Estrogen is a hormone that impacts several functions within the body, such as sexual development, pregnancy, childbirth, and menopause. Soy isoflavones, estrogen therapy, and breast cancer risk: analysis and commentary. Dietary genistein negates the inhibitory effect of tamoxifen on growth of estrogen-dependent human breast cancer (MCF-7) cells implanted in athymic mice. They are called phytoestrogens because they come from plants. The rates of recurrence and death did not vary significantly with estrogen and progesterone receptor status or with endocrine therapy. Because of this, some people may worry that eating the phytoestrogens found in soy could increase estrogen in their bodies and encourage breast cancer growth. The other causes of death were cardiovascular disease (12 patients), respiratory disease (5), other cancers (2) and other causes (3). At the time of diagnosis, the patients ranged in age from 29 to 72 years (Table 1). Of the 524 patients, 248 (47.3%) were pre-menopausal, 276 (52.7%) were postmenopausal, 446 (85.1%) received adjuvant chemotherapy, and 55 (10.5%) underwent postoperative radiotherapy. Anastrozole is a third-generation aromatase inhibitor that has been approved for the treatment of postmenopausal breast cancer worldwide. For example, a 2014 meta-analysis of multiple studies in the journal PLOS ONE found that soy was marginally protective against breast cancer in postmenopausal people from Western countries. and unsweetened soy milk can safely be included as an alternative protein or dairy source, even for those going through cancer treatment. Note: ER = estrogen receptor, PR = progesterone receptor. However, if you're not comfortable including soy foods, survivors can have a perfectly healthy diet that does not include soy foods. Julie LG Lanford, MPH, RD, CSO, LDN, registered dietitian and nutritionist with 15 years of experience working in oncology nutrition. National Library of Medicine 2011;20:854-58. In fact, research in patients with breast cancer patients suggests 450 Brookline Avenue, Boston, MA 02215 However, soy pills and isoflavone-enriched powders should be avoided. government site. Inverse associations were observed in patients with estrogen and progesterone receptor positive disease and those receiving anastrozole therapy. CI = confidence interval, ER = estrogen receptor, PR = progesterone receptor, Q1 to Q4 = quartiles according to intake of soy isoflavones, where Q1 is < 15.2 mg/day and Q4 is > 42.3 mg/day. Colozza M, Califano R, Minenza E, et al. The research on soy and breast health has looked at soy foods, not dietary supplements. In contrast, there was no association between soy isoflavone intake and death in postmenopausal patients. We calculated the sample size for Cox regression using the method reported by Hsieh and Lavori.12 According to our preliminary results, we needed a sample of 246 observations to achieve 80% power at a significance level of p = 0.05 to detect an anticipated death rate of 30%. isnt likely to exacerbate cancer growth it is not considered a healthy fat overall. We measured dietary intake of soy isoflavones at baseline using a validated food frequency questionnaire. 8600 Rockville Pike But is it actually true? For each patient, we contacted the attending physician to confirm eligibility, and asked the physician to contact the patient on our behalf. Among the 16 patients who could not be contacted directly, the mortality registry revealed 10 deaths. The question of whether it is OK to eat soy comes up often, especially for patients with hormone receptor-positive breast cancer. Most participants (452 [86.3%]) reported no change in intake of soy foods over the previous five years, 29 (5.5%) reported an increase and 43 (8.2%) reported a decrease. Any one of these other things could be the reason why soy-eating women have lower breast cancer risk. They may exercise more and maintain a healthier body weight. Estimated Asian adult soy protein and isoflavone intakes. Compared with postmenopausal patients in the lowest quartile of soy isoflavone intake (< 15.2 mg/day), those in the highest quartile (> 42.3 mg/day) had a significantly lower risk of recurrence (HR 0.67, 95% CI 0.540.85, p for trend = 0.02). We also asked all participants whether their intake of soy foods after diagnosis was similar to, greater than or less than their usual intake of these foods in the previous five years. The Cancer.Net Blog was named one of Healthline's Best Cancer Blogs of 2020. Soyfood intake during adolescence and subsequent risk of breast cancer among Chinese women. So, could taking soy supplements help reduce a persons risk of cancer or cancer recurrence? Soy lecithin does not contain phytoestrogens and has Of 565 eligible patients whose physicians agreed they could participate, 524 enrolled and completed the questionnaire. Some soy nutrientsthe isoflavoneshave chemical structures that look a bit like the estrogen found in a woman's body. Guha N, Kwan ML, Quesenberry CP Jr, Weltzien EK, Castillo AL, Caan BJ. Soy isoflavones and risk of cancer recurrence in a cohort of breast cancer survivors: the Life After Cancer Epidemiology study. Ingle JN. Careers, From the Departments of Medical Oncology (Kang, Zhang, Huang, Jin) and Pathology (Wang), Cancer Hospital of Harbin Medical University, Harbin, China. We further stratified the analyses by hormonal receptor status and endocrine therapy. In these patients, soymilk accounted for 26% of total intake of soy isoflavones, followed by tofu (21%) and soy flour (15%). We found that the statistically significant inverse associations between intake of soy isoflavones and breast cancer recurrence in postmenopaual women were restricted to estrogen- and progesterone-receptor positive breast cancers. 2010;182:1857-62. Constantinou AI, Lantvit D, Hawthorne M, et al. Shu XO, Jin F, Dai Q, et al. Confusion about soy arises from the term "phytoestrogens." Hsieh FY, Lavori PW. The occasional soy protein bar or snack food is fine, but as with all plant foods, less processed is better. Dana-Farber assumes no liability for inaccuracies that may result from using this third-party tool, which is for website translation and not clinical interactions. Ask your doctor about the risks and benefits if youre considering taking isoflavone or any other dietary supplements. This finding is potentially important in terms of recommendations for intake of soy isoflavones in conjunction with endocrine therapy. Facebook Pasqualini JR, Chetrite GS. Emerging research suggests that soy foods may decrease the likelihood of breast cancer recurrence in women with a history of the disease. This is where the term phytoestrogen originated. Soyfood intake and breast cancer survival: a followup of the Shanghai Breast Cancer Study. Some studies suggest that soy may help protect against breast cancer, but more research is needed to prove this. Share your thoughts on this blog post on Cancer.Net's This website uses cookies. Copyright 2022 Dana-Farber Cancer Institute It is best to eat soy in moderation as part of healthful meals that include plenty of vegetables, fruits, and whole grains. due to their concentrated nature. Soy food consumption and breast cancer prognosis. One limitation of this study is the possibility that other bioactive components in soy, such as soy protein, may have beneficial or harmful effects on breast tissue. You may have also heard of soy protein powder, which can be added to shakes or used while baking to boost the amount of protein. We estimated hazard ratios (HRs) and 95% confidence intervals (CIs) by means of multivariable Cox proportional hazards regression models. Large multicentre clinical trials and other observational epidemiologic studies are needed to confirm these findings. The mean daily intake of isoflavones was 25.6 mg/day for all patients. Brooks JD, Thompson LU. Mammalian lignans and genistein decrease the activities of aromatase and 17-hydroxysteroid dehydrogenase in MCF-7 cells. The bottom line is that soy foods like edamame, tofu Soy contains estrogen-like chemicals called isoflavones. Moderate intake of soy, in food form, does not increase cancer growth. Low-dose dietary phytoestrogen abrogates tamoxifen-associated mammary tumor prevention. You should also look at the label to choose products with lower sodium, fewer added sugars, and fewer additional ingredients. Eating soy foods like tofu, edamame and soy milk has been linked to reduced risk of certain cancers including breast cancer, prostate cancer and gastric cancer. Nakata T, Takashima S, Shiotsu Y, et al. Soy contains something called phytoestrogens, which are the plant version of estrogen. Nutrients. There is no shortage of claims on the internet that certain foods can cause cancer. Messina M, Nagata C, Wu AH. We also share information with our analytics and website partners, who may use it to inform decisions about current or future services. Theoretically these products could provide higher levels of phytoestrogens if taken consistently, We followed patients until July 2008. Soy foods are a healthy option, while soy dietary supplements may not be. All rights reserved. The chemical structure of soy isoflavones is similar to that of estrogens. Among the post-menopausal patients, an inverse association was observed between intake of soy isoflavones and recurrence. Researchers have also discovered that rats metabolize soy differently than humans do. All statistical tests were based on two-tailed probability and a significance level set at < 0.05. Of the original 524 patients, we were able to contact 508 directly for follow-up in July 2008. We also obtained information about disease progress, date of recurrence (if any), and date and cause of death (if deceased). It can be helpful to think of soy products in three distinct categories: Current research supports including soy foods in the diet of cancer survivors and does not suggest harmful effects, even for those experiencing estrogen-receptor positive breast cancer. Kang X, Zhang Q, Wang S, Huang X, Jin S. Effect of soy isoflavones on breast cancer recurrence and death for patients receiving adjuvant endocrine therapy. The short and We then calculated the intake of soy isoflavones using the food composition database published by the Chinese Center for Disease Control and Prevention, which provides the isoflavone content of selected foods.11 We categorized the mean daily intake of soy isoflavones in quartiles. The effect of soy protein supplements and soy derived protein powders on cancer growth is less clearly understood. Chemopreventive effects of soy protein and purified soy isoflavones on DMBA-induced mammary tumors in female Sprague-Dawley rats. Read the nutrition label on soy protein powders to find the total grams of soy in each serving to ensure you stay within the recommended 25 grams. Soy supplements have higher amounts of soy than what is found in traditional Asian diets, which is also generally higher in soy than American and European diets. The take home message regarding soy and cancer is that eating tofu stir-fry, an edamame appetizer or having unsweetened soy milk as a replacement for dairy is safe for cancer survivors. Concern has arisen that soy isoflavones may have a detrimental effect in these women because they may stimulate the growth of estrogen-sensitive breast tumours. We also examined the association between intake of soy isoflavones and recurrence or death among patients with no change in intake over time, to determine whether a change in intake after diagnosis might alter these associations. Until now, clinical research has been limited, and there is little clinical evidence to suggest that intake of soy isoflavones increases the risk of breast cancer among healthy women or worsens the prognosis for those who have breast cancer.17 The results of the Shanghai Breast Cancer Study, conducted between 1996 and 1998, showed that soy intake was unrelated to disease-free breast cancer survival, but the authors of that study did not take endocrine therapy into consideration in their survival analyses.18 A recent epidemiologic study involving 1954 female survivors of breast cancer also suggested a lower risk of breast cancer recurrence with high intake of daidzein and glycetin among both post-menopausal women and tamoxifen users.19. For example, women who eat soy foods also may eat less fried food and more vegetables. There was a trend for an increase in rates of recurrence and death with worsening TNM stage (p < 0.01). sharing sensitive information, make sure youre on a federal Furthermore, in a study published in the American Journal of Clinical Nutrition, roughly 73,000 Chinese women who were part of the Shanghai Womens Health Study and who reported consuming high levels of soy consistently during adolescence and adulthood had a substantially lower risk of breast cancer. The five-year recurrence rate of premenopausal patients was higher than that of postmenopausal patients, but this difference was not statistically significant. It is consistent with the results of a large cohort study that reported a lower risk of postmenopausal estrogen- and progesterone-receptor positive breast cancer in association with higher dietary intakes of plant lignans and high exposure to enterolignans in a Western population.24 A casecontrol study also reported that high intakes of leafy or yellow vegetables were associated with reduced risks of postmenopausal estrogen- and progesterone-receptor positive breast cancer.25 These results were also supported by the epidemiology study of Guha and colleagues,19 who found that the risk of recurrence decreased with increasing intake of isoflavones for tumours that were estrogen- and progesterone-receptor positive, but not those that were estrogen- and progesterone-receptor negative. Aromatase inhibitors: a new reality for the adjuvant endocrine treatment of early-stage breast cancer in postmenopausal women. Liu B, Edgerton S, Yang X, et al. At the same time soy sauce and soybean oil have other nutritional Copyright 2022 eatright.org. Tamoxifen and anastrozole are commonly used as adjuvant endocrine therapy for hormone-sensitive breast cancer, and these drugs are effective in preventing recurrence and prolonging survival.5,6 In some experimental studies the inhibitory effects of tamoxifen on growth of implanted mammary tumours were negated by dietary administration of soy isoflavones,7,8 but in other rodent cancer models, soy food appeared to enhance the beneficial effects of tamoxifen.9 Little is known about the potential effects of consuming soy isoflavones for patients with breast cancer who are receiving adjuvant endocrine therapy. While consensus on clinical guidelines for soy do not yet exist, many healthcare providers favor minimizing intake of soy protein powder supplements (soy protein isolate) in the diets of patients with hormone sensitive Studies done in the laboratory have shown that isoflavone enhanced the growth of breast cancer cells and promoted breast cancer tumors in rats. Lets clear up confusion about the safety of eating soy foods as it relates to cancer risk. There is little clinical evidence about their safety for patients with breast cancer who are receiving adjuvant endocrine therapy. Shuhuai Wang assisted with study design, recruitment of patients and data collection. Sample-size calculations for the Cox proportional hazards regression model with nonbinary covariates. One serving of soy is equivalent to cup of edamame, 1 cup of soy milk or cup of tofu. cancer. Xu Huang was responsible for analyzing the data. Patients were treated with tamoxifen 20 mg/day or anastrozole 1 mg/day as adjuvant endocrine therapy for five years, unless adverse effects were unacceptable or the disease progressed. This type of powder is typically used to make a smoothie or shake but can also be the source of protein in nutrition bars, certain pre-packaged Adolescent and adult soy intake and risk of breast cancer in Asian-Americans. People who are making lifestyle changes after a cancer diagnosis often start eating more fruits and vegetables and consume less red meat and processed foods. Females, in particular, have higher levels of estrogen to help regulate their reproductive system and other systems within the body. ASCO's toll-free patient information line:571-483-1780 or 888-651-3038. This means they do not pose risk in terms of fueling cancer growth. The site is secure. The U.S. Food and Drug Administration says that eating 25 grams of soy per day offers health benefits, such as reducing the risk of heart disease. Accessibility We developed our final multivariable models using stepwise selection, allowing variables to remain in the model if they were significant at the 0.05 level. All of the patients had cancer that was positive for estrogen receptor, positive for progesterone receptor or positive for both (Table 1). Doseresponse effects of phytoestrogens on the activity and expression of 3-hydroxysteroid dehydrogenase and aromatase in human granulosa-luteal cells. Most health experts agree that the evidence is not strong enough to recommend that all women with a history of breast cancer eat more soy. If you require extra calories during cancer treatment from a medical food supplement, the soy protein in this type of product is not a problem. Setchell KD. Here are 3 important things to know: The scientific research to date suggests: Prostate and breast cancer rates are lower in Asian countries where soy foods are a regular part of an overall healthy diet. In this study, high dietary intake of soy isoflavones was associated with reduced risk of recurrence of disease among post-menopausal patients with estrogen- and progesterone-receptor positive breast cancer and those who were receiving anastrozole as endocrine therapy. It found that men at high risk for prostate cancer recurrence who consumed a 20-gram soy supplement dissolved in a daily beverage did not delay or reduce their risk of a prostate cancer recurrence. We identified potentially eligible patients by reviewing the hospitals pathological diagnosis records after surgery for breast cancer. Competing interests: Xinmei Kang and Qingyuan Zhang have received grants from the National Natural Science Foundation (China). In the end, feel confident in whatever choice you make about soy foods. In vitro experiments have shown that isoflavones inhibit the activity of aromatase and 17-hydroxysteroid dehydrogenases involved in the synthesis of estradiol from circulating androgens and estrones.22,23 This may explain the beneficial effects of soy isoflavones on postmenopausal patients who are receiving endocrine therapy. We use cookies to optimize and personalize your experience, provide relevant content and analyze online traffic. Regardless, those seeking to avoid GMO in soy foods can elect to purchase organic options. For those who do include soy in their diet, additional questions about genetic modification (GMO) and conventional versus organic options sometimes arise. Before All rights reserved worldwide, Nutrition Recommendations During and After Treatment, How to Spot Suspicious Herb and Supplement Claims During Cancer, Evaluating Complementary and Alternative Therapies, American Institute for Cancer Research: Soy and Cancer: Myths and Misconceptions, American Cancer Society: Soy and Cancer Risk: Our Experts Advice. and The authors thank the staff of the Chinese Anticancer Association for assistance with data collection and Jie Piao for programming and statistical support. about navigating our updated article layout. Clinical review 97: Potential health benefits of dietary phytoestrogens: a review of the clinical, epidemiological, and mechanistic evidence. Academy of Nutrition and Dietetics. The https:// ensures that you are connecting to the Soy lecithin is an emulsifier, meaning it is used to help keep things like salad dressing stable in the bottle. Summary: The current consensus among health experts who study soy is that breast cancer survivors can safely eat these foods. Recent insight on the control of enzymes involved in oestrogen formation and transformation in human breast cancer. An official website of the United States government. This means researchers collect diet information from women, then follow them for many years to see who gets breast cancer. There was no statistically significant difference in physical activity or other aspects of usual diet between patients eating high and low amounts of soy food, which would appear to exclude any effect of these lifestyle factors in the risk analyses. positive breast cancer. We applied the restricted cubic spline function in Cox regression analyses to test for the proportional hazards assumption and to evaluate the pattern of association between intake of soy isoflavones and recurrence or death.13 To test for linear trends across quartiles of soy isoflavone intake, we assigned the median value for the study population to each category and used these values as a continuous variable. After obtaining informed consent, we asked each patient to complete a comprehensive questionnaire covering demographic characteristics, physical activity and usual diet. and transmitted securely. The food frequency questionnaire was modelled after a validated instrument10 and included questions about usual consumption of soymilk, soy flour, dry soybeans, fresh soybeans, soybean sprouts, tofu and other soy products. will also be available for a limited time. The total number of deaths was 154, and 132 of these were due to breast cancer. We used Cox proportional hazards regression to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between intake of soy isoflavones and recurrence or death, with HR values above 1.0 indicating increased risk. This is true for women with estrogen-receptor positive breast cancer They point toward a protective effect of soy on breast health, regardless of other lifestyle and diet choices. Even though soybean oil From the medical records of patients who could be contacted at that time, we obtained complete clinical data for our analyses, including age at diagnosis, medical history, Karnofsky performance status, menopause status, pathological diagnosis, clinical stage of cancer, treatment (surgery, chemotherapy, radiotherapy and endocrine therapy), response to treatment and overall outcome. Forest plot of adjusted hazard ratios (HRs) for the effect of intake of soy isoflavones on recurrence among postmenopausal patients with breast cancer, stratified by estrogen and progesterone receptor status and endocrine therapy. Recipes, discoveries, workshops, stories of hope and triumph can be found in the pages of Spotlight, Dana-Farbers free digital newsletters. These amounts fall within the average range of intake of soy isoflavones in Asian countries (2550 mg/day).14 All participants completed the supplementary survey about intake of soy foods. Cassidy A, Hooper L. Phytoestrogens and cardiovascular disease. 2017 Aug;96(33):e7802. However, these studies were not done in people, and laboratory studies are not used to make dietary recommendations for people. Touillaud MS, Thibaut AC, Fournier A, et al. Please note that some translations using Google Translate may not be accurately represented and downloaded documents cannot be translated. Are soy foods safe for breast cancer survivors, including women who were treated for estrogen receptor positive breast cancer? Ju YH, Doerge DR, Allred KF, et al. In addition, we did not obtain biological samples such as blood or urine for determination of soy levels, because of the difficulty of collecting such samples during a follow-up study. Dana-Farber assumes no liability for inaccuracies that may result from using this third-party tool, which is for website translation and not clinical interactions. Research is less clear on the effects of consuming these more concentrated sources of soy. There was no association between intake of soy isoflavones and recurrence or death among premenopausal patients, and this relationship did not vary by selected prognostic factors, including age at diagnosis, hormonal receptor status, TNM stage or cancer treatment (Table 2). The .gov means its official. Statistically significant inverse associations between intake of soy isoflavones and recurrence were observed for patients with estrogren- and progesterone-positive disease and for patients receiving anastrozole therapy (Figure 1). We stratified the analyses for risk of recurrence according to estrogen and progesterone receptor status and endocrine therapy for postmenopausal patients. The results of analyses for mortality specific to breast cancer were similar to those for all-cause mortality (HR 0.92, 95% CI 0.601.31, p for trend = 0.82 for risk of death). ACS Guidelines on Nutrition and Physical Activity for Cancer Prevention, American Institute for Cancer Research, Soy Update. Note: CI = confidence interval, HR = hazard ratio. Federal government websites often end in .gov or .mil. Such data might help to explain the influence of internal metabolism on the activity of isoflavones.
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