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Attitudes, perceptions and practices of oncologists and naturopathic physicians regarding the role of diet in breast cancer prevention and treatment Novak, Kerri L.


Increasing consumer demands for holistic health care and dietary advice parallel conflicting and incomplete messages in the scientific and lay literature regarding the role of nutrition in breast cancer. Oncologists and naturopaths are important sources of advice to help women sort out such conflicting information. In this qualitative study, 10 oncologists and 11 naturopaths were interviewed to explore their beliefs and counseling practices regarding the relationship between diet and breast cancer. Interviews were transcribed verbatim and analysed using qualitative methods. The oncologists believed age, genetics and reproductive factors are important risk factors, and while dietary factors such as fat and alcohol consumption may play a role, such relationships have not been proven scientifically. The oncologists suggested increasing fruit, vegetable and fibre intakes could improve overall health; however because available research evidence does not meet the criteria of evidence-based medicine, they did not make specific dietary recommendations for breast cancer prevention or treatment. Alternatively, the naturopaths implicated exogenous hormones, environmental pollutants and lifestyle factors like diet and stress as important contributors to breast cancer etiology. They recommended that patients increase consumption of organic whole foods, antioxidant supplements, fruits and vegetables, and avoid processed or refined foods, animal fats, dairy products and sugar to decrease breast cancer risk. These recommendations were based on a combination of published scientific evidence, clinical experience and single case studies. The naturopaths' lack of exclusive reliance on science to justify clinical recommendations was described by oncologists as their primary reason for not working directly with naturopaths. Alternatively, the naturopaths believed they were excluded from conventional breast cancer care for political reasons. Differences in practitioners' beliefs and perceptions of each others' profession reflect variations in their training in the scientific method and their educational and professional socialization. The variation in these health professionals' beliefs, use of evidence, and resulting clinical practices and misperceptions of each other fuel mutual misunderstanding. An open and respectful dialogue between oncologists and naturopaths is important to bridge gaps between these professionals, and to facilitate patients' ability to make informed choices about their health care and dietary practices.

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