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Lowering The Risks

by Kelly James-Enger

TWO WINTERS AGO, I found a lump in my breast. I was taking a shower on a Saturday morning and doing my monthly self-exam when I felt a hard, distinct lump on the upper left side of my left breast. I prodded and poked, but it didn’t go away. My heart pounding, I climbed out of the shower and called my husband. I placed his fingers on my breast. “Can you feel that?”

He looked at me and nodded. Monday morning, I called my obstetrician/gynecologist and scheduled a mammogram—my first. At 39, I’d been thinking of going in for a baseline, or first mammogram, but had been busy with my six-month-old son. Now a mammogram was my first priority.

Though I’d heard horror stories, my mammogram wasn’t uncomfortable, and the technician was warm and gentle. The fear of what she might find was far worse. The radiologist came in to show me the films, and to tell me that I needed a needle biopsy. He said that the lump wasn’t a cyst, a fluid-filled sac, and it didn’t appear to be due to fibrocystic changes, which are considered a normal variation of breast tissue. While the lump didn’t look cancerous, the radiologist explained that it’s impossible to tell what it is without examining the breast tissue itself.

After considering my options and talking it over with my husband, I decided to have the lump removed with a minor surgical procedure called a lumpectomy. I figured if the lump was cancerous, the sooner it came out, the better. Even if turned out it wasn’t, I didn’t want to keep that hard grape-sized mass in my breast. I found myself touching it and worrying about it all the time.

My outpatient surgery took about an hour; I checked into the hospital in the morning, and was home that afternoon. My breast was sore, both where the incision had been made and inside where the lump had been cut out, but otherwise I felt fine—especially when my doctor called to tell me the lump had been a fibroadenoma, a benign mass that only rarely becomes cancerous.

The soreness took a while to wear off. I couldn’t run or do any activity that caused my breast to bounce (even walk down the stairs braless) for the next six weeks, and I now have a two-inch scar along the top of my left breast. And I feel extremely lucky—and I still do my monthly exams.

My lump turned out to be benign. However, the chances are that you’ve heard the frightening statistic of ‘1-in-7’—that one in seven women will develop breast cancer during their lifetimes. Some risk factors, like family history, can’t be changed, but others can.

Read on to learn how you can help protect your health and reduce your risk of breast cancer in your 20s, 30s, 40s, and 50s and beyond.

IN YOUR 20s

According to the Centers for Disease Control, breast cancer is the second most commonly diagnosed cancer among American women. However, your chance of developing it in your 20s is relatively low—less than 0.5% of women will get breast cancer before the age of 39. Here’s how you can help keep that risk low:

Check Out Your Family History

The biggest risk for breast cancer has to do with your genes. If you have certain genetic mutations, called BRCA1 or BRCA2, you’re at much higher risk for developing the disease. “Somewhere between 20-30% of those women will have breast cancer by the age of 40, and 50% will have it by the time they’re 50,” says breast cancer specialist Suzanne Mahon, DNSc, RN, clinical professor of hematology/oncology at Saint Louis University School of Medicine. “Over a lifetime, it’s about a 95% risk.”

A simple blood test can tell you whether you carry one of the mutations, but it’s expensive, costing about $3,100. There are also significant emotional and psychological consequences of testing to consider as well as the risk of discrimination by insurance companies if you do have the genetic abnormality.

In any case, you should definitely examine your family history. “Women really need to inquire about anyone with breast cancer, especially before the age of 50,” says Mahon. If your family history is significant, talk to someone with an expertise in genetics to help determine your individual risk.

Have a Baby – If You Want To!

If you have a child before the age of 30, your risk of breast cancer is also somewhat lower. Your breasts complete their development after a first pregnancy, which makes them less sensitive to carcinogens, or cancer-causing substances, says Mahon. Obviously, this is only a benefit to early motherhood and shouldn’t be the reason you have a child.

Eat A Variety of Fruits and Vegetables

Researchers are studying the effects of diet on breast cancer risk. According to the National Cancer Institute, it’s not yet proven that a low-fat diet or a diet rich in fruits and vegetables will prevent breast cancer, but a diet rich in beta-carotene may decrease your risk. Eat a healthy diet that includes foods high in beta-carotene such as broccoli, carrots, tomatoes, squash, peaches, apricots, and cantaloupe.

Check Your Breasts

Your doctor will perform a breast exam at your annual checkup, but you should do regular monthly breast exams as well. Circle the calendar and examine your breasts at the same time every month—one week after your period starts. That’s when you’ll have the lowest level of hormones that produces nodularity, or lumpiness, making your breasts easier to examine.

IN YOUR 30s

Continue to check your breasts every month, and if you notice anything unusual, have your doctor check it out immediately. Maintain your healthy diet, and:

Watch Your Alcohol Intake

Alcohol consumption increases the risk of breast cancer. “Women who consistently drink one or two drinks every day have an elevated risk primarily because it enhances estrogen metabolism,” says Mahon. “It’s a small risk but one you can control.”

Get Moving!

Women who are sedentary are at slightly higher risk to develop breast cancer; so are overweight women, theoretically because they have more fat cells, which means they have more estrogen receptors, says Mahon. Maintain a healthy weight, and try to get at least 30 minutes of moderate physical activity every day to reduce your risk of breast cancer and other diseases.

Consider Switching Birth Control

While higher-dose oral contraceptives of the past were associated with a small increased risk of breast cancer, today’s pills contain a lower dose of hormones. The available data, however, suggests a slightly increased risk, so consider whether the benefits of the pill outweigh the risk of taking it. If you have a family history of breast cancer, for example, you may want to choose a different form of birth control.

IN YOUR 40s

In your 40s, your risk of developing breast cancer increases to about 2%. “Getting older is a risk factor you can’t change—it’s somewhat related to the number of total ovulatory cycles that a woman has over a lifetime,” says Mahon. Your risk is a bit higher if your first menstrual period is before the age of 12, and if you have a relatively late menopause.

Get a Baseline Mammogram — and Annual Ones Thereafter

At 40, you should schedule your first mammogram (called a baseline) and have one every year thereafter. If you know you have a high heredity risk or known mutation, though, you may start with a baseline as early as age 25.

Stay Active

Keep up your healthy eating habits, and maintain a regular exercise program as well. “Exercise to maintain your weight and to decrease the number of fat cells you have,” recommends Mahon. Strength-building exercise like lifting weights helps you maintain muscle tone and increases the number of calories your body burns even at rest, and aerobic exercise burns calories and improves your cardiovascular fitness as well.

Skip the Soy?

Researchers aren’t sure whether soy, which has a pseudo-estrogenic effect, can increase a woman’s risk of developing breast cancer. If you have significant risk factors, you may want to avoid this food.

IN YOUR 50s AND BEYOND

You’re most likely to develop breast cancer after the age of 50; according to the Centers for Disease Control, 75% of breast cancer cases occur then. Your risk gradually increases as you age, if you live to be 90, you have a 1 in 7 chance of developing the disease.

The same advice applies to older women as to younger, but annual mammograms are even more important now because of the heightened risk. In addition to the above advice:

Question Hormone Replacement Therapy

Just as taking the pill may cause a small increase in the risk of breast cancer, postmenopausal women may increase their risk by taking HRT, or hormone replacement therapy. Women should consider the risks and benefits of HRT before going on the regime—if you have a significant family history of breast cancer or have had breast abnormalities before, HRT may not be worth the risk.

The bottom line? “Every woman is at risk and some women are at higher risk than others. You can have every risk factor and never get it or you can have none and get it,” says Mahon. “Be aware of the risk and change where you can. And if you really think you have a problem…take responsibility and seek out a health care provider who is going to help you.” •

from the November-December 2008 issue

HOW TO PERFORM
A BREAST SELF-EXAMINATION

Perform your breast self-exam
at the same time of the month,
preferably a week after your period begins.
Start by looking at your breasts in the mirror
with your hands on your hips,
checking that your breasts look normal
and don’t have any swelling, dimpling,
or puckering of the skin.
Then raise your arms above your head
and check them again.
Squeeze your nipples gently to make sure
they don’t produce any discharge.

Using several fingers, feel each entire breast,
using enough pressure that you can feel
all of your breast tissue.
Lie down and repeat the process
on each breast.
If you notice anything new or unusual,
see your doctor to have it checked out.

You'll find more detailed information
about breast self-exams at:

www.komen.org/bse

www.breastcancer.org/dia_detec_exam_5step.html