OCTOBER is the International Breast Cancer Awareness Month, and Zhang Qian talks with doctors from Western and traditional Chinese medicines about the No. 1 cause of cancer deaths among women.

Breast cancer is on the rise in China, especially in major cities such as Shanghai and Beijing, and doctors are urging women to educate themselves, eat right and avoid pollution and toxins. And see the doctor for regular checkups and mammograms.

October is the International Breast Cancer Awareness Month. Breast cancer is now the second-most prevalent cancer worldwide (lung cancer is No. 1) and the most common cause of cancer-related deaths among women.

More than 1.3 million people worldwide were diagnosed with breast cancer in 2009, according to the American Cancer Society.

In China there are about 200,000 new cases a year, according to Dr Li Hongwei, advisor to the director of Ruijin Hospital. She is also the chairperson of the Ruijin-Haagen-Dazs Breast Cancer Seva Foundation.

The breast cancer rate in Shanghai has increased rapidly since the 1980s with the city's rapid economic growth - the same is true for other coastal industrialized areas where toxin and pollution levels are high. Urban populations also tend to be more stressed, which can be a factor in cancer.

In 1980 the rate in Shanghai was 40 out of 100,000; in 2008 it was 78 out of 100,000. Current statistics are not yet available.

The exact causes of breast cancer are difficult to pinpoint, though genetics, diet, environmental pollution and stress contribute, according to Dr Zhuang Zhiqiang, chief of the Breast Department of the Shanghai No. 1 Maternity and Infant Health Hospital.

Dr Zhuang cites a Westernized diet and processed foods as a factor. Foods with hormone additives are especially dangerous to women's health, she says, noting that livestock and poultry are often injected with or fed hormones to speed their growth and muscle mass - and these are then found in the meat, milk and other products. Food can also be contaminated in other ways and tainted with additives, including illegal ones.

Research shows that breast cancer happens mostly among Chinese women in their 40s and 50s, while it mostly occurs in American women in their 50s. "Early and frequent ingestion of hormones is a major reason. It's difficult for ordinary people to control over what they eat, as immoral businessmen add illegal additives for big profits," Zhuang says.

Fish, crabs, eels and other animals are also fed hormones to increase production. So far, there is no effective way to prevent this contamination, says Dr Zhuang.

Traditional Chinese medicine holds that all tumors, including breast cancer, are the result of deficient healthy qi (energy) and an invasion by strong pathogenic qi.

Good health depends on normal flows of fluid and energy (blood and qi). These flows are responsible for nutrition and waste elimination but they are affected by physical, mental and environmental influences.

Poor flow (stagnation) can lead to accumulations such as tumors and cysts. When toxins cannot be properly eliminated because of stagnation, stress is placed on cells and cancer can be one outcome.

As early as the Song Dynasty (960-1279), breast cancer was recorded in medical documents, according to Dr Chen Hongfeng, chief of the Breast Department of Longhua Hospital attached to the Shanghai University of TCM. The condition was called ru yan (breast rock) and was usually accompanied by stagnation of qi in the liver and deficient qi in the spleen.

Medicine today recognizes that too much stress is toxic and linked to the stress hormone Cortisol.

TCM too recognizes the health dangers of stress, anger, anxiety and extreme emotions.

"Bad mood is considered a major reason for all tumor cases in TCM," says Dr Chen. "Anger damages the liver, sadness damages the lungs, while over-thinking and anxiety damage the spleen."

The damage often results in blood and energy stagnation, and in the long run can lead to tumors.

"Clinical research has found that many breast cancer patients had experienced major emotional issues or life upheavals before diagnosis. And it's more common with highly educated and well-paid white collars," says Dr Chen. "Psychological pressure from work and family cannot be ignored."

Early diagnosis is crucial for effective treatment. As much as 90 percent of breast cancers can be achieved with early diagnosis and treatment, according to local doctors.

Self-examination used to be widely recommended some years ago but today it has been found less effective than previously believed, says Dr Zhuang.

"There are successful cases in which women discovered a lump, leading to timely diagnosis and treatment, but some tumors are so small that they cannot be felt by the fingers. Mammograms are important."

Dr Zhuang recommends regular mammograms: once every two years for women in their 30s and 40s; once a year for women in their 50s and 60s; the rate drops significantly in the 60s. But women with family histories should have annual mammograms.

Major treatments include surgery, chemotherapy, radiation treatments and medication.

"It is not always necessary to remove the entire breast and doctors try to perform smaller lumpectomies when possible," says Dr Zhuang. Chemotherapy, radiation, endocrine and other treatments are used in these phases, Zhuang says.

Lumpectomies are usually more expensive and the 10-year recurrence rate is higher, though not for everyone, Zhuang says, emphasizing the importance of post-surgical treatment and follow up over the years.

Traditional Chinese medicine can help patients both before and after surgery and is considered especially helpful in coping with the effects of chemotherapy, says Dr Chen.

For example, herbal soup and acupuncture before surgery can strengthen the body, improve qi flow and soothe the nerves. After surgery they can help relieve side effects such as vomiting, fatigue and low leukocyte (white blood cell) index.

In the long term - and for prevention - TCM therapies can boost the immune system and overall health.

In terms of prevention, some foods can improve healthy energy and flow of qi and help expel toxins. Patients should consult their doctors before using TCM along with any Western medicine.

TCM therapies for post-operation treatment

Joyce Zhang

Traditional Chinese medicine treatments such as herbal soups, prescriptions and acupuncture can assist in breast cancer prevention, post-surgical treatments and recovery, according to TCM experts.

TCM can help lessen the severe side effects of chemotherapy and radiation, such as vomiting, fatigue, poor appetite, anxiety and low immunity, according to Dr Chen Hongfeng, chief of the Galactophore Department of Longhua Hospital.

Liver-stomach energy disharmony and phlegm stagnation are the most common problems for these post-operative patients, she says.

Patients with liver-stomach disharmony usually feel chest pressure and discomfort, nausea, vomiting and anxiety. Soothing the liver and regulating stomach energy is the main strategy in these cases.

Ginger soup is the most widely used dietary therapy while herbs like banxia (pinellia ternate), zhuru (bamboo shavings) and dried orange peel are often prescribed.

Patients with phlegm stagnation problems vomit a lot. They usually need treatment to dispel pathogenic heat and resolve and eliminate phlegm. Doctors often prescribe bamboo shavings, beimu (bulb of fritillary) and gualou (snake gourd).

When patients have a very low leukocyte (white blood cell) index, the priority is strengthening the spleen, says Dr Chen. Fuling (tuckahoe), banxia and dried orange peel are often used.

Herbal medicine is taken when patients feel nauseous.

To reduce or stop vomiting, acupuncture on the nei guan point (inside of wrist, 2 inches above wrist) can help.

TCM can also help rebuild the healthy qi and boost immunity when Western therapies are completed.

Energy reinforcement is the key and prescribe herbal therapies suited to individual needs, such as general energy reinforcement, nourishing the blood, nourishing yin (cold) energy, supporting the liver, kidney or spleen.

To nourish yin energy, doctors recommend various prescriptions containing huangqi (milk veteh), dangshen (codonopsis pilosulae or poor man's ginseng), shashen (root of straight ladybell) and maidong (lily turf root).

Dihuang (rehmannia root), shaoyao (peony) and gouqi (wolfberry) can help nourish the blood.

Dr Chen warns against eating foods taking supplements with hormone additives and notes that many farmed fish, eel and soft-shelled turtles are fed with additives.

A relatively plain and nutritious diet is recommended for recovering patients; it should include plenty and diverse fresh fruits, vegetables and certain spices.

Many foods contain important anti-oxidants and phytochemicals with cancer-fighting properties. The list is long, including fresh mushrooms, broccoli, cabbage, carrots, nuts, green teas, tomatoes, soy products, sea vegetables, red grapes, citrus fruits.