Self Defense for Healthy Breasts
As we approach midlife, most of us are anxious to do all we can to make sure we are not the one in eight who gets breast cancer. While we cannot change such things as advancing years, family history, or the age at which we had our first child, we can make lifestyle choices that may lessen our chances of getting the disease and will definitely improve our health overall.
There is convincing evidence that these are the most important steps you can take to reduce your risk:
Maintain a healthy weight. Studies in a number of countries among different racial and ethnic groups clearly show that women who gain excess weight, especially after menopause, are more prone to breast cancer. Body fat produces estrogen and proteins that cause inflammation and insulin resistance, all of which promote abnormal cell growth and may contribute to the development of cancer. While some studies suggest that belly fat is most dangerous, the connection is less clear for breast cancer than for some other diseases, says Rachel Ballard-Barbash, MD, of the Division of Cancer Control and Population Sciences at the National Cancer Institute. To find your ideal body mass index or BMI—a measure of body fat that takes into account your height and weight—go to www.nhlbisupport.com.
Get Moving. Here again, many studies have found that women who are physically active—even those who waited until middle age to start exercising—have a 20 to 30 percent reduced risk of breast cancer. Physical activity may help by keeping weight in check, but scientists are also exploring other mechanisms, such as its effect on inflammation and metabolic hormones that may play a role in cancer.
Experts agree that moderate exercise, such as brisk walking, at least 30 minutes every day is sufficient to provide some protection. As your fitness improves, try to increase moderate activity to 60 minutes a day or exercise vigorously for 30 minutes every day to gain added benefit.
Limit alcohol. Evidence is strong that the more alcohol you consume, regardless of the type of drink, the greater your risk of breast cancer. If you choose to drink, limit it to one drink per day. That translates into 5 ounces of wine, 1½ ounces of hard liquor, or one 12-ounce beer.
Avoid hormone therapy. Data from the Women’s Health Initiative (WHI), a randomized controlled study, confirmed that postmenopausal women who used combined estrogen-progesterone hormone therapy (HT) had a 24 percent increased risk of breast cancer. In a more recent study, researchers at the University of California found that women who used combined HT for 15 years or longer had an 83 percent greater risk than women who never used it. For reasons that are not clearly understood, thinner women were at greater risk than the obese. According to the WHI study, there was no increased risk found with estrogen-only HT.
“If you feel you must take HT for menopausal symptoms, take the lowest dose for the shortest term possible,” advises Larissa A. Korde, MD, breast medical oncologist and epidemiologist at the Fred Hutchinson Cancer Research Center in Seattle.
Consider your family history. Your risk is higher if close relatives on either your mother’s or father’s side have had breast cancer. Knowing this may make you more diligent about regular screening and may guide some of your lifestyle choices. For example, although moderate alcohol consumption has been shown to be somewhat protective against heart disease, says Ballard-Barbash, “If I had a strong family history of breast cancer, I wouldn’t be drinking at all.” But it’s also wise to keep things in perspective: 70 to 80 percent of all women who get breast cancer do not have a family history of it.
What about Genetic Testing?
If you have a significant family history of breast cancer, you might want to consider getting a blood test to determine if you have inherited a mutated gene that can boost risk dramatically. Genetic testing may be advised for women who have a strong family history of breast and/or ovarian cancer or who carry a BRCA gene mutation. Genetic counseling with a trained health care professional will help you understand the risks and benefits of the test and if it’s right for you. Keep in mind that inherited gene mutations are responsible for only about 1 in 10 breast cancers. Genetic tests vary in cost, are not always covered by insurance, and do not provide definitive answers about when or if you will get breast cancer, even if you do have a “bad” gene.
Other lifestyle factors that may have some impact on breast cancer, but for which the jury is still out, include:
High-fat diet. Much of the blame has stemmed from studies that showed a rising incidence of breast cancer among women from Asian nations who migrated to Western countries and began eating a fattier diet. However, more recent studies have not fingered fat as the only, or worst, dietary culprit. The type of fats consumed or excess calories from all sources that are converted into body fat may prove to be more important than the amount of fat in the diet, says Sally Scroggs, RD, health education specialist in the Cancer Prevention Center of the MD Anderson Cancer Center in Houston.
Vitamin D and fish oil. There is some evidence that women with higher blood levels of vitamin D have lower risk of breast cancer, but the WHI study found no lesser incidence among women who took calcium plus vitamin D supplements than among women taking a placebo. Since researchers now believe most of us don’t get enough vitamin D, moderate supplementation is probably a good idea in general. Megadoses, however, are not.
In a study that recently made headlines, researchers at the Fred Hutchinson Center found that among 35,000 postmenopausal women, those taking fish oil had a 32 percent reduced risk of breast cancer. But, they said, it’s too early to promote fish oil supplements as protection against the disease.
A large five-year-long controlled trial just getting under way in Boston that will look at the health effects of vitamin D and fish oil supplements should provide some answers.
Soy. There is evidence that soy consumed before puberty may confer some protection against breast cancer. But it is not yet known whether it will help a 45-year-old woman who starts taking it now. But, as Scroggs points out, soy is low in saturated fat and cholesterol, a source of fiber, and a complete protein that makes it a good substitute for meat.
Smoking. It’s a bad idea on so many levels, and it’s clearly implicated in cancers of the lung, bladder, and head and neck. But there’s no evidence that smoking is to blame for breast cancer.
So , what’s the bottom line?
The American Institute for Cancer Research, which focuses on the impact of diet and exercise on cancer, estimates that almost 40 percent of the breast cancer cases in the United States—about 70,000 cases a year—could be prevented if women maintained a healthy weight, exercised, and limited the amount of alcohol they drink. For the individual woman, of course, there are no guarantees. But says, Ballard-Barbash, “There’s a lot of evidence that changing health behaviors, even in middle age, may reduce your risk of breast cancer. Furthermore, those actions will have substantial benefits in terms of other diseases, your overall sense of well-being, and your quality of life.”
By Phyllis McIntosh