Your Breast Cancer Handbook

At any time during your breast cancer experience

All throughout your cancer experience, you may turn your attention to boosting your health and resilience and also creating a body that is less supportive of cancer. Many practices and therapies that you can implement all throughout your cancer experience can improve survival, reduce your risk of recurrence, or help manage symptoms and side effects.

Also see separate sections in this handbook about further recommendations and approaches you can use at specific times during your cancer experience.

Top practices and therapies we have reviewed for improving cancer outcomes and body terrain at any time

Your body terrain is the whole environment in which your cancer grows and includes specific terrain factors that can impact cancer growth and development.

These practices and therapies have at least modest evidence for the medical benefits listed. We add to this list as we complete new reviews of practices and therapies.

Self-care practices

Complementary therapies

On this page

Improving cancer outcomes

We present self-care practices and complementary therapies supported by evidence to promote better cancer outcomes or body terrainthe internal conditions of your body, including nutritional status, fitness, blood sugar balance, hormone balance, inflammation, and more. Those with the best evidence are presented first.

A practice or therapy may show a stronger effect or have more evidence in some situations than in others. The evidence supporting the effects for each practice or therapy is listed in the full reviews available through the links.

Strong, good, or modest evidence of benefit for cancer outcomes

Strong evidenceconsistent, significant effects in several large (or at least one very large) well designed clinical studies or at least two meta-analyses of clinical studies of moderate or better quality (or one large meta-analysis) finding similar results (this is the CancerChoices definition; other researchers and studies may define this differently) indicates confidence that the practice or therapy has an effect as noted. Good evidencesignificant effects in one large or several mid-sized and well-designed clinical studies (randomized controlled trials (RCTs) with an appropriate placebo or other strong comparison control or observational studies that control for confounds) (this is the CancerChoices definition; other researchers and studies may define this differently) indicates that the practice or therapy is linked to the outcomes described with reasonable certainty. Modest evidencesignificant effects in at least three small but well-designed randomized controlled trials (RCTs), or one or more well-designed, mid-sized clinical studies of reasonably good quality (RCTs or observational studies), or several small studies aggregated into a meta-analysis (this is the CancerChoices definition; other researchers and studies may define this differently) means the practice or therapy may be linked to the outcomes described, but with a lower degree of certainty.

Healthy lifestyle: modest evidence

Eating Well: good to preliminary evidence

• Better survival among postmenopausal women eating foods high in plant lignans—flaxseed and sesame, but also whole grains, berries and some other fruits, vegetables such as broccoli and kale, and green tea—or fiber (good evidence)
• Better survival among people with breast cancer eating soy foods (modest evidence)
• Better survival and reduced risk of early events such as relapse or metastasis among people drinking coffee (preliminary evidence)
• Higher mortality among people with ER-positive tumors and those with higher body mass index (BMI) drinking sugar-sweetened soda beverages (modest evidence)
• Lower overall and cancer-specific mortality among people with breast cancer eating a diet for diabetes risk reduction before and after a diagnosis of breast cancer (preliminary evidence)

Cancer as a whole:

• Better survival among people with cancer as a whole following the recommended diet patterns of increasing vegetables and fruits and reducing red meat, processed foods, and saturated fats (modest evidence)

Moving More: strong to preliminary evidence

• Better cancer-specific survival among people with any level of physical activity after a breast cancer diagnosis (preliminary evidence)

Cancer as a whole:

• Moderately better survival with cancer as a whole among people with higher activity levels after diagnosis (good evidence)

Managing Stress: strong and preliminary evidence

Sleeping Well: modest evidence

Creating a Healing Environment: good and preliminary evidence

Cancer as a whole:

• Better cancer survival among people who are married, partnered, or have more social connections (good evidence)
• Lower incidence of of suicidal thoughts among people with cancer with higher levels of social support (modest evidence)

Manage anxiety: good evidence

Cancer as a whole:

• Higher cancer-specific and all-cause mortality among people with cancer experiencing anxiety (good evidence)

Manage your body weight: good and modest evidence

Specific to breast cancer:

• Worse survival after diagnosis among people with diabetes (modest evidence)
• Higher risk of breast cancer diagnosis, recurrence, and possibly mortality among people with higher levels of insulin-like growth factor 1 (modest evidence)

Solid tumors as a whole:

• Slightly higher mortality among people with solid tumors with diabetes (good evidence)

Some cancer treatments, including chemotherapy for breast cancer, are linked to higher risk of developing high blood sugar or insulin resistance. Checking your blood sugar levels regularly is recommended.

Aspirin: mixed evidence

Cancer as a whole:

• Lower mortality among people with adenocarcinoma using aspirin regularly, particularly among those without metastasis, and with greater benefit among people who smoke (strong evidence)
• Better progression-free survival but no evidence of an effect on overall survival among people with cancer as a whole treated with low-dose aspirin during treatment with immune checkpoint inhibitors (good evidence)

Metformin: mixed evidence

• Better survival and response rates among people with breast cancer and diabetes treated with metformin (modest evidence)
• Lower levels of a marker of cancer proliferationa chemical or substance, such as certain proteins or genetic material, that are associated with the presence of cancer or a change in status or prognosis; these markers can be detected in blood, urine, or tissue. Tumor markers are not direct measures of clinical outcomes such as survival or metastasis, and if a therapy or treatment shows an impact only on tumor markers, we cannot surmise that it will affect survival. among people with breast cancer receiving metformin as treatment for diabetes (modest evidence)
• Lower risk of distant metastases among people with triple negative breast cancer and diabetes treated with metformin (weak evidence)
• No evidence of an effect on overall survival or cancer-specific survival among people with breast cancer (not specific to diabetics) treated with metformin in several combined analyses of studies
• Lower markers of tumor proliferation among nondiabetic people with breast cancer and higher insulin resistance treated with metformin (modest evidence), but no evidence of benefit among people with lower markers of insulin resistance
• A lower marker of tumor proliferation among nondiabetic people with HER2-positive DCIS lesions, and especially ER-positive/HER2-positive DCIS, treated with metformin (modest evidence)

Cancer as a whole:

• Lower cancer-specific mortality among people with diabetes treated with metformin (modest evidence)
• No evidence of an effect on survival among people with cancer (not specific to diabetics) treated with metformin in addition to immune checkpoint inhibitors in a combined analysis of studies

Mistletoe: mixed evidence

Vitamin D: mixed evidence

Cancer as a whole:

• Moderately better cancer-specific survival among people with cancer with high vitamin D levels (good evidence)
• Lower overall mortality among people with cancer taking vitamin D supplements (modest evidence)

Preliminary or weak evidence of benefit for cancer outcomes or body terrain

Preliminary evidencesignificant effects in small or poorly designed clinical studies OR conflicting results in adequate studies but a preponderance of evidence of an effect (this is the CancerChoices definition; other researchers and studies may define this differently) means the practice or therapy may be linked to the outcomes described, although substantial uncertainty remains. Weak evidenceone or more case studies, supported by animal evidence OR small treatment effects of limited clinical significance OR studies with no controls OR weak trends of effects (this is the CancerChoices definition; other researchers and studies may define this differently) may mean that the effects are small or that a high degree of uncertainty remains about the links between the practice or therapy and the outcomes described.

No evidence or insufficient evidence of benefit for cancer outcomes

Fasting or calorie restriction ›

Specific to breast cancer:

• No evidence of an effect on cancer-specific or all-cause mortality among nondiabetic women with early stage breast cancer fasting 13 or more hours per night in a large study

Ketogenic diet ›

Cancer as a whole:

• Insufficient evidence of anticancer effects with cancer as a whole

Mediterranean diet ›

Cancer as a whole:

• Insufficient evidence of increased survival among people with cancer with the highest adherence to a Mediterranean diet

Optimizing your body terrain

Your body terrain is the whole environment in which your cancer grows.  

See these completed body terrain handbooks for information about the connections between these factors and cancer, and for guidance on improving your body terrain. You can do much on your own, but professional healthcare management may also be necessary. Find health professionals who specialize in managing body terrain ›

Other terrain factors

We haven’t published these handbooks yet; these assessments are from our research so far.

Managing symptoms and promoting wellness

Self-care practices, supplements, mind-body therapies, and other complementary therapies may reduce symptoms and enhance your quality of life all throughout your cancer experience.

For some symptoms, we have complete handbooks, as linked below. For other symptoms and for quality of life and physical function as a whole, we list here the effects of complementary therapies and practices we’ve reviewed.  

We report the evidence relating to benefits from using these practices and therapies. Please also review the Safety and precautions page within the linked reviews for guidance on safe use. We recommend supervision from a medical professional trained in the use of complementary therapies.  

Strong evidenceconsistent, significant effects in several large (or at least one very large) well designed clinical studies or at least two meta-analyses of clinical studies of moderate or better quality (or one large meta-analysis) finding similar results (this is the CancerChoices definition; other researchers and studies may define this differently) indicates a high degree of confidence that the therapy is linked to the outcomes as noted. Good evidencesignificant effects in one large or several mid-sized and well-designed clinical studies (randomized controlled trials (RCTs) with an appropriate placebo or other strong comparison control or observational studies that control for confounds) (this is the CancerChoices definition; other researchers and studies may define this differently) indicates a relatively high degree of confidence that the therapy is linked to the outcomes as noted.

Preliminary evidencesignificant effects in small or poorly designed clinical studies OR conflicting results in adequate studies but a preponderance of evidence of an effect (this is the CancerChoices definition; other researchers and studies may define this differently) typically indicates that not much research has been published so far, although the outcomes may be meaningful. Weak evidenceone or more case studies, supported by animal evidence OR small treatment effects of limited clinical significance OR studies with no controls OR weak trends of effects (this is the CancerChoices definition; other researchers and studies may define this differently) may mean that the effects are small or that only very preliminary research has been published.

A therapy may show a stronger effect or have more evidence in some situations than in others. The evidence supporting the effects for each therapy is listed in the full reviews available through the image links.

Further therapies

Therapies that report benefit with breast cancer

These therapies are reported to improve survival, body terrain, and/or quality of life among people with breast cancer. We have not fully assessed the evidence, although we provide preliminary reviews as linked.

Therapies that are possibly dangerous or lack evidence of benefit with breast cancer

How experts approach care throughout your cancer experience

Clinical practice guidelines

Physical activity before and after a cancer diagnosis is likely to be relevant for improved survival for those diagnosed with breast cancer, with data suggesting that postdiagnosis physical activity provides greater mortality benefits than prediagnosis physical activity.

Clinical practice guidelines on the evidence-based use of integrative therapies during and after breast cancer treatment ›  This 2017 set of guidelines has been endorsed by the American Society of Clinical Oncology (ASCO). The full-text guidelines are available free of charge. 

Evidence-based clinical practice guidelines for integrative oncology: complementary therapies and botanicals ›

Recommendations from these 2009 guidelines relate to managing symptoms common among people with cancer.  Specific recommendations for each symptoms are listed in separate handbooks: Managing Symptoms and Side Effects ›

Published programs and approaches

These programs and approaches address many phases of cancer care. See other pages in this handbook for further programs that apply to specific phases.

Lise Alschuler, ND, FABNO, and Karolyn Gazella

Dr. Alschuler recommends fasting overnight for at least 13 hours, as this has been associated with improved survival after a diagnosis of breast cancer. For instance, you could finish dinner at 7pm and eat nothing until 8:00 the next morning when you “break fast.” In addition, for people having significant side effects, especially gastrointestinal, from chemotherapy, Dr. Alschuler may also recommend fasting for 48 hours—from after dinner on the day before chemo, through the day of chemo and the day following chemotherapy. The chemo fast can be a water fast (which includes coconut water and vegetable broths), or you can eat up to 600 calories per day of vegetable soup and/or low-carbohydrate vegetables. She stresses the importance of your being motivated to fast, and also that fasting during chemotherapy should be cleared with your treating oncologist. You should modify or stop the fast if you become dizzy or weak (try adding boiled eggs or nuts), or if you feel worse than if you had eaten.

Keith Block, MD

The Block Center, founded by Keith Block, MD, an integrative oncologist and CancerChoices advisor, offers a comprehensive cancer treatment program combining conventional treatments—often delivered in novel ways, such as according to circadian rhythms—along with nutrition and supplementation, fitness and mind-spirit instruction. The program is highly individualized and provides care to people with any kind of cancer.

A collaborative research group looked at survival data for a consecutive case series of 90 women with advanced metastatic breast cancer who received this comprehensive treatment program at the Block Center. Findings:¹Block K, Gyllenhall C et al. Survival impact of integrative cancer care in advanced metastatic breast cancer. The Breast Journal. 2009 Jul/Aug;15(4):357-366.

Despite a higher proportion of younger and relapsed patients, survival of metastatic breast cancer patients at the center was approximately double that of comparison populations and possibly even higher compared to trials published during this period. Explanations for the advantage relative to conventional treatment alone may include the nutritional, nutraceutical [relating to foods with medicinal properties beyond their nutritional value], exercise and psychosocial interventions, individually or in combination; self-selection of patients cannot be ruled out.

The researchers propose that the doubling of survival in those treated with the integrative program may be physiologically based and not due to self-selection. For example, patients in this program followed a low-fat diet, demonstrated in randomized controlled trials to improve relapse-free survival. Other specific program elements that may have helped with either prolonged survival or treatment tolerance:

• Increased intakes of antioxidants and phytochemicals
• Improved body composition and weight reduction due to increased exercise
• Reduction of stress hormones with mind-spirit interventions
• Higher intakes of vegetables, fiber and omega-3 fatty acids

The Block Center program also evaluates and supports a patient’s quality of life and mental/spiritual responses to cancer and treatment. “Systematic training is provided in relaxation strategies, cognitive-behavioral interventions, and other approaches to enhance coping skills, pain management and sleep hygiene in order to manage the challenges associated with a cancer diagnosis and to mitigate side effects of chemotherapy, while improving treatment tolerance.”²Block K, Gyllenhall C et al. Survival impact of integrative cancer care in advanced metastatic breast cancer. The Breast Journal. 2009 Jul/Aug;15(4):357-366. Being able to tolerate treatment better also means that women may be able to complete the treatment, improving their response and benefits.

Barbara MacDonald, ND, LAc

This book discusses what naturopathic physicians need to know about conventional breast cancer treatment and naturopathic approaches to integrate into patient care.

People with breast cancer may use this book to learn about an integrative naturopathic approach to discuss with their cancer care professionals.

Commentary

CancerChoices advisor Lise Alschuler, ND, FABNO, recommends fasting overnight for at least 13 hours, as this has been associated with improved survival after a diagnosis of breast cancer. For instance, you could finish dinner at 7pm and eat nothing until 8am the next morning when you “break fast.” 

CancerChoices advisor Ted Schettler, MD, March 4, 2019: Lavender oil (as with some other essential oils) has estrogenic properties at some concentrations.³Simões BM, Kohler B et al. Estrogenicity of essential oils is not required to relieve symptoms of urogenital atrophy in breast cancer survivors. Therapeutic Advances in Medical Oncology. 2018 Apr 2;10:1758835918766189; Henley DV, Lipson N, Korach KS, Bloch CA. Prepubertal gynecomastia linked to lavender and tea tree oils. New England Journal of Medicine. 2007 Feb 1;356(5):479-85; Diaz A, Luque L, Badar Z, Kornic S, Danon M. Prepubertal gynecomastia and chronic lavender exposure: report of three cases. Journal of Pediatric Endocrinology & Metabolism. 2016 Jan;29(1):103-7; Politano VT, McGinty D et al. Uterotrophic assay of percutaneous lavender oil in immature female rats. International Journal of Toxicology. 2013 Mar-Apr;32(2):123-9; Shinohara K, Doi H, Kumagai C, Sawano E, Tarumi W. Effects of essential oil exposure on salivary estrogen concentration in perimenopausal women. Neuroendocrinology Letters. 2017 Jan;37(8):567-572; Henley DV, Korach KS. Physiological effects and mechanisms of action of endocrine disrupting chemicals that alter estrogen signaling. Hormones (Athens). 2010 Jul-Sep;9(3):191-205. It might be wise to avoid skin application of lavender oil in the setting of an estrogen-positive breast cancer diagnosis.

Helpful links

Keep reading about breast cancer

Choose what to read next

• Introduction
• At any time during your breast cancer experience
• Preparing for breast cancer treatment
• During breast cancer treatment
• Surviving and thriving with and beyond breast cancer
• Reducing your risk of breast cancer
• Are you a health professional?

Authors

Laura Pole, MSN, RN, OCNS

Senior Clinical Consultant

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Laura Pole is senior clinical consultant for CancerChoices. Laura is an oncology clinical nurse specialist who has been providing integrative oncology clinical care, navigation, consultation, and education services for over 40 years. She is the co-creator and co-coordinator of the Integrative Oncology Navigation Training at Smith Center for Healing and the Arts in Washington, DC. Laura also manages the “Media Watch Cancer News That You Can Use” listserv for Smith Center/Commonweal. In her role as a palliative care educator and consultant, Laura has served as statewide Respecting Choices Faculty for the Virginia POST (Physician Orders for Scope of Treatment) Collaborative as well as provided statewide professional education on palliative and end-of-life care for the Virginia Association for Hospices and Palliative Care.

For CancerChoices, Laura curates content and research, networks with clinical and organizational partners, brings awareness and education of integrative oncology at professional and patient conferences and programs, and translates research into information relevant to the patient experience as well as clinical practice.

Laura sees her work with CancerChoices as a perfect alignment of all her passions, knowledge and skills in integrative oncology care. She is honored to serve you.

Laura Pole, MSN, RN, OCNS Senior Clinical Consultant

Nancy Hepp, MS

Lead Researcher

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Ms. Hepp is a researcher and communicator who has been writing and editing educational content on varied health topics for more than 20 years. She serves as lead researcher and writer for CancerChoices and also served as the first program manager. Her graduate work in research and cognitive psychology, her master’s degree in instructional design, and her certificate in web design have all guided her in writing and presenting information for a wide variety of audiences and uses. Nancy’s service as faculty development coordinator in the Department of Family Medicine at Wright State University also provided experience in medical research, plus insights into medical education and medical care from the professional’s perspective.

Nancy Hepp, MS Lead Researcher

Gwendolyn Stritter, MD

Physician and CancerChoices advisor

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Dr. Stritter is board-certified in anesthesiology. She was also certified in pain medicine from 1996 to 2016 and served as the director of the Kaiser San Jose Pain Medicine Clinic for 10 years. Wishing to pursue a more patient-centered style of practice, Gwen subsequently trained with Dr. Mark Renneker, honing her medical advocacy skills to help those with life-threatening health problems. Her own high risk for breast cancer led her to focus on that area in particular.

During her 13 years of clinical advocacy practice, she appeared on radio, lectured and wrote many articles on medical advocacy. She also coauthored the chapter on clinical advocacy in the textbook Patient Advocacy for Healthcare Quality: Strategies for Achieving Patient-Centered Care (2007).

As fate would have it, Dr. Stritter was diagnosed with breast cancer in 2013. Although side effects of treatment forced closure of her medical advocacy practice, she continues to enjoy attending several breast cancer conferences every year, learning best integrative oncology practices and mentoring the next generation of breast cancer medical advocates.

Gwendolyn Stritter, MD Physician and CancerChoices advisor

Reviewers

Michael Lerner

Co-Founder

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Michael Lerner is co-founder of Commonweal and co-founder of the Commonweal Cancer Help Program, Healing Circles, The New School at Commonweal, and CancerChoices. He has led more than 200 Commonweal Cancer Help Program retreats to date. His book Choices In Healing: Integrating the Best of Conventional and Complementary Approaches to Cancer was the first book on integrative cancer care to be well received by prominent medical journals as well as by the patient and integrative cancer care community.

Michael Lerner Co-Founder

Walter Tsang, MD

Integrative oncologist

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Dr. Walter Tsang is quadruple board-certified in medical oncology, hematology, lifestyle medicine, and internal medicine. In addition to providing cutting-edge treatments for cancer and blood diseases, Dr. Tsang regularly advises his patients on nutrition, physical activity, stress management, and complementary healing methods. He has seen firsthand how this whole-person approach improved his patients’ quality of life and survival.

Outside of his clinical practice, Dr. Tsang teaches integrative oncology at the UCLA Center for East-West Medicine and directs an educational seminar program for cancer survivors in the community. His research interests focus on comparing and integrating the traditional Eastern and modern Western perspectives of cancer care. His fluency in Chinese further allows him to study the enormous integrative medicine literature published in the East that is not easily accessible to the West due to the language barrier.

Dr. Tsang is an active member of the American Society of Clinical Oncology, Society for Integrative Oncology, and American College of Lifestyle Medicine. He currently practices in the Inland Empire region of Southern California.

Walter Tsang, MD Integrative oncologist

Last update: April 21, 2024

Last full literature search: January 2023

CancerChoices provides information about integrative in cancer care, a patient-centered approach combining the best of conventional care, self care and evidence-informed complementary care in an integrated plan cancer care. We review complementaryin cancer care, complementary care involves the use of therapies intended to enhance or add to standard conventional treatments; examples include supplements, mind-body approaches such as yoga or psychosocial therapy, and acupuncture therapies and self-care lifestyle actions and behaviors that may impact cancer outcomes; examples include eating health-promoting foods, limiting alcohol, increasing physical activity, and managing stress practices to help patients and professionals explore and integrate the best combination of conventionalthe cancer care offered by conventionally trained physicians and most hospitals; examples are chemotherapy, surgery, and radiotherapy and complementary therapies and practices for each person.

Our staff have no financial conflicts of interest to declare. We receive no funds from any manufacturers or retailers gaining financial profit by promoting or discouraging therapies mentioned on this site.

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