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Preventing Breast Cancer

During the month of October, as has become an annual tradition, we have

heard much about breast cancer. The primary message is "early detection" and

"treatment". An aspect that does not receive adequate attention and

awareness is the concept of PREVENTION.

Not only have we learned much about the prevention of breast cancer, cancer

in general can be significantly reduced with lifestyle changes. Some risk

factors including family history, can't be changed. It is very empowering to

learn that even with strong predisposition risk factors for the development

of breast cancer, much can be done to lessen the manifestation of these


The following are steps that you can take to to lessen the risk of breast

cancer as well as in some cases, cancer in general:

* Eat a healthy diet rich in fresh fruits and vegetables and fish to ensure

adequate vitamins and minerals and micro nutrients. Keep refined sugars to a

minimum as they act as "fuel" for inflammation which in turn enhances cancer

risk. Use products grown with "sustainable growth" techniques whenever


* Be physically active. For most healthy adults this should consist of 30 ­

60 minutes of exercise most days (at least six out of seven) that should

include strength training at least twice a week.

* Control your weight. Being overweight or obese increases the risk of

cancer, especially breast cancer. This is especially true if obesity occurs

later in life, particularly after menopause.

* Breast feed. Breast ­ feeding plays a role in breast cancer prevention.

The longer you breast ­ feed, the greater the protective effect.

* Limit dose and duration of hormone therapy. Combination hormone therapy

for more than 3 to 5 years increases the risk of breast cancer. If you are

taking hormone therapy for menopause symptoms, ask your doctor about other

options. You may be able to manage your symptoms with nonhormonal therapies,

such as physical activity. If you decide that the benefits of short-term

hormone therapy outweigh the risks, use the lowest dose that works for you.

* Avoid or minimize exposure to radiation and environmental pollution

whenever possible. This should include medical ­ imaging methods such as CT

scans that use relatively high doses of radiation which have been linked

with breast cancer risk. Reduce your exposure by having such tests only when

absolutely necessary.

* Limit alcohol. The more alcohol you drink, the greater your risk of

developing breast cancer. If you choose to drink alcohol ­ including beer,

wine or liquor ­ limit yourself to no more than one drink per day.

* Do not smoke. Smoking increases breast cancer risk, particularly in

premenopausal women. Smoking carries significant additional adverse risk

factors against good health.

* Chemoprevention is the use of drugs to reduce the risk of cancer. Several

drugs have been found to lower breast cancer in patients at increased risk

of primary or recurrent breast cancer, ie. tamoxifen, Evista, others. These

are usually those that have "estrogen receptor ­ positive" factors.

* Preventative surgery is an option for a select group of women at very high

risk for breast cancer. Preventative (prophylactic) mastectomies can reduce

the risk of breast cancer by up to 97%. Prophylactic oophorectomy (ovary

removal) has been shown to reduce the risk of breast cancer by more than 50%

in women with BRCA genetic mutation if performed before menopause.

A number of older studies suggested that birth-control pills slightly

increase the risk of breast cancer, especially among younger women. In these

studies, however, 10 years after discontinuing birth control pills, women's

risk of breast cancer return to the same level as that of women who never

used oral contraceptives. Current evidence does not support an increase in

breast cancer with birth control pills.

Regular self-breast exams and the importance of early detection to include

regular mammograms and genetic testing in select situations cannot be over

emphasized. Recent research has led to a new understanding of the

pathophysiology and approach to treatment for breast cancer which provides

hope. Fortunately in the process of looking for a cure and improved

management, a greater understanding has evolved related to prevention.

Paul Block, MD, FACP, FCCP

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