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Long before we get our first pimple, budding breasts remind us that we're women in training. We love them, we hate them. We want them to grow bigger, we wish they'd stop growing, we wonder why this one is smaller/bigger/rounder/flatter than the other, why men are staring at them--and why they're not.
No matter how conflicted we may be, breasts are part of our female identity, which may be why, for most of us, having breast cancer is our biggest fear. We're more afraid of it than we are of heart disease, which is 10 times more likely to be what sends us to the great beyond.
Yet fewer women get breast cancer, and fewer die from it, than ever before. "Cancer is not an inevitability. Women have more control over the disease than they think," says Margaret I. Cuomo, MD, author of A World without Cancer: The Making of a New Cure and the Real Promise of Prevention. "Everything we do from the moment we wake--from what we eat and drink to whether or not we exercise and avoid BPA, parabens, and other carcinogenic chemicals--is a factor that can turn on or off the genetic switches in our bodies, including ones that could lead to cancer. The risk of many cancers, including breast cancer, can be significantly reduced by living a healthy lifestyle."
There are also new ways to improve your risk profile, including becoming aware of the geography of your breasts and tracing your dad's family history, not just your mom's. You won't eliminate risk altogether; the biggest risk for breast cancer is being a woman. But you may be able to dramatically slash your chance of developing the disease. Here's where to start.
1. Find out how dense you are
One of the newest ways to protect yourself is to learn whether you have dense breasts . When you have more tissue than fat in your breasts it makes cancer harder to detect on a mammogram: Both tumors and breast tissue show up white, while fat looks dark. Even more important, having dense breasts makes your cancer risk up to six times higher.
Experts aren't sure why that is, but one possibility is the fact that there is no standardization for measurement of breast density, so doctors' scores are subjective.
As of this past year, at least 13 states (Alabama, California, Connecticut, Hawaii, Indiana, Maryland, New York, North Carolina, Nevada, Oregon, Tennessee, Texas and Virginia) require clinics that perform mammograms to inform patients of their breast density scores; two states (Utah and Maine) allow voluntary notification and more states are expected to follow suit.
In the meantime, ask the radiologist who does your mammogram whether your breasts are dense.
If your density is low, you still need regular checkups. If it's high, there's nothing you can do to lower it, but you can protect yourself by asking your doctor about adding MRI or ultrasound to your screening regimen, or switching from traditional mammography to digital, which is higher in contrast, making it easier to see abnormalities in dense breast tissue.
2. Get moving
Exercise seems to protect against breast cancer in several ways.
- First, it helps control weight. An American Cancer Society study found that women who'd gained 21 to 30 pounds since age 18 were 40% more likely to develop breast cancer than those who hadn't gained more than 5 pounds. The reason: estrogen, which can stimulate cell overgrowth and breast cancer. Before menopause, most of a woman's estrogen is produced by her ovaries; after menopause, when ovaries stop producing the hormone, most of the estrogen comes from fat tissue. The more fat in a woman's body, the more estrogen.
- Second, exercise alters estrogen metabolism, according to a study published in the journal Cancer Epidemiology, Biomarkers & Prevention. "Among women who exercise, the ratio of 'good' estrogens to 'bad' estrogens [those that can damage DNA and increase a woman's breast cancer risk] improved by roughly 25%. Past research has shown that the greater this ratio, the lower a woman's breast cancer risk. Among women who don't exercise, the ratio didn't budge," says study coauthor Mindy Kurzer, PhD, a professor of nutrition at the University of Minnesota.
That doesn't mean you have to start training for an Ironman. In fact, the Women's Health Initiative found that women who walked briskly for 1¼ to 2½ hours a week had 18% less risk of breast cancer than women who were inactive. To protect yourself from breast cancer—and all cancers—the ACS recommends aiming for 150 minutes of moderate-intensity exercise weekly, which breaks down to 30 minutes 5 days a week.
3. Know your family cancer history— even your dad's
About 5 to 10% of breast cancer is hereditary, passed from one generation to the next via a variety of mutated genes. Your father's family counts as much as your mother's. And look at your family's history of other kinds of cancer, too. Men can carry some of the same aberrant genes, such as BRCA1 and 2, that up the risk of not only breast cancer but also ovarian cancer in women, pancreatic cancer in men and women, and early prostate and testicular cancers in men.
Also, multiple diagnoses on either side of your family can be a clue to a hereditary link.
You may know that the medical history of first-degree relatives (parents, siblings, and children) is most important for assessing risk, but take a look at second- and third-degree relatives, too (aunts, uncles, cousins, great-grandparents, grandchildren, nieces, and nephews). If your family history worries you, enlist the help of a genetics expert.
Dance instructor Suzanne Citere, 49, of Lighthouse Point, FL, examined her family history—her mother died young from breast cancer, while her maternal grandfather, maternal grandmother, and two of her mother's siblings all died from different cancers—and called a genetic counselor, who recommended testing. Citere found out that she did indeed carry a genetic mutation—BRCA2—and made the tough decision to have a prophylactic double mastectomy. People with a mutated BRCA gene are about five times more likely than other women to get cancer.
"Genetics is a very complicated topic, and genetic counselors can not only provide you with the most accurate, up-to-date information regarding your risk but also help you decide whether or not genetic testing is right for you," says Sue Friedman, founder and director of FORCE (Facing Our Risk of Cancer Empowered), a national support network for people at high risk of breast and ovarian cancers. "Then, if it is, they can also help you really understand your test results and your options based on them." Contact the National Society of Genetic Counselors to find an expert in your area.
4. Minimize radiation exposure from screening tests
It's ironic. Mammograms are the staple of breast cancer surveillance, yet ionizing radiation—the kind in many high-tech screening tests—is a risk factor for the disease, because ionizing radiation can cause DNA mutations in cells.
That doesn't mean you should cancel your mammogram.
"Mammograms deliver very small doses of radiation, and if you follow general guidelines, it's not going to be an issue," says Robert N. Hoover, MD, ScD, director of the epidemiology and biostatistics program at the National Cancer Institute. "The same is true for annual dental x-rays and airport security screening, and if your doctor says you need a diagnostic x-ray for any reason, the risk of minimal radiation exposure is outweighed by the possibility of diagnosing a potential medical problem."
There are exceptions: Women who have had radiation therapy to the chest area for previous cancers such as Hodgkin's disease and non-Hodgkin's lymphoma have significantly higher odds of developing breast cancer. (The greater the dose and the earlier the age at treatment, the higher the risk.)
In general, the FDA says that x-rays should be performed only when "the referring physician judges them to be necessary to answer a clinical question or to guide treatment of a disease." If your doctor tells you that you need an x-ray, make sure you understand the reason why; if you're still not certain you need one done, get a second opinion.
5. Limit hormone therapy
The Women's Health Initiative found that long-term use of combined estrogen plus progestin therapy increases a woman's risk of breast cancer by 24%, but unless your risk is significant, you can still talk with your doctor about the use of hormone therapy to manage menopausal symptoms such as hot flashes.
Just determine the smallest dose that will help, and take it for the shortest time possible.
"The average woman taking HT should weigh the potential increased breast cancer risk versus the quality-of-life component and limit the duration of use," says Mary L. Gemignani, MD, a breast surgeon at Memorial Sloan-Kettering Cancer Center in New York City. "However, women with a significantly high risk of breast cancer should avoid taking it if at all possible unless they've had their ovaries removed and are going through surgical menopause."
If you opt for HT, the National Institutes of Health recommends that you and your doctor reevaluate the decision every 6 months. If you choose not to take it, talk with your physician about other options to manage symptoms.
6. Consider breast-feeding
Women who consistently breast-feed for the first 6 months have a 10% reduced risk of death from cancer, compared with those who don't, found a recent study in the American Journal of Clinical Nutrition. One reason: Because a woman doesn't menstruate while breast-feeding, it limits the number of cycles she has over a lifetime, which lowers the amount of estrogen to which her body is exposed.
Bottom line: "There is significant data that suggests that breast-feeding lowers risk," says Otis Brawley, MD, chief medical officer for the ACS. "If a mom can do it, it's worth trying."
In other words, you've heard experts say that "breast is best" for babies, and now there's extra proof that it's best for moms, too.
7. Eat the right foods—every day
Research continues to produce promising evidence that what you eat can affect your risk. For example, Harvard researchers recently found that women who had the highest carotenoid levels in their blood had a 19% lower risk of breast cancer than those with the lowest levels. Carotenoids are found in fruits and vegetables such as leafy greens, carrots, and red peppers.
Women who consumed more carotenoids had an even lower risk of developing estrogen-receptor-negative breast cancer (which is often more aggressive). Other phytonutrients may also protect against breast cancer, including sulforaphane (found in cruciferous vegetables) and lycopene (the chemical that gives tomatoes their red color).
The ACS recommends eating five or more servings of fruits and veggies a day, limiting processed and red meats, and choosing whole grains to help reduce risks of all types of cancer.
Finally, limit alcohol to no more than one drink per day — any more than that increases your breast cancer risk to 1½ times that of someone who doesn't drink at all.
8. Detect it early
When breast cancer is caught early, the prognosis is often excellent. The 5-year survival rate for breast cancer that's found early and confined to the breast is 99%, says the American Cancer Society (ACS). Here's what you need to know.
- If you're of average risk (no family history), the US Preventative Services Task Force recommends having a mammogram and clinical breast exam every one to two years starting at age 50. Other experts and organizations including the ACS recommend starting mammograms in your early 40s. Speak with your doctor to determine the best plan is for you.
- Be familiar with how your breasts feel normally so that you can report any changes in appearance or texture to your doctor. Also, always notify your physician if you notice any bleeding or crusting on the nipples and if you experience any pain.
- Women at higher risk might want to start such screening much earlier and more often, and they might want to consider a screening MRI, as well.
9. What can "previvors" do?
You may have heard this hybrid word when Angelina Jolie announced this year that she'd had a prophylactic mastectomy after learning she had a BRCA mutation. You don't need a faulty gene to be a previvor, though: It refers to anyone who hasn't had cancer but is at high risk. And while a prophylactic mastectomy can drastically reduce risk, it isn't your only option.
After learning that she carried the same BRCA mutation as her close relatives with breast cancer, Jill Amaya, 48, of Clayton, N.C., started rotating between a breast MRI and a mammogram every 6 months. "This surveillance makes me feel more secure that, should something be detected, it'll be caught early," she says.
Some women also opt for chemopreventive drugs such as tamoxifen, which reduce risk, along with close monitoring and lifestyle changes.
10. A battle plan for survivors
Eating right, exercising, maintaining a healthy weight, and being vigilant about screening can help you prevent a recurrence.
You should also talk with your doctor about her recommendations for breast cancer screening—you may want to add ultrasound or MRI to your regimen. If you're taking tamoxifen to treat breast cancer, your doctor might recommend you stay on it longer. A study recently presented at the annual American Society of Clinical Oncology conference found that women who took the drug for 10 years instead of 5 had a significant reduction in the risk of recurrence.
You might also consider making an appointment with a genetic counselor, if you haven't already. If it turns out that your breast cancer is linked to a mutation, your relatives might also be at risk of breast cancer, as well as ovarian and other cancers.
Finally, don't let the rest of your health fall by the wayside. "It's normal for women to focus on breast cancer after they've been diagnosed," Mary L. Gemignani, MD, a breast surgeon at Memorial Sloan-Kettering Cancer Center. "But as they move into survivorship, it's important to remember other components of health, such as regular gynecologic and dermatologic visits and keeping up with other routine screenings."
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