Breast Cancer Prevention
Essentially all women are at risk for breast cancer and a significant number of women will be affected by breast cancer. Thus, all women should consider ways to reduce their risk. Due to the many different factors and unimaginable complexity involved in the development of breast cancers, risk determination and prevention are an enormous challenges. Despite these difficulties, we currently have several effective means of reducing risk.
Diet/Nutrition - In this context, diet is all about nutrition and not about weight loss. However, a good diet, coupled with exercise will help an individual maintain an appropriate weight. The influence of lifestyle on breast cancer risk has been apparent for many years. Particularly, diet seems to play an important role. Currently, a diet low in fat, 30 grams or less daily, high in fiber (20 - 30 grams/day) and five servings of fruits and vegetables a day will significantly reduce breast cancer risk or recurrence of breast cancer in survivors. In breast cancer survivors, this risk reduction is in addition to the recurrence reduction associated with chemotherapy or hormone therapy. These concepts are augmented with consultations and discussions with a registered dietitian. Practical approaches to good nutrition are emphasized including recipes and other strategies. Please see the link below for more informationhttp://www.hsph.harvard.edu/nutritionsource/pyramids.html
The goals of an exercise program are designed to provide fitness for all levels of ability. Note that the Center for Disease Control (CDC) recommends: “People with chronic diseases, such as a heart condition, arthritis, diabetes, or high blood pressure, should talk to their doctor about what types and amounts of physical activity are appropriate”.
Exercise provides the most benefit when it is performed at a moderate level for periods of up to 30 minutes, ideally 5 times per week. A moderate level of exertion means you are “huffing and puffing” a bit and can be gauged using the Borg Perceived Level of Exertion Scale below:
Another technique involves using heart rate as a gauge of physical exertion. This can be done by checking your pulse as you exercise or with a heart rate monitor. Suggested heart rate levels vary with age and can be calculated using the information below:
Exercise – coupling exercise with a good diet creates an obvious synergy. Exercise need not be an excruciating experience. About 30 minutes of exercise 5 times per week is considered beneficial. For exercise to be beneficial, the required effort must be sufficient to raise your heartbeat significantly. To determine the appropriate level for an individual, discussion with you primary care physician and the advice of a personal trainer are essential.
Other aspects of lifestyle which may influence risk include age at first pregnancy, and breast feeding. Controlling these factors can be more difficult. Ideally, a first pregnancy before age 30 results in a lower risk and the earlier the pregnancy the lower the risk. Breastfeeding as long as is reasonably possible up to a year has been shown to greatly benefit the mother and baby.
Avoidance of alcohol excess (more than one glass of wine, beer or drink daily) and smoking are essential to good health. While these lifestyle choices have been variably implicated as contributors to breast cancer risk, their overall negative effects are undeniable.
Lastly, improvements in lifestyle initiated by one member in the family can have significant positive repercussions on the rest of the family. Promoting a healthy lifestyle in your children at a young age or adolescence may have an even greater impact on their future breast cancer risk. Additionally, the influence of these changes on a male significant other in the family may reduce their risk of prostate cancer, heart disease and colon cancer.
Medication - can also be used to reduces the risk of breast cancer. Tamoxifen has been demonstrated to reduce breast cancer risk in high risk women by 50%. A careful weighing of risks versus benefits is required for women considering tamoxifen for risk reduction. Raloxifene (Evista) has been compared to Tamoxifen for prevention in the STAR trial. Preliminary results of this trial were released in 2006. At present, Raloxifene may have some advantages in post-menopausal women but some doubt exists over whether it is equally effective at preventing breast cancer. A trial in Europe called IBIS 2 is currently being performed to evaluate the drug Arimidex for prevention in post-menopausal women. Arimidex is commonly used in the treatment of breast cancer but is only effective in the post-menopausal group. I believe this medication will prove to be superior for prevention in this population of women but we must await the results of the IBIS 2 trial before one can consider this approach.