I'm a cancer specialist - this is what you need to know about supermodel Elle Macpherson's cancer treatment and chemotherapy refusal

Australian supermodel Elle Macpherson has revealed she was diagnosed with breast cancer seven years ago. The 60-year-old opened up about her secret battle with the disease and has explained why she turned down receiving chemotherapy.

She recounted how she was diagnosed after undergoing a lumpectomy and her doctor suggested “a mastectomy with radiation, chemotherapy, hormone therapy, plus reconstruction of her breast”. But instead she opted for “an intuitive, heart-led, holistic approach” to treating her cancer which used a “combination of therapies and lifestyle changes to treat and heal the whole person”.

Supermodel Elle Macpherson’s decision to support her mind and body with a healthy lifestyle and diet is commendable but some facts need to be stressed before other women decline curative conventional therapies, to their detriment.

First, it must be noted that Elle did not decline all treatments - she did, very sensibly, have the tumour surgically removed. This is the fundamental essential to any cancer management - I would urge everyone to accept this. For some cancers, such as those originating in the prostate, radical radiotherapy is an attractive alternative and, with advances in technology, is usually well tolerated.

Either way, the original source of legal cancer cells have been removed or killed. I get very saddened when patients come to me to discuss integrative management without primary treatment. My experience, over the last 30 years, is that in the vast majority of these patients, the breast cancer grows and spreads often with horrendous, mutilating consequences.

The next decisions with Elle’s oncology team would have been related to further “adjuvant” treatments. These are what The Princess of Wales recently called supportive treatments.

They are designed to reduce the odds of the cancer returning later in life, either in the breast or elsewhere in the body. It is not actually clear, however, from her memoirs whether Elle received further local adjuvant treatments. Elle mentioned that a mastectomy was recommended by her doctors, so there must have been some risk factors for local relapse such as a large-sized tumour or close resection margins.

She did not mention whether she received radiotherapy which would have been advisable, if this was the case. In most cases, such as Kylie Minogue, using the latest radiotherapy techniques, the shape, texture of the breast and condition of the skin is maintained so should not have affected her career.

Her tumour was apparently oestrogen receptor positive, so she would have had some reduction in risk of relapse with tamoxifen or other hormone drugs such as anastrozole.

These can have side effects such as hot flushes, joint pains and other menopausal-like effects. Unless the tumour is very low risk, I usually advise these and use dietary and lifestyle strategies to mitigate or eliminate the side effects. This personal experience empowers women to make more informed decisions going forward, even if it means stopping the tablets or changing to different types.

Our research team conducted a number of clinical trials switching between different types of hormones and some women found types which suited them, so were able to continue, but others decided to stop.

As regards her chemotherapy, Elle mentioned her tumour was HER2+ve so, again she would have had a reduction in risk with chemotherapy and Herceptin. Depending on the individual features of the cancer these could halve the risk of cancer coming back but they do have many risks and side effects. On top of the immediate risk of hair loss, infection, heart damage, blood clots, diarrhoea and nausea these are more common adverse effects which can linger for months and even years:

Changes in body image including hair loss, weight gain and damage to the nails. These often affect a person’s sense of identity and confidence socially and in the workplace.

Fatigue, loss of muscle mass and other physical symptoms such as joint pains can make it difficult to perform daily tasks that were previously routine.

Cognitive impairment (”Chemo Brain”) can affect memory, ability to concentrate and make decisions. This can last up to six months or longer if also taking hormone drugs.

Menopausal symptoms can brought on earlier in life and more abruptly. Unfortunately, HRT is usually contraindicated following breast cancer but some supplements can help.

The emotional and psychological toll of cancer and treatment can be substantial. Anxiety, depression and fear of recurrence are common among cancer survivors.

Sleep disruption is common, caused by ongoing medication, and physical and psychological symptoms. Fortunately, sleep hygiene and other nutritional interventions can help.

Damage to the nerves can cause troublesome pins and needles and a burning sensation in the hands and feet. Exercise and dietary strategies can help, but this can still last for years.

Bearing in mind these risks and side effects, it is clearly not an easy decision to proceed with chemotherapy or not. There are now extra tools such as NHS Predict and oncotype DX which help patients and doctors understand the risks and benefits of treatment, so make the decision easier. Even after chemotherapy there is still chance of relapse but fortunately more and more scientific evidence is showing that dietary and lifestyle strategies can not only reduce the risk of the cancer coming back but improving overall wellbeing and quality of life. Here is a brief summary of the most important factors:

Avoid being overweight or obese which increases the risk of breast cancer relapse. Abdominal obesity, raised sugar, fats, blood pressure and inflammation, a condition called metabolic syndrome, is particularly harmful.

Smoking is the main cause of lung cancer but also correlates with a higher risk of aggressive breast cancer and relapse after treatment.

Regular exercise for about 2.5 - 3 hours a week, and avoiding long periods of sitting, have been linked to about a 30% lower risk of breast cancer relapse. It’s important to find an activity which is enjoyable and sustainable such as running, brisk walking or cycling.

Ensuring adequate vitamin D levels reduces the increased risk of breast cancer. Sun bathing, without burning, is the best way to increase levels but a supplementation, in the darker months, would be sensible, especially if combined with a probiotic that enhances its effect.

Try to get a good night’s sleep as chronic insomnia can lead to alteration in the circadian rhythm, fatigue, and a demotivation to exercise and undertake healthy living programmes all of which increases breast cancer risk. There are lots of dietary and lifestyle tips to improve sleep patterns and some over-the-counter supplements which can help.

Be careful with alcohol: Although a few glasses of red wine a week has not been linked to higher breast cancer relapse, studies suggest that any amount of alcohol increases the risk of breast cancer in the first place.

Improved gut health has been linked with a lower risk of many cancers, less fatigue, better mood and motivation to lead a healthy anti-cancer lifestyle. Factors which affect gut health include exercise, processed sugar, smoking, obesity and stress. Bacteria-rich foods such as kefir and kimchi help. Probiotic capsules, especially those combined with vitamin D have a role especially in people with existing gut problems.

Ditch the processed sugar, especially in drinks, as this increases the risks of many diseases including arthritis which impedes exercise, obesity which lead to breast cancer. Adding sugar to tea or coffee also negates their otherwise protective benefits.

Eating more fruit, nuts, cruciferous vegetables and spices increases the intake of healthy phytochemicals, which protect us from cancer and breast cancer relapse by reducing excess inflammation and improving gut flora. They helps many of the long-term side effects of treatments and some trials have shown that boosting the diet with phytochemical rich supplements can reduce the risks of progression.

Avoid certain supplements which are not evaluated for safety and effectiveness in ethically approved scientific trials. Some contain strong extracts from cloves and spearmint which can over-ride antioxidant pathways and have significant hormonal effects which could do harm. Also be careful with vitamin A and E supplements as they are also direct anti-oxidants and a number of studies have actually reported an increased risk of cancer. Fish oil supplements have rarely shown a benefit over a good diet as most are preserved with vitamin E.

Reducing meat and particularly processed meat intake such as grilled sausages, bacon, sliced ham and tinned meats will reduce the risk of many cancers including breast compared to low or no meat eaters.

Avoid Ultra Processed Foods (UPF) which are high in salt, sugar, nitrates, trans fats, colours, flavourings, and industrial contaminants, whilst low in fibre, minerals, vitamins and phytochemicals. They can cause oxidative stress, inflammation and reduced immunity so people who eat a lot of them are more prone to infections and cancer but also other conditions which indirectly increase the risk such as obesity, diabetes and poor gut health.

Carcinogens: We are surrounded by potentially toxic chemicals which can promote cancer growth. The worse culprits include smoked food, aromatic amines in chargrilled meats, and acrylamides in superheated sugary snacks and cereals. Some environmental chemicals such as pesticides, plastics, cosmetic, deodorants, household cleaning agents and air pollution can promote cancers of the breast via abnormal hormonal stimulation. Try to limit exposure by using glass or stainless steel containers instead of plastic, choose natural personal care products, and avoid using pesticides.

Eating more soy products such as soy milk, tofu and edamame has been linked to a reduced risk of breast cancer and relapse after treatment. Concentrated soy extracts are too strong and should be avoided after breast and prostate cancer.

Omega fatty acids are essential for vital immune and inflammatory pathways. Diets rich in omega fatty acids are associated with lower breast cancer risk and relapse. We certainly should be eating more nuts, flax, avocados, pumpkin and chia seeds, and as well as seafood including algae, seaweed, mackerel, sardines at least three times a week.

Keeping the teeth clean will reduce chronic inflammation. Studies show that people with poor dental hygiene have more cancers and other inflammatory related diseases such dementia, heart attacks and strokes which can be more common after cancer treatments.

So, in conclusion, chemotherapy, radiotherapy and hormones reduce the risk of breast cancer and save thousand of lives every year. Most women with high risk disease tolerate them, to a certain extent, but there can be serious long-term consequences which Elle Macpherson clearly understood. She made the decision understanding the risks and benefits and that has to be respected. More importantly she made substantive changes to her diet and lifestyle which also improved her wellbeing and reduced her risks. The fact that she is here to tell the tale, eight years later, speaks for itself.

Further information about lifestyle strategies after cancer can be read in the book How to Live.

Eating more nuts helps reduces the risk of bowel and prostate cancer but more importantly it reduces the risk of death because nut eaters develop slower growing more curable cancers.

Consuming adequate calcium via both diary and non-dairy foods reduces bowel cancer risk. A recent large USA survey also suggested that men who included some diary in their diet also had a lower risk of heart disease. Very high intake of dairy products, on the other hand, has been linked to a slightly higher risk of prostate cancer and weigh gain. It is clear that, despite popular misconceptions, moderate amounts of milk in tea, and coffee clearly do not increase cancer risks, as do not fermented cheeses and yogurt.

So, in conclusion, although we cannot completely eliminate the risk, we can do a lot to reduce the chances of contracting cancer as well as other chronic diseases, premature aging and death. For those of you who have read to the end of this article (well done!) you may be interested in my book How to Live which provides more in-depth explanations of how and why lifestyle interacts with cancer disease and effects longevity.