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One in eight women will develop breast cancer over the course of their lifetimes, and almost all of us spend a lot of time worrying that we might. A recent survey by the Society for Women's Health Research found that 22 percent of women named breast cancer as the disease they fear most, more than twice as many who said heart disease.
Is the fear founded? In your 30s, your chances of developing breast cancer are generally 1 in 229; by your 40s, the risk is 1 in 68; in your 50s, 1 in 37; and in your 60s, 1 in 26. Those numbers should actually reassure you and help you better understand that even when a study reports a 20 percent increase in risk, that means the likelihood that you'll get cancer if you're 45 has gone from 1 to 1.2 in 68 women. If your risk is doubled, that still translates to just 2 in 68 -- not as scary as it sounds.
Breast cancer risk is higher among those who have a mother, aunt, sister, or grandmother who was affected before age 50. If only your mother or sister had breast cancer, your risk doubles. Having two affected first-degree relatives pushes your risk up to five times the average. Sometimes the problem is a hereditary mutation in one of two genes, called BRCA1 and BRCA2, which normally protect against breast cancer by producing proteins that hold abnormal cell growth in check. For women with the mutation, the lifetime risk of developing breast cancer can soar up to 80 percent (compared with the general population's risk of 13 percent). Still, this condition accounts for only 5 to 10 percent of all breast cancer cases. All told, between 20 and 30 percent of all women with breast cancer have a family history of the disease.
For the other 70 percent of us, the risks are harder to pin down. Several factors -- diet, weight gain, alcohol consumption -- can raise our bodies' levels of estrogen, the hormone that feeds many breast cancers. Fortunately, there's a lot we can do every day to keep excess estrogen in check and protect our breasts. Although prevention isn't a word scientists like to use ("'risk reduction' is the preferred terminology," says Debbie Saslow, PhD, director of breast and gynecologic cancer at the American Cancer Society), here are 10 of the smartest moves that the latest research indicates will reduce your breast cancer risk.
Work up a sweat for at least 30 minutes at a time, five days a week. Physical activity is thought to lower the amount of estrogen in the body, thereby lowering your breast cancer risk, explains Dr. Saslow. In one study, researchers asked 1,550 women ages 40 to 85 if they participated in a sport or physical activity vigorous enough to break a sweat and how often they engaged in the activity at the time of the study, as well as during their adulthood. The most active women were up to half as likely to develop breast cancer as those who did no strenuous activity. Even if you haven't been active since high school gym class, it's never too late to start. A brisk 30-minute walk five days a week can reduce breast cancer risk 18 percent, according to another recent study of more than 74,000 women ages 50 to 79.Maintain a Healthy Weight
A recent American Cancer Society study of more than 62,000 women found that the more weight women gain after age 18, the greater their risk of developing postmenopausal breast cancer. Women who gained more than 70 pounds during adulthood doubled their risk. The extra pounds likely increase estrogen production, which can fuel cancer growth. But if you have gained weight since your teens, don't despair. One study showed that while women who were inactive and overweight had twice the risk of breast cancer of those who were lean and active, being heavier alone did not seem to increase risk among women who regularly exercised.Focus on Good Fats
Limit the polyunsaturated fat (in corn, safflower, and sunflower oils) and saturated fat (in meat and dairy) in your diet; high levels of either have been linked to breast cancer. Opt for more monounsaturated fats, such as olive and canola oils. A six-year study in Sweden of more than 61,000 women between the ages of 40 and 76 showed that for each additional 10 grams of monounsaturated fat a woman consumed, breast cancer risk dropped by an estimated 45 percent. Every extra 5 grams of polyunsaturated fat, on the other hand, increased breast cancer risk 69 percent. These findings may explain why breast cancer rates are low among women in Spain, Greece, and Italy. Although fat makes up 42 percent of total daily calories for people in these countries, most of it typically comes from olive oil.Veg Out
Carotenoids are powerful cancer-protective pigments found in a wide array of fruits and vegetables. Researchers at New York University compared blood samples from 270 women who subsequently developed breast cancer to samples taken at the same time from 270 women who remained healthy. Women with the lowest total carotenoid levels had twice the breast cancer risk of women with the highest levels. Aim for five to nine half- to one-cup daily servings of fruit and vegetables, especially carrots, tomatoes, watermelon, or spinach.Learn to Enjoy Soy
Women in Asia have one-fifth the breast cancer rate of Western women, and scientific speculation has focused on their soy-rich diet. A Japanese study found that the more miso soup (made with fermented soybeans) women consumed, the lower their breast cancer risk. Those who ate three or more bowls a day had half the risk of those who had less than one bowl a day. Soy foods contain phytoestrogens, plant substances that behave in the body like weak forms of estrogen and may protect against breast cancer by latching onto estrogen receptors in breast tissue and locking out cancer-fueling estrogen produced in the body. Include one to two servings of soy foods daily: a cup of soy milk or half a cup of tofu, tempeh, or soy nuts.Flavor Food with Flaxseed
These nutty-tasting seeds are rich in omega-3 fatty acids, which in addition to protecting against heart disease may lower the risk of all types of cancer. Flaxseed is also loaded with lignans, compounds that may decrease estrogen action in the body. Studies have shown that lignans shrink breast tumors, at least in rats. Sprinkle two to three tablespoons of ground flaxseed on your morning cereal, mix it into smoothies, or use flaxseed oil in salad dressings, suggests breast cancer reconstructive surgeon Christine Horner, MD, author of Waking the Warrior Goddess, a book about habits that promote breast health.Limit Alcohol
As few as one or two drinks a day can up your chances of getting breast cancer, since alcohol intake is linked to higher levels of cancer-fueling estrogen. But if you enjoy an occasional sip of Chardonnay, take 400 micrograms of daily folic acid (the amount found in most multivitamins). While taking folic acid (called folate when found in fruits and vegetables) isn't a license to overindulge, a Mayo Clinic study showed that women with the lowest folate intake who drank even a small amount of alcohol daily -- just half a drink -- had a 59 percent increased risk of breast cancer, but a high intake of folate cancelled out any increased risk among moderate drinkers. It's not clear how folate lessens breast cancer risk, but experts agree most Americans don't get enough of it.Choose to Breastfeed
Not only can it benefit your infant, but lactation also can suppress ovulation and your body's production of estrogen. Researchers compared the birth rates and breastfeeding patterns among women in developed countries with those in developing nations in Asia and Africa and calculated that the breast cancer risk in developed countries could be cut in half if women had as many babies and breastfed each child for as long as women in developing countries (an average of 30 months per child). Breastfeeding alone would account for two-thirds of the reduced risk. The study also found that for each year of breastfeeding, a woman's breast cancer risk dropped 4 percent.Put Out That Cigarette
The younger girls are when they first light up, the greater their chances of developing breast cancer before menopause. Other studies suggest that women with a family history of breast and ovarian cancer may increase their own risks if they smoke, and that smokers (past and present) who develop breast cancer are twice as likely to get an aggressive form that isn't dependent on estrogen to develop and grow. A recent report from the California Environmental Protection Agency also designated secondhand smoke as a cause of breast cancer, mainly in younger women.Avoid Unnecessary Antibiotics
The next time you have a cough or the sniffles, don't automatically pester your doctor for a prescription. New evidence suggests that the more often you take antibiotics, the higher your breast cancer risk. A study of more than 10,000 women revealed double the breast cancer risk among those who took antibiotics for more than 500 cumulative days (the equivalent of about 25 prescriptions) over an average of 17 years compared with women who never took the drugs. Researchers caution, however, that other factors, such as underlying illness, a weakened immune system, or hormonal imbalances, could account for the elevated risk.
While drugs such as tamoxifen -- currently the only FDA-approved drug for reducing breast cancer incidence -- have helped many breast cancer survivors effectively stave off a recurrence, scientists are closely watching whether these same medications can benefit healthy, albeit high-risk, women. By attaching to receptors in breast cells, tamoxifen locks out natural estrogen that might promote cancer growth. A National Cancer Institute study showed it can reduce the chances of breast cancer 44 percent among women at high risk because of their age, family history or previous precancerous breast changes. Hot flashes are the most common side effect, but tamoxifen also carries a small risk of uterine cancer, stroke, and blood clots in the lungs.
Aromatase inhibitors, a newer alternative already being used to treat breast cancer patients, block the action of an enzyme that the body needs to produce estrogen, thereby lessening the amount of hormone the body makes. Side effects commonly include hot flashes, nausea, and joint and muscle pain.
Researchers in the United States and Canada are currently recruiting 4,500 healthy, postmenopausal women for a five-year study to see whether aromatase inhibitors can prevent breast cancer among those at increased risk for the disease. Advance word: Researchers expect to see a two-thirds reduction in breast cancer incidence.
Another potential preventative is the osteoporosis drug raloxifene (its brand name is Evista). In a large study of its bone-building effects among postmenopausal women with osteoporosis, researchers found that raloxifene cut breast cancer risk 76 percent. The drug is now being tested against tamoxifen among postmenopausal women at high risk for breast cancer. First results are expected by next summer.Aspirin's Breast Benefits?
In 2004, a study of 3,000 women found that regular aspirin use reduced the risk of estrogen-sensitive breast cancer by nearly 30 percent. Researchers suspected that aspirin decreases production of aromatase, which in effect suppresses estrogen production. The same study looked at ibuprofen but found that aspirin had a much stronger protective effect. A year earlier, research involving 81,000 women ages 50 to 79 had found that aspirin and ibuprofen users had a 21 percent reduction in the incidence of breast cancer over women who didn't take the drugs.
On the basis of these and other findings, doctors were cautiously optimistic that taking aspirin might offer women protection against both breast cancer and heart disease. But this year, a California study involving more than 114,000 women found that women who took aspirin daily for five years or more had an 81 percent greater risk of developing estrogen-negative breast cancer, which can be more aggressive and harder to treat than the estrogen-dependent type. The researchers also found that women who took ibuprofen daily for five years or more had about a 50 percent increased risk of developing either type of breast cancer.
Even experts don't know what to make of the conflicting findings. "The minute you tell women, 'This is a risk,' some study comes along showing 'No, it's not,'" says Ruby Senie, PhD, a breast cancer researcher and professor of epidemiology at Columbia University's School of Public Health, in New York City. A randomized trial may shed more light on these observational studies. Until then, if you need one of these drugs for occasional pain relief, don't be afraid to take it.Don't Delay Your Breast Exam
On October 21, National Mammography Day, make it a point to schedule your annual breast exam if you haven't done so already. Starting at age 40, women should have two x-rays of each breast once a year, recommends the American Cancer Society. While routine screening won't prevent breast cancer, catching it in its early stages will increase the likelihood of treating it successfully. To find a breast-imaging facility in your area, call the American Cancer Society at 800-227-2345.
Originally published in Ladies' Home Journal magazine, October 2005.