Breast Cancer: How to Cut Your Risk and Control Your Care
The new breast cancer watchword is targeted -- and that applies whether you're taking steps to prevent cancer, choosing the best screening technology, or ensuring that medical treatments are tailored to your individual biology. The strongest message from the dozens of experts we consulted: Take the time to find out where you fit in and don't be afraid to push for the answers you need.
The first question every woman needs to answer is "Am I at high risk?" If you are, you should be screened earlier and more often and ask about taking tamoxifen or raloxifene (Evista), a newer estrogen-suppressing drug with fewer side effects. Both can reduce your chances of getting breast cancer.
More than 70 percent of women with breast cancer, however, have no known risk factors. The likelihood you'll be diagnosed with breast cancer and the type you get also depend on your stage of life -- how old you are and whether you're before or after menopause when the cancer hits. Breast cancer in younger women tends to be the more aggressive HER2 or triple-negative malignancies. Older women are more susceptible to hormone-sensitive tumors; they're also more likely overall to get breast cancer.
Although you can't alter your genes or stop your biological clock, you can make lifestyle changes that will reduce your risk:
- Minimize estrogen exposure. Estrogen plays a huge role in the development of most types of breast cancer because it stimulates the rapid growth of cells in breast tissue. Over the years, cells that grow faster can mutate and become cancerous. The cumulative effect of estrogen may be the reason that some 77 percent of breast cancer occurs in women 50 and over, and about 60 percent of primary breast cancers are hormone dependent, which means they grow in response to estrogen and/or progesterone. Any factor that prolongs your exposure to estrogen ups your risk of breast cancer: hitting puberty early (before age 12) or starting menopause late (after 55), having children after age 30 or not at all, and obesity.
- Get regular exercise. This can cut your breast cancer risk in half. Brisk walking just three to five hours a week will do it; so will jogging or cycling. Exercise boosts immune function, bolstering the body's ability to fight off cancer, and reduces the overall amount of tumor-fueling estrogen the body produces over a lifetime.
- Watch your weight. An estimated 10 to 24 percent of all postmenopausal breast cancers are thought to be due to obesity or weight gain. Estrogen is stored in fat and therefore obesity increases levels of estrogen. The greater the weight
gain, the worse the odds: Women who put on more than 60 pounds are up to three times as likely to get advanced metastatic cancers as are women who are not overweight.
- Check your breasts. While no scientific evidence proves that monthly breast self-exams are necessary, experts still encourage women to become familiar with the appearance and feel of their breasts and report any changes. Cancers in younger women -- one in five hits women under 50 -- tend to be more aggressive, making early detection even more crucial. Make sure, too, to get a clinical breast exam from your doctor every three years if you're under 40 and every year if you're 40 or older.
- Get regular screening mammograms. These find tumors at earlier stages than other detection methods, says the M.D. Anderson Cancer Center's Donald A. Berry, PhD. Nearly 70 percent of women over age 40 now get regular mammograms, up from 29 percent in 1987. If you have no family history of breast cancer, get one every year starting from age 40.
Getting yearly mammograms helps pick up small tumors not caught by previous exams. Some doctors recommend that women with very dense breast tissue get additional breast tests, such as an ultrasound or an MRI. If you're under age 50 or have dense breast tissue, you may want to ask about digital mammograms, which are up to 15 percent more sensitive than traditional film mammograms at picking up cancers in these groups, the American Cancer Society says.