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Table of Contents
Forward.9
About the Authors.10
Preface.12
Dr. Barbara MacDonald’s Acknowledgements .14
Dr. Kelly Jennings’ Acknowledgements.16
INTRODUCTION.21
Why integrative medical care is so important in the treatment of cancer.25
Chapter One: Before Conventional Treatment Begins .26
Section 1 – The Initial Consultation.26
 1.1 
 Preparing for the first interview.26
1.2 
 Developing Trust .28
 1.3 
 Potential Pitfalls of Integrative or Naturopathic Care.29
1.4 
 Establishing A Consultation Schedule.31
 Section 2 - Pre-treatment Evaluations .32
 2.1 
 Assessing & Reviewing Your Patient’s Risk.32
 2.1.1 Non-modifiable Risk factors.32
2.1.2 Modifiable Risk Factors.33
 2.1.3 Factors Theorized to Increase Risk.36
2.1.4 Inflammation in the Etiology of Cancer .37
 Section 3 - Building Bridges.39
 3.1 
 Choosing Alternative Care Only.39
 3.2 
 Working with the Conventional Medical Team.40
 Chapter Two: Understanding Diagnosis and Treatment Options .42
Section 1 - Diagnosis of Breast Cancer .42
 1.1 
 Helping Your Patient Understand Her Diagnosis.42
 1.2 
 How Breast Cancer is Diagnosed .42
 1.2.2 Breast MRI.44
1.2.3 Breast-Specific Gamma Imaging.45
 1.2.4 Biopsy .46
1.2.5 The controversy about breast biopsy seeding .48
 Section 2 - Pre-treatment Laboratory Evaluation.52
 2.1 
 Conventional Lab Tests – Highly Recommended .52
2.2 
 Naturopathic Pre-Treatment Testing Considerations.55
 Section 3 - Interpreting the Pathology Report .57
 3.1 
 Procedural and Gross Descriptions.58
3.2 
 Types of Invasive and Non-Invasive Breast Cancer.58
 3.2.1 Invasive (or Infiltrating) Ductal Carcinoma .58
 3.2.2 Invasive (or Infiltrating) Lobular Carcinoma .59
3.2.3 Inflammatory Breast Cancer .60
 3.2.4 Non-Invasive Breast Cancer - Ductal Carcinoma In Situ.62
 3.3.1 Tumor Size.63
3.3.2 Histological grade .64
 3.6 
 HER-2 status .66
3.7 
 Breast Cancer Staging.67
 3.7.1 TNM Staging .67
3.7.2 Summary Staging.68
 Section 4 - Clinical Decisions Based On Pathology Report .70
 4.1 
 Lumpectomy and Radiation vs Mastectomy for Invasive Breast Cancer.70
 4.2 
 Lymph Node Removal.71
4.3 
 Neoadjuvant Chemotherapy/Endocrine Therapy.72
 4.4 
 Reconstruction Considerations .74
 Section 5 - Hereditary Cancer: BRCA Gene Mutations.75
 5.1 
 Normal Function of the BRCA1 and BRCA2 genes .75
5.2 
 Risk of Breast and Ovarian Cancer with BRCA Gene Mutations.75
 5.3 
 Clinical Characteristics of People with BRCA Gene Mutations .76
5.4 
 Pathologic Characteristics of BRCA1/2 Positive Breast Cancer.78
 5.5 
 Prognosis of Women with BRCA1 or 2 Positive Breast Cancer.79
5.6 
 Modifiable Factors that May Influence Risk in Women with BRCA Gene Mutations.80
 5.7 
 Prophylactic Measures For Hereditary Cancers .81
 5.7.1 Prophylactic Oophorectomy for BRCA carriers.81
 5.7.2 Prophylactic Mastectomy for BRCA Carriers .82
 5.8 
 Tamoxifen for BRCA Carriers.82
 Section 6 - The Young Pre-menopausal Breast Cancer Patient.83Section 7 - Your Recommendations Do Matter .85Chapter Three: Non-Invasive Breast Cancer.88
Section 1 - Ductal Carcinoma In Situ.88
 1.1 
 Factors Influencing Rates of Recurrence of DCIS .89
1.2 
 Conventional Treatment Options for DCIS .90
 1.3 
 Naturopathic Treatment Options for DCIS.91
 Section 2 - Lobular Carcinoma In Situ.92
 2.1 
 Conventional Treatment Options for LCIS.93
2.2 
 Naturopathic Treatment Options for LCIS .94
 Section 3 - Alternative Medicine Only for DCIS or LCIS .94Chapter Four: Surgery .95
Section 1 - Preparing for Surgery .95
 1.1.1 Simple Cleanse Recommendations.96
 1.2 
 What to Avoid Two Weeks Prior to Surgery.97
 Section 2 – The Surgery Experience.97Section 3: Naturopathic Therapies to Use Before, During and After Surgery .103
 3.1
 Naturopathic Support - Preparing for Surgery.104
 Section 4 - Breast Reconstruction .106
 4.1 
 Implant Reconstruction Concerns.107
 4.2 
 Flap Reconstruction Concerns .107
4.3 
 Breast Size .108
 4.4 
 Additional Reconstruction Information and Concerns .108
4.5 
 Naturopathic Support of Women Having Reconstruction.109
 Section 5: Guided-Imagery For Surgery.110
 5.1 
 Preparation for Guided-Imagery.111
 5.2 
 A Guided Meditation for Letting Go of the Breast with Gratitude.114
5.3 
 A Guided Imagery to Improve the Surgical Experience.116
 Chapter Five: Chemotherapy .120
Section 1 - Indications for Chemotherapy.120Section 2 – Chemotherapy Drugs and How They are Administered.121Section 3 - The Chemotherapy Experience .125
 3.1 
 Working with the Medical Oncology Team during Chemotherapy .126
 3.1.1 Symptoms and Lab Results that Will Halt Chemotherapy Treatment.128
 3.2 
 Polymorphism CYP3A4 and Chemotherapeutic Agents.129
 Section 4 - Support of the Patient during Chemotherapy.130Section 5 – Doxorubicin/Cyclophosphamide (Adriamycin/Cytoxan).131
 5.2 Common Side Effects of Adriamycin.132
 5.2.2 Fatigue.132
5.2.3 Increased Risk of Infection .132
 5.2.4 Myelosuppression .133
5.2.5 Nausea & Vomiting .133
 5.2.6 Mucositis.133
Nutrients and botanicals that May Increase the Efficacy of A/C.134
 5.3 
 What to Avoid during A/C Chemotherapy .135
 Section 6 – Paclitaxel (Taxol) .136
 6.1 
 Naturopathic Support during Taxol .138
6.2 
 What to Avoid During Taxol .139
 Section 7 – Trastuzumab (Herceptin).142
 7.1 
 Naturopathic Support for the Patient receiving Herceptin.143
 7.1.1 Improving Sensitivity to Herceptin.143
7.1.2 Decreasing Side Effects of Herceptin and Preventing Toxicity .146
 Section 8 - Managing General Side Effects of Chemotherapy .147
 8.2
 For the Blood: Leukopenia .148
8.3
 Anemia.149
 8.4
 Thrombocytopenia .151
8.5
 Chemotherapy side effects related to quality of life .151
 8.6
 Constipation .151
8.7
 Herpes/cold sores.151
 Section 9 - Menopausal Symptoms .155
 9.1 
 Hot flashes and Night Sweats .155
9.2 
 Vaginal dryness and Dyspareunia.156
 9.3 
 Acupuncture for Hot Flashes .158
 Section 10 - Guided Imagery for Chemotherapy.159Section 11 – Antioxidants and Chemotherapy.162Section 12 – Chemotherapy Classification Chart .169Chapter Six: Radiation .173
Section 1 - The Radiation Experience .173Section 2 - Radiation Side Effects .174Section 3 – Naturopathic Support of the Patient Undergoing Radiation.176
 3.1. Maintain Energy Levels During Radiation.177
 3.1.1 Supplements to Support Energy.178
 3.2 Protect and Nourish Healthy Cells .179
3.3 Limit Side Effects .180
 3.4 Enhance Radiation Therapy.180
3.5 Immune Support .180
 Section 4: Prevention of Lymphedema .182Section 5 - Topical Applications to Maintain Healthy Skin .184Section 6 - Brachytherapy: Alternative to External Beam Radiation .186Section 7 - Antioxidants and Radiation .188Section 8 - Chinese Medicine and Radiation Therapy .192Section 9 – Guided-Imagery: Preparing for Radiation.193Chapter Seven: Hormone Blocking Drugs .196
Section 1 – The Use of SERMS for Estrogen Sensitive Breast Cancers.196
 1.1 Side Effects of Tamoxifen/SERMs .196
 1.1.2 Cardiac Risk.198
1.1.3 Cataracts, Liver and Gallbladder Disease.198
 1.2 Use of Tamoxifen In Cancer Prevention .199
 1.3 Using Polymorphism Testing to Pre-determine Tamoxifen Efficacy .199
 Section 2 - Naturopathic Support for Patients on Tamoxifen .201Section 3 – Conventional Alternatives to Tamoxifen .203Section 4 - Tamoxifen vs. Raloxifene.204Section 5 - Aromatase Inhibitors.206
 5.1
 Practicing Prevention While On Aromatase Inhibitors .208
 Section 6 – SERMS vs. AIs – Which is Optimal For Your Patient .210Chapter Eight: Advanced Breast Cancer .212
Section 1 – Monitoring While in Remission .212Section 2 - Recurrent and Metastatic Breast Cancer.213Section 3 - Sites of Metastasis .214Section 4 - Symptom Picture of Metastatic Breast Cancer .215
 4.1 
 Bone metastasis.215
4.2 
 Lung Metastasis .215
 4.3 
 Liver Metastasis.216
4.4 
 Brain Metastasis.217
 Section 5 - Medical Options Per Metastatic Location .219
 5.1 
 Conventional Treatment for Bone Metastasis.220
 5.2 
 Natural Treatment For Those With Metastasis to the Bone .221
5.3 
 Conventional Treatment for Liver and Lung Metastasis .222
 5.3.1 Side Effects of Oral Capecitabine (Xeloda) and Gemcitabine (Gemzar) .222
5.3.2 Natural Adjunctive Support for Those on Xeloda .223
 5.3.3 Side Effects of Epirubicin.224
5.3.4 Side Effects of Paclitaxel and Docetaxel .224
 5.4 
 Natural Treatment For Those With Metastasis to the Liver .224
5.5 
 Natural Treatment For Those With Metastasis to the Lungs.225
 5.5 
 Conventional Treatment of Brain Metastasis .226
5.6 
 Natural Treatment For Those With Metastasis to the Brain .227
 Section 6 - Anti-cancer Botanicals for Metastatic Cancer.228
 6.1 Well-Documented Anti-Cancer Herbs .229
 6.2 Other Anti-cancer Nutrients To Consider.230
 Section 7 - Alternate Drugs Used In Advanced Breast Cancer.230
 7.1 
 Abraxane - Albumin-bound paclitaxel.230
7.2 
 Avastin (bevacizumab) .231
 7.2.1 Avastin - Serious Side Effect Profile .232
7.2.2 Naturopathic Support of Patients Receiving Avastin .232
 7.3 
 Tykerb and Xeloda for Patients with HER2+ Metastatic Breast Cancer.233
 7.3.1 Side Effect Profile of Tykerb.234
 Section 8 - Complementary vs. Alternative Medicine in Advanced Breast Cancer .234Chapter Nine: After Conventional Treatment .236
Section 1: Preventing Recurrence and Promoting Healing .236Section 2: The Steps to Preventing Recurrence .238Section 3: Treating Residual Side Effects of Cancer Therapies.240Section 4: Review of Etiologic Factors .241Section 5: Developing a Working Hypothesis .244Section 6: Factoring in Personality .248Section 7: Determining Cause Using Laboratory Analysis .255
 7.2 
 General Health Assessment Testing .256
7.3 
 Salivary Adrenal Stress Hormone Testing.257
 7.4 
 Essential Fatty Acids Testing.258
7.5 
 Estrogen Metabolism Testing (2:16 Hydroxy-estrone Ratio).258
 Section 8: Eliminate, Minimize and/or Treat the Factors Contributing to Cancer Formation .260
 8.1.3 Naturopathic Anti-inflammatory Protocols .262
 8.1.4 Naturopathic anti-inflammatory supplements.263
 8.2 
 Improving Estrogen Metabolism Ratio.263
 Section 9: Improving Constitutional Health.266Section 10: Create a Balanced Prevention of Recurrence Plan .267
 10.2 
 Chinese Immune Modulating Herbs .269
10.3
 Antioxidants.269
 10.4 
 Other Immune Modulators to Consider: Action and Dosage .270
 Section 11: Lifestyle Factors for Recurrence Risk Reduction.273Chapter Ten: Conclusion .275
Your Individual Treatment Style.275Final Word from the Authors .276Appendices .278
Genomic Testing – Single Nucleotide Polymorphisms.278Immune-modulating and Anti-cancer Agents: Mechanism of Action.286
 Green tea – Camellia sinensis (ECGC) .286
Coriolus versicolor.287
 Maitake mushroom .288
Reishi mushroom .288
 Safety and Dosing of Mushroom Extracts.290
Wormwood - Artemesia annua (artemesinin), QingHao .291
 Turmeric – Curcuma longa (curcumin), JiangHuang .293
Astragalus membranaceus, HuangQi.295
 Larch - Larix occidentalis (arabinogalactan).296
Melatonin.296
 Chinese Medicine, the Five Elements and Personality Types.301Lifestyle Factors: Studies on Diet and Exercise.310How to Use Foods and Beverages to Heal Your Body.314Hydrotherapy: Castor Oil Pack .319Hydrotherapy: Warming Socks Treatment.321Ordering Naturopathic Laboratory Tests .328Endnotes.330

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