Prevention
Physical Activity
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Women who exercise regularly have a 25% lower risk of getting breast cancer than those that don’t exercise regularly.
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The American Cancer Society recommends that adults participate in 150-300 minutes (2.5 to 3 hours and the 300 minutes being “ideal”) of moderate physical activity or 75-100 (1-2 hours) vigorous physical activity a week. Moderate intensity exercise is when you’re working at 50-60% of your maximum heart rate you have enough breath to speak but not sing. Vigorous intensity exercise is when you’re working at 70-85% of your maximum heart rate and are able to only say a few words then need to pause for breath. You can calculate your estimated maximum age-related heart rate by subtracting your age from 220 (if you’re 40 years old, your max heart rate is 180 bpm) and then apply the percentage to it to estimate your target moderate and vigorous intensity range. Other calculators that are more specific found online estimate your target heart rate based on your age, gender, height and weight.
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Children and teens should get at least 1 hour of moderate or vigorous intensity activity each day and engage in strength training activities (like climbing or swinging or monkey bars) and bone strengthening activities (like jumping, running) three times a week while limiting sedentary (sitting or laying down) behavior.
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Avoid prolonged sedentary (seated) activities like screen time.
Nutrition
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Women who eat a plant-based diet have a 15% reduction in breast cancer risk. In a study on post menopause women, those who ate 25 or more servings of vegetables weekly have a 37% lower risk of breast cancer than those ate less than 9 vegetable servings a week.
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Eat high nutrient foods, a variety of vegetables and fruits (especially fiber rich and bright in color), beans, probiotics, and limit meats, dairy, sweetened drinks, and processed foods.
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Limit dairy and avoid red and processed meats. Add beans into your diet for protein.
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Eat whole grain foods (quinoa, oats, farro, amaranth, millet, barley, spelt, wild rice, freekah, teff, bulgar wheat, buck wheat, brown rice).
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Avoid processed foods.
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Avoid sweetened beverages.
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Eat food containing prebiotics and probiotics.
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Avoid alcohol (and if you do drink, have no more than 1/2 to 1 drink per day for women or 1 to 2 drinks per day for men).
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Know your vitamin D. Women with a low vitamin D level have a higher risk of breast cancer.
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Avoid Toxins
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Regularly consuming alcohol (1-2 drinks per day) may increase breast cancer risk by 30-50%.
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Women who have smoked for more than 10 years appear have approximately 10% higher risk of breast cancer than women who’ve never smoked.
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Secondhand smoke may increase risk of breast cancer, especially depending on the age of exposure.
Carcinogens are known cancer causing chemicals. Two of the most commonly carcinogenic exposures are smoking and alcohol. Avoid smoking and second hand smoke and avoid alcohol (or on average per week limit yourself to 1/2 to 1 glass of alcohol per day for women and 2 or less for men).
Avoid occupational and environmental toxins. A recent study found more than 900 chemicals that could promote the development of breast cancer, and many of them we may come in contact with everyday. Examine your workplace, home, and beauty and personal care products. Eliminate things that are potential carcinogens like formaldehyde and its derivatives. Xenoestrogens are synthetic estrogen mimicking chemicals (such as parabens, BPAs, PFAs, triclosan, phthalates, and fragrances) that are found in our beauty products, household cleaning products and cosmetics that mimic estrogen and increase our estrogen levels in our bodies which increases breast cancer risk.
Useful apps such as the EWG Healthy Living App, Clearya App, or Think Dirty App examine the ingredients of personal care products, household cleaners, baby care products and give you information on the listed chemicals and potential risk. They can also suggest other healthier options. Look for a future blog post delving into the field of "Clean Beauty" at a later date.
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What about chemicals in our food?
Organic food does not have more vitamins and minerals than conventionally grown food, but organic grown food does have more antioxidants. Cell culture studies have shown that organic fruit and vegetables are better at suppressing cancer growth, but that hasn't been proven in studies on humans (in vivo studies). Conventional produce can contain high levels of toxic heavy metals and pesticide residues.
The Environmental Working Group has compiled a list of the “Dirty Dozen” plants that are most contaminated by pesticides and the “Clean Fifteen” that are least contaminated by pesticides.
However, if you have limited resources, it's better to eat more veggies and fruit than let the question of organic vs conventional stop you. Washing your produce thoroughly will decrease the pesticide residues but not totally eliminate it.
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Organic food can be much more expensive than conventionally grown produce. It’s usually cheaper when purchased frozen, in season, locally from a farmer like in a farm-share Community Supported Agriculture (CSA) program, or grown yourself.
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Optimal Health - Mind, Body, and Spirit
Stress, anxiety, depression, loneliness can all factor into a spirit of dis-ease. Find ways to mindfully combat negative emotions, embrace positive emotions and find community.
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Having a higher Body Mass Index (BMI) after menopause is associated with increased risk of breast cancer (but interestingly, those with a higher BMI before menopause are at lower risk). It is not recommended to have a higher BMI in youth because you are more likely to carry the extra weight into post menopause.
Weight and Body Mass Index may be a difficult topic to discuss in our society because of associated emotional and psychological burdens or associations with with body image. Also, using BMI (which is calculated from heigh and weight) as a measurement isn't ideal as it does not take into account muscle vs fat and the numbers can be misleading. Muscle weighs more than fat, so one could be lifting and exercising every day and still be considered "overweight" by BMI standards. Conversely, being underweight or using unhealthy methods to attain an "ideal" may be dangerous too. Alas, it is what is currently used as a measurement of adiposity.
Aim for a healthy body inside and out. Let yourself be nourished by nutritious foods, movement, mindfulness, purpose and human connection.
Check Yourself
Know your body, check your breasts, and get mammogram screenings when appropriate. Mammograms are a screening test, and intrinsically have their limitations and risks. It is important to discuss the risks and benefits specifically in your situation with your healthcare provider. Here are the mammogram screening recommendations for women at average risk of breast cancer:
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Women at age 40 years old and older: Yearly mammograms.
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Women 55 years and older: Continue yearly mammograms or switch to every other year if recommended by your healthcare provider, until your life expectancy is less than 10 years.
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High risk screening guidelines:
If you think you might be at high risk of breast cancer, discuss your family history of cancer with your healthcare provider who may recommend genetic testing (see below), and screening test of a breast MRI, ultrasound, and/or mammogram every year.
Know Your Risk
Do you have a family history of cancer (including but not limited to melanoma, breast, ovarian, colon, and pancreatic cancer? If so, you may be at higher risk of breast cancer and other cancers from an inherited DNA mutation, lifestyle factors, environmental exposure, etc. Discuss your family history of cancer with your healthcare provider who may recommended genetic testing and a referral to a geneticist. Hereditary cancer syndromes account for 5-10% of all cancers and increased risk of cancer significantly. For example, women with BRCA1 gene mutation are 80% increased risk of breast cancer and 40% risk of ovarian cancer. The BRCA gene is the most commonly thought of when we think hereditary breast cancer, but there are other known mutated genes that increase risk of breast and other cancers including:
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ATM, BRCA1/2, BARD1, CDH1, CHEK2, NF1, PALB2, PTEN, RAD51C, RAD51D, STK11, TP53
Take an online screening quiz to see what your general risk is. However, know that that these guidelines are generalized for the entire population, and inevitably some of us slip through the cracks. This is because guidelines aren't meant to catch everyone, they're meant to catch most without causing the harm of over-testing. As medical researchers discover more gene mutations, family sizes change, and if the alarming trend continues of increasing numbers of young adults diagnosed with cancer, these guidelines must and will change. It takes time to see these trends epidemiologically and for public health policy to adjust. This is frustrating, but we remain hopeful.
Screening tools:
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Seven-question Family History Screening Tool from Risk Assessment, Genetic Counseling, and Genetic Testing for BRCA1/2-Related Cancer in Women: A Systematic Review for the U.S. Preventive Services Task Force. Nelson HD, Pappas M, Cantor A, et al. Rockville (MD): Agency for Healthcare Research and Quality (US); 2019 Aug.
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Dana Farber Cancer Center and Bright Pink's Assess Your Risk tool evaluates your risk of breast and ovarian cancer based on lifestyle, environmental exposure, and family health history and genetics. history of cancer.
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Find a genetic counselor locally or through Telehealth from the National Society of Genetic Counselors.
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Get yourself tested with a home test kit, some for less than $400 or less if covered by health insurance. Make sure that the company testing you is credible, includes genetic counseling so you can understand and interpret the results, and is testing an appropriate number and type of genetic mutations. Remember, your results are only going to give you the results of the specific genes tested. To put that in perspective, the human genome has 20,000-25,000 genes. One credible testing option is the JScreen CancerGEN at home saliva swab test. Jscreen is a national non-profit affiliated with Emory University. They will test individuals 21 years of age and older and currently test for 70+ known mutations.
Delve Deeper
Lynch BM, Neilson HK, Friedenreich CM. Physical activity and breast cancer prevention. Recent Results Cancer Res. 2011;186:13-42.
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PMID: 21113759 DOI: 10.1007/978-3-642-04231-7_2
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Crinnion WJ. Organic foods contain higher levels of certain nutrients, lower levels of pesticides, and may provide health benefits for the consumer. Altern Med Rev. 2010 Apr;15(1):4-12.
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PMID: 20359265.
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Link LB, Canchola AJ, Bernstein L, et al. Dietary patterns and breast cancer risk in the California Teachers Study cohort. Am J Clin Nutr. 2013;98(6):1524-1532.
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Gaudet MM, Britton JA, Kabat GC, Steck-Scott S, Eng SM, Teitelbaum SL, et al. Fruits, vegetables, and micronutrients in relation to breast cancer modified by menopause and hormone receptor status. Cancer Epidemiol Biomarkers Prev. 2004;13(9):1485-1494.
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PMID: 15342450
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McDonald JA, Goyal A, Terry MB. Alcohol Intake and Breast Cancer Risk: Weighing the Overall Evidence. Curr Breast Cancer Rep. 2013 Sep;5(3):10.1007/s12609-013-0114-z. doi: 10.1007/s12609-013-0114-z. PMID: 24265860; PMCID: PMC3832299.
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Schoemaker MJ, Nichols HB, Wright LB, et al. for the Premenopausal Breast Cancer Collaborative Group. Association of body mass index and age with subsequent breast cancer risk in premenopausal women. JAMA Oncol. 4(11):e181771, 2018.
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Kay JE, Brody JG, Schwarzman M, Rudel RA. Application of the Key Characteristics Framework to Identify Potential Breast Carcinogens Using Publicly Available in Vivo, in Vitro, and in SilicoData. Environ Health Perspect. 2024 Jan;132(1):17002. Epub 2024 Jan 10. PMID: 38197648; PMCID: PMC10777819.