Eating a balanced diet, exercising regularly and limiting alcohol — key factors for a healthy lifestyle and prevention of so many conditions — also can help women lower their risk for getting breast cancer, the No. 2 cancer killer among women.
But because breast cancer is often indiscriminate, it can affect even the healthiest of women, cautions one Wichita doctor. About two-thirds of all cases are considered sporadic, meaning a woman had no significant family or medical history for breast cancer.
"Unfortunately there is no safe harbor for women," said Jackie Osland, a doctor with Breast Care Specialists, part of Wichita Surgical Specialists. "Even if you do everything right, there's no way the average U.S. woman can put themselves in a safe harbor. Even skinny women and teetotalers can get breast cancer."
That's because the major risk factors are ones that can't be changed, explained Patty Tenofsky, a breast surgeon with the Wichita Clinic.
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"Being a woman and getter older are the two biggest risk factors for breast cancer," Tenofsky said. "The third biggest factor is family history, and you can't change that either."
But a woman can take control of other things, starting with a healthy lifestyle, say local doctors and experts.
Lowering estrogen is key
Some of the easiest things to control for women are eating right and staying physically active.
"The reason these things work is because they lower estrogen," Tenofsky said. "When you lower the estrogen in your body, you lower the risk."
A woman is subjected to high levels of estrogen, a hormone produced by the ovaries, during her reproductive years. Estrogen stimulates cells in the breast, as well as in the uterus, to grow and divide. Cells that are actively dividing are more prone to DNA damage, increasing a woman's risk of developing cancer.
So what can a woman do to lower estrogen? Here's what local doctors and experts recommend:
* Eat a low-fat diet and manage your weight. Limit fats to less than 35 percent of your dietary intake, and particularly keep your saturated fat intake low, experts say. "Women who have fat or who are obese will have higher estrogen levels," said Terri Cusick, a surgeon with Breast Care Specialists. That's because fat stores estrogen.
* Get plenty of antioxidants and the recommended daily amount of vitamin D. By eating plenty of fruits and vegetables you'll get a good dose of antioxidants, which can help prevent damage from free radicals. Cusick recommends getting at least 1,000 to 2,000 international units of vitamin D daily, through diet, limited sun exposure or supplements. "Studies show an association between low levels of vitamin D and an increased risk for all types of cancer," she noted.
* Exercise regularly. Recommending regular exercise — the kind that gets one's heart rate up, at least four times a week — can be a tough pill for some to swallow, said Allyson Hatfield, an internal medicine doctor with the Wichita Clinic. "People either like exercising or they don't," she said. "There's not many people who fall in the middle. If you're routinely exercising and making yourself healthy, you will do better with treatment if you do get the disease."
* Limit alcohol intake. Recent research shows a correlation between high levels of alcohol intake and an increase in estrogen, the doctors said. Limit drinks to less than one a day or none at all, Cusick recommended.
* Be cautious with hormone replacement therapy. HRT following menopause has been controversial, the doctors said, because it involves increasing a woman's estrogen levels. Any woman considering HRT should visit with her doctor about the risks and benefits of such a treatment plan. Some women can manage menopausal symptoms through exercise, diet or other therapies, experts say.
The family link
For some women, family history and genes make it more likely they'll get breast cancer.
Twenty-five percent of breast cancer cases diagnosed annually in the United States have a family history of the cancer. About 10 percent are linked to the breast cancer gene.
Those women are often presented with more drastic preventative measures, including chemo-prevention drugs and prophylactic mastectomy, which is the removal of breasts when there are no signs of cancer.
Women with a family history of the disease can consider taking tamoxifen or raloxifene, drugs that block estrogen's effect on some tissue. According to the National Cancer Institute, tamoxifen's risk-lowering effects can last for several years after a woman stops treatment.
Both drugs reduce the risk of breast cancer among women by 50 percent, said Tenofsky. "That sounds great but that does mean that half the women on the medication will still get breast cancer."
While not a "perfect" option, Tenofsky said it's still one she offers to those with a strong family history. Women who have two or more cases of breast cancer among close relatives younger than 50 or three cases among relatives of any age fall into that category.
"But not every woman likes it because there are side effects," including putting a woman at higher risk for uterine cancer, she said.
Two genes, known as BRCA1 and BRCA2, normally work to prevent breast cancer. But if a woman inherits an altered gene, it almost guarantees she'll get breast cancer. While it's rare to inherit the mutation, it is significant to those who do, said Tenofsky and Cusick.
Cusick said she considers genetic testing critical for identifying risk in future generations. She recommends testing if a woman develops breast cancer before 45, has ovarian cancer at any age or has a family history of breast cancer.
"It can help us prevent this in other relatives," said Cusick, who expects she'll see more than 300 new breast cancer patients this year alone.
Most women opt for breast removal when they discover they've inherited an altered gene.
Determining risk and screenings
Some doctors, such as Osland, use a computerized model called the Gail model to help women determine the risk of developing breast cancer.
The model takes into account information such as the age of a woman when she first menstruated or had a pregnancy, age, race — being Jewish raises one's risk level — and family and personal medical history related to breast health and cancer.
Doctors generally recommend monthly self-exams, along with an annual clinical breast exam done by a medical professional. Most medical groups still recommend a woman get her first mammogram at age 40 and then annually thereafter, despite recent recommendations by a major U.S. medical task force to go to less frequent mammograms after age 40.