Every woman wants to know what she can do to lower her risk of developing breast cancer. If you have no personal history of the disease, you want to do what you can to stay clear of it. And if you have had breast cancer, you never want to get it again. You want to know how to lower your risk of the cancer coming back, and you want to reduce your risk of getting an unrelated new breast cancer.
The best defense against breast cancer is a good offense. There are no perfect solutions, but you can do many things to reduce your risk.
Regular screening tests for breast cancer, such as an annual mammogram and a breast exam during your annual checkup, allow you and your doctor to ensure that your breasts are as healthy as they can be. Screening also increases the likelihood that your doctor will find breast cancer early, when it's most treatable.
Many factors might affect your risk for breast cancer and other diseases. You may be able to control and modify some of these, including:
what you eat
how much you weigh and maintaining a healthy weight
how much you exercise
whether you smoke
whether you drink alcohol and if so, how much and how frequently
the types of chemicals in your environment
whether you took hormone replacement therapy (HRT) for menopausal symptoms for 5 years or longer
Making these changes in your life can be quite difficult. But it becomes easier to make these changes when you understand each factor, the importance of the changes, and practical ways to make the changes. And when it comes to the factors that can't be controlled, we'll help you work around them.
Some of the factors that increase your risk for getting breast cancer are things you can't control:
Age: Just as with many other diseases, the risk of getting breast cancer goes up as you get older. Your average risk of getting breast cancer over your lifetime is 1 in 7, assuming you live to age 90. But each 20 or so years of your life is associated with a different level of risk:
From birth to age 39, your risk is 1 in 229.
From age 40 to 59, your risk is 1 in 24.
From age 60 to 79, your risk is 1 in 13.
The 1 in 7 statistic comes from averaging all the different risk levels. So the overall risk will always be higher than the risk associated with any one age bracket.
Personal history of breast cancer: If you have had breast cancer already, you are at risk of it coming back. That risk might be low or high, depending on your situation. And you are at higher risk of getting a NEW breast cancer compared to someone else who has never had the disease.
Family history: Breast cancer in your family can have a significant impact on your risk. But this doesn't ALWAYS mean that you are at high risk just because someone in your family had breast cancer. For example, if your grandmother was diagnosed with breast cancer at age 75, this may not increase your risk of the disease. Your grandmother was most likely just one of the 1 in 13 women who gets breast cancer between the ages of 60 and 79.
Certain breast changes: Normal breast cells can sometimes get overexcited and start to misbehave. These changes can show up as a lump, thickness, or calcifications on a mammogram. If a biopsy is done, these changes can be seen under a microscope. When the breast duct cells are overactive and appear unusual, the pathology report may describe these findings with the term atypical ductal hyperplasia. An uncontrolled growth of breast cells in the lobule (the part of the breast that makes milk) is called lobular carcinoma in situ or LCIS. (Even though the word “carcinoma” is part of the term LCIS, it is not considered a true cancer.) These two types of breast changes are associated with an increased risk of breast cancer in the future. But these abnormalities are not themselves cancerous.
Genetic alterations: To date, most inherited cases of breast cancer have been associated with two genes: BRCA1, which stands for BReast CAncer gene one, and BRCA2, or BReast CAncer gene two. The function of these genes is to keep breast cells growing normally and to prevent any cancer cell growth. But when these genes contain abnormalities, or mutations, they are associated with an increased breast cancer risk. Abnormal BRCA1 and BRCA2 genes may account for up to 10% of all breast cancers. Women diagnosed with breast cancer who have an abnormal BRCA1 or BRCA2 gene often have a family history of breast cancer, ovarian cancer, or both. There are also women with a strong family history of breast cancer who might have another kind of genetic abnormality that's not yet been identified. But it's also important to remember that most women with breast cancer have no significant family history of the disease.
Menstrual history: You have no control over the amount of estrogen that your ovaries produce over time. If you were very young when you got your first period, you had a late menopause, or both, you have had more years of exposure to estrogen and other hormones produced by your ovaries. Women who had their first period before they were 12 years old or went through menopause after 55 have a higher risk of breast cancer than women with fewer years of exposure to hormones made by the ovaries.
Race: Breast cancer in the United States occurs more often in white women than Latina, Asian, or African American women. But in women 40 and younger, African American women have the highest risk.
Radiation therapy to the chestbefore you were 30 years old: If you had radiation therapy to your chest before you were 30 years old, and particularly during adolescence, you may have a higher risk of developing breast cancer. This has been seen in young women receiving radiation to treat Hodgkin's disease. (This does NOT include radiation therapy to treat breast cancer.)
Breast density: Past research has shown that women with “dense” breasts, which contain more glandular and connective tissue, are more likely to be diagnosed with breast cancer than women whose breasts are less dense (mainly made up of fat tissue). Breast cancer itself is dense and starts from glandular tissue. Estrogen makes breast tissue more dense. So the connection between breast density and breast cancer may be related to higher levels of estrogen in the body. On a mammogram, a cancer is harder to spot in dense tissue than in fatty tissue. That's because the cancer looks a lot like the glandular tissue around it.
Exposure to DES (diethylstilbestrol): DES is an estrogen-like hormone used in the past to help women prevent miscarriage. Daughters of women who used DES have an increased risk of cancer of the vagina. This drug may also increase the risk of breast cancer in women who used it and in their daughters who were also exposed to it.
Late pregnancy or no pregnancy: Women who had their first full-term pregnancy after age 30 and women who never had a full-term pregnancy are at higher risk for breast cancer than those who gave birth earlier in life. A full-term pregnancy, which stops your menstrual cycle for 9 months, seems to offer protection against breast cancer.
If you weigh uncontrollable factors against those that CAN be changed, you'll see that you can do a lot to lower your risk of breast cancer. And while it's very hard to pin down specific foods or chemicals that are firmly linked to a higher or lower risk of breast cancer, researchers are working hard to find out whatever they can about specific lifestyle and environmental factors that may be within your control.
Making the following changes in your life will improve your overall health and also MAY SIGNIFICANTLY REDUCE your risk for breast cancer.
Stop smoking. You should use every resource you can find to help you quit smoking — for good! Research shows that smoking causes many diseases, and it is associated with an increased risk of developing breast cancer. Smoking can also increase complications from breast cancer treatment. It can worsen radiation damage to the lung, cause difficulty healing after surgery, and increase risk of blood clots with hormonal therapy. But even knowing about all of the dangers isn't always enough to make you quit. Smoking is a habit that's very hard to break. Fortunately, if you're serious about trying, you have lots of help:
The American Lung Association offers a free online smoking cessation program. The American Cancer Society also has a program to help people quit smoking. You can also call their “quitline,” at 1-800-ACS-2345, to get support and free advice on how to stop smoking from trained counselors.
Medications to help you quit can be taken as a pill, chewed as gum, or worn as a patch on the skin.
Acupuncture and meditation can also help.
It's also easier if you have a friend or “buddy” who can either stop with you or cheer you on when you're feeling you can't make it on your own.
Get more exercise. Exercise has many healthy benefits. Research has shown that 5 hours of exercise a week may lower the risk of breast cancer. Over time, exercise may be able to lower the estrogen levels in your body. With less estrogen around, there is less stimulation of breast cell growth, which is associated with a lower risk of breast cancer. Other research on exercise and breast cancer has found that exercise also can help boost the immune system, limit weight gain from chemotherapy, and help ease treatment side effects.
Maintain a healthy weight. Overweight women have an increased risk of getting breast cancer after menopause. And being overweight can increase the risk of breast cancer coming back in women who have had the disease. There are probably several reasons that being overweight is associated with an increased risk of breast cancer. Extra fat cells make extra estrogen that might stimulate breast cell growth. Plus, overweight women tend to exercise less and eat higher-fat foods. Regular exercise can reduce fat in the body and help with weight loss. As we age, it's harder to keep weight under control because our metabolism slows down and we tend to get less exercise. But if you can stick to a low-fat, low-calorie diet and stay physically active, weight is much easier to control. Our Ask-the-Expert Online Conference from January 2005 has some good general tips on losing weight.
Reduce your exposure to estrogen. Prolonged exposure to estrogen without a break can increase your risk for breast cancer. To reduce or eliminate sources of extra estrogen from your diet and environment, try the following steps:
Shed any extra pounds and try to keep those pounds off. Extra fat cells make extra estrogen. At a healthy weight, estrogen levels tend to be lower.
If you have already had breast cancer, avoid taking estrogen-like and progesterone-like products such as menopausal hormone replacement therapy (HRT) and DHEA (dehydroepiandrosterone). So far the increased risk of breast cancer is most closely associated with the combination of estrogen and progesterone pills. Little is known about the relative safety of vaginal creams, gels, rings (such as Estring), “natural” hormones, and herbal hormone-like remedies. Your doctor may prescribe vaginal hormones to help with vaginal dryness and discomfort. Hormone preparations used in the vagina mostly stay in the vagina. But some of these hormones can be absorbed into your bloodstream and get to your breasts. Blood levels of estrogen depend on the dose, frequency of use, the type of estrogen preparation, and your body's ability to absorb the hormone. If you decide to use estrogen with your doctor's advice, try to use the lowest dose possible.
Limit alcohol use. You may choose to stop drinking alcohol completely. But if you enjoy alcoholic beverages and plan to continue using them, try to have fewer than five alcoholic drinks a week. Significant alcohol use is unhealthy for your liver, which helps regulate estrogen levels in your system. So limiting your alcohol use helps your liver keep blood estrogen levels low.
Restrict sources of red meat and other animal fats (including dairy fat in cheese, milk, and ice cream), because they may contain hormones, other growth factors, antibiotics, and pesticides. Some researchers believe that eating too much cholesterol and other fats are risk factors for cancer, and studies show that eating a lot of red and/or processed meats is associated with a higher risk of breast cancer.
If circumstances allow, consider having children sooner rather than later in life and breastfeed your babies. A full-term pregnancy, which stops your menstrual cycle for 9 months, seems to offer protection against breast cancer. Pregnancy produces a blend of several hormones that forces breast cells to “grow up” and learn how to make milk. Estrogen is in the mix of the hormonal blend, but the other hormones seem to balance out its effects. When breast cells mature and have a job to do, they have less time to act out and cause problems — like starting a cancer. Additionally, research shows that breastfeeding lowers breast cancer risk for both younger mothers and women who have delayed having children.
Learn about good nutrition and start eating for good health. Everything your body does — from healing a wound to fighting cancer cells — is affected by what you eat. Bad nutrition seriously hampers your body's ability to function in top form. Good nutrition increases general wellness.
Two leaders in the field — Dr. Keith Block (University of Illinois and the Block Medical Center, Evanston, Illinois) and Dr. Mitch Gaynor (Strang-Cornell Cancer Prevention Center, New York City) — focus on nutrition as a means of reducing cancer risk, extending survival, and increasing quality of life. Their work emphasizes vegetarian diets and fat restriction, coupled with stress reduction and other complementary medicine therapies. They believe these factors combine to strengthen the immune system. A strong immune system can fight disease better, and it seems logical that this would lower your risk for all disease, including breast cancer.
The American Cancer Society has guidelines on nutrition and exercise for cancer risk reduction that may be helpful for you.
Eat your fruits and vegetables! Researchers disagree on whether certain vegetables or fruits reduce risk for breast cancer. One report that combined many dietary studies showed no clear decrease in risk of breast cancer from diets high in vegetables and fruits. But a diet full of produce can help you lose weight or maintain a good weight. So through this indirect result, this type of diet may also be able to help lower breast cancer risk.
Some people chose to eat organic foods when possible to minimize exposure to pesticides, extra hormones, antibiotics, and genetically modified organisms. But keep in mind that the U.S. Department of Agriculture makes no claims that organically produced food is safer or more nutritious than conventionally produced food. More research is needed to find out whether organic foods are more nutritious or healthier compared to foods produced by traditional farming methods.
Here are some easy ways to make sure you get at least five servings of vegetables and fruit in a day (nine is better):
Add chopped squash and carrots to jarred or fresh spaghetti sauce (serve on pasta for a great dinner).
Eat tomatoes, tomatoes, tomatoes — raw in salad, sandwiches, salsa, juice, or alone (like a piece of fruit), or cooked in sauces.
Eat whole fruit rather than drink juice to reduce calories, add fiber, and increase feelings of fullness.
Snack on baby carrots and celery (keep a cooler of them in the car).
Throw handfuls of spinach into stews and soups.
Add shredded lettuce to potato salad.
Add broccoli, tomatoes, or zucchini to scrambled eggs or omelets.
Freeze grapes and berries in single-serving containers for a cool treat during summer months.
Relax. Anything you can do to reduce your stress and to enhance your comfort, joy, and satisfaction will have a major effect on your quality of life. So-called “mindful measures” (such as meditation, yoga, visualization exercises, and prayer) may be valuable additions to your daily or weekly routine. Intriguing new studies suggest that these fundamental but non-traditional interventions may strengthen the immune system. And if your immune system is strong, it's better able to fight disease. For example, improved immune cell function has been documented after people with melanoma, a malignant skin cancer, attended regular support group meetings. Another study found that women in breast cancer support groups had a better quality of life and more immune cells in the blood than those who don't join such groups. The power of support goes a long way to reduce stress and make people feel connected — not alone — in their fight against cancer.
Diet is thought to be partly responsible for about 30% to 40% of all cancers. But diet alone is unlikely to be the "cause" or "cure" of cancer. Although more research needs to be done on diet and breast cancer, findings suggest that physical activity, a healthy diet (particularly one low in fat and high in vegetables and fiber), and a healthy weight can help reduce the risk of breast cancer or the cancer coming back
A tremendous amount of promising research is under way to determine the cause of breast cancer and to establish effective ways to prevent it. Still, doctors can't always explain why one woman develops breast cancer and another doesn't.
Everyone seems to know someone with breast cancer, and we wonder whether we, too, will be affected during our lifetime. All of us want to do everything we can to reduce the risk of ever getting the disease. Right now, though, we just don't know enough about what causes breast cancer and we haven't yet figured out how to keep it from happening — so we can't say that we can “prevent” it.
However, researchers are working to learn how our “external” and “internal” environments may work separately and together to affect our health and possibly the risk of developing breast cancer. “Internal environment” means the things inside our bodies that influence our health, such as genetics (the genes you got from your mother and father), hormones, illnesses, and feelings and thoughts. “External environment” refers to the things outside of our bodies that influence our health, such as air, water, food, danger, music, noise, people, and stress. Also, the external environment enters our internal environment every day — think of the food you eat, water you drink, air you breathe (including whether you smoke or not), and medicines you take. More subtlely, there's the way you “breathe in” or absorb your environment, such as your home or workplace, and the way you take in energy from the people you spend time with.
Some of these factors, such as your genetic makeup and the medicines that you take, have a very direct effect on your breast health. The impact of other, indirect factors, such as air quality, exercise, meditation, and spending time with friends, is less well understood.
Anything that INCREASES your chance of developing breast cancer is called a risk factor. Anything that REDUCES your risk of developing breast cancer is called a protective factor.
You can control some risk factors. For example, if you are overweight, you can seek to lose excess pounds, which may reduce your risk of breast cancer. You can also make informed choices about the medicines you take.
But other factors are beyond your control. For instance, you can't change your gender. Women are much more likely than men to have breast cancer. This is mostly because women have more estrogen and progesterone in their bodies. These hormones stimulate breast cell growth — both normal and abnormal. Also, you can't stop growing older. Aging is the biggest risk factor for breast cancer (besides being a woman).
Risk reduction means making choices to avoid or minimize any possible risk factors that you can. It also means increasing the protective factors in your life so your chances of developing breast cancer are lower.
Although you can control many risk factors, remember that doing so does not guarantee zero risk. It is also important to keep in mind that many women who have a particular risk factor for breast cancer never develop it.
Knowledge is power. Instead of living under the shadow of myths and misunderstandings, KNOW your own realistic level of risk. Then you can talk to your doctor about ways to lessen controllable risk factors and boost your protective factors.
In the following pages of the Lower Your Risk section, you can learn about:
Understanding Breast Cancer Risk
What do the statistics about breast cancer risk mean? What are relative and absolute risk? The facts and figures can help you understand risk.
Genetics and Breast Cancer Risk
Read Conference Transcripts and summaries of research on BRCA1 and BRCA2 gene abnormalities, including how they affect breast cancer risk, as well as reports on the treatment options of removing ovaries and breasts.
Lowering Risk for Everyone
Lifestyle and environmental factors can either increase or reduce your risk for breast cancer. Learn what you should know and what action you can take.
Lowering Risk for People at High Risk
If you have a family history of breast cancer or have the abnormal BRCA1 or BRCA2 gene, you may have a higher risk of developing breast cancer and may want to consider more advanced protection methods. Also, if you have an abnormal BRCA1 or BRCA2 gene, your risk of developing ovarian cancer is increased. Protect yourself with information.
Lowering Risk for People with a Personal History
If you already have been diagnosed with breast cancer, your risk of developing it again is higher than if you had never had the disease. Treatment options are available to help you reduce that risk. Your risk of developing ovarian cancer also may be higher. Understand your options.
revised from breastcancer.org
