Dodging (breast) cancer

— William Shakespeare (1564-1616), English playwright King Henry VI, Part I, Act III Sc. 3 l. 54-55 (1592)

recently released a list of approaches to reduce breast cancer risk. Since there is “no one big way,” as the article states, that breast cancer can be completely avoided, seven combined factors could make a difference.

1. Weight gain. Women who gain 20 to 30 pounds during adulthood (after 18 years old), have a 40% more chance of developing breast cancer after menopause. This is compared to women who gained 5 pounds or less. What’s the connection between more fat and breast cancer? Well if there is too much fat in the body, it helps convert precursors into estrogen, the hormone linked to promoting breast cancer. Even with estrogren production from the ovaries gone by menopause, estrogen remains in circulation because of excess fat tissues.

Recommendation: Enter menopause at a healthy weight.

2. Activity level. Exercise lowers the risk of breast cancer by 20%-30%. But how much activity? Studies indicate at least three to four hours a week of moderately intense (brisk walking, stationary bicycling, or hopping on the stair climber or elliptical trainer) to vigorous (swimming, jogging, aerobic dance, or racquet sports like badminton or tennis). How does regular exercise help? Obviously, it can keep weight down. It may also influence in limiting circulating hormones like estrogen from bombarding breast tissue. There has also been a link between insulin and insulin-like growth factors and breast cancer. Exercise is able to stabilize insulin levels in the blood.

Recommendation: Moderate to vigorous exercise 45 to 60 minutes four times a week is suggested by the American Cancer Society.

3. Alcohol. The link between too much alcohol and breast cancer in women is not clear cut. Some studies have shown that alcohol raises estrogen levels or it may work with carcinogens. Breast cancer risk is increased in women who take alcohol who also don’t have enough of the B vitamin folic acid.

Recommendation: Women with a family history of breast cancer may limit alcohol to one drink a day and take folic acid of 400mcg a day. Folate in food is found in dried beans, green leafy vegetables like spinach and pechay and cereals.

4. Vitamin D. Evidence is accumulating that Vitamin D helps protect against many types of malignancies including breast cancer. One study showed that women who early in life had much exposure to the sun (sunlight initiates Vitamin D production in the skin) had a lower risk for breast cancer.

Recommendation: Too much sunlight of course may not be realistic considering the risk of skin cancer. So supplement Vitamin D at 800-1,000 IUs a day for adults.

5. Oral contraceptives. Since estrogen has been associated with increased breast cancer risk, much concern has been generated with the use of oral contraceptives. The US Nurses’ Health Study found that women taking birth control pills may have an increased risk of developing breast cancer but levels to average 10 years after stopping.

Recommendation: This is an issue best discussed with your OB-GYNE considering that there are other options for birth control.

6. Breast density. More connective and glandular tissue in comparison with fat makes breasts denser. Women with dense breasts have a higher risk of breast cancer owing partly to more cells that can be affected by hormones and growth factors.

Recommendation: On a mammogram, it may be difficult to tell apart the tumor and dense normal tissue. For this reason, the clinician may want other imaging techniques such as ultrasound or digital mammography.

7. Chemoprevention. Several studies have already demonstrated that tamoxifen, an anti-estrogen drug can reduce the risk of breast cancer by 49% in the predisposed. This was seen in the 13,000-woman Breast Cancer Prevention Trial in 1998. A newer study combined tamoxifen with raloxifene (an anti-osteoporosis drug) reduced the risk of invasive breast cancer.

Recommendation: Chemoprevention is not without its own risks. Tamoxifen has been linked to endometrial cancer. Plan with your clinician.

As the Bard laments, ’tis indeed a “woeful breast” if we agree that cancer is a most unnatural wound. But here we find some hope. Email: