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Even though one woman in eight will eventually receive a breast cancer diagnosis, only a minority currently take advantage of the well-established lifestyle measures for reducing chances of developing the disease, and far fewer take medications that can help prevent it in women at higher than average risk. Part of the problem may well be confusion wrought by periodic reports of conflicting evidence for what rises – or lowers – a woman’s chances of developing breast cancer, ranging from the drugs she uses to the foods and beverages she consumes.
Another inhibiting factor is the limited amount of time doctor’s can devote to assessing a woman’s risk of breast cancer and explaining the complex trade-offs involved in breast cancer prevention. In the latest report published in JAMA, experts at the University of California, San Francisco, reviewed compelling evidence for two classes of drugs normally prescribed following breast cancer treatment that can also help prevent cancer in some women not yet affected by this disease.
One class consists of two drugs, tamoxifen and raloxifene, that inhibit the action of estrogen in selective tissues. The other consists of three aromatase inhibitors, anastrozole, exemestane and letrozole, that reduce the levels of circulating estrogen that could stimulate the growth of estrogen-sensitive breast cancers. Whether a woman might consider such drugs depends in part on lifestyle measures and medical history. Their decisions should consider their personal health history and the ailments that run in their families to which they too may be susceptible.
Even a small amount of alcohol, less than one drink a day, can raise breast cancer risk, and the more a woman drinks, the greater her chances of developing it. A friend recently treated for an early-stage breast cancer quit drinking wine, which resulted in weight loss that may also reduce her risk of a new or recurring breast cancer.
On the other hand, moderate consumption of alcohol, and wine in particular, is associated with a reduced cardiovascular risk, so if heart disease figures more prominently than cancer in your family, you may decide to have that daily glass of wine. With smoking, however, there is no health benefit, only risk – to your breasts as well as every major organ and your life.
Another modifiable breast cancer hazard is being overweight, especially after menopause, when body fat becomes the major source of cancer-promoting hormones. The good news here is that the two measures that can help you lose excess weight – a healthy diet and regular physical activity – also protect against breast cancer and reduce the risk of heart disease.
A healthy diet and regular physical activity – also protect against breast cancer and reduce the risk of heart disease. Strive for a mostly plant-based diet of vegetables, fruits, whole grains, beans and nuts; healthy sources of fats like olive and canola oil; and fish in lieu of red meat. And include a weekly minimum of two and a half hours of moderate physical activity, or 75 minutes of vigorous activity, plus strength training twice a week.
Alas, two long-known protective factors – early childbearing (in the teens and 20s) and prolonged breastfeeding – run headlong into the professional goals of many modern women, as well as those of young women financially unable to support a family.
Many older women run into another confusing and controversial decision: whether and for how long to take hormone therapy to counter life-disrupting symptoms of menopause. Barring an earlier history of breast cancer, current advice is for women who have not had a hysterectomy to take combination hormone therapy (that is, estrogen and progestin) for as short a time as need to control symptoms but no longer than a few years.
A recent study, published July 28 in JAMA, described the long-term effects on breast cancer risk among 27,347 postmenopausal women randomly assigned to take hormone replacement or not.
Among the 10,739 women who had no uterus and could safely take estrogen alone (progestin is typically added to prevent uterine cancer), menopausal hormone therapy significantly reduced their risk of developing and dying from breast cancer. However, among the 16,608 women with a uterus who took the combination hormone therapy for the sole purpose of breast cancer incidence was significantly higher, although there was no increased risk of death from the disease.
Dr Christina A Minami, a breast cancer surgeon at Brigham and Women’s Hospital, and Dr Rachel A Freedman, an oncologist at Dana-Faber Cancer Center, wrote that the new findings “are unlikely to lead to the use of hormone therapy for the sole purpose of breast cancer risk reduction.” But Dr Freedman said in an interview, “If I’m counseling a patient who’s really miserable with menopausal symptoms and is a candidate for estrogen only, these findings are reassuring that her breast cancer risk will not be any higher over time.”
The New York Times, 25 Aug 20