October is Breast Cancer Awareness Month!
There’s a lot to be said about breast cancer, both from a scientific standpoint, and from hearing first-hand accounts of women who have gone through it. You’ve probably read the statistic that 1 in 8 U.S. women will develop breast cancer in her lifetime. But if you’re anything like me, you also assume that those are eight other women, and that breast cancer “won’t happen to me.”
That’s how I felt until someone close to me was diagnosed earlier this year. Witnessing someone I care about fight this terrible disease has moved me to pay attention, realize that it could be me, and speak up.
You’re about to read the first of a three-part series on breast cancer that will cover prevention, healthy survivorship, and how you can support a loved one in treatment.
Given that breast cancer is the second most highly diagnosed cancer among women, it is possible that you or someone you love will be affected. Even in the absence of risk factors we can’t control, like being a woman and getting older, there’s no guarantee that a person won’t develop breast cancer. But there are things we can do to minimize the risk, protect our health and longevity, and rise to the occasion should cancer invade our lives.
5 Steps You Can Take to Reduce Your Risk:
1. Maintain a Low-Risk Body Fat Percentage
A low-risk body fat percentage is associated with a reduced risk of cancer, especially after menopause.
The Cedars-Sinai Breast Cancer Program explains that body fat is the source of estrogen after menopause. Estrogen is necessary for long-term health and is not limited to reproduction. The body needs a certain amount to protect our heart, bones, and brain. 1
Prior to menopause, the majority of estrogen (estradiol) is produced by the ovaries. Here, higher levels of body fat have a protective effect against breast cancer in some women. After menopause, that changes. 2
During midlife, estrogen secretion from the ovaries declines. When that happens, estrone, found mainly in fat cells, becomes the body’s primary source of estrogen. Even though many women fight it, that little extra fluff around the middle, lovingly referred to as the “menopot,” is generally considered low-risk. A healthy body fat percentage is helpful as it supplies essential hormones that contribute to a long, healthy life. Without it we experience bone loss, heart disease, stroke, and even dementia.
The problem arises when excess body fat levels contribute to increasing estrogen levels, metabolic dysfunction, and circulating inflammatory factors, the risk of developing estrogen receptor-positive breast cancer rises. A high body fat percentage and metabolic health problems are individual risk factors for developing breast cancer. This means that even if a woman is at a “normal” BMI (weight-to-height ratio), she may still have a higher risk of developing cancer if she has a high body fat percentage, or certain metabolic markers. For women with obesity, that risk increases even more. 3-8
To mitigate this risk, it’s important to maintain a low-risk body fat percentage, minimize excess weight gain, and have good metabolic function. All of these factors can be positively influenced through healthy lifestyle, food, and fitness habits. 9-11
How To Do It:
Choose modest portions of fiber-rich, whole, or minimally process foods most of the time.
Minimize ultra-processed foods, refined sugar, and fried foods.
Let true physical hunger, rather than cravings and stress, guide your eating.
Slow down during meals and stop when you feel satisfied.
Get adequate sleep.
These simple, sustainable eating practices contribute to stable weight, normal metabolic function, good digestion, and lifelong health.
2. Eat 5 A Day
“An apple a day keeps the doctor away.” Well, maybe not 1 apple…more like five. Eating fiber-rich foods goes hand-in-hand with maintaining a healthy weight and can reduce your risk of developing breast cancer.
They key is eating enough. The occasional side salad isn’t going to cut it when it comes to optimal health and disease prevention. Fruits and vegetables are part of a solid foundation of healthy eating, not just something we do as part of a diet. One study revealed that 5.5 servings each day was the sweet spot for measurable breast cancer prevention, and no, they don’t have to be organic. 12, 13
Do eat them as foods, not supplements. Time and again, research has shown that dietary supplements do not produce the same health benefits as eating whole foods. We don’t fully understand why, but we do know that the human body prefers whole foods as much as possible. 14-16 supplements
How To Do It:
A serving is defined as one cup of raw leafy vegetables, half a cup of raw or cooked vegetables, or half a cup of chopped or cooked fruits.
Aim to eat 3 main meals each day.
Include 1 to 2 handfuls of fruits or vegetables with each main meal.
3. Get Fit, For Life!
Being sedentary for hours at a time leads to diminished health, while active women have a 20-30% reduction in breast cancer risk by comparison. Exercise has a direct effect on metabolic function, lean body mass, and maintaining a healthy body, for life. 17
How much is enough?
Physical activity has a dose-response relationship. The benefits of physical activity begin with as little as 20 minutes a day and compounds at 60 minutes or more. Regular, moderate to vigorous exercise, plus frequent movement breaks throughout the day is ideal. In other words, you don’t have to move into the gym, but you do have to move off the couch…often. 18, 19
A combination of strength training and cardio is best. Strength training twice per week reduces one’s risk of breast and other cancers, as well as positively affecting bone health, heart health, hormone function, fall prevention, and maintaining our independence as we age. 20-25
How To Do It:
Schedule time for physical activity. Aim for 30 to 60 minutes per day.
Strength train twice per week.
Choose activities that you enjoy and can do with others.
Group exercise, at-home workout programs, private personal training, bodyweight exercise, running, swimming, and cycling are all beneficial.
Everyday tasks such as gardening, household chores, taking the stairs, and walking frequently also contribute to those total physical activity minutes.
4. Limit Alcohol
Addiction aside, many of us enjoy a glass of wine or beer to wind down at the end of the day. Although small quantities of red wine has some health benefits, alcohol is clearly associated with an increased risk of breast cancer. 26
The risk rises with more than 3 drinks per day, and greatly decreases with 1 or less drinks per day. 27
How To Do It:
Take an honest assessment of how frequently you drink, and how much alcohol you’re consuming at one time. Be objective and truthful. If you deem it necessary to reduce the frequency or amount of alcohol you drink, consider some of these options:
Sip slowly and make the serving last.
Choose “mocktails” over cocktails on a night out.
Set aside a day of the week to enjoy it (provided that this doesn’t translate to over-doing it then).
Challenge yourself to sober-streak and see how many consecutive days you can go without.
You might be surprised by what you learn about how you use alcohol and how you feel with and without it.
5. Don’t Smoke
This one goes without saying. Smoking causes cancer and complicates cancer treatment. Second-hand smoke is harmful to others. 28
If you don’t smoke, don’t start. If you do smoke, and are serious about quitting, help is available.
How To Do It:
Smoking cessation programs exist in most communities and you can speak with your health care provider about options for medicines that might help.
Visit smokefree.org for more information on stopping smoking.
Did you catch it all? Breast cancer prevention comes down to maintaining a healthy body weight, eating a fiber-rich diet that includes fruits and vegetables with main meals, 30 to 60 minutes of physical activity each day, strength training twice a week, keeping alcohol to low levels, and not smoking.
Questions for self-reflection:
Which of these lifestyle factors am I already doing well?
Which ones could I improve on?
Which ones could I use help with?
As stated at the outset, a person can do everything in their power to reduce the risk, and still wind up with a breast cancer diagnosis. When that happens, knowing what happens after treatment becomes important. Stay tuned for the next article in this series: Breast Cancer – Health Survivorship.
Yours in Health,
Hillari Herrador is an NASM Certified Personal Trainer and Nutrition Coach specializing in behavior based weight loss and women’s health and fitness. She has developed a systematic approach to weight loss using proven behavior change methods that result in less reliance on dieting and emotional eating, and more enjoyment of food and fitness. Her goal as a coach is to guide you through the process of transforming your lifestyle so that you can feel strong, healthy, and fit, for life. Coaching services include private, one-to-one phone coaching and private personal training in the local Puyallup, WA area. To inquire about working with Hillari please email email@example.com.
1 Toft, Daniel, MD PHD, Oct 2014, Menopause Complications: Estrogen Loss Increases the Risk of Some Health Problems, EndocrineWeb.com
2 JAMA, Dec 2018, Iyengar, et al Association of Body Fat and Risk of Breast Cancer in Postmenopausal Women With Normal Body Mass Index: A Secondary Analysis of a Randomized Clinical Trial and Observational Study
3 Cancer Epidemiology Unit, University of Oxford, 2007, Cancer incidence and mortality in relation to body mass index in the Million Women Study: cohort study.
4 Increasing body mass in post-menopausal women was associated with an increased risk of breast cancer in the Million Women Study.
5 “Accumulating evidence suggests that obesity increases the risk for cancer recurrence and decreases survival rates for several cancers.”
6 Honey, Karen, PHD, , Jan 2015, American Association for Cancer Research , American Association for Cancer Research
7 Cleary, Margot,et al. Obesity and Breast Cancer: The Estrogen Connection , Endocrinology, Volume 150, Issue 6, 1 June 2009, Pages 2537–2542
8 Singletary, Eva, et al. Apr 2003, “Rating the Risk Factors for Breast Cancer,” Annals of Surgery,
9 Cedars-Sinai, 2019, “Steps to Reduce Breast Cancer Risk”
10 Mayo Clinic, 2019, Breast cancer prevention: How to reduce your risk
11 American Cancer Society, 2019, Can I Lower My Risk of Breast Cancer?
12 American Institute for Cancer Research, Aug 2018, "New Study Links Plenty of Fruits, Veggies with Reduced Risk of Certain Breast Cancers"
13 High intake of fruits and vegetables combined, but not vegetables, is associated with a weak reduction in risk.
14 Study findings suggest that frequent consumption of vegetables is inversely associated with risk of estrogen receptor-negative/progesterone receptor-negative breast cancer, and that specific vegetables may be associated with a decreased risk of breast cancer overall.
15 Farvid, Miriam et al. (July 2018) Fruit and vegetable consumption and breast cancer incidence: Repeated measures over 30 years and follow-up.
16 Rogel Cancer Center, 2009, “Most Wanted Supplements -Are They Cancer Killers or Frauds? What You Need to Know”
17 Physical activity and cancer prevention. 20-30% reduction in risk for 30-60 minutes per day.
18 American Cancer Society, 2018, ACS Guidelines on Nutrition and Physical Activity for Cancer Prevention
19 Medicine and Science in Sports and Exercise [01 Nov 2003, 35(11):1823-1827] Physical activity and cancer prevention--data from epidemiologic studies.
20JAMA Cardiology, Aug 2016, Continuous Dose-Response Relationship Between Sedentary Time and Risk for Cardiovascular Disease
21Office of Disease Prevention and Health Promotion, 2008 Physical Activity Guidelines for Americans
22 Medicine and Science in Sports and Exercise, 2019 Physical Activity, All-Cause and Cardiovascular Mortality, and Cardiovascular Disease
23 Ciupka, Brittany, National Foundation for Cancer Research, April 2019 “Cancer Prevention: Which Types of Exercise Lowers Your Risk?:
24Stamatakis, Emmanuel, et al. American Journal of Epidemiology, Volume 187, Issue 5, May 2018, Pages 1102–1112, “Does Strength-Promoting Exercise Confer Unique Health Benefits? A Pooled Analysis of Data on 11 Population Cohorts With All-Cause, Cancer, and Cardiovascular Mortality Endpoints”
25 Harvard Medical School, 2019, “Want to live longer and better? Do strength training”
26 BreastCancer.org (2019) Drinking Alcohol
27 Centre of Alcohol Research, Univ of Heidelberg, Germany, May 2012, Epidemiology and pathophysiology of alcohol and breast cancer: Update 2012
28 Breastcancer.org, 2019, Smoking