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One of the most important breast cancer risk factors -- in addition to being female, overweight, or having a family history of the disease -- is your age, a mounting body of research shows. "What we're seeing is that women who are 35 years old or younger do worse with their breast cancer than older women," says Jennifer Litton, MD, a medical oncologist at M.D. Anderson Cancer Center in Houston. When breast cancer strikes younger women, it tends to be more aggressive and less responsive to treatment, according to a new study from Duke University. On the other hand, statistics from the American Cancer Society show that once a woman turns 40, her chance of developing the disease increases nearly tenfold. Changing your age is improbable (okay, it's flat-out impossible). But making healthy lifestyle choices is completely within your control. Meet three athletic women blindsided by breast cancer diagnoses who reveal the steps they took to fight back against the illness. Plus, find out how you can prevent it from occurring in the first place.
Breast cancer probably isn't top-of-mind for most twenty-somethings. But this is the decade when you need to start being especially vigilant. Just ask Amy Rhoades, now 21.
In September 2007, Amy started her junior year at the College of Idaho in the prime of her athletic career. She played second base on the varsity softball team and was dominant on her school's soccer squad, where she was goalie. One day that month, Amy performed a routine breast self-exam and felt what she describes as "a bouncy ball" on her left breast. In disbelief, she notified her doctor the next day and had her first-ever mammogram and sonogram two days later. That bouncy ball, it turned out, was a 2.4-centimeter malignant tumor -- stage II cancer. Thankfully, it hadn't yet spread to her lymph nodes.
Almost instinctively, Amy relied on her physical and mental conditioning to cope. A goalie's primary mission on the field is to defend the turf, block invaders. She would do the same with cancer. So she had a lumpectomy to remove the mass, followed by six rounds of chemotherapy. Then, because of her age and the fact that her cancer was of the HER-2 positive variety, which is particularly aggressive, her doctors recommended that she avoid radiation and have a double mastectomy.
"The surgery at first seemed way too radical to me, especially because my lymph nodes didn't show any cancer after the lumpectomy," says Amy. "But the more I learned about my options, the more readily I agreed to it. I feel it gave me the best chance of not having to worry about this again."
More than a year after the operation, follow-up tests detect no cancer in her body. As she returns to training and competing, she has some advice for other young women: "Make breast self-exams part of your routine. Learn how your breasts feel at all times of the month. If something doesn't seem right, make a big deal about it."
Break a sweat
"Regular physical activity reverses the effects of high insulin and estrogen levels -- both of which have been linked to an increase in breast cancer risk," says Douglas Yee, MD, director of the Masonic Cancer Center at the University of Minnesota. In the Nurses' Health Study II of nearly 65,000 women, those who reported an average of 3.25 hours per week of running or 13 hours per week of walking when they were younger had a 23 percent lower risk of developing premenopausal breast cancer than those who exercised less. Activity from ages 12 to 22 seemed to provide the strongest protection against cancer, the researchers say.
Have a baby
Hey, it's your life. All we're saying, or rather, all science is saying, is that as far as breast cancer goes, having a baby lowers your risk. Furthermore, it's better to procreate sooner than later. "Women who have children at a younger age are at a decreased risk," says Kala Visvanathan, MD, a medical oncologist at Johns Hopkins Medical Center. Not only that, breastfeeding lowers your breast cancer risk as well.
Cut back on the cosmos
Experts have linked alcohol consumption to an increase in breast cancer risk. A study from the British Journal of Cancer shows a 7 percent hike for every drink per day. So try not to let happy hour get too happy.
By now, you've got your doctor's office number programmed into your BlackBerry -- but that doesn't mean you always make regular appointments. Former WNBA basketball player Edna Campbell knows that drill. During an off-season game in 2002, she took a hard elbow to the chest from another player. At first, she figured the swollen lump in her right breast was just a basic injury. When it didn't go down after a few weeks, she became suspicious. That's when Edna got herself to the doctor and learned that the lump in her breast was a malignant tumor. She bowed out of the 2002 season and started treatment right away -- she was only 32 years old. Then came another shocker. "I found out that my 90-year-old great-aunt also had breast cancer when she was in her 30s. Sometimes women don't disclose details like that unless they're prompted. As black women, we're taught to be strong and handle things on our own. But it's important to face the truth and share it with other people." Seven years later, Edna is cancer-free. She staged a comeback in the last game of the 2002 season, played for three more years, then retired in 2006. Now she's in school to become a nurse. She stays healthy by exercising regularly and eating a nutritious diet.In your 30s and worried about cancer? Follow these tips:
Get calcium and vitamin D
Taking 1,000 milligrams of calcium and 350 IU of vitamin D is associated with a decreased risk for premenopausal breast cancer, according to data from the Women's Health Study, a large trial of more than 30,000 women. To help your body manufacture the D it needs, spend 5 to 10 minutes in the sun a few days a week without SPF protection (depending on the time of year and where you live), and take vitamin D supplements that contain D3, which the body is better able to use.
Eat less red meat
The risk for certain types of breast cancer rises when you eat pork, beef, lamb, and processed meats, like hot dogs and bacon, according to the Nurses' Health Study II. Researchers think that because the meat contains estrogen, eating it increases the amount of estrogen in your body, influencing your risk for cancer. The American Institute for Cancer Research recommends limiting red-meat consumption to 18 ounces per week and avoiding all processed meat.
Get grill savvy
If you do eat steak, marinate it overnight in teriyaki or turmeric-garlic sauce to reduce the carcinogenic compounds that are produced when it's grilled, according to research from the University of Hawaii. Other studies show that a shorter grilling time also creates fewer carcinogens.
Know where you stand
If you're at least 35 years old, check out the National Cancer Institute's risk-assessment tool at cancer.gov/bcrisktool. After answering a series of questions, you'll find out your probability of getting breast cancer in the next five years and over your lifetime. If your risk is high, Dr. Visvanathan suggests visiting a high-risk breast cancer clinic where you can receive counseling about prevention, screening, and other options, such as genetic testing.
Make breast screenings a must
Mammograms reduce the number of breast cancer deaths, studies show. "In general, when tumors are detected at one centimeter or less and are surgically removed, there's excellent long-term survival, virtually a cure," says diagnostic radiologist and breast-imaging specialist Robert Lapidus, MD, medical director of the Women's Imaging Centre in Lafayette, Louisiana. Although mammography remains the gold standard for screening large populations, there are other techniques, such as breast MRI and screening breast ultrasound, that may help detect tumors in their earliest stages. The National Cancer Institute recommends that women age 40 and older should have a mammogram every one to two years. Women at higher risk should talk to their doctors about starting earlier or testing more frequently.
Watch your waistline
If not for vanity, then do it for health. Piling on the pounds ups your chances of getting breast cancer. "In postmenopausal women, since the ovaries no longer make estrogen, the majority of it is produced in the fat tissue," Dr. Visvanathan explains. "That means people with a higher percentage of body fat have more estrogen in their bodies and therefore have a greater breast cancer risk."
Defat your diet
Reducing fat intake to 20 percent of calories (the USDA recommends limiting fat to 30 percent) helps regulate insulin and other hormones that may encourage tumor growth, according to the Women's Intervention Nutrition Study, a clinical trial of almost 2,500 women ages 48 to 79 with early-stage breast cancer. Their chance of recurrence was 24 percent lower than that of a control group who ate more fat.
The Women's Health Initiative Randomized Controlled Trial, a large study of women age 50 to 79, found that five years of combined hormone replacement therapy (HRT) -- where both estrogen and progesterone are used -- was associated with an increase in the incidence of breast cancer in the recipients, compared with women who took a placebo. Some research has shown that younger women on HRT may not run the same cancer risk. Still, experts suggest using it for the shortest amount of time possible. Talk to your doctor about whether HRT is right for you.
182,460 women in the U.S. will be diagnosed with breast cancer this year.
40,480 of them will lose the battle.
20,080 women in California will be diagnosed with the disease in 2008, the most of any other state; 4,150 will succumb to the illness.
300 women in Washington, DC, will learn that they have breast cancer this year, the lowest incidence in the U.S.
There has been a 25 percent drop in breast cancer deaths between 1991 and 2004.
Female breast cancer has the second-highest mortality rate of all cancers. Lung/bronchus cancer tops the list.
All stats are projections from the American Cancer Society report, "Cancer Statistics, 2008," an annual review of cancer incidence, survival, and mortality. Numbers are based on reporting data from cancer centers across the U.S., using data from previous years.
Your cuppa joe. After years of back-and-forth about the caffeine/cancer connection, a recent large study, with a 22-year follow-up, concluded that women who drink four or more cups of caffeinated beverages daily are at no more risk than those who drink less than one cup per day. Cheers!
The pill. Older formulations of oral contraceptives that used high doses of estrogen and progesterone increased breast cancer risk, says Douglas Yee, MD. The pill currently has lower doses of hormones, making it safer when it comes to the disease.
Fertility drugs. Despite previous research that suggested a link, doctors could not make a strong association between breast cancer and fertility drugs in a recent study of nearly 55,000 women.
If you or a loved one has been diagnosed with breast cancer, call the Breast Cancer Network of Strength's "YourShoes" 24-hour toll-free support center. They know how you feel -- really: All information and advice comes from breast cancer survivors (800-221-2141; English, with interpreters available in more than 150 languages). Or visit networkofstrength.org.
Originally published in FITNESS magazine, October 2008.