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