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Who are the best breast experts? It may not be your doctor -- or even the top researchers in the field. The truth is that you are the best first line of defense when it comes to reducing your risk of developing breast cancer -- at any age -- by making smart choices and becoming your own best health advocate. That's right, you: Whether you start small, by swapping your usual mojito for a seltzer next happy hour, or big, by writing to your Congressperson and asking her to increase funding for screening programs, you'll know you're doing all you can to help keep your breasts healthy. Here's how to take action.1. Educate yourself.
Breast cancer is the second most commonly diagnosed cancer in women after nonmelanoma skin cancer, striking one in eight in the U.S. Most have no risk factors besides being female and getting older: Ninety-five percent of new cases from 1998 to 2002 were in women over 40. For reasons that are still unclear, Caucasian women are most likely to develop the cancer, but African-American women are more likely to die from it. Contrary to popular belief, having large breasts, wearing underwire bras, or using antiperspirant, hair coloring, or hair-relaxing products don't seem to affect your risk; doctors are striving to better determine what genetic and lifestyle factors do. To keep up with new developments, visit the Web sites of Susan G. Komen for the Cure (www.komen.org), the National Breast Cancer Coalition (www.stopbreastcancer.org) and the American Cancer Society (www.cancer.org).2. Learn your family's medical history.
Some 5 to 10 percent of breast cancer cases are inherited, often through abnormalities in the genes BRCA1 or BRCA2, which are strongly linked to ovarian cancer as well. If you have a first-degree relative -- mother, sister, or daughter -- with either of these diseases, you're at a high risk for breast cancer. Having a father or brother with breast cancer (some 2,000 men will be diagnosed in 2007) or two or more first- or second-degree relatives (grandmothers, aunts or cousins) with breast cancer also ups your chance of developing the disease. Generally, the younger the age at which a family member was diagnosed, the higher your chances of getting it, says Debu Tripathy, MD, director of the Komen/UT Southwestern Medical Center Breast Cancer Research Program in Dallas. Since other genetic conditions (such as Li-Fraumeni and Cowden syndromes) are also linked to a higher risk, "the safe thing is to give your doctor as complete a medical and family history as you can," says Dr. Tripathy. "He or she can refer you to a genetic counselor to best assess your risk."3. Master the self-exam.
By age 20, you should be doing a monthly breast self-exam to feel for lumps and other irregularities (for instructions, go to www.fitnessmagazine.com/exam). While no strong evidence exists that women who do self-exams are less likely to die from breast cancer than those who don't, many experts believe they do help. "Self-exams at an early age help a woman know what her breasts feel like, making her more likely to notice a change earlier than someone who doesn't," explains Cheryl Perkins, MD, Susan G. Komen for the Cure's senior clinical advisor.4. Know when to see your doctor.
Even a subtle change in your breasts -- including breast pain and, particularly, any skin change such as dimpling or puckering -- calls for a visit to your physician, says Eric Winer, MD, of the Dana-Farber Cancer Institute in Boston. And because your doctor might detect a lump you've missed, experts advise having him or her examine your breasts once every three years in your 20s and 30s and once a year after age 40 -- which is also when you should start getting an annual mammogram. The test can lead to unnecessary biopsies, but most doctors believe that mammograms are key for diagnosing tumors that aren't detectable in an exam. If you're at high risk, you might also want an MRI (magnetic resonance imaging) every year, starting at age 30. In recent studies, MRIs proved better than mammograms at finding invasive tumors in women with a genetic predisposition to breast cancer.5. Cut back on cocktails.
The more a woman drinks, the greater her risk for developing breast cancer. Yet studies show that moderate alcohol use can help protect against heart disease and other conditions. What to do? According to the American Cancer Society, the key is to make sure your consumption averages out to less than one drink a day (12 ounces of beer, 5 ounces of wine or 1 1/2 ounces of liquor all count as one serving). Cutting white wine with club soda or having a couple of cocktails on weekends and none during the week can help, as can a daily 400-milligram supplement of folic acid, recently shown to slightly offset the risk associated with moderate alcohol consumption, says Rachel Zinaman, RD, a dietitian at the Evelyn H. Lauder Breast Center at Memorial Sloan-Kettering Cancer Center in New York City. "But if you're at high risk for breast cancer, consider not drinking at all -- or drinking just on special occasions," she adds.
Research shows that working out boosts breast health. One reason: Extra weight can make the body produce excess estrogen, which may be why obesity is associated with breast cancer. While this connection is especially strong after menopause, "a significant risk factor for being overweight later in life is being overweight early in life, and regular exercise can help prevent that," says Dr. Winer. Physical activity can also enhance the immune system and lower levels of insulin, which has been linked to breast cancer, says Julie Gralow, MD, an associate professor of medical oncology at the University of Washington School of Medicine in Seattle. So just how much exercise do you need? Researchers at the University of Southern California found that women who kept up a regimen of more than five hours per week of strenuous cardio (such as running or lap-swimming) from high school on -- or about 45 minutes a day -- had a 20 percent lower risk of invasive breast cancer than those who did 30 minutes or less per week. But that doesn't mean you should enter the next Ironman. "It's critical to slowly build your exercise capacity," says Dr. Gralow. For motivation, pair up with a partner (go to www.fitnessmagazine.com/teamfitness to find a buddy) or train for a local race (such as a Susan G. Komen Race for the Cure 5K run/walk -- go to www.komen.org to find a race near you).7. Eat a balanced diet.
Aim for at least five servings of fruits and vegetables a day. Besides keeping your weight in check -- one of the best defenses against breast cancer -- some of these foods have been linked in studies to lower breast cancer incidence. Your best bet, says Zinaman, is to fill your plate with a variety of colors, since fruits' and veggies' cancer-fighting components -- called phytochemicals (see "What Is a Phytochemical?") -- may work best when they interact with one another. Other smart moves: Consuming more salmon and fortified milk (sources of vitamin D, which may boost your defenses), as well as more healthy fats (like olive oil) and lean proteins (think chicken, fish, and beans). A Harvard study of more than 90,000 premenopausal women found a correlation between high consumption (more than one and a half servings a day) of beef, lamb, or pork and an increased risk for one type of breast cancer.8. Breastfeed if you can.
Given its well-documented benefits for your baby, including protection from allergies and infections, you hardly need another reason to nurse. But breastfeeding, especially for one and a half to two years, may also help protect you against breast cancer, likely because it reduces your number of menstrual cycles, which is linked to lower risk. If you want to breastfeed but are having trouble, get help from an expert in your area; find one at the Web site of the International Lactation Consultant Association at www.ilca.org.9. Reduce your exposure to environmental hazards when possible.
A recent review of studies identified 216 chemicals that cause breast tumors in animals. Of particular concern: polychlorinated biphenyls (PCBs), which can contaminate fish, and polycyclic aromatic hydrocarbons (PAHs), found in smoke and soot. Experts caution that more research is needed. Still, it's a good idea to avoid PCB-contaminated fish (find local fish advisories at epa.gov) as well as tobacco smoke and charred food.10. Be a champion for change.
More money is needed to help underprivileged women get checked and treated for breast cancer and to help researchers better understand the disease. Two ways to make a difference: Contact your elected officials to request their support for the National Breast and Cervical Cancer Early Detection Program (NBCCEDP), which gives women access to free screenings (go to www.komen.org for information), and the Breast Cancer and Environmental Research Act, which would increase funding for studies on the environmental causes of breast cancer (learn more at www.stopbreastcancer.org). An even easier way to help: Komen's Passionately Pink for the Cure program. Pick any day in October to donate $5 or more to the organization, which will direct the funds to awareness, free health care and research initiatives -- and wear pink to show your dedication to helping find cures for breast cancer.
84% Get or plan to get annual mammograms by age 40
79% Get yearly breast exams by a doctor
79% Limit alcohol use to less than one drink a day
65% Eat right -- lean proteins and at least five servings of fruits and veggies a day
57% Exercise five or more hours per week
This cruciferous vegetable contains isothiocyanates, which may break down breast cancer cells.Carrots
Low intake of beta-carotene (found in orange fruits and veggies) has been associated with a higher risk.Garlic
Research suggests its allyl sulfur compounds can help prevent the development of some tumors.Mushrooms
They contain conjugated linoleic acid, which has been shown to slow down the production of estrogen.Red Cabbage
Researchers believe the glucosinolates in this vegetable may help inhibit breast cancer.Wild Salmon
Rich in vitamin D and omega-3 fatty acids, which may fight tumor growth, wild salmon is less likely than farmed to contain cancer-causing PCBs.Try This Recipe
Combine these power veggies in a simple, tasty stir-fry. Cook 1 tablespoon minced garlic in 1 tablespoon olive oil over medium heat until translucent. Add 1/2 cup each broccoli florets, sliced carrots, sliced red cabbage, halved white mushrooms, and a pinch of salt (if desired), and stir-fry until just tender (10 to 15 minutes). Brush a salmon fillet with a tablespoon of honey mustard, pan saute for 5 to 10 minutes, and serve alongside the veggies.What Is a Phytochemical?
These plant-based substances include carotenoids (found in carrots), isoflavones (in soybeans), and lycopene (in tomatoes), and seem to help protect cells from damage that could lead to certain types of cancer and other diseases.
To learn how to do a breast self-exam and for more information on defending yourself against breast cancer, go to www.fitnessmagazine.com/breastcancer.
Originally published in FITNESS magazine, October 2007.