HYANNIS – While there are some risk factors for breast cancer that you cannot control such as age and family history, there are things you can do to lower your risk. Oncologist Jennifer Crook, MD, said that even changing a few things in your lifestyle can be helpful.
“If we had to pick just three, I think that screening mammography, smoking cessation and eating and exercising for a healthy BMI are the most important,” she said.
Screening Mammography
Mammograms seem intuitive to physicians like Dr. Crook, but she said that many women either don’t think they are necessary or never get around to having one. Part of the problem is that there are so many different guidelines concerning mammography.
“There’s a lot of different information out there and I think for a lot of women it becomes a little overwhelming,” she said. “As a medical community we emphasize screening mammograms and since the 1990s we’ve seen about a 40 percent decrease in breast cancer related mortality in this country.”
While surgeries and treatments have also improved during those years, Dr. Crook said that better screening deserves a lot of credit because it allows doctors to identify the disease at an earlier stage, which has a much better prognosis. Cape Cod Healthcare performs 3D digital mammograms, which are more precise than analog or 2D mammograms.
3D mammography takes images of each breast from different angles and provides a better view of breast tissue than traditional 2D mammography. It is especially effective at picking up smaller tumors in younger women or women who have denser breast tissue, Dr. Crook said.
As an oncologist, Dr. Crook follows the mammography guidelines issued by the American Society of Clinical Oncology, which recommends starting screening at the age of 40 and continuing to screen annually. There is no age end date in the guidelines.
“The decision when to stop is really something that needs to be individualized based on the woman’s overall health,” Dr. Crook said. “If you are 80, but you are in good health and you have no life-threatening medical conditions and it’s estimated that you’ve probably got another decade of life left, then absolutely we would advocate for continued annual mammography.”
But if an 80-year-old woman is very ill with other advanced diseases of the heart, lungs, kidneys or other organs, that woman is more likely to die from one of those diseases rather than breast cancer. With that in mind, it’s important for elderly women and their primary care doctors to have thoughtful conversations about life expectancy and whether breast cancer screening makes sense.
Smoking Cessation
It would be impossible to live in this country and not know that smoking is bad for your health. Every pack of cigarettes has a warning label on it detailing some of the risks. And yet 34.3 million Americans still smoke, according to the Centers for Disease Control and Prevention. Tobacco use remains the single largest preventable cause of death and disease in the United States, leading to nearly half a million premature deaths.
Lung cancer is the most obvious form of cancer associated with smoking, but cigarettes are also responsible for 14 other types of cancer, including breast cancer.
“Data from multiple studies suggests an increased breast cancer risk in smokers, particularly those who begin smoking early and who demonstrate a lengthy duration of tobacco exposure,” Dr. Crook said.
One of the most compelling studies is The Generations Study funded by Breast Cancer Now. The study showed that a woman’s risk of breast cancer increased by 24 percent if she started smoking before the age of 17. It also showed that the risk increased by about 35 percent if a woman smoked and had a family history of breast cancer.
It is never too late to quit smoking and the National Cancer Institute (NCI) has many resources to help people achieve that goal. They advise talking to your doctor about medications or nicotine replacement products that can make quitting easier. Their Smokefree.gov website offers all sorts of free information and resources including a “Create My Quit Plan,” smart phone apps and text message programs. You can also call the NCI Smoking Quitline at 1-877-448-7448 for individual counseling and referrals to other sources of help.
Maintain a Healthy BMI
“When you look specifically at BMI and breast cancer risk, the association seems to only be present in the post-menopausal setting,” Dr. Crook said. “In younger women we don’t see that link.”
The reasons are not entirely clear, she said, but researchers think that it has to do with the fact that obesity is associated with an increased level of estrogen in fatty tissues. Younger women already have a lot of estrogen flowing in their body, so the additional estrogen from obesity isn’t as dramatic as it is in post-menopausal women who have low estrogen.
“It’s a pretty profound impact,” Dr. Crook said. “If you look at the Women’s Health Initiative Study, there was a portion where they compared women in the healthy BMI range to those in the morbidly obese BMI range and there was over a two times increase in breast cancer. In fact, in some portion of the study it was almost up to three times the risk for getting breast cancer, so it’s a pretty significant difference.”
By the time Dr. Crook sees patients, they have already been diagnosed with breast cancer, but she talks with her patients about their weight to decrease the risk of a second event. She refers overweight patients to the full-time dietician at the Cape Cod Hospital Cancer Center for counseling on healthy eating. She also refers patients to the Livestrong program at the Cape Cod YMCA, which helps cancer survivors create exercise programs.
“A healthy BMI is good for so many things,” she said, including heart health, bone health and a decreased risk of dementia. “But specifically, when you look at breast cancer there is absolutely an association between BMI and breast cancer risk.”
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