Dr. Anagha Zope, Senior Consultant, Breast Oncoplastic Surgery, Program Lead, Breast Surgical Services, Apollo CBCC Cancer Care, Ahmedabad talks about lifestyle and its relation to breast cancer

Mar 21, 2022

Importance of Lifestyle Change as A Preventive Measure Against Breast Cancer

Breast cancer is on an alarming rise in the world and in India. With 178361 new cases and 90408 deaths in 2020, it is the most commonly occurring cancer in Indian women today. The scenario is complicated by delayed diagnosis, irregular and suboptimal treatment and a resultant unacceptably high death rate.

Can I Reduce My Risk of Breast Cancer?

A risk factor is something that increases the chances of getting the disease. Breast cancer is multifactorial, many risk factors can influence one’s risk of getting breast cancer over the course of a lifetime. Many of these factors cannot be changed like increasing age, positive family history, while many can be effectively controlled like obesity, alcohol intake etc.

Reducing these risk factors can lower your risk of getting breast cancer. Women who are known to be at increased risk for breast cancer, can adopt additional steps that might reduce the risk of developing breast cancer.

There is no fool proof way to prevent breast cancer. Your best defence against breast cancer is adopting risk reducing strategies, early diagnosis and optimal treatment.

Lifestyle and breast cancer risk

Lifestyle factors are known to modify risk among high-risk women with a family history and those with normal risk of the general population. However, their effects among women with BRCA mutations are not well defined.

Studies estimate that successful lifestyle changes could prevent 25% to 30% of cases of breast cancer. These reductions will only be achieved if we can implement prevention programs specifically aimed at high-risk women and women in population-based breast screening programs during their childhood, adolescence, and early adulthood. This the time of rapid development of the breast, when it is particularly susceptible to carcinogenesis or cancerous transformation.

Lifestyle related factors affecting breast cancer risk

  • Excessive body fat increases risk for post-menopausal breast cancer.
  • Healthy diet
  • A vegetarian diet with a variety of fruits, vegetables, whole grains, beans and pulses can help you maintain a healthy weight and therefore lower your risk.
  • Physical activity
  • Being physically active reduces the risk for breast cancer.
  • Regular physical exercise activity decreases risk for pre-menopausal breast cancer.
  • Breastfeeding
  • If you are able to, breastfeeding your baby lowers your risk of breast cancer.
  • One year of breastfeeding reduces the risk of cancer by 4.3%
  • Late Pregnancy
  • Women who have not had children or who had their first child after age 30 have a slight increase in the overall breast cancer risk.
  • Menopausal hormone replacement therapy (HRT)
  • Use of combined hormone replacement therapy after menopause increases the risk of breast cancer.
  • This increase in risk is typically seen after about 4 years of use.
  • A woman’s breast cancer risk seems to reduce within about 5 years of stopping treatment, although the increased risk does not go away completely.
  • Alcohol and tobacco
  • Drinking alcohol in any form increases breast cancer risk.
  • Regular heavy smoking may increase the likelihood of getting breast cancer.

Lifestyle change as a preventive measure against breast cancer

Lifestyle is a dynamic process, bringing in lifestyle changes may need change in attitude and commitment to adopt risk reducing steps. These changes will have to be adapted to the various stages of your life and will not always be static. To begin is important but to persist is more effective.

The World Cancer Research Fund/American Institute for Cancer Research (2007) and the ACS (2012) have produced guidelines for prevention of a range of cancers that focus on weight control, regular exercise, reduced alcohol consumption, and a plant-based diet. The same measures play a significant role in reducing the lifestyle related cardiovascular disease risk in women.

Lifestyle changes help reduce the risk of getting breast cancer in all women, especially so in women at high risk. Adopting these lifestyle measures can also help breast cancer survivors have a better quality of life and longer survival.

The World Cancer Research Fund/American Institute for Cancer Research (2007) and the ACS (2012) have produced guidelines for prevention of a range of cancers that focus on weight control, regular exercise, reduced alcohol consumption, and a plant-based diet. The same measures play a significant role in reducing the lifestyle related cardiovascular disease risk in women.

Lifestyle changes for all women

    Maintain a healthy weight:
    - Women who gain 20 kg or more during adulthood double their breast cancer risk.
    - Studies show that a weight loss of at least 5% either before or after menopause reduces the risk for breast cancer by 25% to 40% compared to women who continued to gain weight.
    - Eat more vegetables, fruits, whole grains, pulses and beans complemented with protein-rich foods.
    - Avoid refined flour, processed foods, fast food made using these
    - Avoid sugary drinks and alcoholic beverages
    Be physically active:
    - The American Cancer Society recommends that adults get at least 150 to 300 minutes of moderate intensity or 75 to 150 minutes of vigorous intensity activity each week (or a combination of these), preferably spread throughout the week.
    - Getting to or exceeding the upper limit of 300 minutes is ideal and best done under professional supervision.
    Breast feed your child if possible
    Supervised use of menopausal hormone replacement therapy:
    - Using hormone therapy after menopause can increase your risk of breast cancer.
    - To avoid this, talk to your health care provider about non-hormonal options to treat menopausal symptoms.
    Avoid or limit alcohol and smoking
    - It is best not to drink alcohol at all.
    - For women who do drink, they should have no more than 1 alcoholic drink a day.
    - Avoid smoking completely, even passive smoking is harmful.

Lifestyle changes for women at increased risk of breast cancer

If you are at increased risk for breast cancer (for instance, because you have a strong family history of breast cancer, a known inherited gene mutation that increases breast cancer risk, such as in the BRCA1 or BRCA2 gene, or you have had DCIS), there are some things you can consider that might help lower your chances of developing breast cancer or help find it early.

A specialist breast surgeon or oncologist along with a medical geneticist can help you determine your risk of breast cancer, as well as which, if any, of these options might be right for you.

  • Genetic counselling and testing for breast cancer risk (if it hasn’t been done already)
  • Medicines to lower breast cancer risk
  • Preventive (prophylactic) surgery with very high breast cancer risk
  • For women at increased breast cancer risk who don’t want to take medicines or have surgery, some doctors might recommend close observation to look for early signs of breast cancer including
    - More frequent doctor visits (such as every 6 to 12 months) for breast exams and ongoing risk assessment
    - Starting breast cancer screening with yearly mammograms at a younger age with medical advice
    - Possibly adding another screening test, such as breast MRI

While you may not be able to prevent breast cancer by this approach, it might help find it early, when it’s likely to be easier to treat.

Its not always easy to implement these changes. It involves a lot of self-care, think of how you would want your daughter, your sister, your friend to take care of herself. You also deserve the same care.

Begin today, share your knowledge and experience with other women. Together we can reduce the breast cancer risk in our community.

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