Breast Cancer

INTERVIEW WITH ROBERT M. KRADJIAN, M.D.

Host: I wanted to go back to your medical career. You have gone into surgery and may have seen the aspect of cancer like few people have, in fact maybe only surgeons have. Can you talk about your experience? Dr. Kradjian: Well, the surgery for breast cancer is fairly straight forward.

In the early days of my training, I graduated from medical school in 1960, the old Halstead Radical Mastectomy was the surgery that we used and fortunately we've gotten virtually entirely away from that rather drastic and even mutilating operation.

We subsequently went to the modified radical which saves the muscles and much of the skin and is a much kinder operation, but then thankfully more recently we've gone to the lumpectomy and so now I rarely do a mastectomy unless there is some compelling reason to do so. We've even changed our approach to the axillary lymph nodes and do not routinely take out the axillary lymph nodes. For example, an elderly woman's instance if they are not palpable. In every regard we are trying to make the surgery better and gentler and I think it is. In fact many times we treat the patient entirely as an outpatient, they never even enter the hospital. The surgery is all done as an outpatient. Radiotherapy, if it's administered to the breast should a lumpectomy be done and breast conservation is preferred, it is very kind now, it does not seem to cause a difficult reaction and so the surgery is really improving a great deal. But we would like to see fewer cases, we would like to eliminate this disease.

I think that perhaps fifty, sixty or even as much as eighty percent of this disease incidence could be reversed or prevented by strict dietary change and that's the whole basis of my presentations to the women at this conference. I've made three presentations and we have a couple more to go and in that I simply outline the details that I've included in my book "Save Yourself From Breat Cancer" and try to layout before a provident woman, a very careful woman, who is willing to make a radical change in her diet, what needs to be done after giving her the proofs that this is a reasonable thing to do and then the woman can indeed make her own choice. She can choose to continue to live as most American woman do, in which case she will have the risk of breast cancer that we all know about, it's extremely high. Or she can live, using some of the features of the diet of women in countries that are protected, and also (at) the same time preserving some of the excellent features of our diet and our lifestyle. Really combining the best of both worlds, and in so doing it is my belief that she will greatly reduce her risk of breast cancer and in so doing she will also decrease her risk of heart disease, other cancers, stroke, diabetes, and many, many other conditions, not to mention obesity and lesser problems.

So to me it's a no-lose proposition, but it's not easy to do, and it's not a pill, and you're not going the way the American food culture pushes you. I might emphasize early that I don't blame women for getting breast cancer. The real blame lies with the American food culture. It has nothing to do with the woman. She is doing the best things that she has been taught to do, and taught really in all love by her parents and by the authorities in her school and so forth. But it just happens to be a disastrously dangerous diet, although it's the envy of the world. Host: In fact isn't it quite extraordinary when someone finds that the standard diet in the United States, not to mention the super industrialized world that diet and the contents that it has is a major factor on health? Maybe not just cancer but many other diseases as well. Dr. Kradjian: Well I think without a doubt that the master word in disease is diet.

When we get rid of the infectious diseases, that would be things such as malaria, tuberculosis, which are huge killers internationally, the thing that really kills Americas is not those infectious diseases, we conquered those, although we do have a sad return of tuberculosis to our country in recent years. But the thing that causes problems are the degenerative diseases. Number one cause of death in America is heart disease. Well, we know what causes that. It's mainly what we eat.

The number two cause of death in America are cancers, cancers of all kinds. Now, not all cancers are caused by what we eat.

The leading cancer, lung cancer, is caused by what we smoke.

So, we can see from that cancer, our most lethal cancer, that simple choices in what we do on a daily basis, choices we make when we get out of bed in the morning to not smoke, will drastically reduce your risk of ever getting lung cancer, perhaps by 90 or 95%.

And so you're quite right, nutrition is the key word.

The problem with our American nutrition is that unfortunately it's based on high-fat, low-fiber foods and it is essentially meat-centered and a dairy-centered diet. You never hear somebody saying, "Come over to my house, we're going to have...broccoli! "Or, come over to my house we're going to have carrots."

They say, "We're having pork, we're having lamb, we're having steak." And that is the centerpiece of the meal and that is what is causing our trouble. Host: Your book, published in 1994, has this been many years in the making, or how long did it take you to really put your notes and then actually go to publishing? Dr. Kradjian: Well, that's an interesting question.

I didn't want to write this book, I have no interest in writing books, I'm a surgeon.

The book was really written out of frustration because nobody else was interested in doing it. I went to the leaders in this field and I asked them if they would be interested in teaching women how to live in such a way that they would not get breast cancer.

And they said, "Well now, no, we can't do that because we don't have enough research, we need more research and we don't know what causes breast cancer, it's a mystery. We just can't figure it out.

It's just too difficult, it's too complicated. And after several years of this, I began to realize that this message - number one it was a true one, I could find nothing wrong with the logic and the scientific foundations of the argument and then number two, if I didn't do it, I didn't know who was going to, and so I started in. It took me about two and a half years, working early in the morning and late at night.

I reviewed over 7,000 scientific articles, I thought about my own experience over the past 35 years as a doctor and then in addition I thought about my early experience when I was a young doctor travelling around the world doing volunteer medicine.

I worked in nine different countries, and one of the things that I've learned when I was in different countries such as Vietnam as a volunteer, and in Cambodia, in India and then in Tunisia and Sri Lanka, was that breast cancer was non-existent. I just never saw a case.

When we tried to find a case so we could demonstrate things to the medical students and the residents, it took months to find such a case. And so that further confirmed my ideas that breast cancer is a geographic disease. Think of it this way, why should a woman born on one spot on this earth with a certain latitude and longitude have a drastically different risk for breast cancer than a woman born at another latitude and longitude.

It doesn't make any sense, and then when you find out when the woman moves from point A to point B, her risk changes, you now know that this is basically an environmental disease, perhaps there is a genetic susceptibility, but it is not brought out in the low-risk country.

Host: In fact, is it pretty much true that you can predict the cancer rate of a certain region by either studying their diet or by following how the people live there? Dr. Kradjian:Absolutely. If you tell me what a woman eats over her lifetime, in general terms, I can tell you rather precisely her breast cancer risk. There are exceptions, but that is a good general rule that holds up beautifully.

Host: By statistically speaking would this become more true over more people, like, you really couldn't tell whether one or two people might get cancer but you could probably get close to a range if you were to talk of a thousand people or perhaps a hundred thousand people like many studies do? Dr. Kradjian: It takes a large number of people to average all of this out, and the way it's usually figured out is the incidence per hundred thousand women per year. That's the standard sort of approach that the epidemiologists use, and when you do that you find out that the highest numbers that we garnered in this country are around 125-130 women per hundred thousand per year. That doesn't sound like much but that's actually fabulously high when you compare it to the lowest published numbers which are 1.08 per hundred thousand women per year in Kenya (Africa). Now think of that. 1.08 compared to approximately 130, that's an easy 100-fold difference.

There is no possibility that this is not a genetic difference. When African women, since Kenya is in East Africa, when African women come to America, and live here for some time, as we have many wonderful black American women who unfortunately have developed breast cancer, there rates are somewhat similar to everybody around them. So once again, proving it's not primarily a genetic disease. It really depends on the environment.

So then a search should be: What is it in the environment? Some people think it's radiation. Some people think it's, oh, electromagnetic fields. A lot of other people, and they're very serious ones, think that it's chemicals, pollution and pesticides in the water and the food. And although I think that the latter may be of some importance, I think the real culprit is the diet, and that's based on a number of observations which are included in the book. Host: And would you put diet in front of something like stress?

Dr. Kradjian: I would indeed.

I would put diet in front of stress. I know that's not a popular notion. A lot of people feel that stress is the number one thing that causes cancer, because almost anybody, if they come down with a disease can point to a stressful episode somewhere around the time the disease was developing or was discovered. But when you look at the remarkable experience of World War I and World War II in Europe, where women were under terrible stress and fear and anxiety, just incredible ranges of these three terrible factors. Yet at the same time they were on an extremely low-fat diet and were probably working hard, and the protective effect of the low-fat diet and also the absence of alcohol I might add, plus the hard work that they did resulted in their having very very few heart attacks and a greatly reduced rate of cancers of many types including breast.

So I don't think that stress is the main thing. We don't want women in constant anxiety with high cortisol levels, but that is not the main issue. The main issue is what we eat and we also know this of animal experimentation. When animals who are prone to develop breast cancer get a high-fat diet they develop breast cancer very promptly.

Any line of evidence that you look at forces you to the conclusion that breast cancer is primarily a dietary disease. The main reason American doctors don't think it's a dietary disease is because of several studies that have been highly publicized but are badly flawed, and the most famous of these and the most notorious I should say, is the Harvard Nurses Health Study. In this study which has been published twice, once in 1987 in the New England Journal of Medicine and once in 1992 in the Journal of the American Medical Association on October the 21st, the conclusion was offered that breast cancer has nothing whatever to do with dietary fat or dietary fiber, exactly the opposite of what I'm telling you. But the problem with that study is that it had the fallacy of the too-narrow range. In other words, the women in the study were all eating a dangerous diet. When you took the best of that group and compared it with the worst, there was not enough differentiation. They were eating somewhere between 28 and 55% of their calories as fat. Way too high. All in the harm's way. They needed to have a group that was eating around 10 or 15% of the calories as fat, as all the women are at this meeting that we're at now.

A vegan diet brings you in somewhere between 8 and 12, maybe 15% fat. That strongly protects against breast cancer. Host: Is this also known as the Willets Study?

Dr. Kradjian: Walter Willett is the chief investigator, that's correct, and he is the chairman I understand of the Department of Nutrition at Harvard.

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