether fat intake was associ- body of data suggests the [causes] of these differ- ated with any particular types of breast cancer ent types of breast cancers is different, too." subtypes by ER, PR and HER2 status, a level of DESIGN
Debra Tunnicliffe
The theory that high consumption of fat nuance in breast cancer typing that has evolved od Creative
increased the risk of breast cancer has been considerably over the past decade.
UPFRONT U KAIORA IS around since the 1970s, "but has been persistently Source: Sieri S, et al: Dietary fat intake and devel-
PRINTED WITH THE controversial," the authors wrote.
opment of specific breast cancer subtypes, Journal The early research suggesting that fat intake of the National Cancer Institute 2014, Apr 9.
NEVILLE NEWCOMB REPROGRAPHIC CENTRES June/July 2014 • Issue 115 Upfront U Kaiora
Breast Cancer Network – Networking in Action by Sue Claridge
At the Breast Cancer Network annual gen-
The third "leg" of their work is support.
including activities such as Snow Planet or eral meeting, held at the Cancer Society's They run a specialist breast cancer advice Rainbows End, and High Tea at a hotel. One Domain Lodge in Auckland on the 14th of phone line – 0800 BC NURSE – but they are member said "it took her mind off her treat- May, it was all about networking. Starting not in the game of duplicating the services ments, and gave her normal family time with with the Cancer Society's provision of the offered by other organisations, so online they her children". With the success of the pilot, meeting room free of charge, this year our host the Pink Pages, where there is informa- Sinda said that Sweet Louise is seeking fund- AGM was all about connections with others tion about all manner of organisations in the ing to continue this strand of supportive care.
in the breast cancer community.
For some time, Sweet Louise has run a Although the gathering was small, it was men's group, facilitated by a male psychologist wonderful to see two past BCN powerhouses – and psychotherapist. The group is run at dove Barbara Holt, co-founder of BCN, and Gillian house and is for men with a family member Woods a dedicated proponent of the Stop with a life threatening disease, not just breast Cancer Where it Starts project. After the formal- cancer. At each meeting there is a guest speaker ities we heard from guest speaker Evangelia and the meetings are held once a month.
(Van) Henderson, Chief Executive of the New BSC offers group and one-on-one peer Zealand Breast Cancer Foundation. Only a year support to women who have been diagnosed younger than BCN, NZBCF celebrates its 20th with breast cancer, emphasising that BCS pro- anniversary this year, and Van gave us a com- vides support and information not medical prehensive overview of the organisation's his- advice. There are nine local Breast Friends tory and core business.
groups around the greater Auckland area, plus Indisputably New Zealand's biggest and a young women's support group for those most well-known breast cancer charity, between 20 and 45 years of age. Keeping the NZBCF was started by five doctors – includ- networking theme going, Caroline acknowl- ing one of its current patrons, Dr Ron Kay – edged NZBCF's vital support of the young who were worried about a lack of awareness women's group.
of the disease among women.
breast cancer community. On a practical level As with most volunteer run, charity Best known for its breast cancer education they support Sweet Louise, Pink Pilates and organisation, BCS has their difficulties main- and awareness campaigns, Van likened the YWCA Encore Programme, among other taining services reliant on volunteers and in a NZBCF's activities to a three legged stool, with tough funding environment. However, the the other legs being research and support of Following Van's presentation, Sinda Hall young women's support group has proven women with breast cancer. However, education from Sweet Louise, and Caroline Crann immensely successful and they have recently and awareness remains their key point of dif- from BCS, spoke about their organisations.
implemented new initiatives including an ference, with annual awareness campaigns (in Sweet Louise has supported 1300 women 0800 number (0800 BreaCanSupport / 0800 2014 launched their Any Changes campaign, with secondary breast cancer since their 273 222) "manned" by Jane Bissell.
driven by research that found the majority of launch in 2006 and now provides services And with Jane Bissell we have come full women were unaware of breast cancer symp- throughout the North Island, after their circle in our focus on networking and con- toms beyond a lump) and National educators launch in the Waikato last year.
nections. Many readers will "know" Jane on the road spreading the message.
Sweet Louise has come to the realisation through the regular articles that she writes Van also discussed the research that NZBCF that, in caring for women with secondary for Upfront U Kaiora, and she is the epitome supports with funding. Since 2000 they have con- breast cancer, it is important to care for the of connectedness in the breast cancer world, tributed more than $2.5 million to the regional whole family. They undertook a pilot study of heavily involved with BCS and Sweet Louise, breast cancer databases. In addition, they have children of women with advanced cancer and with associations and friendships with provided funding towards the establishment of a offering outings and activities for children of many in a community brought together by breast cancer tissue bank, medical scholarships members. The women choose the activity this disease. That connectedness is what and medical professional development.
they and their children will most enjoy, helps so few people to achieve so much.
Breath Test May Help Avoid Unneeded Mammograms A new breath test may help women avoid unnecessary mammo-
in the breath specimens and estimate the markers' potential for grams. The breath test assesses levels of volatile organic com- distinguishing between patients with and without breast cancer.
pounds associated with oxidative stress and induction of a meta- "A negative breath test might safely 'rule out' breast cancer and bolic pathway, which are implicated in the development of cancer.
reduce the number of needless mammograms without loss of Investigators in the US and the Netherlands evaluated the test in diagnostic sensitivity," said Dr Michael Phillips, CEO of Menssana 130 patients who had undergone screening mammography and Research, which developed the breath test.
114 who had breast biopsies.
Source: Phillips M, et al: Detection of breast cancer and abnormal
Breath samples from the patients were analysed and mathemat- mammograms with rapid point-of-care breath test, IMPAKT ical modelling was used to identify potential molecular biomarkers Breast Cancer Conference 2014; Abstract 1P.
Upfront U Kaiora
June/July 2014 • Issue 115 "All that is necessary for the triumph of evil is for some good men to do nothing." No Action, Despite Recommendations by Sue Claridge
Readers who have been with us over the last
high priority in the allocation of Regarding the expert panel, the response seven or eight years will remember the BCN Government research funds." said "The Ministry of Health will table this Parliamentary petition. Newer readers likely A majority of the committee called for Government response and the Health have no idea what this was about, but it is the establishment of an expert advisory Committee's Report at the next Cancer important because, in essence, BCN panel to initiate research into breast cancer Control Council meeting for its comment achieved cross-party agreement that the prevention (the National MPs demurred on and advice on the most practicable and government needed to take action on envi- this point), particularly in the area of strategic approach to this recommendation." ronmental factors in the development of endocrine disruption. This panel of two to The government response concluded: breast cancer. However, since a "While the Government sup- Health Select Committee report ports most of the recommen- was released in December 2007, dations of the committee in no progress has been made.
principle, it will take sometime for the recommendations A STEP BACK IN TIME
to be considered by all parties On the 9th of November, 2006, and a practical way forward to BCN's Gillian Woods and Barbara Mason, supported by The response also said "The several Wellington BCN mem- bers, presented our 10,971-sig- by nature are long term. The nature Stop Cancer Where It Government proposes to exam- Starts petition to then Green ine progress again in one year." The Government response was released on the 13th of The petition asked the March 2008. However, 2008 Gillian Woods presents the BCN petition to MPs Sue Kedgley, Jo Goodhew, Barbara Government to implement a Stewart, Peter Dunne and Maryan Street in 2006.
was election year. The incum- breast cancer strategy focused bent Cancer Control Council on reversing the rising incidence of breast three scientists with expertise in the area was unceremoniously dumped and replaced.
cancer in New Zealand. Additionally, it would advise on the links between chemicals Gillian and Barbara were accorded a brief asked that Government acknowledge that and the development of breast cancer, and audience with the new CCC only to discover synthetic chemicals in the environment have on raising public awareness of the steps that that its members really had no idea what they a role in the development of breast cancer, can be taken to limit exposure to potentially were talking about. Gillian and Barbara had and asked that New Zealand women be harmful chemicals used in daily living.
assumed some sort of background knowl- tested to establish the level of residues car- The Committee also agreed that the edge on the part of the Council members ried in their bodies. Finally, it requested that Hazardous Substances and New Organisms regarding endocrine disrupting chemicals a precautionary approach be adopted with (HSNO) Act 1996 and regulations, needed to and the potential influence of environmental all chemicals where there is evidence of a be amended to require the inclusion of factors in the development of breast cancer, link with breast cancer.
endocrine disrupting effects in the registration but found they were sadly mistaken.
The petition was presented to the House and reassessment of hazardous substances.
The new National Government honoured the following day, and referred to the Health The press release announcing the report their election promise to fund Herceptin, but Select Committee for consideration.
stated that the Government had 90 days to BCN's petition and the Health Select In early 2007, BCN made written submis- respond to these recommendations.
Committee report, far from being put on the sions in support of the petition, and on "The Health Committee looks forward to back burner, seem to have been allocated to Wednesday the 5th of September, BCN a positive response," concluded Ms Kedgley.
the shredder. I can find no evidence that the made supporting oral submissions to the government examined progress after one year.
Health Select Committee. Gillian Woods Time, and space in this edition, not to and Barbara Mason, together with Dr Meriel The Government duly responded to the mention difficulty in being able to speak to Watts, addressed the committee on behalf of Health Select Committee report (document avail- the major players in the report and response, the 10,971 signatories to the petition.
able at have prevented me from reporting further for those who would like to read it). It is rel- on this, in this edition of Upfront U Kaiora.
atively brief (five pages) and seems to me to However, it would be a huge shame if the In a report released with little fanfare in mid- be a lot of waffle and reasons why the gov- incredible work undertaken by Barbara, the Health Select ernment actually can't do anything: Gillian, and BCN members and supporters, Committee endorsed BCN's concerns.
"The Government does not fund health to get the 2006 petition to Parliament, was Committee Chair, Sue Kedgley, said at the research directly"… "Organisations such as all for nothing. I hope to be able to bring you time that "the committee agreed on the need the OECD are working to ensure specific test an update, and some response from the cur- for research into breast cancer prevention, methods are readily available to enable the rent Government, on the actions that BCN particularly in the area of endocrine disrup- nature and extent of the endocrine disrupting has asked our politicians to take for the ben- tors, and that this research should be given potential of a substance to be determined." efit of all New Zealanders.
June/July 2014 • Issue 115 Upfront U Kaiora
Avoiding Common Chemicals will Reduce Risk
A new study, conducted
by scientists at the
The study identifies 17 types of chemicals future research into breast cancer. Previous Silent Spring Institute, and published in the as a high priority because they cause mam- breast cancer studies have not tested women journal, Environmental Health Perspectives, mary tumors in animals and many women for many chemicals linked to breast cancer, has identified the most important chemicals are exposed to them. These include chemi- due to a lack of knowledge both about women should reduce exposure to, to reduce which chemicals to focus on, and about how their risk of breast cancer.
best to test for them.
The study demonstrates that when chem- Three authoritative government panels icals are shown to cause mammary cancer in (the President's Cancer Panel, the Institute rats, often those same chemicals are associ- of Medicine, and the Interagency Breast ated with breast cancer in women. This vali- Cancer & Environmental Research Co-ordi- dates and extends findings from other lead- nating Committee) have pointed to envi- ing authorities, including the International ronmental chemicals as a promising direc- Agency for Research on Cancer (IARC), tion for breast cancer prevention.
which has declared that "it is biologically "Every woman in America has been plausible that agents for which there is suffi- exposed to chemicals that may increase her cient evidence of carcinogenicity in experi- risk of getting breast cancer. Unfortunately, mental animals also present a carcinogenic the link between toxic chemicals and breast hazard to humans." cancer has largely been ignored," said Dr "The study provides a road map for Ruthann Rudel, Research Director of the Silent Spring Institute.
Julia Brody, study author and Executive breast cancer prevention by identifying Director at Silent Spring Institute.
high-priority chemicals that women are cals in petrol, diesel and other vehicle "Reducing chemical exposures could save most commonly exposed to and demon- exhaust, flame retardants, stain-resistant tex- many, many women's lives. When you talk to strates how to measure exposure. This infor- tiles, paint removers, and disinfection by- people about breast cancer prevention, mation will guide efforts to reduce exposure products in drinking water (see table below).
chemical exposure often isn't even on their to chemicals linked to breast cancer, and By measuring the presence of these radar. Studies that address toxic chemical help researchers study how women are being potential breast carcinogens in women's exposure account for just a drop in the affected," said study author Ruthann Rudel, bodies, and providing an evidence-based bucket of money spent on breast cancer." Research Director of the Silent Spring prioritisation of chemicals based on animal Kristi Marsh, author of the book "Little evidence, this study will greatly expand Changes", advocate for women's environmental Inhalation of cigarette smoke, automobile exhaust, and gasoline fumes, as well as emissions from industrial facilities.
Diet, especially starchy foods, such as French fries, cooked at high temperatures, and tobacco smoke.
These are intermediate compounds in the industrial synthesis of polyurethane, pesticides, dyes, and many other products.
Petrol (travelling in a car, pumping petrol, storing petrol in an attached garage) and tobacco smoke, although automobile exhaust and other forms of urban and industrial air pollution are also important exposure sources.
Halogenated organic solvents
These have been widely used in the past, including in dry cleaning, hair spray, soil fumigants, food processing, petrol additives, and paint and spot removers. Although use has declined, occupational exposures are still common, and some consumer exposure remains.
Ethylene (EtO) and propylene oxide (PO)
EtO is used to sterilise medical equipment, food and spices, clothing, and musical instruments; it has also been detected in tobaccosmoke and auto exhaust. PO is used to manufacture other chemicals (including polyurethane foam) and as a sterilant and fumigant,and in some automotive and paint products. Tobacco smoke is also a source of exposure.
Flame retardants and metabolites
Used in a wide range of products including furnishings and fabrics, polyester resins, plastic polymers, and rigid polyurethane foams.
Found in meat cooked at high temperatures and tobacco smoke.
Endogenous & pharmaceutical hormones, EDCs1
Estrogens, progesterone, and DES, along with other hormones and hormone mimicking compounds such as Bisphenol A, parabens and phthalates.
One of hundreds of genotoxic by-products of drinking water disinfection.
Air pollutants thought to primarily come from diesel exhaust.
Ochratoxin A
A naturally occurring mycotoxin, ochratoxin A exposure occurs mainly through consumption of contaminated grain, nuts, and pork products.
Inhalation of tobacco smoke or polluted air, and ingestion of charred food.
Perfluorooctanoic acid (PFOA)
PFOA and other perfluorinated compounds (PFCs) are used in non-stick and stain-resistant coatings on rugs, furniture, clothes andcookware, as well as in fire-fighting applications, cosmetics, lubricants, paints, and adhesives.
These include four chemotherapeutic agents, two veterinary drugs possibly present in food, the diuretic furosemide, the anti-fungalgriseofulvin, several anti-infective agents, and two drugs that are no longer widely used – phenacetin, an over-the-counter pain reliever, and the anti-hypertensive drug reserpine.
Inhalation of indoor air and cigarette smoke and intake of food that has been in contact with polystyrene. Styrene is present in consumer products and building materials, including polystyrene, carpets, adhesives, hobby and craft supplies, and home maintenance products • 1 Endocrine disrupting chemicals • 2 Mutagen X or 3-chloro-4-(dichloromethyl)-5-hydroxy-2(5H)-furanone •3 polyaromatic hydrocarbons
Upfront U Kaiora
June/July 2014 • Issue 115 health and breast cancer survivor, responded to replacement therapy; certain flame retar- Exposure Biomarkers as Tools For Breast the study saying "It's impossible to pinpoint dants; a chemical used in stain-resistant tex- Cancer Epidemiology, Biomonitoring, and why I got breast cancer at 35 years old and tiles and non-stick coatings; and styrene, Prevention: A Systematic Approach Based with no family history, but like all women I've which is in tobacco smoke and is also used to on Animal Evidence, Environmental Health been exposed to harmful chemicals. We can't make polystyrene. Drinking water can con- Perspectives, 2014 May 12.
afford to ignore any of the causes of breast tain mammary carcinogens, such as by- Silent Spring Press Release: Scientists Identify cancer. It is imperative that industry and the products of disinfection or solvents that are Highest Priority Toxic Chemicals to Target for government reduce exposure to the most common well water contaminants.
Breast Cancer Prevention, 12 May 2014.
problematic chemicals. In the meantime, Sources: Rudel RA et al., 2014: New
women can create little changes and choosewiser to reduce their exposure and becomeadvocates for their own bodies." Steps Individuals Can Take:
Petrol and chemicals formed by combus- • Lessen exposure to fumes from petrol. Limit exposure to exhaust from diesel or tion (e.g. benzene and butadiene) are among other fuel combustion, for example from vehicles or generators. Don't idle your the largest sources of mammary carcinogens car. Use electric rather than petrol-powered lawn mowers, leaf blowers and weed eaters.
in the environment. People are exposed from • Use a ventilation fan when you cook and limit consumption of burned or charred food.
vehicles, lawn equipment, tobacco smoke, • Don't buy furniture with polyurethane foam or ask for foam not treated with flame and charred or burned food. Other mam- • Avoid stain-resistant rugs, furniture and fabrics.
mary carcinogens include: solvents, such as • Find a dry-cleaner who doesn't use PERC or other solvents; ask for "wet cleaning." methylene chloride and other halogenated • Purchase a solid carbon block drinking water filter.
organic solvents used in spot removers, spe- • Reduce exposure to chemicals in house dust by removing shoes at the door, using a cialty cleaners, and industrial degreasers; vacuum with a HEPA filter, and cleaning with wet rags and mops.
pharmaceutical hormones such as hormone Your Liver Needs Some Love By Heather Moore The liver is a complex organ that plays a key role in most To ensure that Phase II is working
metabolic processes, especially detoxification. The metabolic well, eat:
processes which make our bodies run normally produce a range • adequate amounts of protein at of toxic metabolites, which the liver efficiently neutralises. Many each meal (several amino acids are of the toxic chemicals the liver must deal with come from what used to combine with and neutralise we eat, drink and breathe. Oestrogen metabolites are also excreted by the liver.
• foods rich in folic acid (green leafy vegetables), vitamin B6 (whole Proper functioning of the liver's detoxification system is partic- grains and legumes), vitamin B12 ularly important for the prevention of cancer. Many cancers are (animal products or supplements); Heather Moore is a thought to be due to the effects of environmental carcinogens, • sulphur containing foods (egg yolks, Nutritionist, registered Naturopath and registered such as those in cigarette smoke, food and drink, on a body which garlic, onions, broccoli, Brussels sprouts); Medical Herbalist.
is weakened by low levels of the nutrients needed for efficient • citrus peel which contains limonene( detoxification and a strong immune system.
BUT NOT GRAPEFRUIT PEEL); Drugs such as pain killers and chemotherapy drugs inevitably • molybdenum rich foods (legumes and whole grains).
increase the load on the liver so it is great to know that there are a To ensure that bile is absorbed by fibre and excreted, eat plenty of:
number of things you can do to nurture and support it.
• high fibre vegetables, fruit and whole-grains.
The liver plays several roles in detoxification: it filters the blood Since ethanol (alcohol) is so toxic to the brain, the liver priori- to remove large toxins, synthesises and secretes bile, which serves tises its removal from the body. Drinking alcohol when liver as a carrier to remove many toxic substances, and enzymatically enzymes are elevated will only slow the detoxification of other sub- disassembles unwanted chemicals. This enzymatic process occurs stances (oestrogen metabolites, xeno-oestrogens from pesticide in two steps, referred to as Phase I and Phase II, with Phase I mod- residues, chemotherapy chemicals) and so delay the liver's recovery.
ifying the chemicals to make them an easier target for one or more of the several Phase II enzyme systems.
• drink plenty of filtered water; Chemical constituents in the following foods support phase I:
• minimise sugar, artificial sweeteners, preservatives, food- • brassica family foods (cabbage, cauliflower, broccoli, kale, bok colouring and trans-fats; choy, Brussels sprouts, broccoli sprouts); • choose unsprayed produce when possible; • vitamin B rich foods (whole grains); • consider the herb Silybum marianum – Milk thistle – which, • vitamin C rich foods (peppers, cabbage, tomatoes); according to a number of in vivo and in vitro studies has been • citrus foods (oranges, lemons BUT NOT GRAPEFRUIT); shown to have a protective effect on liver cells and to accelerate the • globe artichokes.
regeneration of hepatocytes after liver damage.
June/July 2014 • Issue 115 Upfront U Kaiora
Lifestyle Changes Will Reduce Breast Cancer Risk
Promoting lifestyle changes to reduce obe-
breast cancer will increase because of the Physical activity reduces the risk of breast sity, promote regular physical activity, increasing number of older people and cancer. However the type and amount of reduce hormone replacement therapy use increasing size of our population.
exercise required for a measurable impact on and avoid high alcohol intake are the most "Important modifiable lifestyle risk fac- incidence rates remains unknown. It is also important strategies to reduce the risk of tors for breast cancer include alcohol, lack of unclear whether there are specific ages in a breast cancer in New Zealand, University of physical activity, obesity, and hormone woman's life where physical activity will have Canterbury researchers, James Hayes and replacement therapy (HRT). The most a greater protective effect.
Professor Ann Richardson, say.
important risk factor for female breast can- "A strategy to promote regular physical The number of women diagnosed with cer is age," Hayes says.
activity and reduce obesity could also have other benefits, such as reducedrisks of cardiovascular disease anddiabetes. Given the additionalhealth benefits associated withsuch changes, public health inter-ventions towards achieving themare reasonable,'' Richardson says.
Physical activity does reduce the risk of developing diabetes,hypertension, heart disease andcolon cancer. It can enhance men-tal health and helps maintainfunction and preserve independ-ence in older adults.
"In New Zealand, physical inac- tivity is the second most important
cause (after tobacco) of healthy years
of life lost. The increasing prevalence
of obesity in New Zealand has been
attributed to changing dietary and
physical activity patterns, reflecting
an environment that facilitates over-
consumption of energy-dense foods
and drinks and reduces opportuni-
ties for physical activity,'' Professor
Richardson says.
Source: University of Canterbury
Press Release.
Obesity and Diabetes Adversely Affect Outcomes
An analysis of more than 10,000 patients
The obesity study included 8,872 patients nosis; 17.6% in diabetic patients compared enrolled in two trials of neoadjuvant from seven German studies and 1,855 with 7.7% among non-diabetic patients.
chemotherapy has found that obese and patients from a multinational European trial.
Diabetic patients also had an increased diabetic breast cancer patients had signif- In the German studies, five-year dis- risk of metastatic recurrence and a lower icantly worse survival .
tant disease-free survival declined from distant disease-free survival.
A separate analysis of 4,000 patients 79.4% for the women with a BMI of 25 Sources: Fontanella C, et al: Effect of dia-
enrolled in two different trials of neoadju- and under, to 73.7% for women with a betes mellitus on early breast cancer vant chemotherapy showed that breast can- BMI of 30 or higher (clinically obese). In patients receiving neoadjuvant therapy, cer patients with type 2 diabetes had more the multinational study, distant relapse- EBCC 2014; Abstract 0419.
advanced disease at diagnosis and worse free survival was 73.0% for a BMI of 25 or Fontanella C, et al: Influence of body five-year distant disease-free survival.
less, and 62.2% for BMI of 30 or more.
mass index on long-term outcome of Both studies were reported by Dr The diabetes analysis included 112 breast cancer patients receiving neoadju- Caterina Fontanella, of the German patients who had type 2 diabetes at diagnosis vant therapy — Combined results from Breast Group, Neu-Isenberg, at the of breast cancer. A higher proportion of dia- GBG and EORTC cohorts, EBCC 2014; European Breast Cancer Conference.
betic patients had advanced disease at diag- Abstract 0418.
Upfront U Kaiora
June/July 2014 • Issue 115 The fact that Heather Moore is now BCN chairperson, instead of
The BCN Committee in 2013, from left: Kim Sipeli, indicates that there was a significant blow to the com- Heather, Bonnie, Robyn, Anne and Violet.
mittee part way through the year, when Kim left Auckland to takeup a new job in Rotorua. She was a great loss to us. We also missADHB researcher, Beth Cauldwell, who, after her mother died ofbreast cancer last year, wanted a new focus.
We were very fortunate to have Louise Bobbitt join us. Louise is a registered nurse and clinical nurse specialist in breast cancercare and breast reconstruction. She is an aromatherapy and reikipractitioner and has a special interest in mindfulness meditation.
Louise is a dynamic addition to our committee.
Treasurer Keith Clark continues to be a steadying force on the committee, offering much needed wisdom and guidance waybeyond his finance role. Robyn Kingdon-Mason, Violet Lawrenceand Anne Iosefa are committed and reliable lynchpins of thecommittee and we couldn't do without them.
As administrator, Bonnie Clark is often the face of the BCN committee. She brings skills and a passion for BCN's risk reduc-tion focus that we deeply appreciate. Special mention must alsobe made of a previous committee phenomenon, Gillian Woods.
committee, at which we decided to change tack a little. We are dis- Gillian continues to guide and advise us.
satisfied with the reach of our information workshops and realise Last year's focus was a series of information workshops held at that huge sections of the New Zealand population who might ben- efit, are not able to access these sessions. With the success of the 1. Edna Levy, whose session was a combination of yoga, pilates all-day Breast Cancer and Environmental Risks seminar two years and Qi Gong. She demonstrated breathing, core focus and flowing ago in mind, we have decided to hold a similar event – Reducing
movement to address issues stemming from breast cancer surgery.
the Risk – on the 30th of August at King's School auditorium in
2. Dr Nickie Baillie, who, uniquely for a medical practitioner, is Remuera (see page 1). All speakers will be videoed and these will also a medical herbalist. Dr Baillie explained how to use plants and be able to be accessed on the BCN website. It is our hope that they herbs to mitigate the side-effects of chemotherapy and radiation, will be used by various groups around the country for educational and how to use herbal medicine to build the immune system.
purposes and discussion. We are fortunate that each of the five 3. Breast surgeon, Mr Trevor Smith, reviewed risk reducing speakers is willing to give their time without compensation, medical interventions together with the big four lifestyle inter- although we will need to fundraise to bring them to Auckland.
ventions which have considerable evidence: no smoking, no alco- Fundraising is also needed to re-print and update our Stop hol, daily exercise and maintaining an ideal weight.
Cancer Where it Starts brochure, and we aim to make this docu- In November, BCN celebrated its 20th anniversary, and 10 ment available to clinics and doctor's rooms around the country.
years for Sue Claridge as editor of Upfront U Kaiora magazine.
On a monthly basis we need help to distribute the magazine to local Sue produced a special edition of the magazine which reviewed libraries or doctor's waiting rooms or to put up advertising posters for the milestones in BCN's progress. We continue to be grateful that seminars or workshops. If you could help by dropping the magazine we have a journalist of Sue's calibre and experience to produce the or Stop Cancer Where it Starts leaflets to your doctor's rooms or your magazine. One of our aims is to increase the reach of this impor- library, please contact Bonnie at the office. Anyone who would like to tant source of information.
know what is involved in being part of our committee, also, please talk February was planning time with an all-day session for the to Bonnie. We would love to have your involvement.
Cancer Risk from Apnoea
A long term study has found that obstruc-
observational studies, one from Wisconsin OSA, more extensive ascertainment of tive sleep apnoea may raise cancer risk.
showing a 2.0-fold higher risk of dying from important confounders, and detailed cancer Moderate-to-severe obstructive sleep cancer with moderate obstructive sleep outcomes are needed," Drs Richard Kim and apnoea was associated with a 2.5-fold higher apnoea and 4.8-fold risk with severe obstruc- Vishesh Kapur, of the University of likelihood of cancer after adjustment for tive sleep apnoea, and one from Spain show- Washington in Seattle, wrote in an accompa- obesity and a full range of other factors, Dr ing elevated cancer incidence as well.
nying editorial.
Nathaniel Marshall and colleagues found.
All three analyses were spurred by mouse Source: Marshall NS, et al: Sleep apnea and 20-
Cancer mortality was 3.4 times more com- model findings suggesting that hypoxia year follow-up for all-cause mortality, stroke, mon in those with sleep apnoea than with no spurred more rapid tumour growth.
and cancer incidence and mortality in the sleep apnoea during 20 years of follow-up.
"Additional long-term longitudinal stud- Busselton Health Study Cohort, Journal of These findings were in line with two other ies which include objective assessment of Clinical Sleep Medicine, 2014; 10(4): 355-362.
June/July 2014 • Issue 115 Upfront U Kaiora
Living Life to the Fullest: Lisa's Story Pt 2 By Jane Bissell
"Cancer is not always obvious like a broken leg in a cast. It is ever present … but regardless of this,
we are living life to the fullest, glowing cheeks and all."
In the last edition of Upfront U Kaiora, Lisa dents from school and watch them blossom, told how, at the age of 32, she was diag- work, become independent, and gain a new nosed with breast cancer. Four months later, appreciation for all they have back here. It's on New Year's Eve, she discovered that her grass roots stuff. They have to give up all of cancer had moved to her spine and that their technology during the trip but theylearn so much." there would be no "cure" for her.
A recent holiday to Rarotonga with her Supported by a strong faith, Lisa believes
family provided a welcome break.
she is taking this journey for a reason.
"We toured around, snorkelled and "If I can help others through the telling of enjoyed a tour on a glass bottomed boat.
my story, whether it is promoting the value What I appreciated most about that trip was of early detection and diagnosis, or as an arriving at the airport and checking my lug- emotional support, then it has all been gage. It was as if I'd checked in my cancer as worth it for me. From the outset I have been well. I went on my trip, had eight days of fun, open about my cancer. As soon as I found sun and relaxation, an awesome time and did- out, I told the management at school and n't think about the cancer at all. I came back they asked how I would like to handle it. I and going through Auckland Airport to col- said I wanted to tell the staff myself. That lect my bags it was like, "Oh, I remember you, way they would hear it firsthand from me, should look like and I guess it is of someone old friend" and I picked my cancer up again." could see that I am well and coping, and who is pale, sickly and on their death bed.
Lisa joined Sweet Louise in March 2013 could ask any questions they liked." They don't expect me to still look like me.
and is grateful to have found out about the Family, friends, colleagues and the However, from personal experience with help available for women and men living church community have given Lisa ‘huge both my mirror and mingling with other with secondary breast cancer.
support', for which she is most grateful. She women who are also living with secondary "It was about six to seven weeks after my feels privileged and blessed.
cancer – women I now call my friends – I diagnosis. Mum was at the Cancer Society "People have brought cooked meals, can honestly say that we all look happy, talking to a Reflexologist there and she asked, helped in the garden, have been there just to healthy and full of life. Cancer is not always "Does your daughter know about Sweet sit and laugh with me. I believe that having a obvious like a broken leg in a cast but it is Louise?" She gave Mum a pamphlet and on the positive attitude is 90% of the battle and I've ever present. Regardless of this, we are living same day I was talking to my Breast Care remained very positive. There have been a life to the fullest, glowing cheeks and all." Nurse, Cheryl MacDonald and she asked me if couple of instances where I've lost it, I've Writing her second book, How to Look I'd heard of Sweet Louise. I hadn't so after two cried and had a ‘bad moment' but it's only a Boobalicious, has been good therapy, referrals on the same day I registered online." moment; it's not even been a bad day. Some recording the highs and the lows of the jour- "It's an astounding organisation. I am friends pick me up when I need it; others ney and providing a ‘behind the scenes' look blown away by their services and feel incred- give me a bit of a shake and say ‘Wake up at life with secondary breast cancer.
ibly blessed to be a part of it. Sweet Louise girl! You're OK, live for the moment!' "It has been really helpful to revisit things, has been so helpful and Geraldine (local Sometimes I need to be told that." to write them down. Sometimes it brings up Support Co-ordinator) is amazing and very Some of her friends needed to be memories and you think, ‘Oh that hits a supportive. Meeting other women in the reminded that she was still the same person.
chord' but I can work through it as I'm writ- same or similar boat as you, to laugh and "Sometimes people don't know what to ing and that's been helpful for me. I've tried share, has been really good." do, say, or how to act around you. I had one to keep the story light, humorous, and with a Lisa has enjoyed using her vouchers for friend who avoided me at the start because positive outlook so that people can see it's reflexology treatments, and promoting he didn't know how to handle it. I showed not all doom and gloom with cancer, but I Sweet Louise is high on her agenda.
up on his doorstep one day, knocked on the also have to be honest so readers can see "I want to see wider publicity for, and door and said ‘I'm here!' and when he saw what really goes on after a cancer diagnosis.
acknowledgment of, Sweet Louise because I how positive I was, and that I was still me – My goal is to [have it published in 2014]." don't think enough people know about the happy, healthy, looking and feeling good, And there's more. To say Lisa is an ‘adven- organisation and what it provides. The work and still doing what I needed to do – he turous type' would be quite the understate- they do brings so much hope to others.
thought ‘OK, I know how to be around her ment. She has undertaken several mission Meeting other women is hugely beneficial again – she is still the same'." trips through her church and school (one to and the practical support is there when you Lisa feels one of the strongest misconcep- Rarotonga, two to the Solomon Islands), and need it. I'd like more people to know about tions to dispel is the popular comment, ‘But has another coming up in 2014 to Viet Nam Sweet Louise and get behind it!" you look so well!' where they will build some accommodation For more information about Sweet "People have an image in their head as to blocks to shelter local children.
Louise, please visit what a person living with secondary cancer "These trips are incredible. We take stu- or phone 0800 11 22 77.
Upfront U Kaiora
June/July 2014 • Issue 115 Breast events to come • 21 June – Lisa's Wish free events for children whose parents have a cancer diagnosis: Extreme Indoor Kart Racing Bathurst Teams: East
Tamaki. To book please contact: Ian and Rosemarie Chapman-Smith on 021 037 3870, 021 1322 483 or [email protected], or visit www.lisas- for more information.
25 June – Sweet Louise Auckland Men's Group, at dove house, Glendowie. A light meal will be provided at 6pm. Dr Graham Southwell will be
speaking about "Spirituality". There will be time for questions and discussion. This presentation would be of particular interest for any man (carer,
relative or patient). RSVP by Monday 23rd June to Reception staff at dove house on 575 4555.
18 July – Lisa's Wish free events for children whose parents have a cancer diagnosis: Extreme Edge Rock Climbing: Glen Eden. To book please
contact: Ian and Rosemarie Chapman-Smith on 021 037 3870, 021 1322 483 or [email protected], or visit
for more information.
17 August – Lisa's Wish free events for children whose parents have a cancer diagnosis: Roller Skating: Mt Wellington. To book please con-
tact: Ian and Rosemarie Chapman-Smith on 021 037 3870, 021 1322 483 or [email protected], or visit for
more information.
• 30 August – BCN Risk Reduction Seminar.
Breast Cancer Support (BCS) Young Women's Group
meets on the fourth Monday of the month, 7pm-9pm, at The NZ Breast Cancer Foundation,
11-13 Falcon St, Parnell, Auckland. For more information please call BCS on 0800 273 222
Breast Cancer Network would really like to help you publicise your event. The deadline for Breast Events for every edition of Upfront U Kaiora is now the 10th of the month before publication(Upfront U Kaiora is published in February, April, June, August, October and December each year). If you would like to be reminded prior to each issue of publication date, so that you canensure your event gets in to Breast Events, please send the email address of the person who should receive the reminder to Sue at [email protected].
Supporter Members Breast Cancer Network (NZ) Inc is offering companies and like minded groups 'Supporter Membership'. This is an annual commitment of
$250.00 plus GST for companies who believe in the objectives of Breast Cancer Network. For your investment we will advertise you as a sup-
porter of the Breast Cancer Network in Upfront U Kaiora, under our supporter section, and also we will display your logo on our website with a link to your own website. We will allow you the use of our logo and link to promote the relationship established between
both parties. We will also acknowledge all Supporter Members at our Annual General Meeting, and ask that our members to support you in
turn. Breast Cancer Network (NZ) Inc is a registered charity. For further information contact our office or visit our website
Welcome to new supporter member, Maree Louise Underfashions, at the north end of the Papakura shopping centre at 113 Great South Road.
Maree specialises in the correct fitting of bras, undergarments, prostheses and medical hosiery, including in-flight stockings - a must for any
long overseas flight - abdominal supports (male and female) and an extensive range of mastectomy products in the latest styles and colours.
Living Nature Devonport Lingerie The New Zealand Alarm Shop Maree Louise Underfashions
The Breast Centre The New Zealand Chefs' Association Telephone Market Research Company Ltd
Bertelsen Harry Waters Ltd, Chartered Accountants and Business Advisors Naturalwear
To support the work of BCN and receive a regular copy of UPFRONT U KAIORA send your name and address to:
Breast Cancer Network NZ, PO Box 24 057, Royal Oak, Auckland 1345
Membership $40 Institutional $100 (Subscriptions include GST)
Name: Miss/Mr/Mrs/Ms/Dr Amount enclosed: membership $
donation $
My payment has been credited to account 06-0284-0088795-00 (Please use your name as reference and mail this form to us)
A/c name: Breast Cancer Network NZ Incorporated, National Bank, Penrose Branch.
I prefer to receive Upfront U Kaiora (in colour) by email I prefer to receive Upfront U Kaiora (black and white) by post Please tick here if you have experienced breast cancer.
I am interested in helping with BCN activities I agree to BCN (NZ) contacting me by email with news, information and updates Age Group (Optional - Please circle applicable group) Breast Cancer Network (NZ) Inc., PO Box 24 057, Royal Oak, Auckland 1345. (Office: 101 Onehunga Mall, Onehunga, Auckland 1061). Phone: (09) 636 7040 Email: [email protected] Web: June/July 2014 • Issue 115 Upfront U Kaiora
Anti-oxidant-rich Pumpkin Soup
Pumpkin and butternut are excellent sources of antioxidant carotenes:
alpha-and beta-carotenes, plus lutein and zeaxanthin and beta-cryptox-
anthin. Winter squash (which includes butternut) is also thought to have
various anti-inflammatory and anti-cancer effects as shown in laboratory
studies of cancer cell lines and animals.
In addition, turmeric, curry powder and ginger – also in this recipe – are not only tasty and warming, they also have powerful anti-inflammatory andanti-cancer properties. Apples contain pectin, flavonoids and polyphenolsand are thought to protect against cancers of the lung, colon, breast and liver.
Lastly, pumpkin seeds contain immune-boosting zinc and their oil isthought to promote prostate health. They are also a good source of variousforms of vitamin E: alpha-tocopherol, gamma-tocopherol, delta-toco-pherol, alpha-tocomonoenol, and gamma-tocomonoenol.
To balance the natural sweetness of the pumpkin/butternut and apples, add a few drops of chilli sauce if you like.
1. Heat oil in a large, heavy-bottomed pot, add onion and cook at medium
2 tbsp olive or coconut oil
temperature until soft. Add grated ginger and cook another 2 minutes.
1 large onion, chopped
2. Add squash, curry powder and turmeric and cook with the onion, stirring
1 tbsp grated fresh ginger
constantly, for another 1-2 minutes, then pour in stock. Cover and simmer on 750g organic pumpkin or butternut squash (peeled), cubed
low heat for 10 minutes.
1 tsp curry powder
3. Add apples, cover and cook for another 10-15 minutes until squash and
1 tsp turmeric
apples are soft.
750ml vegetable stock
4. While the soup is cooking, toast pumpkin seeds in a dry skillet, stirring with
300g apples, cored and cubed
a wooden spoon until they start to expand and crackle (3-4 minutes). Add 200ml coconut milk
tamari; there will be much hissing and steam but keep stirring and soon the squeeze of lemon juice
pan will be dry and the seeds coated with a salty crust. Tip onto a plate to cool.
chives for garnish
5. To make cashew cream, tip cashew nuts, water and salt into a small
salt & freshly ground black pepper
blender and blend for 2-3 minutes until completely smooth. Dilute to desired Tamari-toasted pumpkin seeds
thickness (it should be like pouring cream).
4 tbsp raw pumpkin seeds
6. When squash and apples are soft, transfer to blender and puree to a fine
1 tsp tamari (wheat-free soy sauce)
consistency. When fully blended, pour into a clean pot. Add coconut milk,reheat gently and season to taste with salt, pepper and lemon juice. Removefrom heat and cover.
7. Ladle soup into bowls and dress each portion with a teaspoon of Cashew
3 cup raw cashew nuts (unsalted, untoasted), if possible
cream. Sprinkle with pumpkin seeds and chives for garnish.
soaked for a few hours or overnight; drain and rinse
before using

Recipe from Zest for Life: The Mediterranean Anti-Cancer Diet by Conner 3 cup fresh, filtered water pinch of salt
Middelmann Whitney.
Some Breast Cancers Need Longer Treatment
Breast cancers with high-level estrogen
test had a recurrence rate of 13.6% dur- vant hormone treatment that extends sensitivity had a significantly greater risk ing years five to ten after diagnosis, more beyond five years," Dr Dowsett said.
of late recurrence, possibly indicating a than double the recurrence rate during The results add to the longstanding need for more than five years of adjuvant the first five years. In contrast, women recognition that estrogen receptor-posi- hormonal therapy, according to Dr with HER2-positive, highly estrogen-sen- tive tumors have a higher risk of late Mitchell Dowsett of the Institute for sitive tumours did not have an increased recurrence compared with ER-negative Cancer Research in London, and col- risk of recurrence beyond five years.
leagues who reported their findings at the "Our data suggest that these patients, Source: Dowsett M, et al: Estrogen mod-
European Breast Cancer Conference.
who appear to benefit most from the cur- ule of 21-gene recurrence score predicts HER2-negative tumours with a high rent standard five years of endocrine increased late recurrence for ER+ HER2- score on the estrogen panel of a genetic treatment, may also benefit from adju- breast cancer, EBCC 2014; Abstract O-216.
Upfront U Kaiora
June/July 2014 • Issue 115


Componenti pregiate, fragranze esoti- che: Prija è una linea di cortesia calda e terrestre, prodotta da GFL nel rispetto di standard qualitativi molto elevati e rivolta a clienti attenti alla qualità cosmetica e al design degli articoli del settore cortesia. Fine ingredients and exotic fragrances: Prija is a warm and earthly complimentary line. Produced by GFL according to very high qualitative standards, it appeals to customers who are sensitive to the quality of cosmetics, and to the design of compli-mentary items.

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April 2005 Student Volunteer's Experience Inspires Film "Smile" B.D. Fox & Friends, Inc. Advertising In 2001, Katharine Kramer, a 15-year-old high school student in Malibu, Calif., joined her school's Operation Smile club to raise money for Message from our Co-founders children with facial deformities. The following year, she participated as a student educator on an