Best Way To Reduce Risk Of Breast Cancer

What Does The American Cancer Society Say About Reducing Breast Cancer Risk? 

Author: Dr. Stephen Chaney

breast cancerBreast cancer is a scary disease. The American Cancer Society tells us:

  • 281,000 women will be diagnosed with invasive breast cancer in 2021.
  • 43,000 women will die from breast cancer in 2021.
  • The good news is that both prevention and treatment of breast cancer have gotten much better:
    • The 5-year survival rate is 90%.
    • The 10-year survival rate is 84%.
    • For women over 50 the death rate has decreased by 1%/year between 2013 and 2018 (mainly due to recognition that hormone replacement therapy is a risk factor for breast cancer).
  • The bad news is:
    • The cost of breast cancer treatment can range from $50,000 to over $180,000.
    • The side effects of breast cancer treatment can be brutal.
      • For example, there is an effective treatment to prevent breast cancer recurrence for some forms of breast cancer, but many women discontinue the treatment after a few years because of the side effects.

So, wouldn’t it be wonderful if there were some simple changes you could make that would dramatically reduce your risk of developing breast cancer in the first place? There are lots of options for reducing your risk of developing breast cancer, but which one(s) should you choose?

  • Dr. Strangelove and his friends are only too happy to recommend their favorite potion, food, or diet.
  • There are long lists of foods you should avoid if you want to reduce your risk of breast cancer.
  • There are also lists of harmful chemicals in cleaners and other household products that you should avoid.

It can become confusing. It can become overwhelming. It would be easy to just throw up your hands and say, “I give up. I don’t know what to do.”

You may be thinking, “Why doesn’t someone simplify things by identifying the top few lifestyle changes that are most effective for reducing my risk of developing breast cancer?”

It turns out someone has. Today I will share two recent studies that have identified the top 6 strategies for reducing your risk of breast cancer, and I have ranked them from 1 to 6 in order of effectiveness.

What Is The Best Way To Reduce Risk Of Breast Cancer?

AwardThe first study (RM Tamimi et al, American Journal of Epidemiology, 184: 884-893, 2016 was designed to identify the major modifiable risk factors for invasive, postmenopausal breast cancer (The term “modifiable risk factors” refers to those risk factors that are under your control.

The study utilized data collected from the Nurses’ Health Study between 1980 and 2010. During that time 8,421 cases of invasive breast cancer were diagnosed in 121,700 postmenopausal women in the study. The study looked at the effect of nonmodifiable and modifiable risk factors on the development of invasive breast cancer in these women.

  • Nonmodifiable risk factors included current age, age at which menstruation began, height, age of first birth, number of births, weight at age 18, family history of breast cancer, and prior benign breast disease.
  • Modifiable risk factors included weight change since age 18, alcohol consumption, physical activity level, breastfeeding, and postmenopausal hormone therapy use.

Here were the results from the study:

  • All the risk factors included in this study accounted for 70% of the risk of developing invasive breast cancer in postmenopausal women.
  • Modifiable risk factors accounted for 34.6% of the risk of developing invasive breast cancer in postmenopausal women.

When they analyzed the effect of modifiable risk factors on the risk of developing invasive breast cancer separately:

  • 44 pounds of weight gain since age 18 increased the risk by 50%.
  • Postmenopausal hormone replacement use increased the risk by 35%.
  • More than one alcoholic beverage/day increased the risk by 32%.
  • Low physical activity increased the risk by 7%.
  • Lack of breastfeeding increased the risk by 5%.

What About The Effect Of Diet On Breast Cancer Risk?

You may be wondering, “What about the effect of a healthy diet on my risk developing invasive breast cancer?” Unfortunately, the study I described above completely disregarded the effect of diet on breast cancer risk.

However, the second study (MS Farvid et al, International Journal of Cancer, 144: 1496-1510, 2019) I will discuss today partially addresses this issue. It uses the same database as the first study and looks at the effect of fruit and vegetable consumption on the risk of developing invasive breast cancer.

When this study compared high versus low intake of fresh fruits and vegetable on the risk of developing invasive breast cancer:

  • Women eating >5.5 servings/day of fruits and vegetables had a 11% lower risk than women consuming ≤2.5 servings/day.
  • Women consuming >2.5 servings/day of fruit had a 9% lower risk than women consuming ≤0.5 servings/day.
  • Women consuming >4.5 servings/day of vegetables had a 9% lower risk than women consuming ≤0.5 servings/day.

While all fresh fruits and vegetables contributed to this effect:

  • The most protective fruits were berries and cantaloupe & melons.
  • The most protective vegetables were yams & sweet potatoes, green leafy vegetables (such as kale, mustard greens, and chard), and cruciferous vegetables (such as Brussels sprouts).

The authors concluded, “Our findings support that higher intake of fruits and vegetables, and specifically cruciferous and yellow/orange vegetables, may reduce the risk of breast cancer, especially those that are more likely to be aggressive tumors.”

Now we are ready to answer your question, “Which lifestyle changes are most effective for reducing your risk of developing breast cancer?” If we combine the two studies and rank order the modifiable risk factors, it would look like this.

#1: Minimize weight gain during your adult years.

#2: Don’t use postmenopausal hormone replacement therapy unless absolutely necessary.

#3: Drink little or no alcohol.

#4: Eat a healthy diet with lots of fresh fruits and vegetables.

#5: Be physically active.

#6: Breastfeed when possible.

What Does The American Cancer Society Say About Reducing The Risk Of Breast Cancer?

American Cancer SocietyThe advice of the American Cancer Society is remarkably similar. Here are their recommendations:

  1. Get to and stay at a healthy weight.

After menopause, most of your estrogen comes from fat tissue. Having more fat tissue increases the amount of estrogen your body makes, raising your risk of breast cancer. Also, women who are overweight tend to have higher levels of insulin. Higher insulin levels have also been linked to breast cancer.

If you are already at a healthy weight, stay there. If you are carrying extra pounds, try to lose some. Losing even a small amount of weight can also have other health benefits and is a good place to start.

3) Be physically active and avoid time spent sitting.

Current recommendations are to get at least 150-300 minutes of moderate intensity or 75-150 minutes of vigorous intensity activity each week. Getting to or exceeding 300 minutes is ideal.

In addition, you should limit sedentary behavior such as sitting, lying down, watching TV, and other forms of screen-based entertainment. This is especially important if you spend most of your working day sitting.

3) Follow a healthy eating plan.

A healthy eating pattern includes a variety of vegetables, fiber-rich legumes (beans and peas), fruits in a variety of colors, and whole grains. It is best to avoid or limit red and processed meats, sugar-sweetened beverages, highly processed foods, and refined grain products. This will provide you with key nutrients in amounts that help you get to and stay at a healthy weight.

4) It is best not to drink alcohol.

Research has shown that drinking any alcohol increases the risk of breast cancer. If you choose to drink alcohol, the American Cancer Society recommends that women have no more than 1 alcoholic drink on any given day. A drink is 12 ounces of regular beer, 5 ounces of wine, or 1.5 ounces of hard liquor.

5) Think carefully about using hormone replacement therapy.

Studies show that HRT using a combination of estrogen and progestin increases the risk of breast cancer. This combination can also lead to increased breast density making it harder to find breast cancer on mammogram.

Talk with your doctor about all the options to control your menopause symptoms, including the risks and benefits of each. If you decide to try HRT, it is best to use it at the lowest dose that works for you and for as short a time as possible.

The Bottom Line

Breast cancer is a scary disease. The good news is that detection and treatment of breast cancer has improved over the past decade. The bad news is that treatment is expensive, and the side effects can be brutal.

There are lots of options for reducing your risk of developing breast cancer, but which one(s) should you choose?

  • Strangelove and his friends are only too happy to recommend their favorite potion, food, or diet.
  • There are long lists of foods you should avoid if you want to reduce your risk of breast cancer.
  • There are also lists of harmful chemicals in cleaners and other household products that you should avoid.

It can become confusing. It can become overwhelming. It would be easy to just throw up your hands and say, “I give up. I don’t know what to do.”

You may be thinking, “Why doesn’t someone simplify things by identifying the top few lifestyle changes that are most effective for reducing my risk of developing breast cancer?”

It turns out someone has. Today I will share two recent studies that have identified the top 6 strategies for reducing your risk of breast cancer, and I have ranked them from 1 to 6 in order of effectiveness in the article above.

For more details about these studies, my ranking of the top 6 strategies for reducing your risk of breast cancer, and the American Cancer Society recommendations, read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure, or prevent any disease.

Does Obesity Begin In Kindergarten?

Is Obesity Caused By Bad Genes Or Bad Lifestyle?

 Author: Dr. Stephen Chaney

 In past issues of “Health Tips From the Professor” I have shared some common sense weight loss tips. But what if it is all for naught? What if there is nothing you can do about your weight?

Fat ChildYou may have seen the headlines suggesting that obesity in kindergarten is a very strong predictor of obesity later in life. If so, you are probably wondering what that means for your kids or grandkids – and what it means for you. You are probably asking questions like:

  • Should you be worrying about that your toddler’s baby fat?
  • What can you do as parents and grandparents to protect the ones you love from a lifetime of obesity and all of the health challenges that involves?
  • Is there anything you can do about overweight and obesity? Are some people just fated to be obese from childhood on?

What Does the Study Actually Show?

This was a very well done study. It followed 7738 children of all socioeconomic classes who were enrolled in kindergarten (mean age 5.6) in the US in 1998 and followed them through the 8th grade (mean age 14.1) (Cunningham et al, New England Journal of Medicine, 370: 403-411, 2014).

When the children entered kindergarten, 12.4% of them were obese, and another 14.9% of them were overweight. By the time they reached the 8th grade 20.8% were obese and 17% were overweight. Those results didn’t make the headlines. They are similar to many previous studies.

The results that made the headlines were:

  • Overweight 5 year olds were 4 times more likely to become obese by age 14 than normal weight 5 year olds.
  • 87% of obese 8th graders (14 year olds) had a body mass index above the 50th percentile in kindergarten, and 75% had a body mass index above the 70th percentile.
  • Only 13% of overweight 8th graders had been normal weight (<50th percentile) in kindergarten, and only 13% of the normal weight 8th graders had been overweight in kindergarten.

These results are fully consistent with earlier studies showing that overweight toddlers are likely to become overweight teens, and overweight teens are likely to become overweight adults. What was unique about this study (and generated the headlines) was the precision of the statistics.

Does Obesity Begin In Kindergarten?

The answer to that question is clearly yes. However, the more important question is what message we, as responsible health advocates, should be sharing with the general public. Let me break that down to some of the most important questions that you are probably asking.

Is Obesity Caused By Bad Genes Or Bad Lifestyle?

Bad GenesTaken on face value, the results of this study might seem to suggest that genetics is the primary cause of obesity. However, if that is the message we convey to the public, it is likely to simply fuel the perception that most overweight individuals are genetically destined to be obese. There is nothing they can do about it. So, why even bother trying?

However, the authors of the study also noted that the percentage of children aged 6 to 11 who are above the 95% percentile of weight has increased 4-fold between 1963 and 2000. Genetics does not change in a mere 37 years (37 generations maybe). That 4-fold increase in severe childhood obesity is clearly driven by lifestyle changes over the past 30 or 40 years.

While nobody knows the exact percentages, a reasonable interpretation of recent research in this area might be:

  • 10-15% of us are genetically destined to be obese. There is little we can do to change our weight, but a healthy lifestyle can significantly reduce our risk of disease.
  • 10-15% of us are genetically predestined to be lean no matter what we eat (Yes. Your suspicions are true). Once again, lifestyle has relatively little influence on our weight, but a healthy lifestyle can significantly reduce our risk of disease.
  • The other 70-80% of us are genetically predisposed to become obese if we adapt the typical American lifestyle. For most of us lifestyle choices can make a big difference in our weight as well as our health.

So the answer to this question is BOTH. For most of us, obesity is caused by bad genes AND bad lifestyle.

When Should We Intervene?

You probably already know that any extra fat cells we develop in childhood never go away. They are always with us, looking for those extra calories they can store as fat.

This study suggests that by the time we are in kindergarten, the die may already be cast. Those extra fat cells may have already developed.

And, for many people, the time to intervene may be even sooner. This study also showed that birth weight plays an important role as well. Children who weighed 9 pounds or more at birth were 2-fold more likely to be obese in kindergarten than children who weighed less than 9 pounds at birth.

Once again, a small percentage of overweight babies is due to genetics, but it is lifestyle choices during pregnancy that lead to the majority of overweight babies.

The authors of the study noted that most public health initiatives (school lunch programs, lifestyle education programs, etc.) are targeted at school aged children. The authors went on to say that by then it may be too late to have any significant effect on the incidence of obesity in our children.

They suggested that we need to place a stronger emphasis on influencing lifestyle changes that affect the weight of babies at birth and are likely to influence whether or not they become obese by the time they reach kindergarten.

That’s not the realm of public health policy. That’s our responsibility.

What Should We Do?

If You Are Pregnant:

  • The old adage “You are eating for two” was never true.
  • Aim for an extra 150 calories during the 1st trimester, 300 during the 2nd and 3rd trimesters (That’s 1 or 2 servings of healthy foods).
  • Aim for little or no weight gain during the 1st trimester and a total of 20-26 pounds during the last two trimesters (a bit less if you are overweight).

If You Have a Young Child Who Is Overweight:

  • Don’t restrict calories. Restricting calories can stunt growth and interfere with normal mental and physical development.
  • Encourage your kids to exercise rather than watching TV and playing video games. You may need to set the example, and that’s a good thing for you as well as for them.
  • Provide your kids with a healthy diet. For most kids, that means more fruits and vegetables and less sugary beverages, fruit juices, and processed snack foods. That may simply mean that you don’t bring those kinds of foods into your house. Again, that would probably be a good thing for everyone in the family.

I know some of you are saying “My kids won’t eat healthy stuff”. Let me give you my take on that.

When I was a kid, my mom had a pretty simple policy. If I didn’t like what she cooked, I didn’t have to eat it. I could simply wait until the next meal – when she would be serving the same kinds of healthy foods again.

I got the message pretty quick. It wasn’t eat healthy or eat junk food. It was eat healthy or go hungry. I decided early on that healthy was better than hungry.

Now, let me step down from my soapbox and summarize.

The Bottom Line:

1)     The latest research suggests that if a child is overweight by kindergarten, they are likely to be overweight for the rest of their lives. So if you want to spare your kids and grandkids  from a lifetime of obesity, you want to intervene early.

2)     A small percentage of those kids are destined to be obese no matter what they do. However, for the vast majority of them obesity can be prevented by a healthy lifestyle.

3)     If you are pregnant, don’t “eat for two”. That is terrible advice. If your pre-pregnancy weight is stable (neither increasing or decreasing), you only need to add a serving or two of healthy foods to your diet during pregnancy. Check with your doctor about the amount of weight gain that is right for you and follow their advice.

4)     If you have a young child who appears to be overweight, don’t restrict their calories. Instead, provide them with healthy food choices and encourage them to exercise.

5)     Finally, if you have been overweight since childhood, don’t despair. For most of us obesity is a combination of genetic predisposition and lifestyle choices. You can’t your genes, but you can change your lifestyle.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

Health Tips From The Professor