Do Plant Compounds Lower the Risk of Breast Cancer Coming Back and Reduce the Chance of Death?

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The quest for veracity in these findings would ideally be substantiated through randomized controlled trials, though conducting such studies on food consumption poses considerable challenges.

A plethora of research has correlated phytochemicals in plants with the incidence and outcomes of various cancers, yet the data remain inconclusive. Among the extensively studied compounds are isoflavones present in soybeans and related products, phytonutrients found in green tea and cruciferous vegetables, and lignans found, for instance, in flaxseed and nuts.

In an endeavor to make sense of the variegated research landscape, Dr. M. Diana van Die and colleagues from Western Sydney University undertook a systematic review and meta-analysis. This involved scrutinizing studies exploring the associations between phytochemical consumption and breast cancer outcomes.

The study authors elucidate that plant compounds have the capacity to regulate multiple molecular and metabolic processes pivotal in cancer development and progression. These include cell signaling, cell cycle regulation, oxidative stress, inflammation, apoptosis, angiogenesis, and metastasis. Notably, soy harbors plant-derived phytoestrogens capable of binding to estrogen receptors, inducing effects akin to, albeit milder than, human estrogen. Some studies posit that catechins in green tea impede cell proliferation, potentially enhancing the efficacy of certain cancer treatments.

A comprehensive search across various databases yielded 32 pertinent studies, with most classified as high quality. After stringent eligibility criteria, 22 predominantly prospective observational studies remained for the meta-analysis. Phytonutrient consumption was gauged through food frequency and dietary questionnaires, predominantly focusing on pre-diagnosis intake.

The meta-analysis encompassed 11 studies on soy isoflavones, proteins, or products, totaling over 44,000 participants; three studies on cruciferous vegetables, with over 17,000 participants; three studies on lignans, involving more than 14,000 participants; three studies on enterolactone, a byproduct of gut bacteria digesting lignans, with 3,864 participants; and two studies on green tea, comprising 1,632 participants.

The findings unveiled that soy isoflavones correlated with a 26% reduction in the risk of breast cancer recurrence, particularly impactful for postmenopausal women and those with estrogen-receptor-positive tumors. Soy proteins and products exhibited a more substantial 52% reduction in recurrence. While the overall links between soy isoflavones and product consumption and lower mortality were statistically insignificant, soy products demonstrated a 25% reduction in breast cancer-specific death for ER-positive disease.

Elevated levels of enterolactone in the blood pre or post-diagnosis were linked to an overall 28% reduction in breast cancer-specific mortality and a 31% decrease in all-cause mortality. However, the benefits were significantly pronounced in postmenopausal women and those with non-lymph node-involved cancer.

Lignan consumption displayed a non-significant decline in breast cancer-specific and all-cause mortality for postmenopausal women, but a potential rise in deaths for premenopausal women. This suggests hormonal nuances may influence their effects, necessitating further research. Notably, no studies probed the impact of lignans on breast cancer recurrence.

Pre-diagnosis green tea consumption was associated with a 44% reduction in the risk of recurrence for individuals with Stage I and II breast cancer, with the most pronounced effects observed in those consuming at least three cups daily. Cruciferous vegetables, despite reported low consumption, exhibited no discernible impact on cancer recurrence or mortality, leaving room for speculation on potential effects at higher doses.

The study categorized the enterolactone mortality findings as "probable" evidence, backed by an ample sample size and a plausible biological mechanism. In contrast, most other findings were graded as "limited suggestive" evidence or remained ungraded due to small sample sizes or a lack of established biological mechanisms.

In conclusion, the researchers from this analysis were unable to definitively determine whether consuming soy, lignans, and other plant compounds prior to versus after breast cancer diagnosis yielded a substantial difference. While some evidence suggests that phytochemicals safeguard against cancer development, the impact of lifetime consumption on later disease progression remains unclear. This raises the query of whether individuals already diagnosed with cancer can enhance their outcomes by incorporating more phytonutrients into their diet.

Senior study author Dr. Channing Paller of the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins emphasized the need for more robust studies in this domain, exploring optimal dosages of these compounds and evaluating whether post-diagnosis consumption parallels the effects of lifelong dietary habits pre-diagnosis. Paller underscored, "This is the information patients are seeking."

Pending further elucidation, Paller issued a note of caution: "It is of utmost importance to emphasize that these studies involved women who underwent medical and/or surgical treatment for breast cancer, and these foods and phytonutrients should not be regarded as substitutes for treatment."

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