May 13, 2008
Breasts
Reducing Your Risk for Breast Cancer

By RONI CARYN RABIN
GO for regular checkups, do breast self-exams and get your mammograms on time, and chances are you’ll detect breast cancer
early on, when it is most treatable. But what about prevention? Short
of radical surgery, are there steps you can take to reduce the risk? Turns out there are. True, immutable factors like genetics,
a family’s medical baggage and just being born female determine much of
the risk of breast cancer. And, as with all cancers, that risk
increases with age: a 30-year-old woman’s chances of developing breast
cancer over a 10-year period are less than half of 1 percent, or 1 in
234, while a 60-year-old has a 3.5 percent risk, or 1 in 28. (The
often-heard “one in eight” figure refers to the lifetime risk that
women face.) But there is now solid evidence that lifestyle can
play a role as well. Choices that have an effect include how much
alcohol a woman drinks (none is best), the amount of physical activity
she gets (the more the better) and whether she takes hormones (the less
the better). Doctors also urge women to keep their weight down, as obesity increases the risk of developing breast cancer during the postmenopausal years. “Breast cancer is a disease of how much estrogen you have in your body,” said Heather Spencer Feigelson, strategic director of genetic epidemiology for the American Cancer Society,
and these seemingly disparate factors — alcohol, physical activity and
hormone pills — affect levels of estrogen and other hormones. “There
are things you can’t change, like when you got your first period, or
your family history,” said Dr. Carolyn D. Runowicz, director of the
Carole and Ray Neag Comprehensive Cancer Center at the University of Connecticut
Health Center in Farmington, Conn., referring to two well-known risk
factors, early menstruation and having a close relative with breast
cancer. “But you can change a lot about you. Empower yourself with
knowledge and information.” Know your family’s medical history —
but even if there is no history of breast cancer, don’t be complacent.
Consult a genetic counselor if you are concerned about your family
history, and inquire about being tested for the genetic mutations that
increase breast cancer risk (more common among Ashkenazi Jews). Do not
forget that breast cancer genes come from both sides of the family, not
just your mother’s. Among relatives, “the special red flags”
are premenopausal breast cancer, bilateral breast cancer (cancer that
appears in both breasts) and ovarian cancer, said Dr. Larry Norton, deputy physician in chief of breast cancer programs at Memorial Sloan-Kettering Cancer Center.
But even if no one in the family had breast cancer, that is no
guarantee that you are safe, said Dr. Runowicz; in fact, only 10
percent of breast cancer patients have a family history. Cut
down on alcohol, or avoid it altogether. When it comes to breast
cancer, studies have been pretty consistent: there is no safe amount of
alcohol. Even one glass of wine a day can increase your risk slightly,
and the risk climbs with each additional drink. “This is something you
can control,” said Jasmine Q. Lew, a student at the Pritzker School of
Medicine at the University of Chicago who recently completed a National Institutes of Health study that is one of the largest on the subject. “Women can choose not to drink.” Exercise, exercise, exercise. Obesity after menopause
increases the risk of breast cancer, so try to keep your weight down.
But exercise is beneficial regardless of weight, and even a small
amount of physical activity may be helpful. “Women who are overweight
and exercising are at lower risk than those who are overweight and not
exercising; women who are lean and exercising are at lower risk than
women who are lean but not exercising,” Dr. Feigelson said. Risk drops
with increased hours and strenuousness of exercise, and studies have
found that women who do an average of three hours of strenuous exercise
a week reduce their risk of breast cancer by 20 percent. Breast-feed if you can. Early menstruation, late menopause, postponing pregnancy
and never having gone through a full-term pregnancy increase the risk
of breast cancer, but those factors cannot be changed easily. If you do
have a baby, however, you may want to breast-feed, and the longer the
better; studies have found that breast-feeding reduces the risk of breast cancer. Try
not to take combined hormone therapy. The recommendation for all
hormone therapy is to take the lowest dose for the shortest period
necessary. A Women’s Health Initiative study found a slightly higher
risk for breast cancer among women who took estrogen with progestin
after menopause, and a drop in breast cancer diagnoses since then has
been attributed to the fact that many women quit using hormones. (In
the same study, women on estrogen-only therapy, which is used by those
who have had hysterectomies, did not have a higher breast-cancer risk.) A woman who has recently used birth control
pills is also at greater risk; Dr. Norton urges women to find
alternative contraceptive methods and avoid so-called natural or herbal
hormones as well. Have regular mammograms, but if you have
very dense breast tissue or are at high risk of breast cancer for other
reasons, insist on an M.R.I.
as well. Having high breast-tissue density can drastically raise your
risk of developing breast cancer, as does finding atypical hyperplasia,
or abnormal cell growth, which is confirmed by a biopsy.
After a mammogram, discuss the results with your physician. “Everyone
just wants to hear that it’s negative,” Dr. Runowicz said. But
important information can be gleaned even from a negative screening,
she said. “Learn about your breast density. If a biopsy shows
hyperplasia, your doctor can put you on a chemoprevention program.” Become
familiar with your personal risk factors. Your breast cancer risk could
be higher than normal if you are above average height, upper middle
class (probably related to the tendency to postpone childbearing and
having fewer children), never had a full-term pregnancy or you had
children after age 30, or if you ever had endometrial, ovarian or colon cancer or ever had high-dose radiation to the chest, your risk for breast cancer could be higher than average.

http://www.nytimes.com/2008/05/13/health/13breast.html