In the United States, approximately 225,000 people are diagnosed with breast cancer each year. Approximately 1% of those are men. Annual screening mammogram of women starting at age 40 has resulted in decreasing the number of deaths caused by breast cancer but it has not resulted in a decrease in the number of women who will be diagnosed with the disease. The average Lifetime Risk of Breast Cancer for a woman in the United States is 1 in 8. While complete prevention of breast cancer is not yet possible, we can reduce our risk of breast cancer by modifying certain risk factors. There are both modifiable and non modifiable risk factors.
NON MODIFIABLE BREAST CANCER RISK FACTORS
- ADVANCING AGE–As you get older, your risk of breast cancer increases. No matter how hard you try, you cannot turn back time.
- FAMILY HISTORY OF BREAST OR OVARIAN CANCER—Most women diagnosed with breast cancer each year DO NOT have a family history of breast cancer (96%). Only 2-4% of women diagnosed annually have a family history of breast or ovarian cancer. First degree family members and those who have premenopausal breast cancer are more indicative of risk.
- BRCA 1 OR 2 MUTATION–The incidence of BRCA 1 or 2 gene mutation in the general population is 0.2 %. It is ten times higher in high-risk families and five times higher in women with ovarian cancer. Six percent of women with breast cancer before the age of 40 will have a mutation.
- EASTERN EUROPEAN JEWISH ANCESTORY (ASHKENAZI)—The incidence of BRCA 1 or 2 mutations is 2.5% in general in this population. Of AJ women with breast cancer before the age 40, thirty percent will have a gene mutation.
- AGE OF ONSET OF MENSES—An early onset of getting your first full period and a late onset of your last period confer an increased risk of breast cancer because of the duration that your body was producing estrogen.
- LATE FIRST PREGNANCY OR NO PREGNANCY—First full term pregnancy after the age of 26 or never having a full term pregnancy confers an increased risk of breast cancer. This may be a modifiable risk factor in some women.
MODIFIABLE BREAST CANCER RISK FACTORS
- WEIGHT—Adults that gain weight as they age have an increased risk of cancers, especially breast cancer. The excess fat increases the amount of circulating estrogen. Losing weight is associated with a decrease of that elevated risk of breast cancer.
- ACTIVITY/EXERCISE—Increased physical activity is associated with decreasing risk of breast cancer. This effect seems to be greater in post menopausal women than premenopausal women.
- DIET/NUTRITION—A low fat diet has been associated with a lower risk of breast cancer. Although it seems intuitive that a diet rich in legumes, whole grains and fresh fruits and vegetables, would be good for your risk of breast cancer, studies have shown a trend but no clear statistical improvement in the rate of cancer. This is most likely due to the high variability of each person’s diet items, daily consumption volume, and effects of individual metabolism, activity/exercise, and other medical issues. No specific foods have been identified as significantly influencing breast cancer risk.
- ALCOHOL CONSUMPTION—As little as one drink a day can increase a post menopausal woman’s relative risk of breast cancer 10%.
- HRT USE—Use of hormone replacement therapy after menopause is associated with an increased risk of breast cancer that begins to rise after 5-7 years of use. Risk will return to normal for age 5-7 years after cessation.
Modifying your risk factors can have a positive effect on decreasing your risk of breast cancer, but this requires life style changes. Gradual, steady weight loss by increasing your activity and making smarter dietary choices is a good start. Weight lost more slowly by making purposeful permanent changes to your diet, tends to be weight that you can keep off. Weight lost by sudden crash diets or radical exercise programs tends to be weight regained. Starting a diet for the purpose of weight loss can be imposing and depressing. (I speak from experience, lots of experience). It can mean cleaning out the pantry, buying new and unfamiliar foods and radically changing the way you eat. Most of us won’t stick with that, especially when the inevitable plateau occurs. Instead start by making one change to your diet that will be to your benefit such as cutting back on the fat or eating more servings of fresh vegetables. After you master that and make it part of your life, you can move on and add another new idea that will benefit you. But these choices need to be a permanent part of your life as you go forward.
Increasing how active we are is another life style change. While parking farther away from the grocery store and taking the stairs more are both good things for your body, the type of activity that is going to be beneficial for reducing your risk of breast cancer is sustained activity for the purpose of exercise. The World Health Organization and CDC both recommend that to maximize positive effect and decrease the negative effects of exercise that people target 4000-6000 METs (metabolic exercise equivalent units) per week. This equates to 75 minutes of running or 150 minutes of walking a week. This is equal to twenty one minutes of walking a day. Surprisingly, walking as little as 30 minutes a day in a sustained continuous time frame has been shown to reduce the incidence of dementia.
Limiting alcohol intake is another lifestyle change. In order to have a positive effect, this too must be maintained over the long term. This certainly doesn’t mean you can’t toast the bride or celebrate your wedding anniversary with a cocktail or glass of wine or beer. It does imply that alcohol intake is not a regular or daily thing.