"I don't know why nobody ever told me to go to a nutritionist or how important diet is to recurrence," McGee said. "A nurse once told me in passing to try to stay away from too much sugar," but that was it.
On her own initiative, she started to eat a healthier diet, loading up on fresh fruits and vegetables. "I'm feeling better than I have in a long time."
Scientists continue to learn more about the effects dietary changes can have on people with breast cancer, and this year, for the first time, the American Cancer Society is confident enough in the research to issue guidelines encouraging more attention to exercise and diet to help maximize health and reduce breast cancer recurrence.
A weighty connection
Past studies have indicated that overweight and obese women have a higher risk of recurrence from breast cancer than women who are slimmer. That's because carrying around so much extra weight can compromise the immune system, leading to chronic inflammation. This increases levels of estrogen that contribute to cancer formation, said Joseph Sparano, associate chairman of the Department of Oncology at Montefiore Medical Center in New York.
Sparano and Jennifer Ligibel, a medical oncologist at Dana-Farber Cancer Institute in Boston, have recently conducted trials showing that the relationship between obesity and increased risk of breast cancer recurrence and death is true for patients treated with the most current chemotherapy regimens.
With this in mind, breast cancer survivors can be proactive with their weight and diet. "When women are diagnosed with breast cancer and are scared, they usually will do anything such as change diet to prevent another 'bullet,'" said Lillie Shockney, administrative director of Johns Hopkins Breast Center and its Cancer Survivorship Programs. "But the problem is sustaining the changes, which usually last about six months and then wane as the fear subsides."
Shockney said people are more likely to stick with dietary changes if they make them a little at a time. Looking at labels to determine nutritional content and becoming more informed about what you're eating is a good start.
What to eat
The American Cancer Society advises survivors to reach a healthy body weight, to exercise and to limit high-calorie foods.
Portion control can help you reach those goals, but what foods, specifically, should you be shunning or embracing?
Doctors and nutritionists versed in the latest research recommend a plant-based diet rich in natural compounds known as phytochemicals, said Amanda Bontempo, oncology dietitian at Montefiore-Einstein Center for Cancer Care.
Phytochemicals have health-promoting properties that work together with vitamins and nutrients to prevent, halt and lessen diseases. They act as antioxidants to protect against or repair damage to cells and are found mostly in colorful fruits and vegetables but also often found in beans, grains, onions, garlic and corn.
Breast cancer survivors "should eat a variety of antioxidant-rich foods every day," Bontempo said. Her dietary advice follows:
Less of: Red meat, processed meat, trans fats, saturated fats, refined carbohydrates, refined sugars and other "white" foods. The American Cancer Society warns that alcohol could increase the risk of estrogen-receptor-positive breast cancer recurrence and recommends no more than one drink a day. Soda should also be avoided because it interferes with calcium absorption and has absolutely no nutritional value.
More of: Whole foods such as fruits and vegetables, whole grains, nuts, seeds, legumes, olive oil and lean protein such as fish, poultry and beans. Include semolina pasta, whole-grain breads and whole grains themselves like bulgar, barley and quinoa, but do keep portion size in mind. Tumeric, ginger and other healthy herbs and spices contain potent antioxidant and anti-inflammatory properties that may inhibit tumor cell growth and suppress enzymes that activate carcinogens.
Cruciferous vegetables such as broccoli, cauliflower, kale, cabbage and Brussels sprouts, also rich in phytochemicals, help fight breast cancer by converting a cancer-promoting estrogen into a more protective hormone. They're also a good source of vitamin C and soluble fiber, which helps control weight by slowing down digestion and making you feel full.
Omega 3, the fatty acid found in flaxseed and oily fish such as sardines, salmon, tuna, mackerel and herring, may benefit the immune system by reducing inflammation and the risk of metastatic cancer.
Allium vegetables that include garlic and onion are known to be protective and can be added to almost any dish. Tomatoes, berries, whole grains, apples, legumes and green peas are also rich in anti-cancerous properties.
White and green teas are recommended because they contain antioxidants that may stave off breast cancer recurrence.
Whole soy, which mimics estrogen, can be eaten in moderation, Bontempo said, but processed soy is high in estrogen and should be avoided. For those being treated with tamoxifen, any soy can interfere with therapy, so consult with your doctor.
Vitamin D can directly or indirectly control carcinogenic genes in the body, studies show. Sun-dried tomatoes, shiitake mushrooms, egg yolk, fortified cow's milk, fortified soy milk and other foods contain high levels of vitamin D.
"Supplements and sunlight are also sources of vitamin D," said Bontempo, "but every breast cancer survivor should consult a physician before taking any supplement, because supplements are not FDA regulated and could contain harmful chemicals." Vitamin D, required for optimal calcium absorption, can also be found in spinach and white beans.
Water should be a survivor's go-to drink. It flushes toxins out of vital organs and carries nutrients to cells.
The good news
Most women today who are diagnosed with early-stage breast cancer can expect long-term survival, making the prevention and control of other diseases caused by unhealthy foods imperative. "Eating should not be a chore," Bontempo said, "and survivors need to learn to enjoy their food and choose indulgences wisely."
Find a dietitian
The Academy of Nutrition and Dietetics offers an online tool to find a dietitian near you who specializes in cancer. Visit eatright.org/programs/rdfinder/.
(It may take a minute to load because it's map-based.) Once there, enter your ZIP code, click on "Expertise Area" and select "Cancer/Oncology Nutrition."
The American Cancer Society offers free over-the-phone counseling on nutrition by registered dietitians specializing in oncology. Follow-up materials and support is also offered. Call 800-227-2345 for more information.