Breasts: An Owner’s Manual: Every Woman’s Guide to Reducing Cancer Risk, Making Treatment Choices and Optimising Outcomes

About the Author

Dr. KRISTI FUNK, board-certified breast cancer surgeon and cofounder of the Pink Lotus Breast Center, is an expert in minimally invasive diagnostic and treatment methods for all types of breast disease. She has helped thousands of women through breast treatment, including well-known celebrities such as Angelina Jolie and Sheryl Crow, who have turned to her for her surgical expertise.

After graduating with distinction from Stanford University in 1991, Dr. Funk received her medical degree from the UC Davis School of Medicine. Following her surgical residency at Virginia Mason Medical Center in Seattle, Washington, she completed a surgical breast fellowship at Cedars-Sinai Medical Center in Los Angeles, where she then excelled as a surgeon and breast center director for seven years. In 2009, Dr. Funk, alongside her entrepreneurial husband, Andy Funk, opened the Pink Lotus Breast Center in Beverly Hills. The Pink Lotus Breast Center fuses state-of-the-art screening, genetic testing, diagnosis, and treatment with preventive strategies and holistic, compassionate care.

Dr. Funk is also the founding ambassador of the Pink Lotus Foundation, whose mission is to provide low-income, uninsured, and underinsured women free access to breast cancer screening and care.

When not appearing as a breast expert and TV personality in hundreds of television segments, documentaries, news articles, and stories, Dr. Funk enjoys Half Ironman triathlon races, vegan cooking, and card games. She resides with Andy and their three sons in Santa Monica, a peaceful suburb of Los Angeles.

Copyright

An imprint of HarperCollins Publishers Ltd

1 London Bridge Street

London SE1 9GF

First published in Great Britain by HQ in 2018

Copyright © Kristi Funk 2018

Kristi Funk asserts the moral right to be identified as the author of this work.

A catalogue record for this book is available from the British Library.

This novel is entirely a work of fiction. The names, characters and incidents portrayed in it are the work of the author’s imagination. Any resemblance to actual persons, living or dead, events or localities is entirely coincidental.

All rights reserved under International and Pan-American Copyright Conventions. By payment of the required fees, you have been granted the non-exclusive, non-transferable right to access and read the text of this e-book on-screen. No part of this text may be reproduced, transmitted, downloaded, decompiled, reverse engineered, or stored in or introduced into any information storage and retrieval system, in any form or by any means, whether electronic or mechanical, now known or hereinafter invented, without the express written permission of HarperCollins.

Ebook Edition © June 2018 ISBN: 9780008271398

Praise for Breasts: An Owner’s Manual

“I love this book! In Breasts: An Owner’s Manual, Dr. Kristi Funk’s evidence-based advice will have you kicking breast cancer—and all of life’s major killers—to the curb.”

—MICHAEL GREGER, MD, FACLM

Founder, Nutritionfacts.org

New York Times Bestselling Author

“Dr. Funk writes Breasts: An Owner’s Manual just like she talks: with conviction, passion, and a laser focus on you.”

—DR. MEHMET OZ

Host, The Dr. Oz Show

Professor of Surgery, New York Presbyterian Columbia University

Director, Integrative Medicine Center,

Columbia University Medical Center

New York Times Bestselling Author

“Breasts: An Owner’s Manual is an empowering guide to the latest life-saving information. It has everything you need for protecting and improving your health, tackling medical questions, planning health-supporting meals, and breaking through the myths that could hold you back, all in an easy-to-read format.”

—NEAL D. BARNARD, MD, FACC

Adjunct Associate Professor of Medicine,

George Washington University School of Medicine

President, Physicians Committee for Responsible Medicine

New York Times Bestselling Author

“Dr. Funk has written an incredibly detailed and carefully documented book on the very complex topics of breast health and breast cancer. She lays out a clear plan for breast health, cancer prevention, and, in reality, a lifestyle that we all could use to improve our health. Presented in an easily approachable manner, Breasts: An Owner’s Manual does not spare the science (in fact, it really ladles it on), but Dr. Funk makes the science readable in a conversational style that both calms and empowers the reader (exactly how I imagine she talks with her patients!). As she writes in the introduction, ‘Knowledge is power, and power replaces fear with confidence and joy, which motivates you to implement changes’—words that all patients (and all of us) can take to heart, making positive changes and taking control of our futures!”

—PETER D. BEITSCH, MD, FACS

Director, Dallas Breast Center

Past President, American Society of Breast Surgeons

“Dr. Funk uses scientific facts, complex theories, and clinical experience to artfully compose and communicate pearls of advice that are actionable and sensible. Breasts: An Owner’s Manual will become an indispensable and valued guide for women looking to optimize health and minimize breast illness.”

—DEBU TRIPATHY, MD

Professor and Chair, Department of Breast Medical Oncology,

University of Texas MD Anderson Cancer Center

Editor-in-Chief, CURE Magazine

“In Breasts: An Owner’s Manual, I can hear Dr. Funk’s straight-talking, witty voice as she debunks breast myths, simplifies complex choices, and inspires you to become your healthiest self. An important read for anyone looking to take charge of their health.”

—TRAVIS STORK, MD

Host, The Doctors

Emergency Medicine Physician

“Breasts: An Owner’s Manual not only provides a clear path to breast health, but a road that leads straight to your healthiest self. As someone who has faced breast cancer, I suggest you follow it.”

—ROBIN ROBERTS

Coanchor, Good Morning America

“Dr. Kristi Funk distills the complex topic of cancer causation and promotion down to practical, actionable advice and cutting-edge nutritional science. Breasts: An Owner’s Manual will become a cherished, life-saving manual shared among all generations of women throughout the world, for both breast health and breast illness. There’s simply no guide like it—and it’s so compelling to read!”

—CAROLYN “BO” ALDIGÉ

President and Founder, Prevent Cancer Foundation

“Breasts: An Owner’s Manual is highly readable, informative, and practical. Dr. Funk is a trustworthy and knowledgeable source of information. If you’re searching for the comprehensive book on breast health, look no further.”

—MIKE DOW, PSYD

Psychotherapist

New York Times Bestselling Author

“I believe that Breasts: An Owner’s Manual will change and save lives and serve as a gateway for many women to enter into a total health transformation: physical, mental, and spiritual. It is a comprehensive how-to, go-to book addressing the lifestyle issues of anyone with breasts. Somehow Dr. Funk has been able to neatly dissect, define, and package this explosive information. You now hold in your hands knowledge of revolutionary proportions. The light of this manual chases away the darkness that can be associated with breast health. Now sit back and enjoy the ride.”

—BEVERLY “BAM” CRAWFORD, DD

Chancellor, Bible Enrichment Fellowship International Church

“We all have (or had) breasts, but who has ever told us how to care for them? What should you eat, not eat, do, not do—and what about all those risk factors over which you have no control? There are so many mixed messages about screening and even about what to do after you’ve been diagnosed. In Breasts: An Owner’s Manual, Dr. Funk helps you sift through all the confusion as though you’re having coffee with a dear friend—a friend who just happens to know a lot about breast health and illness! So grab a cup and turn the page.”

—LISA LING

TV Journalist

Producer and Host of This Is Life with Lisa Ling

To the women and girls all over this wonderful world who have—or had—breasts.

Contents

Cover

About the Author

Title Page

Copyright

Praise

Dedication

Foreword by Sheryl Crow

Author’s Note

Introduction

PART 1: Breast Health Basics

Chapter 1: Breast Care ABCs

Chapter 2: Debunking Breast Cancer Myths

PART 2: Reducing Cancer Risk

Chapter 3: Eat This

Chapter 4: Don’t Eat That

Chapter 5: Beyond Food: What You Should Do

PART 3: Learn Your Personal Risk Factors and Control What You Can

Chapter 6: Uncontrollable Risk Factors: Do You Have Them?

Chapter 7: Medications and Operations to Consider

PART 4: Making Medical Choices and Living with Risk

Chapter 8: Breast Cancer Screening and Detection

Chapter 9: Cancer Happens: A Newly Diagnosed Starter Kit

Chapter 10: Now What? Life After Diagnosis and Treatment

Acknowledgments

Appendix: Acronyms and Abbreviations

Notes

Index

About the Publisher

Foreword

I’m embarrassed to say that when I first walked into my appointment with Dr. Kristi Funk, I wanted to turn around and leave. I thought, There’s no way this young woman whose beauty rivals Jessica Simpson’s can be the doctor I’ve heard so much about from my gynecologist and my internist as being someone who is widely known for her dedication and expertise to breast surgery. Boy, was I wrong! And furthermore, that appointment was one of the big blessings to come from my cancer experience. Not only was she then—and remains now—one of the finest breast surgeons a woman could have, but she also has been an inspiration and a friend to me ever since I walked into her office.

It was February 2006, and I was due to have my yearly mammogram. This one seemed to be more of a nuisance than ones in the past, because my engagement had just fallen apart five days before and I really didn’t want to be bothered with something I knew would be a waste of time. I was healthy and extremely fit, having spent the better part of the previous three years riding my bicycle up the sides of mountains—and I had no family history of breast cancer. I licked my wounds and went ahead and got it over with.

A few days after my mammogram, my gynecologist called me and suggested that I have two biopsies just to answer any questions that had shown up on the film, rather than waiting the recommended six months to view the areas again. She advised me to see Kristi Funk, who performed surgery a few days later.

I went through the painful process of a wire-localized open surgical biopsy and went home to resume the business of getting on with life. Four days later, I went in for my postoperative appointment with Dr. Funk. I will never forget the look on Kristi’s face when she told me that, although the odds of my having invasive cancer had been extremely minimal, mine was invasive, and I would need additional treatments. It was a blow of the first degree to someone who, until that point, had had complete and total control over every aspect of her life, or so I thought. And it seemed a blow to Kristi as well.

Now that I know Dr. Funk as I do, I believe each time she has had to deliver the outcome of a cancer screening that renders a malignant diagnosis, it has felt like a blow to her.

I got through my treatment uneventfully and went about rebuilding my life, personally and physically. Cancer was a game changer in the best and hardest of ways. I had to learn to put myself first, and I had to challenge what it means in a woman’s life to always nurture others but never to allow anyone to nurture her. I had to learn to say no and to be okay with not everyone liking or respecting me. I had to learn how symbolic breasts truly are and to accept that reality.

Accepting these truths seemed to be the lesson in the cancer experience for me—and from what I have heard from the countless women I have met in the most random of places who come up to me and share their cancer experiences, there is a lesson in it for everyone. Additionally, cancer changed my behavior; I had to learn about self-care and quality of living through nutrition and alleviating stress.

After some time passed, Kristi and her husband, Andy, and I met about their dream of opening a place that offered a “one-stop shop” where breast cancer screening, diagnosis, and treatment happened seamlessly and comfortably under one roof. I was all in. Their dream would eventually become Pink Lotus, including the free care they provide to underserved women via the Pink Lotus Foundation. The Pink Lotus Breast Center would offer the first contrast-enhanced digital mammograms in North America, combining Western medicine with complementary and alternative medicine, nutrition, psychology, physical therapy, genetics, and innovative technologies — and offering women holistic, whole-body view of health and wellness.

Over the years, I have learned so much about how to live a healthier life through diet and exercise and meditation. I wince every time I hear from someone I know or someone who is distantly connected that they’ve been diagnosed with breast cancer or cancer in general. The 1 out of 8 statistic seems to hold on, but we are learning more about prevention, and until there is a cure . . . well, early detection is a great help, but prevention is the greatest hope for us all.

Over a decade later, I remain grateful to Kristi for continuing to be driven to learn more about how to outsmart this insidious disease. Whether you live with or without breasts, there is so much to know and so many things one can do. Navigating it all can become confusing, especially with all the contradictory advice out there. Dr. Funk’s book is a gift to women everywhere looking for answers to breast issues and to health in general. Kristi shares what she learns in the hopes that eventually she will be out of a job as a breast cancer surgeon!

—Sheryl Crow

Author’s Note

My mom was thirty-six years old and had five children under the age of fourteen (I was two) in December 1971. She was in peak fitness as a competitive A-level tennis player who swam daily when she suffered a stroke and inexplicably fell into a coma that lasted three weeks. The UCLA doctors told my father on multiple occasions not to leave for home that night, for she would surely die by morning. A priest administered the sacrament of last rites, which I believe made heaven take notice: Oh heck no, we aren’t ready for that ornery MaryAnn; give her another fifty-plus. So she woke up! (If you ever meet me—and I hope you do—ask me how she woke up.) My mom remained in rehab for a year before returning home, relearning how to speak and how to walk, since she would never move her right side again (hemiparesis). All of my parents’ “friends” disappeared and my dad downsized the house, but his love for her never diminished; in fact, it grew. To this day, in their late eighties, he defends her fiercely and assists her tenderly. How could you not cherish a warrior who stared down death and won—without speaking a word?

That’s where I come from, and that’s what I offer you. I possess the dogged determination and tenacity of my mother, mixed with the empathy and compassion of my father. So when you fling excuses and hopelessness at me, I will whack you with a reality check. And when you come to me scared and broken, I will hug you until you’re whole again.

After my relationship with God, I only really care about two things in this life: loving family and killing cancer. You picked up this book. You’re family now, so let’s get going.

Introduction

From the age of four, I wanted to be an actress. (Ha! You thought I was going to say I always wanted to be a doctor, didn’t you?) I performed in every school play, beginning with Sleeping Beauty in the second grade and continuing all the way through college, when I starred as Oedipus in an all-female production. Yet Hollywood was never my endgame. I actually pictured myself helping children heal from illness, using drama and imaginative play to explore the feelings and fears brought on by sickness.

Cut to my sophomore year as a psychology major at Stanford University, when I experienced an epiphany that would both change my course and guide it to this day. In the midst of studying for a neuropsychology final, painstakingly trying to memorize which neurotransmitters in the brain led to which functions of the body, I experienced an unmistakable and repetitive “interrupting thought” that made my own neurotransmitters buzz. It came from God.

You’re going to be a doctor, it said. Whoa.

Okay, that was interesting. Incorrect, but interesting. You see, my female role models married young, and all I wanted was to raise a family and work as a drama therapist. I traveled to Africa a week later on a summer missionary trip that had been planned for months. When I saw firsthand the health challenges that millions of men, women, and children face, my life’s purpose snapped into shape—and not in the form of theater or therapy. I felt newly inspired to care for people in the one way that matters most to them—by helping them maintain the very vessel that carries them around all day: their bodies. Disease robs far too many people of joy, replacing hope with chronic illness and death. It isn’t right. As I sat cross-legged in a dung hut, balancing potatoes on my head to make the tribal kids laugh, I decided to do something with my life to try to stop the killer of joy: I heeded God’s voice and resolved to become a doctor.

I went to medical school, did my residency in general surgery, and then completed a surgical breast fellowship at Cedars-Sinai Medical Center. I stayed on to become the director of patient education at their breast center, where I gave a number of community and physician lectures. Most women don’t want to hear about cancer unless they have it and need to make some decisions, so rather than bore them to tears with medical jargon, I challenged my audiences by discussing attention-grabbing studies that would incite them to alter their behavior. I delved into risk reduction and discovered all sorts of lifestyle game changers. I loved the work, and patients responded like crazy. I couldn’t wait to get to the office to spend all day examining and educating women, operating with curative intent, and becoming creative when a diagnosis or cosmetic issue became challenging. Everything I did back then and continue to do today—helping women boost their health, reduce their breast cancer risk, make sense of a diagnosis, or find their way after treatment—inspired the book you’re reading now.

A MULTILAYERED PROBLEM

Whether perky or droopy, full or flat, for two organs perched front and center on half the population’s chests, it is pretty crazy that breast health remains rather mysterious to many breast owners. Most women don’t know much about their breasts, what their purposes are, and how to keep them healthy so the rest of their bodies can thrive. Everyone knows that breasts can grow cancer, which is the number-one killer of women ages twenty to fifty-nine, yet there’s never been a solid and informed conversation about how to reduce our risk factors for this disease and why certain precautions might help.

Any breast health conversation needs to focus on two problems: numbers and knowledge. First and foremost, breast cancer is a pandemic concern, and the numbers sure prove it. In the United States alone, 1 in 8 women will be diagnosed with breast cancer at some point in their lives. Every year, we identify 1.7 million new breast cancer cases worldwide, with over 300,000 in the US. Interestingly, incidence rates vary fourfold across the globe, ranging from 27 per 100,000 in Middle Africa and Eastern Asia, to 93 in the US, to 112 in Belgium, and it’s not the weather that accounts for these global disparities. If this freaks you out, you’re not alone.

Based on my experience as a board-certified breast cancer surgeon who has helped tens of thousands of women navigate breast health issues, I know for a fact that we have the power to reduce our breast cancer risk in achievable and dramatic ways. Enter our second big problem with breast cancer awareness: erroneous public perception. Most women believe that family history and genetics determine who gets breast cancer, but for most people, they don’t. Inherited mutations, like BRCA, only cause 5 to 10 percent of breast cancer; in fact, 87 percent of women diagnosed with breast cancer do not have a single first-degree relative with breast cancer.1

I’ll give you a minute to pick your jaw up off the floor.

For the last thirty years, the medical community has not corrected the false notions held by the majority of breast cancer survivors who attribute their breast cancer entirely to family history, environmental factors, stress, or fate—all factors predominantly not under their direct control.2 Yet research tells us that if, before reaching menopause, women embrace a lifestyle that prioritizes exercise, not smoking, not drinking alcohol, and a diet shifted away from meat and dairy toward whole food, plant-based eating, their odds of getting breast cancer are slashed in half. And for older women, risk drops by 80 percent.3

That’s right. You have the opportunity to impact the way you behave toward your breasts and how your breasts respond to that behavior. Rigorous science and firsthand experience in the trenches back up everything I know to be true about breast cancer risk reduction and care. The women I treat are exactly like you. They share your concerns about any new mammogram finding, pain, lump, itch, or discharge. They want to know if there’s anything new under the sun that they can do to ward off this disease. Most of the patients who heed my diet, lifestyle, and medical advice come away from our conversations feeling empowered and relieved, gaining clarity over “the right thing to do.” Depending on the changes they make, women might also notice that their fibrocystic lumps and pain disappear, their obesity or diabetes improves, or they find themselves cancer-free year after year.

I must mention here that having an unhealthy lifestyle doesn’t guarantee a future breast cancer diagnosis; similarly, we can never know with certainty that lifestyle choices caused the cancer you might have already had. Moreover, even women following an ideal lifestyle get breast cancer (although not as frequently, as we shall repeatedly see), and boy, are they upset. “I did everything right!”