10 Ways to Keep Breast Cancer Out of Your Future

Why it’s important: Learning whether you have dense breasts is one of the newest ways to protect yourself. When you have more tissue than fat in your breasts—which is common in younger women—it makes cancer harder to detect on a mammogram: Both tumors and breast tissue show up white, while fat looks dark.

Even more important, having dense breasts makes you six times more likely to develop cancer. Experts aren’t sure why that is, but one possibility is the fact that there is no standardization for measurement of breast density, so doctors’ scores are subjective.

A majority of states have enacted bills that require your health care provider to provider information about your breast density on your mammogram report. Several other states are woking on or have at least introduced similar bills. (Find out where your state stands here.)

Take action: Even if your breast density is low, you still need regular checkups. If it’s high, there’s nothing you can do to lower it (though breast density does tend to decrease with age), but you can protect yourself by asking your doctor about adding an MRI or ultrasound to your screening regimen. You can also switch from traditional mammography to digital. Since it’s higher in contrast, it’s easier for doctors to see abnormalities in dense breast tissue.

Why it’s important: Exercise seems to protect against breast cancer in several ways. First, it helps control weight. An ACS study found that women who’d gained 21 to 30 pounds since age 18 were 40 percent more likely to develop breast cancer than those who hadn’t gained more than 5 pounds.

Blame it on estrogen, which can stimulate cell overgrowth, and thus, breast cancer. Before menopause, most of your estrogen is produced by your ovaries. But after menopause, your ovaries stop pumping out the hormone and most of it becomes fat tissue. The more fat in a woman’s body, the more estrogen.

Second, exercise alters estrogen metabolism, according to a study published in the journal Cancer Epidemiology, Biomarkers & Prevention. Translation: for women who exercised regularly, the ratio of ‘good’ estrogens to ‘bad’ DNA-damaging estrogens improved by roughly 25 percent. “Past research has shown that the greater this ratio, the lower a woman’s breast cancer risk. Among women who don’t exercise, the ratio didn’t budge,” says study coauthor Mindy Kurzer, PhD, a professor of medicine at the University of Minnesota.

Take action: That doesn’t mean you have to start training for an Ironman. In fact, the Women’s Health Initiative found that women who walked briskly for 1 hour and 25 minutes to 2.5 hours had an 18 percent less risk of breast cancer than women who were inactive. To protect yourself from breast cancer—and all cancers—the ACS recommends aiming for 150 minutes of moderate-intensity exercise weekly, which breaks down to 30 minutes 5 days a week.

Why it’s important: About 5 to 10 percent of all cancers, including breast cancer, are hereditary, passed from one generation to the next via a variety of mutated genes. Your father’s family counts as much as your mother’s.

Look at your family’s history of other kinds of cancer, too. Men can carry some of the same abnormal genes, such as BRCA1 and 2, that up the risk of not only breast cancer, but also ovarian cancer in women, pancreatic cancer in men and women, and early prostate and testicular cancers in men. Research shows that roughly 72 percent of women who inherit a BRCA1 mutation and 69 percent who get a BRCA 2 mutation will develop breast cancer by the time they hit 80, the National Cancer Institute says.

Multiple diagnoses on either side of your family can be a clue to a hereditary link, so be sure to take a look at second- and third-degree relatives, too (aka, your aunts, uncles, cousins, and more).

Take action: If your family history worries you, enlist the help of a genetics expert. After dance instructor Suzanne Citere, of Lighthouse Point, FL, examined her family history (her mother died young from breast cancer, while her maternal grandfather and grandmother, along with two of her mother’s siblings all died from different cancers), she called a genetic counselor, who recommended testing. Citere found out that she did indeed carry a BRCA2 mutation and made the tough decision to have a prophylactic double mastectomy.

“Genetics is a very complicated topic, and genetic counselors can not only provide you with the most accurate, up-to-date information regarding your risk, but also help you decide whether or not genetic testing is right for you,” says Sue Friedman, founder and director of FORCE, a national support network for people at high risk of breast and ovarian cancers. “Then, if it is, they can also help you really understand your test results and your options based on them.” (Contact the National Society of Genetic Counselors to find an expert in your area.)

Why it’s important: It’s ironic. Mammograms are the staple of breast cancer surveillance, yet ionizing radiation—the kind in many high-tech screening tests—is a risk factor for the disease, because it can cause DNA mutations in cells.

That doesn’t mean you should cancel your mammogram. “Mammograms deliver very small doses of radiation, and if you follow general guidelines, it’s not going to be an issue,” says Robert N. Hoover, MD, ScD, director of the epidemiology and biostatistics program at the National Cancer Institute. “The same is true for annual dental X-rays and airport security screening, and if your doctor says you need a diagnostic X-ray for any reason, the risk of minimal radiation exposure is outweighed by the possibility of diagnosing a potential medical problem.”

There are exceptions, though. Women who have had radiation therapy to the chest area for previous cancers such as Hodgkin’s disease and non-Hodgkin’s lymphoma have significantly higher odds of developing breast cancer. (The greater the dose and the earlier the age at treatment, the higher the risk.)

Take action: In general, the Food and Drug Administration says that X-rays should be performed only when “the referring physician judges them to be necessary to answer a clinical question or to guide treatment of a disease.” If your doctor tells you that you need an X-ray, make sure you understand the reason why; if you’re still not certain you need one done, get a second opinion.

Why it’s important: The Women’s Health Initiative found that long-term use of combined estrogen plus progestin therapy—say, to manage menopausal symptoms—increases a woman’s risk of breast cancer by 24 percent.

“The average woman taking hormone therapy (HT) should weigh the potential increased breast cancer risk versus the quality-of-life component and limit the duration of use,” says Mary L. Gemignani, MD, a breast surgeon at Memorial Sloan-Kettering Cancer Center in New York City. “However, women with a significantly high risk of breast cancer should avoid taking it if at all possible, unless they’ve had their ovaries removed and are going through surgical menopause.”

Take action: Unless your risk is significant (say, you have a strong family history of breast cancer), you can still talk with your doctor about the use of hormone therapy to manage the unpleasant symptoms of menopause, such as hot flashes. Just determine the smallest dose that will help, and take it for the shortest time possible.

If you opt for HT, the National Institutes of Health recommends that you and your doctor reevaluate the decision every 3 to 6 months. If you choose not to take it, talk with your physician about other options to manage symptoms.

Why it’s important: Women who consistently breastfeed for the first 6 months have a 10 percent reduced risk of death from cancer compared with those who don’t, found a recent study in the American Journal of Clinical Nutrition. One reason: Because a woman doesn’t menstruate while breast-feeding, it limits the number of cycles she has over a lifetime, which lowers the amount of estrogen her body is exposed to.

Take action: “There is significant data that suggests that breastfeeding lowers risk,” says Otis Brawley, MD, chief medical officer for the ACS. “If a mom can do it, it’s worth trying.” In other words, you’ve heard experts say that “breast is best” for babies, and now there’s extra proof that it’s best for moms, too.

Why it’s important: Research continues to produce promising evidence that your diet can impact your cancer risk. For example, Harvard researchers recently found that women who had the highest carotenoid levels in their blood—including lycopene and beta-carotene—had a 19 percent lower risk of breast cancer than those with the lowest levels. Carotenoids—vibrant pigments that act as antioxidants—are found in fruits and vegetables such as leafy greens, carrots, sweet potatoes, tomatoes, and red peppers. Women who consumed more carotenoids had an even lower risk of developing estrogen-receptor-negative breast cancer (which is often more aggressive).

Other phytonutrients, including sulforaphane (which is found in cruciferous vegetables like broccoli) may also protect against breast cancer, research shows.

Take action: The ACS recommends eating at least 2.5 cups of fruits and veggies a day, limiting processed and red meats, and choosing whole grains to help reduce risks of all types of cancer.

Finally, limit alcohol to no more than one drink per day, which is defined as 12 ounces of beer, 5 ounces of wine, or 1 1.5 ounces of hard liquor. Around three drinks per day increases your breast cancer risk to 1.5 times that of someone who doesn’t drink at all.

Why it’s important: When breast cancer is caught early, the prognosis is often excellent. The 5-year survival rate for breast cancer that’s found early and confined to the breast is 99 percent, says the ACS.

Take action:

• If you’re of average risk (no family history), the U.S. Preventive Services Task Force recommends having a mammogram and clinical breast exam every one to two years starting at age 50. Other experts and organizations including the ACS recommend starting mammograms in your early 40s. Speak with your doctor to determine the best plan is for you.
• Be familiar with how your breasts feel normally so that you can report any changes in appearance or texture to your doctor. Also, always notify your physician if you notice any bleeding or crusting on the nipples and if you experience any pain.
• Women at higher risk might want to start such screening much earlier and more often, and they might want to consider a screening MRI, as well.

Why it’s important: You may have heard of the word “previvor” when Angelina Jolie announced that she’d had a prophylactic mastectomy after learning she had a BRCA mutation. You don’t need a faulty gene to be a previvor, though: It refers to anyone who hasn’t had cancer but is at high risk. And while a prophylactic mastectomy can drastically reduce risk, it isn’t your only option.

Take action: After learning that she carried the same BRCA mutation as her close relatives with breast cancer, Jill Amaya of Clayton, NC, started rotating between a breast MRI and a mammogram every 6 months. “This surveillance makes me feel more secure that, should something be detected, it’ll be caught early,” she says.

Some women also opt for chemopreventive drugs such as tamoxifen, which reduce risk, along with close monitoring and lifestyle changes. (Make sure you are giving yourself a breast self-exam. Learn how to do one here.) To connect with other previvors, visit FORCE and Bright Pink.

Eating right, exercising, maintaining a healthy weight, and being vigilant about screening can help you prevent a recurrence. You should also talk with your doctor about additional screenings—you may want to add ultrasound or MRI to your regimen.

If you’re taking tamoxifen to treat breast cancer, your doctor might recommend you stay on it longer. A study recently presented at the annual American Society of Clinical Oncology conference found that women who took the drug for 10 years instead of 5 had a significant reduction in the risk of recurrence.

Consider making an appointment with a genetic counselor, if you haven’t already. If it turns out that your breast cancer is linked to a mutation, your relatives might also be at risk of breast cancer, as well as ovarian and other cancers.

Finally, don’t let the rest of your health fall by the wayside. “It’s normal for women to focus on breast cancer after they’ve been diagnosed,” says Dr. Gemignani, “but as they move into survivorship, it’s important to remember other components of health, such as regular gynecologic and dermatologic visits and keeping up with other routine screenings.”