I get this question almost daily from my breast cancer patients. People are understandably confused. As is the case with other foods, as research evolves, there are changing messages disseminated about their impact on health matters.
So, what information compels you to make decisions in life? The story about soy is the story about the evolution of knowledge about diet and cancer in general, as they say, and here is the rest of the story.
The earliest studies in the '70s and '80s indicated that Asian women had lower breast cancer risk than European and American women. [1] [2] [3] It turns out that many things about the life and culture of Asian women are different beyond their diets. The early thinking about possible connections to lower cancer risk focused on low fat intake and soy. Many in the research community advocated lowering dietary fat and increasing soy intake to reduce breast cancer risk and improve survival. Thus was born a wave of enthusiasm for all things soy.
As better research surfaced, it turned out that lower dietary fat had minimal effect on overall breast cancer risk. [4] [5]
As is typical of Western science, soy was dissected and found to contain a variety of nutrients with potential cancer effects. One series of compounds, isoflavones, were found to possess estrogen-like effects, albeit far weaker than human estrogen compounds. Laboratory research subsequently indicated a potential adverse risk with an increase in breast cancer growth with exposure to isoflavones compounds typically consumed through diet or with supplementation. [6] [7] This started the shift in attitudes suggesting a potential risk rather than benefit for soy consumption.
Other studies in animals as well as long-term human studies supported the idea that any benefit of soy only occurred when consumed prior to puberty. [8] [9] [10] This would alter the later risk of developing breast cancer through favorable changes during maturation of the breast. There remained concern, however, that consuming soy at high doses in adulthood might increase breast cancer risk and, in breast cancer survivors, impact survival through possible higher recurrence risk. There was also concern that soy might impair the effectiveness of hormone therapies, such as tamoxifen, prescribed to patients at higher risk of getting breast cancer or recurrence. As more and more women were using powdered soy protein or isoflavone supplements, this was particularly worrisome.
I am particularly interested in one critical piece of evidence, which is what happens to large groups (many thousands) of women with breast cancer who consume soy at varying levels. Do they show greater recurrence risk of breast cancer? Unfortunately, these studies are expensive, take years and often decades to complete but provide the best and most reliable evidence of risk, short of a very large "randomized control trial" in breast cancer survivors.
Despite the fears, the result of higher levels of soy intake shows no clear evidence of risk. In fact, several studies showed that the higher the soy intake there appeared to be a lower risk of breast cancer recurrence and mortality. [11] [12] [13] [14] Surprisingly, this effect was noted in both estrogen receptor negative and positive women. Remembering all the press from earlier pronouncements, which were based on inadequate and limited studies, many women are leery and find this hard to believe. Beliefs are hard to dislodge once they become part of the accepted wisdom (wisdom, indeed!).
The bottom line is: What happens to women who eat soy? And the answer in my opinion is that it is safe in regard to breast cancer recurrence risk.
Are you still worried about eating soy? Rest assured, the current thinking on soy among cancer nutritionists and the American dietetic community has changed based on these new larger and reassuring studies. As the field has evolved, better research on long-term outcomes in very large populations of breast cancer patients confirms that soy is NOT bad and has no adverse impact. It may even be beneficial as part of a healthy, prudent plant-based diet.
The safety of soy and breast cancer risk is separate from the question of GMO (genetically modified) soy. These studies didn't separate sources of dietary soy. They included all soy products, presumably both GMO and non-GMO, suggesting that may not be an issue for breast recurrence. With the high use of genetically-modified soy in U.S. products, this remains a very controversial area.
GMO soy is in widespread use in the U.S. and has been recognized as safe by the FDA as well as international organizations. Nonetheless, there remain many unanswered questions, from impact on long-term human health to the risk to native plant populations that acquire these genes (as is inevitable) and the ecologic and evolutionary consequences.
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References:
1. J Nutr. 1999 Mar;129(3):758S-767S. Dietary isoflavones: biological effects and relevance to human health. Setchell KD, Cassidy A. Clinical Mass Spectrometry, Children's Hospital Medical Center, Cincinnati, Ohio 45229, USA.
2. Cancer Epidemiol Biomarkers Prev. 1996 Nov;5(11):901-6. Tofu and risk of breast cancer in Asian-Americans. Wu AH, Ziegler RG, Horn-Ross PL, Nomura AM, West DW, Kolonel LN, Rosenthal JF, Hoover RN, Pike MC. Department of Preventive Medicine, University of Southern California, Los Angeles 90033-0800, USA.
3. Am J Clin Nutr. 1998 Dec;68(6 Suppl):1437S-1443S. Soy intake and risk of breast cancer in Asians and Asian Americans. Wu AH, Ziegler RG, Nomura AM, West DW, Kolonel LN, Horn-Ross PL, Hoover RN, Pike MC.Dept of Preventive Medicine, University of Southern California, Los Angeles 90033-0800, USA. annawu@hsc.usc.edu
4. JAMA. 2006 Feb 8;295(6):629-42. Low-fat dietary pattern and risk of invasive breast cancer: the Women's Health Initiative Randomized Controlled Dietary Modification Trial. Prentice RL, Caan B, Chlebowski RT, Patterson R, Kuller LH, Ockene JK, Margolis KL, Limacher MC, Manson JE, Parker LM, Paskett E, Phillips L, Robbins J, Rossouw JE, Sarto GE, Shikany JM, Stefanick ML, Thomson CA, Van Horn L, Vitolins MZ, Wactawski-Wende J, Wallace RB, Wassertheil-Smoller S, Whitlock E, Yano K, Adams-Campbell L, Anderson GL, Assaf AR, Beresford SA, Black HR, Brunner RL, Brzyski RG, Ford L, Gass M, Hays J, Heber D, Heiss G, Hendrix SL, Hsia J, Hubbell FA, Jackson RD, Johnson KC, Kotchen JM, LaCroix AZ, Lane DS, Langer RD, Lasser NL, Henderson MM. Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Wash 98109, USA.
5. N Engl J Med. 1996 Feb 8;334(6):356-61. Cohort studies of fat intake and the risk of breast cancer--a pooled analysis. Hunter DJ, Spiegelman D, Adami HO, Beeson L, van den Brandt PA, Folsom AR, Fraser GE, Goldbohm RA, Graham S, Howe GR, et al. Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA.
6. Cancer Res. 2002 May 1;62(9):2474-7. Dietary genistein negates the inhibitory effect of tamoxifen on growth of estrogen-dependent human breast cancer (MCF-7) cells implanted in athymic mice. Ju YH, Doerge DR, Allred KF, Allred CD, Helferich WG. Department of Food Science and Human Nutrition, University of Illinois at Urbana-Champaign, Urbana, Illinois 61801, USA.
7. Eur J Obstet Gynecol Reprod Biol. 2002 May 10;102(2):188-94. Synergistic inhibitory effects of genistein and tamoxifen on human dysplastic and malignant epithelial breast cells in vitro. Tanos V, Brzezinski A, Drize O, Strauss N, Peretz T. Department of Obstetrics, Hadassah Medical Center, Ein-Kerem, The Hebrew University Hospital, P.O. Box 12000, Jerusalem il-91120, Israel. tanosv@spidernet.com.cy
8. Cancer Epidemiol Biomarkers Prev. 2001 May;10(5):483-8. Soyfood intake during adolescence and subsequent risk of breast cancer among Chinese women. Shu XO, Jin F, Dai Q, Wen W, Potter JD, Kushi LH, Ruan Z, Gao YT, Zheng W. Vanderbilt University School of Medicine, Center for Health Service Research, Nashville, Tennessee 37232, USA. Xiao-Ou.Shu@mcmail.vanderbilt.edu
9. Carcinogenesis. 2002 Sep;23(9):1491-6. Adolescent and adult soy intake and risk of breast cancer in Asian-Americans. Wu AH, Wan P, Hankin J, Tseng CC, Yu MC, Pike MC. Department of Preventive Medicine, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA.
10. Cancer Prev Res (Phila). 2011 Sep;4(9):1436-48. Protective effects of prepubertal genistein exposure on mammary tumorigenesis are dependent on BRCA1 expression. de Assis S, Warri A, Benitez C, Helferich W, Hilakivi-Clarke L. Lombardi Comprehensive Cancer Center and Department of Oncology, Georgetown University, Washington, District of Columbia, USA.
11. Am J Clin Nutr 2012 Jul;96(1):123-32. Soy food intake after diagnosis of breast cancer and survival: an in-depth analysis of combined evidence from cohort studies of US and Chinese women. Nechuta SJ, Caan BJ, Chen WY, Lu W, Chen Z, Kwan ML, Flatt SW, Zheng Y, Zheng W, Pierce JP, Shu XO. Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
12. Cancer Epidemiol Biomarkers Prev. 2011 May;20(5):854-8. Soy food consumption and breast cancer prognosis. Caan BJ, Natarajan L, Parker B, Gold EB, Thomson C, Newman V, Rock CL, Pu M, Al-Delaimy W, Pierce JP.Division of Research, Kasier Permanente, Oakland, CA 94612, USA. bette.caan@kp.org
13. Breast Cancer Res Treat. 2009 Nov;118(2):395-405. Soy isoflavones and risk of cancer recurrence in a cohort of breast cancer survivors: the Life After Cancer Epidemiology study. Guha N, Kwan ML, Quesenberry CP Jr, Weltzien EK, Castillo AL, Caan BJ. Department of Epidemiology, University of California, Berkeley, CA, USA. neela@berkeley.edu
14. JAMA. 2009 Dec 9;302(22):2437-43. Soy food intake and breast cancer survival. Shu XO, Zheng Y, Cai H, Gu K, Chen Z, Zheng W, Lu W. Department of Medicine, Vanderbilt Epidemiology Center, 2525 West End Ave, Ste 600, Nashville, TN 37203-1738, USA. xiao-ou.shu@vanderbilt.edu