Some evidence-based strategies for avoiding the single most common cause of death among women between the ages of 35 and 50.
I wear my seatbelt, get my flu shot, wash and sanitize my hands, wear sunscreen, scrub the fruits and veggies clean, look both ways when I cross the street, and never take candy from strangers. But what can I do to protect myself (and my family) from the single most common cause of death among women in my own age group, 35 to 50 years old? Here are a few evidence-based strategies to increase your odds of avoiding advanced breast cancer:
LACE UP. According to the large-scale, decades-long Women's Health Initiative study, women who walked just 30 minutes per day at least five days a week (exercise pace, not a leisurely stroll) decreased their breast cancer risk by 20 percent. I know how hard it is to summon the motivation to fit exercise into your life, but then I think about what Rachel Ballard-Barbash from the National Cancer Institute (NCI) says about that: "If you can't make time for being physically active in your daily life, plan to make time for being sick."
KNOW YOUR BODY MASS INDEX. And make a realistic weight loss plan to keep it under 25. Calculate your BMI in less than a minute here. According to the American Cancer Society: "Both increased body weight and weight gain during adulthood are linked with a higher risk of breast cancer after menopause." Some have placed this increased risk at 25 percent. "If there was a medication that gave us the same improvement as weight loss, we would be all over it," Dr. Oz has said. And we'd be stalked by even more mind-numbing pharmaceutical advertisements during our favorite TV shows.
LEARN HOW TO DO A BREAST SELF-EXAM. And set a date to do it every month. Smaller cancer equals greater chance of survival. Go to Don't Be Shy for more info and links to instructional videos.
QUIT THE SMOKES. Do you need another reason? We've already got lung cancer, heart disease, tongue, oral and nasopharyngeal cancer, emphysema, hypertension, peripheral vascular disease, stroke, premature skin aging, yellow teeth, stench, expense, social isolation. If that's not enough for you, add breast cancer to the list. A Canadian panel of experts reviewed data linking smoking to breast cancer and concluded: "Results from the nine cohort studies reporting exposure metrics more detailed than ever/never and ex/current smoker show that early age of smoking commencement, higher pack-years and longer duration of smoking increase breast cancer risk 15 percent to 40 percent." They also found a 65 percent increase in pre-menopausal breast cancer risk in non-smokers exposed to second-hand smoke. It's time.
LIMIT THE COCKTAILS. And don't shoot the messenger. According to the American Cancer Society, the consumption of alcohol is clearly linked to an increased risk of developing breast cancer. The risk increases with the amount of alcohol a woman drinks. Compared to non-drinkers, women who consume one alcoholic drink per day have a very small increased risk. Those who have two to five drinks daily have about 1½ times the risk of women who drink no alcohol. If you choose to imbibe, a recent small study suggests that red wine might be the safer beverage choice due to its activity as a nutritional aromatase inhibitor, inhibiting the conversion of androgens to estrogens and potentially conferring a protective effect on the breasts. Call me a buzz-kill if you will, but for now mindful sipping seems the prudent course.
FIND OUT IF YOU ARE AT HIGH RISK. Talk to your doctor about your breast cancer risk status, since you might need to be followed more carefully in certain circumstances. But keep in mind that 75 to 90 percent of women diagnosed with breast cancer are not high risk. Having a family history of breast cancer puts you at higher risk, but having no family history does not protect you. I can't tell you how many times I've heard women declare, "There's no breast cancer in my family so it isn't an issue for me." This false sense of security leads women to forgo screening, and they sometimes live to regret their complacency.
SCHEDULE A MAMMOGRAM APPOINTMENT. If you are over 40 you need to have yearly mammograms if you want to maximize your chance of survival. Some doctors will recommend a baseline mammogram at age 35, and I wouldn't argue with that. The government task force (USPSTF) recommending that women delay mammograms until age 50, and have them every other year after that, was created by an organization charged with creating cost-saving public-policy recommendations, not offering life-saving advice for individual women. The task force's own data show that starting annual screening at age 40 saves more lives. The most likely thing to kill you between the ages of 35 and 50 is breast cancer. If there's any time to screen for it, it's then.
KNOW YOUR BREAST DENSITY. If your breasts are dense, your mammogram won't find up to half of cancers, and you should have an additional test with your mammogram each year (breast ultrasound or MRI, depending on your risk factors) if you want to be more effectively screened. Your density information is usually included in the official report from your mammogram, so ask your doctor. If it's not in the report, call the radiologist who read your films and ask. It might take some legwork, but you have the right to know this, and the information could save your life. A grass-roots legislative movement is afoot to make disclosure of breast density information mandatory when a woman has a mammogram. This would be a very good thing for women.