All of these comments are a resource for me and I will keep them for future reference. I am 56, with fibrocystic/ dense breasts. Every time I get a mammogram I am afraid of bad news.
One thing among all preventions mentioned ( no alcohol, exercise , maintained a healthy weight, don’t eat red meat, you need vitamin D, iodine, and omegas.
My comment is to not buy drugstore cosmetics. There are many clean beauty products: BareMinerals, Tarte cosmetics, Beekman 1802,, and Josie Maran. There are more, but not many more. Secondly, your clothing; Stay away from Synthetic fabrics which use dyes that are criminal, as well as the fabric itself. Try to buy organic clothing. Linen Cotton and wool can be organic. Tencel is made from bamboo.
That’s why there is google. Seek clean fabrics and clothing out.
Lastly, do not eat Genetically modified foods and try to buy organic everything.
Otherwise, you are eating pesticides and other chemicals. No, they don’t wash out when you rinse vegetables before cooking or eating.
Watch the movie “What the Health” it’s an eyeopener.
Thank you so much for everyone’s comments. I am grateful for the knowledge. Best to all,
Ps. If you’d like to know of some organic clothing online sources, just message me.
1
@Annie "Stay away from synthetic fabrics " "Do not eat GMO food and try to buy organic everything." Seriously? Organic everything! Where's the evidence to support these statements?
1
I didn't see any mention of the potential role of Vitamin D in breast cancer prevention. According to breastcancer.org, "research suggests that women with low levels of vitamin D have a higher risk of breast cancer. Vitamin D may play a role in controlling normal breast cell growth and may be able to stop breast cancer cells from growing." About 40% of U.S. adults show low levels of Vitamin D. I was very deficient in this vitamin at the time of my breast cancer diagnosis.
5
I was shocked when I found my tumor at age 60, which was malignant but fortunately not metastasized. There was a history of a lot of cancer in my family but no BC in my immediate female relations. I found out only after diagnosis that 80% of women diagnosed with BC have no family history of it. Being overweight is a risk factor for estrogen-sensitive tumors, as mine was. But skinny girls get BC too.
As for that online risk calculator link in the article, I took it and answered as I would have 5 years before my diagnosis. It's a crock. My advice: eat little sugar and high glycemic carbs, stay active, and most important: get annual mammograms after 50.
3
I took raloxifene for years post menopause as a preventative for osteoporosis, as well as breast cancer. I had NO bad effects from it. I stopped when I turned 65 because I had read that the incidence of strokes increased in older women who took it. But while I took it, it did not disrupt my life at all. Since stopping it I have not developed osteoporosis. I am still in the osteopenia range. And no breast cancer - fingers crossed because I think that can happen to any of us.
2
Just want to point out that you can’t “contract” breast cancer from another person, I think the word “contract” is used erroneously in the last paragraph. (Yes I know some cancers are associated with viral infections, like cervical cancer and HPV, but breast cancer isn’t one of them.) (Honestly what could I have expected from a Jane Brody piece… definitely not scientific accuracy…)
6
I'd like to add that the Breast Cancer Prevention Partners is an organization that has done important work in the area of BC prevention research and education since 1992 and a terrific resource for anyone seeking more information.
1
I was diagnosed with HER2+ breast cancer in 2016. I had chemo, lumpectomy and 11 lymph nodes taken out and then radiation. I was 60 years old. I was put on Anastrozole (aromitase inhibitor) in 2017. After 4 years of being on the drug I was feeling more and more depressed. So I decided to get off it. I spoke with my oncologist and he asked if I would be willing to have a test done on the breast tissue that was taken at my lumpectomy. They found that I have a 12.7% chance of distant recurrence. I thought that was a pretty low number, but it's not. I'm back on the drug and will need to be on it for 10 years in total.
It's important for women to know what the rate of recurrence for them is. Some women absolutely will not benefit from taking the drug longer then 5 years. But some will. It's important to have this knowledge. My tissue was sent to Biotheranostics (in LA). They're the ones that will ascertain whether you should remain on the inhibitor for 10 years or just stay for the full 5.
I'm working with a naturopathic oncologist (alongside my regular oncologist) to preemptively stave off (as best I can) the horrific side effects from the drug. I have always had an extremely healthy diet but I want to make sure I'm taking the right amount of vitamin D (for instance) and I'm eating flaxseed and chia - both very high in Omega 3 (very important for cancer patients). Anyway - knowledge is important and we can only do the best we can.
8
Being overweight before menopause has a slight prophylactic effect when it comes to breast cancer. Doesn't fit with the obesity = cancer narrative, so rarely highlighted.
4
I read a lot of people talking about not taking chemo to treat cancer. Other question using the aromatase inhibitors or tamoxifen.
Please follow your oncologists advice. These cancer cells are hard to kill!
I spent five years on Arimidex, an aromatase inhibitor. I was nervous coming off it as I felt that every day I took the pill I was doing something to prevent recurrence.
Yes there are side effects, but if it saves your life, why complain. Yes, my joint hurt when I got up. Yes my feet hurt from the neuropathy caused by chemo.
I wake up every day, happy and grateful to be alive.
I lost a dear friend to cancer the year I was diagnosed, she wished the chemo worked on her cancer.
Please see your doctor every year, get all the preventative screening you can.
Cut out the alcohol, walk, eat your veggies.
11
Thank your for saying that women who get cancer should not be blamed. When I was diagnosed six years ago I asked my doctor what I did, she said you have breasts. She also mentioned that the woman she saw before me was a tri-athlete.
But many people treated me as if I had done something wrong and/ or interrogated me on my family history. People do this to make themselves feel better, which is a horrible way to treat a cancer patient.
Most cancers are not caused by known genetic mutations. That people with known mutations have higher risks for cancer does not mean all cancer is caused by an inherited gene.
When I asked my oncologist what I could do to prevent the cancer from coming back she said:
1. Don’t drink alcohol
2. Eat lots of fruits and vegetables
3. Exercise
Giving up drinking was easy for me. I had a solid year, 52 weeks, of intense chemo, six weeks of daily radiation, and three surgeries.
I have NO desire to drink. Just thinking about chemo cures any desire for a wine with dinner.
My biggest problem is my sweet tooth!
Thanks again, this was a very informative column.
15
I've had breast cancer. Got genetic testing as my mother had also had breast cancer. Result: no BRCA gene. However I was told at the time that there were nearly 100 other genes that were being studied as possibly being associated with breast cancer. In my case, a lumpectomy revealed that I had abnormal single breast cells sprinkled around. Each and every one of those abnormal cells could develop into breast cancer. My sister quickly had a biopsy done and found out she had abnormal cells sprinkled around also. I was told having this "condition" is considered to be genetic and that women with this condition were highly likely to be diagnosed with breast cancer again. Had a double mastectomy. My reconstruction surgeon told me he had several patients before me with this problem and one had five separate lumpectomies before she finally had the double mastectomy when diagnosed that sixth time.
Incidents of genetic breast cancer may be much higher than we currently know.
9
Since a lot of women use alcohol, and a large subset are quietly suffering with it, I'll speak up in case my experience can help someone. I had 4-6 drinks almost every night for 25 years. Since alcohol is a big risk for BC as well as many other illnesses, I hope more people will consider how and why they use it. My advice is incomplete for those who need to be medically supervised in order to detox safely. But for everyone, education is key. Learn about behavior (my favorite book is The Willpower Instinct by Kelly McGonigal, PhD. It's a valuable resource for anyone). I read more specifically about alcohol in the books Never Enough (about all kinds of drugs) and Alcohol Lied to Me (about alcohol and society). I found Russel Brand's documentary on addiction (YouTube) very helpful (there are many great sources on YouTube). The key for me was to understand why I couldn't think my way out of this habit. I had to acknowledge that I had trained my body as well as my mind to expect this substance, and wasn't conscious of the impact of that physical dependence on my behavior. Once I understood what was going on in my mind and my body, I was able to take advantage of a week off - a break in my routine - and one night I just "surfed the urge" (see McGonigal). I felt so much better the next day that I was eager to see whether I could do it again. I could. Quitting did not solve any of my problems, but it made it possible for me to work on them. You can do it. Let yourself be well.
19
Over 50% of this article discusses specific drugs as preventive treatment (11 of 21 paragraphs on my screen). This content dominance seems odd especially since it is not breaking news: there has been at least a 20 year push by the makers of tamoxifen and raloxifene to extend the use of their cancer patient treatments to healthy women with risk factors for breast cancer, a goal that is not without some controversy. Intentional or not, the article comes across as advertising for these drugs.
15
@BC I'm a former RN and I'm learning new information. And as a caregiver of my husband who has Parkinson's Disease, I benefit from a neurology magazine full of drug ads called Brain and Behavior.
Your comment is well taken, I doubt this inclusion is intentional. Women need general information on medications being used. It will be new info for a new generation with BC if nothing else.
2
This article is a missed opportunity to talk about real prevention. Yes, women can exercise and be careful about what they eat. People at high risk can take medicines or have prophylactic masectomies. But, no matter how hard we exercise, we can't keep ourselves safe from the proliferation of endocrine disrupting chemicals and breast carcinogens in the environment. . A physician below mentioned that it is just bad luck that causes young people to get cancer.I thought that at first, when my 21 year old sister was diagnosed with breast cancer 30 years ago. But, an increasing number of young people are getting are breast cancer. Just an increase in bad luck? No, there is a cause. We have to put in place a precautionary approach to chemicals development and management. With all the information we have now about cancer and the environment (Dana Farber Cancer Center is hosting a workshop on the issue tomorrow), it just doesn't make sense to write articles about prevention without including this information.
29
@Laura The small city I live in and those nearby are revamping their water departments to reduce the levels of PFAS, a forever chemical found in many products we buy. Massachusetts has reduced the allowable limits of PFAS. The usual cranks are not writing letters to the editor saying its a waste of money. Their letters wouldn't be printed.
1
I'm disappointed the article doesn't address the potential increased risk of BC that occurs from screening tools. While there exists alternatives to mammograms, gaining access to these alternatives is difficult, expensive, and usually impossible for most women like myself.
My most recent mammogram was last week. It was excruciatingly and unnecessarily painful and when it was over I researched alternatives and vowed I would never have another one done again.
With all the technology that exists, we seriously don't have a better screening method than this archaic torture device that has no agreed standard of application?
As this is a women's issue, I can't say I'm shocked to find out that today's screening practices are based on research from 50+ years ago. But I was shocked to find out that the radiation from mammograms had the potential to actually increase the risk of BC and that mammograms lead to more false positives and over-diagnosis.
Knowing this, coupled with my most recent mammogram screening experience, I will never have another one.
14
@Marie
I agree with your comment 100%.
I also no longer get mammograms. Mortality from BC does not change if you get the screening or not (according to Dr. Greger, How not to die.) I refuse to be put through that barbaric screening process. I am confident that I am doing everything preventative that is recommended. I trust myself before some prescription pushing doctor.
1
This article makes me angry for some reason. Maybe because nothing listed here as prevention is new or proven to actually prevent BC. Sure a healthy lifestyle has many advantages but can it actually prevent BC? The answer from any oncologist is no.
Maybe I’m angry because Ms Brody has recycled the same lazy 8th grade report on breast cancer she’s been submitting for years. The only new information is the insane idea to put women on tamoxifen and aromatise inhibitors as prevention for how long? The rest of their lives?
You know what? That’s it! That’s why I’m angry. This idea to preempt cancer by pumping drugs into women is not the answer. As other commenters have noted, the side effects are not only debilitating (severe joint pain, depression, hot flashes, zero sex drive to name just a few) but result in other long term damage to bones, joints, and cardiovascular health that can also shorten your life.
It’s too late for many of us (I was diagnosed at age 43) but we must demand better for our daughters! Research should start with what causes breast cancer. Only then can we begin to figure out how to prevent it.
45
In reading many of the the comments, I am compelled to point out an extremely important point that is not clarified in the article. That is that 'risk reduction' is not the same as 'incidence'. Yes, if one looks at large populations and sorts out the factors that will reduce the overall occurrence of breast cancers that is accurate. However, the vast majority of breast cancer, >99%, (and actually all cancers) occur as a random event without any identifiable cause. All those women stating that they did all the correct life style behaviors and still developed breast cancer at a young age is a fact of mostly random incidence and bad luck. Fortunately, breast cancer is rare in young women but the cruel fact is that it is much more deadly in the young.
Conversely, breast cancer in an older woman (>75) is mostly a benign problem that is easily treated successfully which is one of the main reasons that mammograms are no longer recommended in this age group. Those statistics cited for cure are attributed largely to the older group of women.
I would be cautious recommending any long term drug treatment that has NOT been proven to have mortality benefit (less risk of dying from the disease) as the treatment can have side effects and the benefit would again be a statistical calculation not a necessarily measurable one in the individual. This is an important point not well discussed this article.
Cheers,
George F. Smith, M.D.
Board Certified in Internal Medicine
22
Luck more than good management is probably why I am alive 7 years after diagnosis of Triple Negative breast cancer and a mastectomy. Don’t start me on how lifestyle and prophylactic medication might reduce risk. Blaming the victim is very poor public health and it is over used in cancer, cardiovascular disease and Type 2 diabetes.
12
A reliable resource for breast cancer prevention can be found at the Physicians Committee for Responsible Medicine's Let's Beat Breast Cancer page: https://www.pcrm.org/letsbeatbreastcancer
It offers guidance and healthy recipes on its "four-pronged" approach to preventing cancer:
- Choose plant-based foods;
- Exercise regularly;
- Avoid alcohol;
- Maintain a healthy weight.
These resources were all developed from peer-reviewed research and are all available free of charge.
9
@Ashley
More accurate to call these “risk-reduction” measures that may apply to some but not all cases of breast cancer.
7
@Ashley Avoiding Dairy is another recommendation from PCRM. Dairy and Breast and Prostate cancer go together. Animal proteins turn on Cancer genes go WFPB is your best bet to avoid Cancer.
1
Know your family history! If there is breast cancer, check for a BRCA mutation, as there's a 72% chance of developing an aggressive form (triple negative) by age 80. Prevention for that-- a mastectomy or increased surveillance.
1
Please investigate the Wisdom Study started by breast oncologist, Dr Laura Esserman, and consider joining.
1
ALCOHOL.
10
This article (and much of breast cancer oncology) focuses on estrogen as a big culprit for breast cancer. Okay, so if estrogen is such a horrible cancer-causing hormone, let's ask ourselves some questions. First, why is breast cancer most common in menopausal women (age 50+)? The average menopausal woman has hardly ANY estrogen left in their body (very very low levels on average). So then why are women with very little estrogen getting breast cancer that is supposedly often deemed to be caused by estrogen? And let's also ask ourselves about women that naturally have extremely high estrogen levels: women in their late teens/early 20s and pregnant women. Again, if estrogen is such a horrible substance, why aren't we seeing more breast cancer among these groups (or at least closer to the ages of these groups)?
It doesn't add up and oncology has been barking up this wrong tree for decades now. The WHI study reversed it's findings in 2017 and determined that estrogen therapy does NOT in fact have a higher risk for breast cancer.
Proactively giving women estrogen-blockers (the drugs mentioned in this article) to prevent breast cancer is just going to make them miserable due to the extreme side effects these drugs often have. We need better research and acknowledgement that cancer is more complicated than this article suggests.
17
@Cindy
Well said!
1
In my family 3 woman treated for breast cancer. The one with great health care insurance coverage (2 policies) recieved every imaginable test, therapy, treatment and multiple surgeries over 1 year. Over $1 million and counting. The treatment nearly killed her... And still might. She has been miserable from the drugs and treatment. She was vibrant and feeling well before treatment.. now.. a shadow. The other .. good health care and Medicare.. too many diagnostic tests that didn't change treatment plan but made them a lot of money. She died miserable +500k 3rd. Poor insurance.. not a lot of money.. They wasted her money on expensive unnecessary diagnostics that didn't change treatment plan. The only thing she could afford was surgery. She fared the best out of all of them and is healthy enough to enjoy life. < $60k and most on unnecessary tests. Some of the drugs mentioned have horrible and at times life threatening side effects with highly questionable benefit while financially benefiting others and financially harming the patient. The stress of financial hardship for any cancer patient is enough to cause physical, social and emotional harm. More people probably die from cancer treatment than from cancer. More people probably die with cancer than from cancer. Extremely poor article. Cancer treatment is all about big money. Sell the patient false hope, or bully, or scare the patient, into expensive unnecessary diagnostics and treatment.
13
@Zoe
You are so right.
1
All of these statistics are hogwash. The simple fact is that, adjusted for population changes, the number of people who die from cancer is the same today as it has been for 50 years. "Survival rates" is a meaningless phrase that has been invented to defraud the public. Here is the truth: if, in 1970, someone "got" (which is a problematic verb, I understand) cancer when he or she was 50, it was detected when he/she was 52 and the person died of the disease at 55, the metric attached was 3. The same person today "gets" cancer when 50, it is detected when the person is 52 and the person dies at 55, now the metric is 4, that is, a 33% INCREASE IN SURVIVAL. Which is nonsense. It is also true some sorts of cancers are treated more effectively, but we have more and some that are not. I understand for someone with a more treatable species, this analysis seems harsh, but here is another fact for you: the money spent on cancer research in this period -- many trillions -- could have save every single person who died of malnutrition during that same period, that is, every single life could have been saved. We are not going to "cure" cancer. Never, ever. I, just for one, prefer to spend limited funds on something that can be cured -- like hunger.
13
A) You used the exact same numbers in your incorrect claim about overall survival.
B) Overall survival, disease specific survival and progression free survival are all separate metrics that we use to avoid lead-time biases (just detecting a cancer earlier, but not necessarily changing the natural history of the disease). They all show that for most cancers, we are increasing the number of people cured with cancer and making people live longer.
C) What you are referring to is the relative cost benefit of $1. Almost across the board, most medical care in America is not a good use of money. The reason for that is, our life expectancy is relatively long. If you spend money on something that affects poor people or those affected by conditions in young adults/children, you will always see a bigger benefit.
However, no one would ever agree to allocating financial resources to these kind of conditions because the people donating to medical research are rich and, by and large, cancer is a disease of success. If you live long enough and don’t have other medical conditions, you will likely get cancer, hence why so many millionaires/billionaires fund research for it. You will have a hard time convincing them to spend it on hunger eradication or treatment of river-borne parasites (an example of an infectious disease that the WHO thinks could be one of the single most cost effective ways of increasing life expectancy in Africa).
4
What about the trend of women undergoing homeopathic care for breast cancer rather than chemo? My doctor said a lot of her colleagues choose to do homeopathic medicine rather than traditional chemo if they have breast cancer.
2
@Tracy
The chemo causes heart disease. Nobody talks about this.
1
Seems like 3 approaches could help. Some have more risk than others, re-healtth. Others have multiple health benefits:"
The Win-Win ideas: Stop smoking cigarettes; Reduce or stop alcohol. Both increase breast cancer risks as well as other health risks. The impact of each is dose dependent. The more we use the more likely we are to get sick. The combination of alcohol and cigarettes interacts to increase risk more than the added risk of each together. Colon, mouth and throat cancer.
Reduced processed foods.
Can help, might hurt ideas - adding long term medication to gain preventive effects that outweigh possible negative effects in other health arras.
Focused research: Track and report on 5 yr AND 10 yr survival rates.
1
@Bill Zwick
Avoid high-fat animal products, ie dairy.
3
Interesting and helpful article overall. However, I must comment that some misinformation has been conveyed here.
In the paragraph describing food recommendations, Ms. Brody says, The American Cancer Society recommends eating soy foods..." That is incorrect. Research does not yet know whether or not soy and soy products are preventive for breast cancer, especially since soy contains estrogen mimicking isoflavones. So it is recommended that soy foods be avoided and only consumed occasionally.
13
@J. Stadler The American Cancer Society’s website says “So far, the evidence does not point to any dangers from eating soy in people, and the health benefits appear to outweigh any potential risk. In fact, there is growing evidence that eating traditional soy foods such as tofu, tempeh, edamame, miso, and soymilk may lower the risk of breast cancer, especially among Asian women.” They do advise “against taking soy supplements – which contain much higher isoflavone concentrations than food – until more research is done.”
4
The fear about plant estrogens is likely about the dairy industry worried about losing milk drinkers, when in fact studies from the nih.gov clearly discusses the estrogens in dairy products with known risk factors. Google “Hormones in Dairy Foods.” There are numerous studies from scientific bodies available for the general public to read. For the average person there is a great deal of scientific wording but scroll through the pdf and then read the conclusions. I can’t help but think that we also have a chemical pollution problem.
4
For those interested in taking control over factors that might influence their likelihood to be diagnosed with breast cancer, I encourage you to follow the work of Silent Spring Institute in Boston and Breast Cancer Prevention Partners (BCPP) in San Francisco. Both have been researching the links between what we come into contact with environmentally and via our purchasing choices and cellular/hormonal change driving breast cancer likelihood. They are active in pushing federal and state-wide legislation to reduce the number of cancer-causing chemicals allowed in our personal care and cleaning products and creating awareness for at risk occupations and ethnic groups.
Truth is, Big Business in the US has been very effective at keeping regulation to a minimum. In cosmetics alone, the EU has banned or restricted more than 1,300 chemicals while the US has outlawed or curbed just 11. (https://www.theguardian.com/us-news/2019/may/22/chemicals-in-cosmetics-us-restricted-eu)
Many individual products contain unhealthy chemicals which may not exceed proscribed limits, but the average teenage girl leaves the home in the morning with 20+ body products on her skin, nails and hair, most of which contain cancer-causing chemicals. That puts her far over the safe limit.
Demand safe product regulation and in the meantime, educate yourself, friends and family.
21
and change your own behavior top reduce weight, change types of food and beverages.
3
You did not mention the effect of Estrogen blocker medications. While on Anastrozole my joints got so out of whack I could not stand up in front of my dryer. I also got DeQuervanes synovitis in both wrists.  Now I switched to Letrozole and my clothing will not fit. My hair and skin and fingernails are ruined, although my breast was saved. 
8
It's not an accident that Procter & Gamble is one of the leading $ contributors on breast cancer research. All their personal care products marketed to women are full of proven endocrine disruptors: pthalates and parabens. Yep, they kill women for profit.
22
@Comp And this is the issue. All f Brody's recommendations (most of which are recommended for heart and brain health too) place prevention on each individual woman. So, breast cancer becomes a voluntary disease. But even the "choices" Brody recommends are largely non-voluntary. For instance, we live in a toxic, obesogenic environment. Why are the corporate interests of food producers placed before those of the people who will eat the food? Why not, for instance, raise taxes on junk food? Brody herself mentions that the demands made of women place them at a disadvantage for exercising. We could make women's lives easier (e.g., by providing low cost child care or demanding that fathers do their share), but we don't. It is simply unfair to blame the victim.
13
If only the energy and resources directed to Covid vaccines were focused on cancer that kills - Stage Iv. Many lives would be saved.
3
Way more is spent on cancer research than vaccine research.
7
On the contrary, obesity is protective for pre-menopausal women: https://www.frontiersin.org/articles/10.3389/fonc.2021.705911/full.
It's really all a crapshoot. And 90% of women diagnosed with breast cancer have no family history. That was certainly true in my case, when I was diagnosed @ 46 three years ago.
7
@Maia Most breast cancer is post-menopausal. Obesity confers risk for a laundry list of cancers, via several mediators including the effects of insulin like growth factor. Anyone who wishes to avoid a cancer diagnosis would be well-advised to stay within a healthy BMI, abstain completely from alcohol and nicotine, avoid processed meats, and engage in physical activity on a daily basis. But you're right that cancer can be a crapshoot. Very healthy people get cancer every day.
5
However much science and experience in treating breast cancers have altered its prognosis for the better, there is much more that needs to be done. Your suggestions are, of course, a breath of fresh air. But just look at the thousands of women who, for lack of preventive measures, i.e. health care coverage and proper education, do arrive too late for comfort..and survival. Of note, we are spending valuable resources in all the wrong places (a bloated military comes to mind)...instead of contributing to a more rational endeavor, try to conquer any and all malignancies, huge destructors of life and early demise, at its earliest stage...if not prevent it from occurring...to begin with.
4
Thank you for this article, Ms Brody. I was diagnosed with triple negative aggressive, invasive, stage 2 breast cancer 13 years ago at the age of 65. I'm now 77 and proudly vegan and a 100% non drinker. I believe I have been gifted with 13 years that I wouldn't have otherwise had because of the changes I have made. Yes, I embraced all the treatments that were current then - surgery (but a lumpectomy, not a mastectomy), chemo (my hair is very thin), and radiation.
I do believe that the life changes are as important as the medical treatments.
22
@JMW
It is dangerous to say that “life changes are as important as the medical treatments.”
The efficacy of medical interventions as cancer treatment has been well and extensively documented in scientific research. I would not suggest to anyone that they use only lifestyle changes to treat cancer since they would be at great risk of recurrence or metastasis. This may not have been your meaning but some readers may come away with this impression. Following up with lifestyle changes after medical treatment makes good sense.
I’m very glad you are doing well.
1
And then there is the question of who pays for it all? Our health system is predicated on treating disease not prevention……..and Pharma and medical practitioners and hospitals are businesses.
13
Another option not discussed: prophylactic mastectomy. It sounds radical but if you have family history and dense breast tissue (ergo no truly effective testing methods) it's really not.
12
It is refreshing to read a column about prevention rather than treatment of disease, and I appreciate the range of suggestions offered.
However, I was disappointed to see the emphasis in the first half of the article on adding more medications to our lives, even ones that are not well proven, with no mention of what we know about their side effects or interactions with other medications.
From my lay knowledge of the subject, I believe it would be much more informative to have begun the column with the well-documented non-pharmaceutical recommendations (such as avoiding alcohol, red meat and excess weight) which are approaches everyone can and should follow, and only mention the medication at the end of the column as a last resort for individual cases.
27
It is deeply common-sensical and yet practically impossible to prove that toxic chemicals and/or radiation are primary underlying causes for cancer - full stop. Jane mentions this only briefly. See the work of BCPP - Breast Cancer Prevention Partners, which Jane should have mentioned in her article. Their website has helpful guidance and approaches the issue from a different angle. DO: choose less toxic products and foods and food packaging, avoid fragranced products, select non-toxic building and renovation materials, air out your car before putting your children inside, don't bring junk mail and similar stinky printed material into the house, don't purchase clothes that must be dry-cleaned, and so on.
14
@ELM Pthlalates and parabens are in virtually all personal care products, even those without fragrance, and they are known endocrine disruptors. The jury is IN on 'toxic chemicals'.
6
Having lived on endocrine therapy now for two and a half years (diagnosed with breast cancer at age 48), I can tell you these drugs are burdensome on a good day, and frequently misery-making . Women who are contemplating taking endocrine therapy for cancer prevention should really, truly understand the side effects before going on these drugs. Side effects are no minor matter!
33
@Robin I don't know what it's like to do endocrine therapy as a woman, but my father has done it for his prostate cancer, and he found it to be the most miserable aspect of his treatments. He said he preferred the radiation and even the chemotherapy that left him unable to taste and all it's other nasty side effects to hormonal therapy. As his family, we made the extremely naive assumption that once he was past the radiation and the chemotherapy, that he was basically "done" and just had to take a little pill everyday as in insurance policy. We were completely floored to see the level of exhaustion, depression and anxiety, weight gain, you name it, and felt completely unprepared in supporting him through this part of his treatment. His doctor affirmed that most people really struggle with it, and my dad has always said that he's not sure he would do them again if it came to it. He really truly wasn't "himself" for years, and he felt that he didn't recognize his personality on these drugs. I think about it each and every time I read about it as a solution to an increased risk of breast cancer.
18
@Robin - So true those "cancer blocking drugs" of "tamoxifen, raloxifene and aromatase inhibitors" are misery-making! I was on Arimidex (AN aromatase inhibitor) for less than 6 months before I made the decision to stop because of the side effects. My hands developed trigger fingers and thumbs; it was painful to walk due to the same sort of effect on my feet; developed De Quervain's tenosynovitis in both wrists which made it painful to dress. My oncologist said it couldn't be due to the Armidex, but a quick google search led me to a blog of women across the globe who were experiencing the same side effects from the same drug. It took over a year after I stopped the drug before my symptoms completely subsided. My doctor prescribed tamoxifen as a replacement, but I refused to take it because I didn't want to go through another 18 months like I'd just experienced. It's been 12 years since my diagnosis and treatment and there has been no recurrence of the cancer. Oh, and for my quality of life, I've also been on HRT most of that time after reading the book "Estrogen Matters."
8
@Robin, agreed! I took arimidex (an aromatase inhibitor) for 10 months and saw my bone density drop from healthy to osteoporotic, my cholesterol shoot up, and my energy level drop. Meanwhile, I had such intense joint pain in my feet that I could barely walk for the first half hour or so of every day and could not run at all (which was my main and beloved exercise). I switched to tamoxifen, and the change was like night and day. My doctor agreed that the negative effects of arimidex might well have outweighed any benefit. Talk this stuff over with your oncologist! There might be another option.
9
Dear Ms. Brody,
In your article, "Shifting the Focus of Breast Cancer to Prevention", you stated in passing that "early detection of breast cancer has resulted in a dramatic reduction in breast cancer mortality in recent decades."
I believe that mammography testing is controversial, given information currently available. Studies have suggested that most breast cancers would be cured with modern drugs, whether or not detected early. The major downside to mammogram testing is the potential for false positives.
I refer you to some articles:
"Mammogram's Role as Savior is Tested" by Tara Parker-Pope,NYTimes, 11/24/2-11.
"Vast Study Casts Doubts on Value of Mammograms" by Gina Kolata, NYTimes, 2/11/2-14.
Sincerely yours,
Lucia Dunbar
[email protected]
12
@Lucia Dunbar There are multiple problems associated with mammograms. This qualitative approach requires interpretation and concludes you either have breast cancer or your don't. An incredibly naive approach to a disease which undergoes a series of transitional changes. This will soon be addressed in EJNMMI very soon.
6
@Lucia Dunbar I believe you mean over-diagnosis, which is different from false positives. In false positives, the error is found before treatment is begun (e.g., a falsely positive mammo is corrected by a follow-up). This is anxiety-producing, but not physically harmful. In over-diagnosis, a cancer is actually found, but it is a cancer that will not bother you during your lifetime, because it is so slow-growing. Nonetheless, the cancer is treated, because no one knows how to distinguish between cancers that need to be treated and those that don't. So, a substantial proportion (maybe as high as a third) of breast cancers that are treated don't need to be, and of course the woman has undergone surgery, chemo, radiation, whatever. See OVERDIAGNOSED, by H. Gilbert Welch, MD.
10
@Lucia Dunbar
Dr. Greger did a 14 part series about BC screening that was an eyeopener.
Mentions pharmaceutical medications for prevention, but not nutritional supplements. Pharma industry has taken over medicine, and pharma does not like competition from the supplement industry. The NYT doesnt know any better I guess.
iodine and vitamin D prevent breast cancer.
6
I had dense breast tissue. I always chose the “best” level of screening offered, 3-d, etc. In 2019, I was offered the ABUS (Automated Breast Ultrasound Screening) in addition to my mammogram due to the density of my breasts. It was offered in only one location not close to me, and it took a lot longer to do. Guess what? The mammogram didn’t detect my 1mm neoplasm, but the ABUS did. No family history, no BRCA, don’t drink, don’t smoke, excellent health, BMI of 18.5, 47 years old. Had a double mastectomy, even though I could have had a lumpectomy. Get regular screenings and get the best kind of screenings you can.
12
@FFS - My cancer wasn't found by the mammograms nor an ultrasound, only through an MRI. I now get an annual MRI. I'm claustrophobic and require medication to get through it, but it's worth it!
2
@FFS Thank you for referencing ABUS; I did not know about this and now I do.
4
@Stephanie This whole, "don't bother getting screened, it's overkill" movement baffles me. How is it possibly good advice. It's like antivax thinking. This (regular ultrasounds, MRI, etc) is a good idea with no serious down side.
2
What bothers me about generalized advice is that it never acknowledges that breast cancer is not one disease. I have (had) Her2 positive breast cancer and therefore all the advice about lifestyle choices that reduce estrogen exposure are not applicable. I’d like to know what I can do to reduce my risks of recurrence, but I don’t know which of the strategies mentioned in the article are actually applicable to Her2 positive cancers. In the absence of tailored advice, I’ve tried to adopt the ones that are good ideas anyway.
26
The point that breast cancer is not a single disease cannot be underscored enough. I had triple negative breast cancer meaning that none of the lifestyle choices made any difference whatsoever, and there were no preventative drugs that could be taken before/after treatment when I was diagnosed at age 47 shortly after running a marathon and hiking Mt. Kilimanjaro in recent years. I had regular mammograms, exercised regularly, did not smoke, ate healthy foods - mostly plant based, organic, unprocessed, and was still diagnosed with a neoplasm that had already spread to my lymph nodes between mammograms. I don’t have the BRACA gene, there was no history of breast cancer in my family, and although I had dense breasts other than having the 3d mammograms *not covered by my insurance (which I chose to do and pay for, but many women can’t afford) there were no other options offered to me. This article is not helpful, is inaccurate for many women, will leave other women feeling guilty that they didn’t do enough to “prevent” breast cancer should they be unlucky enough to be diagnosed with the disease, and could be dangerous if women seek out medical interventions that are unwarranted.
28
I must second this emotion, as a triple negative breast cancer survivor as well. The ending of “you can’t blame yourself” is SO smarmy coming from someone who clearly has never been in that position. Please don’t condescend to to a general population on cancer risk. I’ve seen plenty of people be lifelong smokers who never develop cancer, and as a lifelong non smoker, lifelong vegetarian, physically active and thin, BRCA negative, I still developed a rare form of cancer. I had an oncologist say to my face “you just have bad luck” So while I appreciate doing everything you can to improve your health, I’ve had too many super healthy YOUNG (30s and 40s) develop colon, pancreatic, and breast cancer-within my friend and family group, and none of them had predispositions that could have ever seen this coming. Many doctors now are beginning to say that the environmental toxins we are exposed to are impacting cancer risk more than they have previously acknowledged. So how do you outrun that?
17
@millcreEE I believe that Ms Brody has had breast cancer, although I agree w your point re environment
2
The topic of this article is so important, yet the contents of the article & some of the comments are kind of a mess. The lack of good references or citations is rather glaring. To get a better sense of how preventable breast cancerS (plural, since BC is an array of different cancers) are or are not, one needs a better understanding of basic 21st century high school biology (cell biology & genetics). Cancer is an *accumulation* of genetic mutations as cells divide. Mutations are mistakes or errors in DNA replication. There are many sources of such mistakes/errors, including ourselves, as replication errors are part of an organism’s normal existence. Living things that have DNA, including humans, have evolved repair systems for these errors. When the repair systems are overwhelmed, cancer has the opportunity to take hold. Irregular cells, ones with abnormal receptors, some of which help the abnormal cells evade the immune system, show up. When these cells accumulate, you’ve got a tumor, which may or may not be detectable. If the discussion can start w a understanding of facts, maybe it can actually be productive.
As for drugs that modulate risk, there’s often a cost/benefit. Tamoxifen may decrease BC risk, but it increases endometrial cancer. Oral contraceptives may be associated with increase BC risk, but it also lowers ovarian cancer risk. It’s a journalistic disservice to just leave these options at “may not be suitable for all women”. https://wp.me/p5ZbTK-1dR
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@reddirt Thank you for the information; I find it very helpful.
5
Prevention needs to be a bigger priority in the United States. Cancer is a wicked disease, and lifestyle changes are absolutely not guaranteed to prevent cancer.
However, many of the lifestyle changes listed (staying at a healthy weight, breastfeeding for at least 6 months if possible, drinking alcohol in moderation, walking, exercising, eating a better diet,) are relevant beyond breast cancer prevention.
These lifestyle habits also may prevent other diseases like heart diseases and metabolic diseases (such as diabetes.)
Cancer is likely no match for a healthy lifestyle, but that doesn't mean we shouldn't be advocating for healthy lifestyle changes.
8
I thought it was interesting that a recent study found hair dye & hair straighteners can increase the risk of Breast Cancer. After being diagnosed with an autoimmune disease 8 years ago I stopped dyeing my greying hair. I often see women in Whole Foods carefully reading ingredient labels, probably nervous about Parabens, additives, gmo food etc, yet their hair is dyed. If the dye is from the hairdresser or a box, it can’t be healthy, saturating your scalp each month with a bunch of unpronounceable chemicals. I also think that the contraceptive pill in any form, low or high dose can’t be healthy either.
7
I'm a physician, and I ran a $5M cross-cultural NCI-funded cancer prevention and control program in the late 1980s through early 1990s.
Cancer researchers, and public health researchers in general, continue to confuse the general public by conflating the terms "Prevention" and "Mortality Reduction".
While the majority of the public understands that "prevention" implies preventing the onset of disease, public health researchers use the term "tertiary prevention" to describe methods that reduce mortality once a person is diagnosed with a certain disease.
In the case of breast cancer, if we diagnose the tumor when it is 5mm in diameter or smaller, and when cancer cells are NOT found in the "sentinel" lymph nodes that drain lymphatic fluid from the breast, then that patient has a 95% or better probability of living for at least 5 years after diagnosis. If we diagnose the tumor when it is 20mm in diameter, and when cancer cells are found in the sentinel lymph nodes, then that patient's probability of living more than 5 years drops precipitously.
Thus, "tertiary prevention" focuses on reducing mortality from breast cancer by detecting it at earlier, more curable stages. It DOES NOT focuses on preventing the occurrence of breast cancer.
8
Slight correction: reducing mortality through early detection is "secondary prevention"; reducing mortality through better treatment is "tertiary prevention."
2
@docBrian What’s a bit noteable that most BC physicians don’t discuss the concept of “early dissemination” with the appropriate patient population, especially previvors. The prevailing idea is still that of surveillance & catching cancers early. The reality is that in a significant number of cases, DCIS (stage zero) patients already have (dormant) BC cells in their bone marrow, & possibly other sites.
1
I was recently diagnosed with DCIS. Can you refer me to a source to learn more about possibe dormant cells in my bone marrow?
5
So there are basically two kinds of comments here:
—Readers asking for better data, questioning it, or contradicting it, as well as pointing out flaws, such as lack of consideration of metastatic disease—overall, rationally questioning the reliability of the information in the article, and
—Lay people telling strangers on the internet what to eat. Or, mostly, what not to eat.
17
to Jane's fact-checker.... Please give a citation for the statement:
"For women previously treated for breast cancer, walking three to five hours a week at an average pace can reduce the risk of recurrence and death by 40 to 50 percent."
That is an amazing statistic that should get headlines over the next new drug.
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Indeed. The idea of walking to limit bc reoccurrence is important information and I have seen the reference before. But who stands to make money on such information? What pharmaceutical makes money one this news? Hence the information just sits.
If only all those big Pharma ads said, “walk!” And our housing and neighborhoods and mass transit systems encouraged such a thing.
If only we had a country that functioned for someone beyond the 1 percent.
10
@tari Here you go: Physical Activity Before, During, and After Chemotherapy for High-Risk Breast Cancer: Relationships With Survival
Rikki A Cannioto, PhD, EdD, Alan Hutson, PhD, Shruti Dighe, MBBS, et al
JNCI: Journal of the National Cancer Institute, Volume 113, Issue 1, January 2021, Pages 54–63, https://doi.org/10.1093/jnci/djaa046
There are many other articles that support the exercise benefit, including to reduce chances of breast and other cancers occurring.
4
@Ariana Here's another source, with info about the original 2017 article in CMAJ: https://www.consumerreports.org/breast-cancer/best-way-to-prevent-breast-cancer-recurrence/
1
Stay away from cheese. The countries with the highest rates of breast cancer are the cheese eating countries.
Also most cheese is not organic leaving one exposed to dangerous hormones.
Hispanic women have a lower rate of breast cancer than white women. This is attributed to the beans they eat which have a lot of fiber.
Japanese women have a low rate of breast cancer and of course they eat soy and no cheese.
Be your own doctor; of course I understand one needs treatment when getting ill.
And do remember that certain kinds of diagnosed breast tumors would never have grown bigger to affect a woman's health, if they hadn't had a mammogram.
14
@Ellen ..."Also most cheese is not organic leaving one exposed to dangerous hormones."...Do these dangerous hormones in non-organic cheese have names?
1
This article is misguided and essentially blaming victims. None of the so called lifestyle changes can prevent breast cancer. Early detection is not the solution since 30% of early stage breast cancers will metastasize to stage 4 which has no cure. What we need is research to understand how cancer metastasizes and a cure for it.
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@Kholo
Early detection IS one effective solution. When the breast cancer (tumor) is detected, it can be treated.
1
@Kholo Absolutely! I had breast cancer recurrence almost twelve years after my initial breast cancer that was confined to my breast. I was extremely healthy and fit, I get so tired of the blame the victim mentality. Cancer doesn’t care about that, many healthy people get cancers and people who do nothing for their health often do not get cancer. Each breast cancer is different and what is really needed is monitoring and prevention of metastatic breast cancer.
8
What is the source of this recommendation:
For women previously treated for breast cancer, walking three to five hours a week at an average pace can reduce the risk of recurrence and death by 40 to 50 percent.
As a cancer patient, I find this potentially very important information. It's quite specific.
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@Joan Mooney
My question also. Where is the citation for such data?
Sadly I do not see a response from Jane.
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@Joan Mooney check out MSK’s exercise oncology dept. website. I’ve seen the stat there and on a video posted of a presentation given by one of their researchers.
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@Joan Mooney https://www.breastcancer.org/research-news/exercise-improves-survival-and-reduces-risk#:~:text=Even%20if%20you%20didn't,can%20help%20you%20live%20longer.
Is it true that eliminating dairy and red meat is a great preventative for breast cancer? The dairy CEOs and meatpackers don’t want to let that out! I’ve heard!!
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True!
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@Marlene Bogo Highly processed meats (bacon, sausage and lunch meats,) are linked to increased risk for cancers.
Eliminating dairy/red meat from your diet may yield health benefits, but to my knowledge, consumption of these foods is not linked to breast cancer.
-Registered Dietitian (RDN)
4
This article buys into the misleading pink ribbon breast cancer campaign that somehow “prevention and detection” will cure breast cancer. It is also victim blaming for those of us that already have breast cancer. Sometimes you do everything “right” and you still get breast cancer. Many of us are young women that have aggressive non-hormone related breast cancer (like HER2 and triple neg) that grow fast and furious, making early detection very tough. Many of us are young mothers that were recently pregnant and breastfed. Please come talk to patients and learn why this type of article does more harm than good for the cause. Only research for cures will reduce death from breast cancer.
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@LAF "Nonetheless, a woman who contracts breast cancer should never be blamed for getting the disease; even the most conscientious practitioners of preventive measures can develop cancer."
Did you skip that part of the article?
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Prevention? Why now? It seems that would have been the appropriate way to deal with this issue for several decades.
5
I am not sure how you could do this article without mentioning the 116 persons daily who die of metastatic breast cancer.
In addition the public and governmental support for “awareness “ instead of research perpetuates the myth that this disease is under control. Just wear a pink ribbon and yay... job done.
30
This article is misleading on so many levels. Scientists have not discovered what causes breast cancer, therefore, there is no definitive way to prevent it. All the items the authors talks about will not prevent breast cancer.
I was a healthy, fit 39 year old who developed cancer, it was treated and it's now come back 10 years later. It is metastatic. I was one of the 3 in 10 "survivors" who will not survive breast cancer.
Sifting focus to "prevention" without knowing the cause will not help. Focusing on research to both understand the cause of breast cancer and on how to cure it will help.
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The statistics about mortality provided in this article are deceptive. As the US has pushed for screening mammography, we are finding more breast cancers and pre-cancers (such as ductal carcinoma in situ) at an earlier time. And yet, we have no data as to whether any of these cancers would have become lethal. And the data suggest otherwise. The incidence of stage IV breast cancer (when it is metastatic and terminal) has not been reduced, despite the increase in finding "early" cancers, which indicates that the cancers we are finding "early" are not those that would progress and lead to death. So we are simply finding more non-lethal cancer and treating it--not improving the mortality rate for lethal cancers. That said, we should be pursuing prevention, and the National Breast Cancer Coalition has been funding research into a preventative vaccine through its Artemis Project since 2010.
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What exactly are we talking about when we say "early breast cancers?"
From my experience with a surprise find of a 5mm invasive tumor, the docs aren't sure about what to do when it's so small and truly "early" regarding chemical therapies.
All of the treatments are designed for "early" detection of larger tumors. And you know what I'm being told to do every 6 months now after surgery and radiation? A mammogram.
Mammograms did NOT find my bc nor did ultrasound. An MRI did. But the recommended screening will only find a larger "early" breast cancer.
Makes no sense to me.
23
A mammo only surveillance makes no sense. Find a new breast surgeon.
3
This article failed miserably to mention what kills in breast cancer. Metastatic disease, breast cancer which has spread beyond the breast to distant organs. In the US, about 115 people (women and men) die of metastatic disease every day. That‘s a daily airplane crash.
Focus on preventing death, research treatments to stop death. Metastatic research is woefully underfunded.
Sure, eat better, exercise, yada yada yada, but let‘s talk about metastatic disease and what can be done about it.
I watched my mother die of metastatic disease in 1991. Twenty years later, I was diagnosed with breast cancer. I‘m lucky - so far, no further evidence of disease. But who knows? And still, people continue to die, to the tune of 40,000 each year in the US.
We don‘t know why some people metastasize, we don‘t know who will and we don‘t know how to stop it. There are people hard at work trying to solve this puzzle.
Please, spend time writing about metastatic research. Say it - metastatic breast cancer. Say it often. Write about it often. Educate!
Don’t give us another fuzzy gray column blaming diet and exercise and then telling us not to shame patients.
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@Eeekdot You are so right. Thanks for posting this comment. I have lost two friends in their early 40s to metastatic breast cancer and I have another friend who is still fighting. Pink ribbons be damned. Research is desperately need for MBC.
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@Eeekdot Spot on. And there's no stratifying ductal vs. lobular breast carcinoma, the latter far more likely to be stealth. Given the current state of research, early detection of/early-stage invasive lobular breast cancer by no means ensures a cure when it often reappears 10 or more years later having spread beyond the breast.
2
As a metastatic breast cancer patient, the idea that focus is shifting to prevention makes me feel that I'm being ignored and written off. I am one of the 30% of early stage breast cancer survivors whose cancer has spread. The most likely cause of my breast cancer is that my mother was given diethylstilbestrol (DES) when she was 6 months pregnant with me, so my healthy life style and other preventative measures were for nought.
Frankly, women have been getting breast cancer for thousands of years, as shown in archeological work. Egyptian women at the time of Cleopatra were not eating GMO foods or breathing the polluted air we have. I'm sick of this prevention talk that fundamentally blames the victim, regardless of the author exhorting us not to.
We need a cure for all stages of BC. #Stage4needsmore
98
The preventative drugs are not easy to handle and not everyone can tolerate them. They are the same drugs offered as adjuvant therapy post cancer. Offering these drugs as a preventative measure to young women will give them all the joys of menopause plus other potential side effects like joint pain, constant headaches, mental confusion, emotional instability, food tasting like paint, and zero sex drive. Additionally the risk of uterine cancer and cardiovascular issues increases on some of these drugs. It is no small thing to take them for five years. This article does not mention the severity of the side effects and kind of brushes that aspect under the rug. We need to develop new approaches to treatment that are less harmful and disruptive to your life and easier to tolerate. The failure rate of these drugs is high, and with good reason. So even if they are available and work they aren’t useful if you can’t handle them.
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And, if one takes these preventive medications there is always the possibility of being the one for whom they did not work. Took Tamoxifen for three years. Was diagnosed with BC 2 1/2 years later. Mine is the slow growing variety of BC and was likely starting its growth while I was on Tamoxifen.
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@Ali The author does note that these drugs are not the right choice for every woman.
(See "'For many women these medications are an important option, but the decision to take them is very individual,' Dr. Pace said.")
2
It is unfortunate that no one addresses Men That Have Breast Cancer. As an 11 year survivor I have seen almost nothing written advising men that they even get this disease let alone what they should be looking for so they are not diagnosed at advanced stages. Come on Jane Brody, write a column that deals with Male Breast Cancer!
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@Bill
Absolutely! And the infrastructure for men to be diagnosed and treated is weak. Correct me if I’m wrong, but men are often diagnosed at more advanced stages and with poorer outcomes. And they also die of metastatic breast cancer. Thank you!
5
Stay clear of all dairy products and eat more whole grain (Brown rice, barley, corn, millet) beans, sea vegetables and fermented foods (miso, pickles, sauerkraut). Eat nuts and seeds. Eliminate meat (factory farmed animals live tortured lives -- we absorb their pain when we eat them. Walk! A lot! A macrobiotic way of life promotes happiness and good health.
15
This is not a very helpful or particularly accurate article. There is literally only a handful lifestyle changes you can do to effect breast cancer risk 1) maintain a healthy weight (as it effects estrogen levels), 2) have children younger (as it effects estrogen levels), and 3) don't smoke (as it elevates your risk of every cancer).
The only interventions otherwise are 1) chemo-prevention with an estrogen blocker (which will likely only move the needle on mortality) in the highest risk individuals for breast cancer or 2) risk reduction mastectomy (which lowers the risk of breast cancer to statistical insignificance)
9
Drinking alcohol as a contributor was also mentioned- and is something not many know about.
5
@RIO As a healthcare provider, I tell patients many healthy lifestyle choices are present to decrease your chance of getting cancer and developing chronic diseases. Some of these are known as modifiable risk factors. Exercise and be active, not sedentary. Eat a well balanced clean, less processed diet. Maintain a healthy weight. Get sleep, work on decreasing stress, limit alcohol and don’t smoke. Specifically for prevention of breast cancer, get mammograms, talk with your healthcare provider about your risk and a good prevention plan, have kids earlier in life if you can, but not everyone can.
Of course, I agree with many comments that despite all of these efforts women are still getting breast cancer, especially younger women. Tackling breast cancer requires maximizing prevention, education, treatment and research for a cure. Listen to your own body and be informed. Support cancer patients, survivors and families who have lost loved ones to be preset cancer.
4
@Susan Mammograms do not prevent breast cancer.
8
The second most important sentence in the article: "Nonetheless, a woman who contracts breast cancer should never be blamed for getting the disease; even the most conscientious practitioners of preventive measures can develop cancer."
21
This article neglects a huge portion of patients who have metastatic breast cancer. 30% of early stage breast cancer progresses to stage IV despite doing all the things right and taking all the medications and treatments. Prevention will not save women at this stage.
33
Several years ago I read The Emperor of All Maladies. Much of the book focused on breast cancer and the "treatments" were horrible. The same could be said for the "theories" about cancer, as much about hutzpah as plain ignorance as to how the disease worked. Clearly there was a learning curve. But I could never get over the book's initial and continued focus on breast cancer. I mean, there are other cancers to discuss too. That focus left me with the feeling that women were lab rats. IDK
7
I love Jane Brody but my first thought after reading this piece was that she had been much too mild in her advice. (To be fair, this is common among physicians and organizations as well.) But seriously, folks, the Physician’s Committee for Responsible Medicine (PCRM.org) has it right. The four prongs of breast cancer risk reduction through lifestyle changes (all of which I live by): Don’t reduce meat etc.: ELIMINATE animal foods and eat a varied healthy PLANT BASED diet . Don’t “try” to add some exercise: COMMIT TO IT. Don’t “limit” alcohol consumption: QUIT ALCOHOL (no one ever wants to hear that one - but even one drink increases risk for many cancers). Finally, get to a healthy weight and maintain it - for me this came as a side benefit to the above three steps. Add in some stress management and social/family connections and at least you’re doing everything you have power over. Yes one can still have breast cancer (I have) but you are still reducing your risks of new and recurrent cancer.
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Most people can’t do what you recommend. Exactly why isn’t clear but it is true anyway.
3
@Patsy Well said! Many people have a hard time committing or have life to deal with or social barriers and can not achieve these recommendations.
3
I'd like to believe that such a strict lifestyle would protect me from recurrence, but I don't. The relationships between lifestyle and cancer are far from clear. Still, moderation in general and cultivating what feels good mentally and physically, makes each day more enjoyable. I can't do much about how many days I will live, but I can do quite a lot to make each one pleasurable.
16
There is only one prevention! Avoid birth control pills, HRT and anything that contains estrogen drawn from horses urine! When I was first diagnosed I was a vegetarian and had lots if physical activity! I had been in HRT for 5 years to prevent pre menopausal bleeding. My doctor never told me of the risk!
9
I lost a sister to bc age 39 so I’m high risk & have a yearly mammo plus my Israeli insurance pays for a yearly breast MRI. Thank God so far at age 60 I’m healthy, yet last year we lost 2 girlfriends ages 29 and 63 to bc. The elder one refused mammos, ate only organic food yet died within a year of her diagnosis. The younger girlfriend had triple negative and who thinks of bc in their 20s when they have no risk factors. Life is precious and we do what we can. Be good to yourself, try eating healthy foods, home cooked meals and stay way from sugar & fast foods. Find a way to lower stress and try not to worry. Thanks for all your comments.
26
This comment in the Nee England Journal of Medicine's Journal Watch on USPSTF's recommendations is worth reading:
https://www.jwatch.org/na49867/2019/09/04/new-uspstf-recommendations-breast-cancer-chemoprophylaxis
1
Are there any studies about whether regular use of nail polish and/or nail polish remover is related to an increased cancer risk?
9
I'm hearing talk about reducing milk and red meat in the diet. Why don't we more forcibly insure the purity of these products. We're eating food laced with hormones, antibiotics, and whatever else is given to those animals that our our food sources. Earlier puberty for girls. Makes perfect sense because of all the hormones given to our animals. Pesticides,
another contributor. We're eating chemicals and surprised at the result.
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@Gloria Utopia I agree that we need to grow animal products with more stringent regulations, but that will happen only over time. Meanwhile, individuals can't control how animals are grown, but they can control how much they ingest animal products.
6
I was a health maniac all my life. Still got Breast Cancer at age 57. Then stage 4 after 3 years. We need to find a cure. I did everything to prevent it.
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@Stage4 “Being a health maniac” obviously needed some additional calibration in your case given the disease outcome. Even if multifaceted, the science and cause/effect benefits of diet supplementation as well as types of exercise keeps changing. But even with a setback, never stop seeking health enhancements within your power. Many are right there with you.
@Peter Rudolfi
I'm not sure of the point of your reply, but it sure falls under the heading of victim blaming.
21
Mother, sister, cousin and myself had BC.. All heathy women. Sometimes bad luck is a risk factor. Many comments here have a cavalier attitude.
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@AW was anyone in your family tested for the BRACA mutation? If yes and you do have the mutation, I believe it is being proactive for any adult offspring To be tested.
I had prophylactic bi-lateral mastectomies 10 years ago because I had had BC 20 years before and am BRCA 1 positive. I wanted to take the threat and fear of a recurrence off the table. Hope this is helpful.
4
Of course people want to think they have some control over their lives, but I just shake my head every time I read one of these articles that says you can prevent breast cancer by doing x, y, z. I had breast cancer (stage 1) when I was 45. I was not overweight, I was a former high school and college athlete so I exercised frequently, ate a healthy diet with lots of fruits and veggies, didn't drink much if al all (maybe one drink/week), I didn't smoke, and I my BRCA test was negative, meaning I didn't inherit breast cancer from my mother. Oh, I had two children and breastfed them both. In fact, I really didn't have any health problems--still don't--aside from developing breast cancer, and knee problems from a sports injury.
Despite my healthy lifestyle, i got breast cancer anyway. So, maybe it would have been worse if I was not already healthy--I don't know. But every time I see an article like this that says "do this and you can prevent breast cancer" I just have to disagree. I don't think there is a direct cause and effect--I don't feel that scientists know enough about what causes cancer to say you can do things in your life to prevent it.
However, I do agree that having a healthy lifestyle will keep many other illnesses at bay. The challenge is for us as a society is to encourage healthy lifestyles and make it possible for people of all backgrounds and income brackets to exercise and eat healthy.
139
@Maggie
I don't think this article (or any) says definitively "do this and you can prevent breast cancer." Of course there is no single "direct cause and effect." But there is such a thing as risk reduction. Nonsmokers get lung cancer, but abstaining from smoking reduces your risk. People who rigorously wash their hands catch colds, but hand-washing reduces your risk. People have no problem accepting the concept of risk reduction in reference to some diseases, but get angry and defensive about it in reference to breast cancer for some reason.
20
@Maggie There is no competition between treatment and prevention. Both aim to stop breast cancer and deaths from it. Prevention makes sense as we already know ways to decrease the risk but we are not applying what we already know. My heart goes out for all with metastatic breast cancer . I will support every effort to cure the metastatic stage. Also I am very passionate about prevention. There is no conflict
9
breast cancer can be preventable waaaay before it starts. studies have shown the relationship with diet and cancer. the rates of breast cancer have increased significantly with the introduction of MILK and other dairy products into the diet of the prepubertal child......this also leads to early puberty. dairy products are known to cause increase in cells especially of reproductive organs.
the cancer rates in the blue zones of the world (also obesity, diabetes,hypertension rates) are low to negligible. to stop breast cancer start with the diet from childhood....
14
@lola Your advice about the hazards of dairy is all clearly described by NIH researcher Dr. T Colin Campell in his “The China Study”, 2005 hailed at the time as the largest epidemiological study ever performed. Therein the casein in milk protein is irrefutable proved (cause and effect, mechanism if action) to be a potent carcinogen!
5
@lola I am always interested in prevention and read extensively about it, but this information does not support what you are saying about dairy:
https://www.wcrf.org/sites/default/files/Meat-Fish-and-Dairy-products.pdf
Can you cite other studies to support dairy causing cancer?
3
@lola ...Is the problem dairy products or increased body fat? Association is not the same as cause and effect.
1
It's odd that the first suggestion given to precent breast cancer is taking drugs. Then healthy lifestyle choices are buried in the middle of the article. Shouldn't it be the other way around?
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@Midwesterner
I had the same thought. What is Jane saying here? Or who is she working for?
The other way perhaps is not the sexist journalist lead, but it is the one ACS uses.
2
We need to stop companies like Monsanto/Bayer from poisoning us with toxic pesticides, GMOs, etc. This is why there is such an epidemic of cancer in America...
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@Emily: Bayer also makes hormonal contraceptives (including the Mirena IUD) whose long term use (5+years) in women older than 40 has been shown in a recent Finnish study to increase the number of BC cases. The increase is small (an additional 13 cases per 100, 000 women) but devastating for each of those people. My family doctors assured me it was safe but studies are now showing taking synthetic progestins alone, without any estrogen, is harmful. Family doctors are being "educated" by drug companies. Bayer was forced to include a suggestion that women with BC or a family history of BC not take Mirena. Maybe they should add that women who want to avoid BC should also not use the product!!
5
@Emily ...To associate GMO's with industrial chemicals makes about as much sense as being an antivaxxer.
1
Not really very informative. Walk, exercise, don't drink, eat mostly plants. Just good habits. Nothing sustantive
10
Too many people do not practice good habits
7
I'm glad she went beyond the screening and drug prevention. There's a lot that can be done for real prevention. An anticancer lifestyle is doable.
1
Question to Jane Brody: Did the BCSC researchers who came up with the risk calculator explain why number of pregnancies and approximate total months of breast-feeding weren't included? These seem significant in affecting lifetime as well as 5- or 10-year incidence.
4
@TMBM I’m a long-time BC survivor, so I’ve done a lot of reading about what might cause It. You weren’t asking about the relation between menses or the lack and BC, but thought I’d comment. As I understand it, every time a woman has her period, there are small changes in her breast tissue which can be mutations that are cancerous. Our body cleans up most of them, but some slip by. Back in the days before birth control, when many women had babies one after the other and nursed them all, the number of menses they had was much lower, so the number of changes in the breast was lower. Also, a lot of BC starts in the milk ducts, so it makes me wonder if the act of milk flowing through the ducts has the effect of cleaning them out? Anyone know?
11
I am so glad you said prevention. Women touch on a daily basis many known carcinogens often already banned in other countries from e.g. cleaning products to beauty-related Items. The most telling was a fact covered by the Candian Broadcast Company many years ago. There is little financial incentive to research prevention. This research would include more than diet/exercise alone when compared to research dollars available to look for cures. Both should have funding available.
12
How sad you had to point out women shouldn't be blamed for gtting breast cancer. But sadly, there is a tendency to blame the victim.
Kudos to you for pointing out the common good health practices (diet, exercise) that help avoid many dire health issues. Important word "help", not "completely".
Drugs sound scary, but good to know about for those of us with cancerous relatives.
12
Simple advice: eat a whole food plant-based diet, which decreases risk of all cancers.
Hard to talk to your doctor about this because most MDs won't follow this advice, but there are some out there.
15
Studies linked milk to higher breast cancer risk (perhaps because farmers milk cows during pregnancy), sugar to high cholesterol. I believe nothing was done about it, not even a warning. You cannot even choose food without GMOs for your kid because labeling is optional.
I think we all will end up dead unless we get money out of politics.
15
Dr. Barnard mentioned dairy products are believed to be linked to breast cancer at the beginning of November, which is Breast Cancer Awareness month.
He is the author of Food For Life. He recommends eating only fruits, vegetables, legumes and grains. Eliminate meat and dairy
He suggested that if these companies really cared about preventing woman from getting breast cancer, they should recommend a dairy-free diet. I believe he said the FDA should at least warn women, but of course that won’t ever happen. Meat producers and dairy farmers are too big and have overfilled lobbyists.
Dean Foods, largest dairy farmer in country filed for bankruptcy this week. They have been behind the consumer’s changing dietary habits, not in front.
They just don’t get it. We, the consumer, have access to information and studies and we read labels. We aren’t stupid. Oh, and we know the difference between soy, almond and coconut milk!
Sorry, had to throw that in there.
8
@John. I think getting “money out of politics” would truly improve the lives of everyone in the world, but John we will all die.
1
@John We will all end up dead in any case.
2
I benefited from taking the SERM, they are known as , selective estrogen reduction modification, Raloxifene for 5 years in my late 40s when they first were prescribed for bone loss only since I had early menopause and a strong family history. It pays to go to lectures to find out the latest and have an empathic gynecologist who keeps up on things and prescribed it off label. They were not recommended for women before menopause since they increased the risk of uterine cancer.
I have some moderately elevated risk factors, but the thought of taking some of these drugs - which are not benign - to POSSIBLY prevent some of the least virulent cancers seems a bit much too me. I'm not usually suspicious, but this smacks of drug companies wanting to increase their profits. Sorry.
26
I think the article neglects to mention natural ways to prevent cancer as opposed to just taking various drugs.
The article mentions "diet and exercise ", which is good, but more specificity, please.
4
My ob prescribed Duavee (estrogen combined with a SERM) for menopausal symptoms. The idea is to get the benefits of estrogen for bone health and reduction of hot flashes while protecting the breast through the SERM. I’ve been hesitant to take it, but it seems that it may be the way forward for prevention of breast cancer.
I don’t drink, I don’t smoke, I breastfed for more than six months, no history of breast cancer in my family, and still my risk is doubled. You see, I did everything right but my mom’s doctor didn’t and prescribed her DES while she was expecting me. A lot of women don’t know they were exposed to DES, and when I got a mammogram it was not listed as a risk factor. Yet it very officially is. So maybe everyone should do their part, including the people who list risk factors. And the labs that made huge profits over a drug with no known benefits to women should at least inform gynecologists and radiologists of the increased risk. DES victims are still waiting for an apology.
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@Marie I, too was a DES baby. So far so good but still. When I was in my twenties, having that camera stuck in me to see if I had cancer yet. Maybe why I do not trust the medical profession to this day.
2
@Marie I'm a DES daughter, too. Is that why I was diagnosed with Stage 3 lobular carcinoma at the age of 44? Maybe, but no way to know for sure.
Walking 5 hours a week reduces the risk of recurrence and death by 40 to 50 percent?
I don't believe it.
27
@Madeline Conant I think that it is possible that a lot of walking reduces risk, by what percentage I don't know.
5
@Madeline Conant
Then why don't doctors and hospitals have armies of breast cancer patients out walking?
9
@Madeline Conant They do in Seattle. We have a doctor founded exercise club for female cancer survivors who dragonboat, walk, do triathlons, and climb tall mountains. It's called Team Survivor Northwest.
31
I thought that it was advised that we avoid soy products, like tofu, because of the phytoester content- thought to increase risk of breast cancer.
18
@Suzan Fischbein
For information based on scientific studies please google Dr. Michael Greger and his Nutrition Studies non-profit.
The short answer to your question is no, soy does not cause breast cancer.
11
@Suzan Fischbein You’re right; there are some that have many more hormone mimickers than others, but it’s evidently complex. As I recall, if soy products are made with the whole pod, phytoestrogen much higher. Here’s a Harvard report:
https://www.hsph.harvard.edu/nutritionsource/soy/
3
watch nutritionfacts.org by dr. Michael Greger about soy products and cancer
5
I had breast cancer. I’m on tamoxifen. Tamoxifen has side effects. It puts you into menopause and that’s bad enough for young women. But the real kicker is that some women can still get a period. It also raises your risk for uterine cancer, the predominant symptom of which is ...vaginal bleeding. So if you get a period on tamoxifen, off you go to get an internal ultrasound, a d&c, and a biopsy of your uterine wall. How on earth is that worth it if you have a THREE percent chance of breast cancer in 5 years when we ALL have a 12% lifetime chance?
Thanks, but I’ll be recommending that my sister just keep up with her mammograms.
19
@Hope It depends on which side of the statistic you land. I had a 2% chance of recurrence and had one. The decision is difficult to make, and in the long run may come down to how frightened a person is of BC. Listening to your doctor may be the answer for some, but for others it will come down to listening to their bodies and hearts, especially if side effects from the drugs are intolerable. I took Tamoxifen for 6 months, during which time my libido died (I was in my 40s), and my hearing decreased. Both returned when I quit the drug.
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@Patricia I am very afraid of BC recurrence and its treatment (chemo). I would gladly tolerate all the side effects you describe in order to watch my daughter grow up. I have not been told my recurrence risk but I am scared to death of BC...
2
@Hope Please advise your sister to also follow-up on any post-mammogram studies she is advised to have. A friend of mine with a strong family history of bc was told by a doctor that she didn't need what was suggested and ended up dying of breast cancer in her early 40s, because the cancer was not caught early.
1
Did everything right—didn’t matter. Know friends that did everything right — didn’t matter. My biopsy removed all the cancer but it had already moved into one of five sentinel lymph nodes. Cancer has much, if not more, to do with pure dumb luck than anything else. But it is so much easier to blame the victim — that way you can live with the fantasy that if you the right things: eat, exercise, weigh, bay at the moon on the third Saturday of the month that you will be fine. NOT.
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thank you for telling it as it is.
23
No one should blame people for getting diseases. I agree it is fear that motivates such attitudes. Many of us are hoping to stack the deck in our favor with whatever lifestyle habits may help. Life, as you know from experience, has no guarantees. I wish you the best in your recovery and a long and healthy post-cancer life.
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@Patricia I do not think that recommendations for eating well and exercising have anything to do with blaming victims. They give hope to humans that there are things we can do for ourselves that may help the situation, although with no guarantees. As you state, much of our health is due to causes beyond our control, and no one should ever be blamed for illness. Period.
4
I began my medical education and 42 year clinical medicine career in 1967 with a cancer research fellowship and have followed the subject with interest. There are no cases of breast cancer in traditional living contemporary Hunter-Gatherer women. Why? Diet, active lifestyle, low stress? Hmmm. How about trapped core body heat due to modern women encasing their breasts in heat insulating synthetic foam bras while our stress filled lifestyles increase core body temps? Men do the same thing by sitting many hours per day on foam cushioned seating, unless they have an Aeron chair. The rate of prostate cancer equals breast cancer.
Every med student knows that a boy born with a non-descended testes must have it mechanically descended or removed by age 6, due to the high risk of cancer. Why? Heat? This hypothesis has never been tested and SEMS have many negative side-effects. Hmmmmm. Stress R Us
22
@Greeley Miklashek, MD I am stunned that an MD is suggesting bras may contribute to cancer. I have read that that was a preposterous notion spread by non-science based fear mongers. Do you have stock in Aeron chairs? Were you trapped between foam cushions as a child and couldn't escape?
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@Greeley Miklashek, MD Thank you for stating what we biomedical researchers have understood for a long time. Fortunately some medical researchers are beginning to add bra usage as one of several factors that promote breast cancer development. Interestingly these papers are not coming from the USA but from Asia, Africa and South America. Americans have been completely bought by the profitable fashion industry. When those foam bras arrived (my wife wears one and I can't convince her not to do so) I was really upset. What is the acronym SEMS that you use? Thanks
@Alex You are wrong on this, within the past few years several peer-reviewed scientific papers have statistically supported the fact that bras (especially if too tight, worn 24/7 and the foam types) are one of several factors that greatly increase the risk of breast cancer. the mainstream MD's have ZERO papers that demonstrate that bra wearing is not a factor.
5
I am a breast cancer researcher and co-author of Dressed to Kill: The Link Between Breast Cancer and Bras. This article ignores the most important lifestyle factor for breast cancer, which is bra usage. Dozens of studies around the world have now shown that the longer and tighter the bra is worn the higher the risk for breast cancer rises, to over 100 times higher for a 24/7 bra user compared to a bra-free woman. In fact, bra-free women have about the same risk as men. This is an inconvenient truth for a bra-using culture. Breast cancer research has been ignoring this factor, like ignoring smoking when studying lung cancer, but some studies are now asking about bra usage like they ask about family history.
The problem with bras is that they are constrictive and interfere with lymph circulation in the breasts, causing chronic breast lymphedema. Most women wear bras too tightly, and many sleep in bras, never giving their breasts a rest from the constriction. This also prevents the breasts from flushing out waste products and toxic chemicals, some of which can cause cancer. If a bra leaves marks in the skin, it is too tight. Tight clothing is a known health risk from compression and constriction.
We are conducting an International Bra-Free Study to see what happens when women stop wearing bras, and our preliminary results show that women lose breast pain and cysts, breathe easier, and feel greater overall health without a bra. Try it and see for yourself.
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@Sydney Ross Singer I am having a hard time with the concept of going bra free as I wear a 32G bra.... It is painful to walk or be active without a bra and the weight moving can cause sprained/strained tissue. What do you recommend for this, please?
19
@56 year old cancer survivor Soft bindings, as have been used by women forever might be the answer. Sort of a criss-cross wrap across your back supporting your front. But no bra band, and no pulling down your shoulders. And they're starting to make soft bras, just not there yet.
1
@Sydney Ross Singer "Bra-free women have about the same risk as men." Please link to the peer reviewed study citation. And please inform us how many women were in the study, over how many years, if it included those with genetic markers, exposure to toxins, HRT or BC use, etc. Because otherwise it's not a useful study it's anecdotal.
12
This article is a disgrace. Grossly misleading, uninformed and frankly negligent of the Times to allow this to be published in a format that doesn't make it clear that it is layman's opinion and not based on medical expertise at all.
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Way down at the bottom, after the list of all the “lifestyle choices” that raise one’s risk is the tiny “Oh, but don’t blame patients” disclaimer. Thanks for that. When I got breast cancer, I was youngish (early 40s), slim, and athletic. I breastfed my kids briefly. I drank alcohol minimally and ate plenty of veggies, with almost zero processed foods. Frankly, I’m one of the healthiest people I know...well, except for the aggressive 2.5cm breast cancer discovered 6 weeks after a no-problems checkup.
So yes, eat healthy, but don’t assume cancer patients did something wrong. Virtuous choices don’t protect us. Luck is the only thing that protects us. Get your mammograms and do your self-exams, ladies.
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@Hope
Me too, although I'm 20 years older than you. Athletic my whole life, babies before 30, and nursed them both for 2 years. Plant-based diet with quality foods for decades.
My diagnosis? Invasive ductal carcinoma. I have a very hard time believing these other lifestyle choices are that important. Dumb luck it is.
25
This is lazy science jounalism. The fact that there is no mention of the different pathologic subsets of breast cancer is unacceptable. These different subtypes determine treatment, risk of recurrence, and overall survival. The medications mentioned for prevention are not even applicable to the most aggressive form of triple negative breast cancer.
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@OncRN ,
"lazy"! Wow, pretty harsh. Every time a NYT journalist writes a health article lots of commenters criticize that the article doesn't mention this or that. Add it all in and the articles would be way too long. Most everything the commenters want have been covered in NYT Health and probably covered recently. Sure, the medications are not applicable to prevention of triple negative cancer (a dangerous minority of breast cancer cases). But triple negative has been covered in these pages, and not even that long ago. If we demand a more comprehensive story, I could think of dozens of other things worth mentioning. But I found the article as is to be quite acceptable. Knowledgeable and trained professionals such as yourself should be free to add valuable insight, but should do it without calling the journalist lazy.
10
@OncRN Calling this piece “science” journalism is generous of you.
1
Not mentioned were genes like BRCA 1 and 2 and HER. BRCA runs in our family at least in my mother, sister, and niece. Fortunately my great-niece doesn't have it, nor do I since males are also affected (for both breast, prostate, and possibly pancreatic cancer).
10
This sounds like a marketing plan for drugs to be sold and used as preventives. What could go wrong? Hook more women into more prescriptions, doctor visits, monitoring tests, for more of their lives. More anxiety, leading to more dependency on medical interventions for the anxiety... how perfect for Big Pharma!
62
Note that in rare cases Tamoxifen causes permanent lung damage.
8
@lovemymangotree And uterine cancer.
2
Dairy products, especially concentrated ones such as yogurt, cheese, butter and ice cream, are significant dietary sources of naturally occurring estrogen and other tumor-promoters (IGF-1). This is true even for organic because dairy is, after all, breast milk from an almost constantly pregnant mammal.
Anyone needlessly concerned about soy (with its in fact protective isoflavones which bind to estrogen receptors and block mammalian hormones) should avoid dairy like the plague.
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@Ellen K However, soy also contains steroids with estrogenic activity.
2
@REB Soy's isoflavones ("phytoestrogens") are recognized by every major credible medical entity to be in fact protective against breast and other hormonal cancers. Check Mayo Clinic, Sloan Kettering, Susan Love Foundation, etc for yourself.
I've had to research this thoroughly and accurately, as a now-10-yr-survivor of metastatic aggressive ER+ cancer.
6
These lifestyle changes are good and right for breast cancer survivors and for people in general. It is puzzling, though, that so many women are getting bc, even those who are careful and sensible in their lifestyles. Is there something else? Some common denominator that is contributing to our risk, like stress or environmental factors like air pollution or pesticides in our food?
I had a lumpectomy for Stage 1 breast cancer last year. Since my diagnosis, I've read and reread the recommendations for reducing the chances of a recurrence, everything from exercise, to increasing muscle mass, to reducing dietary fat, avoiding alcohol and more. Many were already part of my life, like regular lap swimming and a vegetable based diet. Those that weren't, I now follow.
But what about women who've developed breast cancer, despite living these healthy lifestyle practices? One example would be the young elite athlete who was diagnosed with bc soon after winning gold at the Olympics. She was obviously fit and, I assume, with a low BMI. And we all know women who ignore these risk factors and never get the disease. Just luck?
26
@onionbreath : Yes, likely just luck. A large number of cancers -- more than half for certain kinds of cancer -- are caused by random mutations. No living person, no matter what they do, can reduce their cancer risk to zero.
27
For an article on breast cancer prevention, I was surprised not to see any mention of avoiding hormonal contraceptives, especially with a family history of estrogen related breast cancer.
9
@Nicholas Not so. "However, neither drinking coffee nor using birth control pills adversely affects risk."
3
Life doesn't come with a guarantee.
As a 2 time survivor of breast ca, the first time 28 years ago, and a survivor of endometrial ca, at age 83 now it is probably my heart that will write the final chapter.
Each woman makes her own choices, hopefully as fully informed & educated as possible.
Breast ca Prevention is a tricky term when one of the greatest risk factors is being Female.
80
I did not read that abstaining from hormone replacement therapy for menopause also cuts the risk of cancer. I remember Ms. Brody advocating for hormone replacement therapy. But, wasn't she diagnosed with breast cancer after hormone replacement therapy? Estrogen is considered a cancer causing hormone, why would anyone advocate for putting more estrogen in women's bodies? I wonder if birth control pills have added to the increase of breast cancer in younger women? Ms. Brody states there is no negative affect, even though the pill contains estrogen. Where is the data backing up her assertion? It is a known fact that breastfeeding decreases the risk of breast cancer, why is this not shouted from the roof tops?
24
@wenke taule : Because, while estrogen may increase your risk for breast cancer, it protects you from many other diseases. See, e.g., the recent research on estrogen and Alzheimer's, which was published in this newspaper. Also female sex hormones play a protective role against many autoimmune diseases, which is why a woman's risk of developing those diseases increases at mid-life. The human body is complicated.
5
@wenke taule There is no evidence that hormone replacement therapy does any good. It also increased Alzheimer's disease , heart disease and strokes
8
@wenke taule I believe my mother got breast cancer at 57 because she took Premarin. There is no other history of breast cancer in her family. I would be very wary of hormone replacement therapy. She then took Tamoxifen for 5 years. She died at 83 with her 3rd bout of breast cancer. I wonder how her life could have gone without doctors "helping" her. I'm sure most doctors are doing their best, but I would be skeptical, and be informed before making these serious decisions about treatments.
3
So far, neither Ms. Brody, nor those who have left comments have mentioned an important fact that all the drugs that have been show to lower the risk of being diagnosed with breast cancer also increase the risk of developing other serious conditions such as cancer of the uterus and hip fracture. While that might be a worthwhile trade off for people at very high risk of breast cancer, the risk calculator includes almost every woman over age 65 at "increased risk". Promoting the false impression that drugs are available that would help women both prevent breast cancer and stay healthy is misguided and gets in the way of looking for safer approaches to prevention.
86
So far, neither Ms. Brody, nor those who have left comments have mentioned an important fact that all the drugs that have been show to lower the risk of being diagnosed with breast cancer also increase the risk of developing other serious conditions such as cancer of the uterus and hip fracture. While that might be a worthwhile trade off for people at very high risk of breast cancer, the risk calculator includes almost every woman over age 65 at "increased risk". Promoting the false impression that drugs are available that would help women both prevent breast cancer and stay healthy is misguided and gets in the way of looking for safer approaches to prevention.
5
I agree with most of this article with the exception of incorporating soy into our diet. My tumors (2) were estrogen fed and I understand that soy feeds estrogen but try to find foods that don’t contain it. Back to basics - eating nothing that comes in a package.
10
@Martha
Hi Martha,
You’re assumption is based on an old misconception.
Soy is actually protective.
I’ve read a mountain of research papers and a shelf of books on this subject and
the evidence does not point to any dangers from eating soy. As a matter of fact, quite the opposite: the health benefits appear to outweigh any potential risk.
In fact, there is a growing body of evidence that suggests that eating traditional soy foods such as tofu, etc. is protective against breast cancer.
In my case, i am a BIG soy eater and my tumor was mistakenly believed to be a cyst by the radiologist for 5 years of mammograms. The fifth year there was a new radiologist and she correctly read my mammogram. Come to find out I have a high genetic predisposition to breast cancer. However, the most interesting information from this was that my tumor literally did not grow for five years. I was told to keep doing whatever I had been doing before diagnosis, since it was obviously protective. What I had been doing was eating an organic, soy-heavy plant based diet, practicing intermittent fasting (extremely cancer protective), exercising daily, and rubbing kitten tummies :)
38
I also am under the impression that eating any soy products should be limited. Does anyone know about parabens?
2
@laura
My cancer’s diet was discovered to be almost all estrogen (after my tumor was tested).
I was concerned about my diet because I had “heard” soy feeds breast cancer and I eat tofu or tempeh daily and drink soy milk in my morning lattes every day. After my diagnosis I did a lot of reading: actual published research papers (not blogs, etc.) and books written by research scientists and various doctors. What I found by reading through all of this material is that according to the latest scientific studies (some being incredibly large population studies) soy has repeatedly been found to be protective, scientifically speaking.
Anecdotally, I’ll restate that my cancer was well documented by yearly mammograms for 5 years and its diet was almost all estrogen. It clearly had not grown for 5 years (radiologist’s words) and was less than 1cm in size when it was removed.
Also, from the research it would seem that soy is even more protective for Asian women. I am not of Asian descent.
Lastly, soy products should be organic since non-organic soy crops are heavily sprayed.
5
I am a survivor of invasive breast cancer, but only because I insisted on annual MRI’s in addition to mammograms and ultrasounds. We need to advocate for our health needs and not just accept the status quo.
38
I was put on an aromatase inhibitor this summer after a partial mastectomy. I am over 65 and was told tamoxifen is too risky as you get older.
WHY was I told to be on it for TEN years instead of five like in the article? The diction said they used to say five years but they have changed it to ten. Is that true?
I had estrogen positive breast cancer. My onco type cells were only 5 so I didn’t have to get chemo. Just radiation.
The side affects from the drug are difficult for me to deal with and I’d really like to be on it for five instead of ten.
Any suggestions?
7
@BSR
It is almost impossible to get good info on the rate of side effects of these long term medications they are recommending, with doctors being very blasé and dismissive while women are terrified and resisting. I am!
I have Her 2 -/ER+ breast cancer with lumpectomy done and about to start 3 weeks radiation and 1 week boost radiation. Then 5 years of Arimidex, an AI, perhaps another five years due to my age at 58 yo.
The reported side effects of aromatase inhibitors seem horrific so I am doubting how long I will stay on it, having had a gene test that reports recurrence risk at 4-6% without Arimidex.
In order to live to 68 I will be made to become 68 almost overnight in my bone health and other side effects that will dramatically ruin my quality of life. Nobody will have this conversation with me.
The idea of use of AI needs more female voices saying tell me EVERYTHING first.
38
@Moon Ray I am 57 , had the same treatment as you . I took tamoxifen for 3 years and then stopped taking it because it made me feel so old and tired. I immediately felt better. My oncologist persuaded me to try a different AI which I took for 6 months. It caused same side effects. My chance of reoccurrence is 6-8 percent. It was a decision that was so very stressful to make. My oncologist agreed that with my change of reoccurrence it was a choice, while it is not with someone with a high degree of reoccurrence. A large part of my decision has to do with distrust of pharmaceutical companies. I trust my doctor though. Good Luck with whichever path you decide.
12
@pam
This is so helpful!
With surgery radiation and a low recurrence risk why would I choose to injure my body in such a devastating way? I have no injuries or pains, my cholesterol, blood sugar and blood pressure are all fine and without medication, and until this recent cancer diagnosis leading an active life with big plans for life post 58 birthday. I now see myself with a blanket on my knee nodding off to sleep before lunch, staring at the ocean from a cruise liner full of other infirm and elderly folks, not hiking through England and Wales or travelling back to northern Iceland.
It is stressful now to decide what to do- roll a dice and take the odds, or take the pills and be alive but old and sick because I made myself so. This kind of illness is preventable too if you don’t take the pills.
Having had the Prosigna gene test I know I don’t need chemo, but do I need these damaging Arimidex tablets ?
17
The current lowering of standards for exposure to environmental pollution at “Trump’s” EPA is certainly not helping America’s mothers, daughters, and sisters in seeking preventive strategies against breast cancer. Trump and the GOP could care less about the health of American citizens whatever their age or gender.
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@Susan And 53% of white women voted for him.
4
Not all breast cancers are the same, and therefore the prevention strategies are different.
The cancer-blocking drugs mentioned will only work on breast cancer tumors that are fueled by estrogen. They will not work on the so-called triple negative tumors.
About 10 - 20% of all breast cancers are triple negative. However, it is more likely to be diagnosed in women of African-American or Hispanic heritage. And these women are also more likely to die of breast cancer than their white colleagues who are also diagnosed with triple negative.
By perpetuating the myth that there is only one monolithic type of breast cancer, we will continue to do perpetuate the inequities in survival.
74
Well we already know from previous NYT reporting that “awareness” and “early screening” campaigns were launched and funded by Dupont and another company, and are of dubious benefit. In other words, the companies that make the imaging film and the chemo drugs. Not fun fact: my mom developed breast cancer about 3 months after her yearly mammogram gave her an all clear. The mammogram was worthless in her case. She found the lump herself...and she survived.
18
@Laume Me too. My doctor found a tiny lump during a breast exam on the same day that a mammogram and ultrasound missed it. It was triple negative-- 21 years ago. Every grateful to my female surgeon, who not only found the cancer but advocated for NOT doing a mastectomy.
14
@Laume I have read and heard about this type of "miss" by mammography so many times. Patients need to know more about the much better use of contrast-dye MRI scans for breast cancer screening. Our insurance industry greatly discourages doctors from informing women and sending them for an MRI scan. If a patient finds out about MRI for screening, as I did, doctors lie and try to cover up its use.
Our insurance industry is in an extremely corrupt relationship with doctors. It functions like a single payer system in China! It rewards doctors for not spending money on highly advanced screening and makes it detrimental to them if they do.
Please read my experience in a story posted at
http://mammogramsanddcis.blogspot.com (mammograms and dcis).
You'll be shocked by what you have not been told. My story could save your life.
2
I usually find Ms. Brody to be knowledgeable and up to date in her columns, but you seem to have missed the mark here. I have no sisters, no daughters, but a father who passed on the BRCA 1 gene to me. I learned this from genetic testing in 2003. Nevertheless, I have spent almost all the years since then encountering medical providers who ask me, “do you have a mother, sister , or daughter who has had breast cancer?” I’ll just say that I find this alarming.
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@SH I'm lucky - my insurance covered a genetic testing as I got breast cancer at a fairly young age - and I have a very small, male-heavy family (I'm an only child, no kids of my own, both parents had only brothers).
So I agree that 1) asking about only female relatives can miss some important information and 2) geneticists can't assume that people have large families with lots of female blood relatives. (Or that they're not adopted!)
5
Why are five-year survival rates increasing? Because "cancers" are being diagnosed earlier, not necessarily because deaths are being postponed. Imagine a woman who dies of breast cancer at age 70. If she was diagnosed at age 69, she survived one year. If diagnosed at 65, she survived five years. If diagnosed at age 50, she survived 20 years. All this without postponing her death by a single second. It's called lead time bias. If you really want to extend breast cancer survival rates, just assign everyone a breast cancer diagnosis at birth. For myself, I'm way more interested in treatment of existing (clinical, symptomatic) disease, not in medicalizing non-existent disease (also known as risk, also known as health).
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@Margaret Peterson exactly. Well said!
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@Margaret Peterson
Years ago with surgery the only treatment and women terrified of telling the doctors or families of lumps, women didn't live long with breast cancer, it was a death sentence and certainly not 20 years. 1/8 lifetime risk doesn't mean 1/8 dying from the disease. That is the point. However some BC treatments increase heart disease.
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I'm confused about why the risk calculation does not include identification of a genetic mutation. There are at least 17 known genetic mutations that increase breast cancer risk and the mutations can be inherited from either parent. Am I missing something? My husband and most of his family are CDH1+, which carries a 70-80% risk of stomach cancer and a 50% risk of developing breast cancer. Unless I've missed something, I'm disappointed with this "research."
"The estimate of risk is based on five factors: age; race/ethnicity; family history of breast cancer in a mother, sister or daughter; history of a breast biopsy; and breast density."
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@Aubrey: There's a good chance the studies they're looking at don't have sufficient data to break out identification of a genetic mutation, because those studies are looking at different issues. This article is talking about prevention, and the task force is looking at a lot of different studies, many of which are based on the general population as opposed to only studies of women who have already been diagnosed. Typically, genetic testing for breast cancer genetics is not done until after a woman or family member has been diagnosed. Also, in a sense although not specific, the genetic mutation factor is lumped in with "family history of breast cancer in a mother, sister or daughter."
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When I was diagnosed with early-stage, triple-positive breast cancer in 1999, the doctors at MSKCC told me that I should limit consumption of soy products, because soy has phytoestrogens and my tumor was (as above) ER-positive. Has it been found that soy is actually beneficial to women not living in countries where soy is consumed at an early age?
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@Carol Derrien the studies I have read indicate that if one grew up eating large amounts of soy, then it has a protective effect. If soy was not part of the diet growing up and one begins to eat it later in life, then it has a negative effect as it can fuel estrogen receptor positive breast cancer. Just another example of the confusing information we navigate after surviving treatment of breast cancer
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@Vicki Hujsak - thank you. That’s what I guessed. But others here are saying that new studies say that it IS beneficial for bc survivors to eat soy. I’m staying away from it, as I think it causes my migraines.
First I was questioned about how much exposure to estrogen I'd had. Did I take the Pill? HRT? How about fertility treatments? I was never so shocked. All those products touted as making women's lives better increased the likelihood of breast cancer substantially. The second shock, was hearing the Oncologist say, "Breast cancer is never 'cured.' If you don't die from something else first, you will die of this." Not all breast cancer is estrogen positive. Aromatase Inhibitors, which virtually eliminate estrogen, prevent maybe 30% of cancers from returning--for awhile, at least. I found the side effects crippling. A lot of women quit or switch to Tamoxifen, which has similar results and other, awful side effects. Breast cancer does NOT have modern cures that make it a killer of times past--as we are led to believe. We desperately need new, more sophisticated cancer treatments, not more destructive drugs and radiation--really just improvements on treatments used for decades.
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@roxana
two friends both with initial breast cancer at age 30.both alive over age 70. One had a second occurrence in the other breast, a primary lesion.e Mastectomies. Lots is luck.
Another friend died after a lung cancer followed by a late diagnosed breast cancer -- pain was her symptom and apparently ignored for almost a year. She had also had breast reduction surgery. I do not know which cancer wqas implicated in her death.
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@Auntie Mame
at the point of multiple cancers, it doesn't matter which is the death culprit.
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@roxana - I, too, have heard that “bc is never cured.” I wonder, however, how anyone can tell that someone who had bc forty years ago and ends up dying at age 90 of, say, pneumonia, would’ve died if bc if she’d lived longer. Something screwy about that supposition.
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Prevention is not profitable, which is why no one in the medical establishment mentions it (except, of course, drugs for prevention). Yes, maintaining ideal body weight and regular exercise cut the risk of ALL cancers by 40%. Lowering the risk of all cancers, including breast cancer, is achievable by modifying one’s lifestyle, and will also lessen your risk of heart disease, diabetes, osteoporosis, and osteoarthritis. Just do it!
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Screening is super profitable though, and of dubious value.
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Walking 5 hours a week reduces the risk of recurrence and death by 40 to 50 percent?
I don't believe it.
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Maybe women worry about it because they are relentlessly hounded by the health media about a disease that, as you point out yourself, now has a high survival rate and is mostly a random occurrence at an older age, weepy stories about dying 40 year olds wondering if they should have started mammograms at 38 notwithstanding.
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@Di I've known six women between the ages of 30-50 who have died of ovarian cancer, but I don't know any women who have succumbed to breast cancer.
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@Di I agree. Heart disease is the biggest killer for women, yet receives little exposure. Heart disease is not "sexy" because the victims are mostly older women, relative to the vision of a young women with breast cancer.
If I have any health fears it is certainly not breast cancer, it would be heart disease.
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Women younger than 40 are being diagnosed with various forms and stages of breast cancer. Breast cancers are often more aggressive in young women. Some ARE dying of b.c.
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At university and in a class for women, we were informed by the professor that there is one component found in most deodorants that should be avoided: ALUMINUM. I have followed that recommendation to avoid aluminum since I turned 21, using only non-aluminum deodorants or soap and water instead. So far, so good ... and this is 52 years later. Think about it: A deodorant stick or spray is applied in the armpit, just above the breast. Could there be something to this as an “ounce of prevention”? How simple this solution. Genetically, however, I have no cancer in my family history or family tree. Fortunately.
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@JAY The aluminum-breast cancer link has long been disproven. To learn about the chemicals and other toxicants that you should avoid, see
https://d124kohvtzl951.cloudfront.net/wp-content/uploads/2018/04/27212917/BCPP_032018_State-of-the-Evidence-report1.pdf
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I am so glad to see this article by Jane E Brody. Breast cancer prevention is a reality and it is constantly ignored. It is possibe to significantly reduce breast cancer risk with well tolerated medications for the right patient.
It is not offered to most women who are increased risk for breast cancer which is a shame.
Issue can be summarized as follows:
1. There are medications that can significantly decrease breast cancer risk. Physicians should offer these medications to women at increased risk . Shared decision making after risks and benefits are explained may help many women.
2. It does not make sense to state these medications were never proven to increase breast cancer survival. They are proven to decrease breast cancer period. It is horrible to go through very "effective" horrendous treatments to achieve survival . Almost all women will prefer not to have breast cancer and survive that way. Just because these horrendous treatments are so effective and keeps you alive does not mean that women would love to go trough them
3. If the focus on prevention could be increased. It is very possible to find ways to bypass the side effects of these medications by only applying them to the breast. This technology is today available by slow release delivery, local delivery and nanotechnology. If anti estrogen effect can be only delivered to breast and not any other tissue this will automatically eliminate major side effects . I
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Sulforaphane, found in cruciferous vegetables kills both cancer cells and the stem-like cancer cells that spread BC. Sulforaphane activates our immune systems to prevent mutations to DNA.
It is easy, economical, environmentally friendly, and extremely healthful to grow your own broccoli sprouts. These sprouts are by far the richest source of sulforaphane: between 10 and 100X that of mature broccoli. Please read the Johns Hopkins research if you doubt this. Google Jed Fahey Cullman Chemoprotection Center.
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The diet you describe as best for breast cancer prevention: low in red meat and with "more vegetables, fruits, whole grains and traditional soy foods like tofu" sounds very similar to a diet that German scientists believe can prevent a range of chronic diseases: https://www.ncbi.nlm.nih.gov/pubmed/24069505
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It would be helpful to mention that men who inherit the BRCA2 gene have a risk of breast cancer that is equivalent in magnitude to women in the general population. These men (who are often overlooked) may also benefit from the preventive measures mentioned in your article.
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@Nancy
It’s actually about half the female risk: 6% lifetime vs. 12% lifetime. That’ still greatly elevated. Men should check themselves and men with BRCA2 mutations should get mammograms if they are not able to do thorough self exams.
When I read the headline, I thought “FINALLY!!”
Then I read the article, and was disappointed that the first preventive measure described was drugs. There are so many things wrong with this approach, the most important being that the drugs decrease “the most curable and the least likely to cause death and have yet to be shown to reduce the overall risk of dying from the disease.”
However, Ms. Brody did get around to risk factors that we can control: a healthy diet, exercising, not drinking alcohol or smoking tobacco, and maintaining a healthy weight. And one of the healthiest diets, if not the healthiest, is plant based whole food. Avoid animal products and processed foods.
So eat lots of veggies and fruit, legumes (beans, chickpeas, lentils, etc) and WHOLE grains (not refined grains like wheat flour, which is white flour), and in moderation nuts and seeds.
And then work toward reducing those risks that we can’t control on our own: cleaning up the air we breathe and the water we drink. The products we use.
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one does not need to debate the benefits of a healthy life style, exercise etc as a good idea in order to point out the extraordinary benefits of drugs like the aromatase inhibitors, and SERM's[ tamoxifen and others]. it is simply denial to not recognize that studies show AI's reduce breast cancer risk up to 75%. that is emphatically not just the 'benign' breast cancers. data show that most women cannot correctly tell whether they are on a SERM or an AI [ as compared with a placebo ] and those with side effects can simply stop the drugs if they wish as the side effects are largely self-limited. furthermore, to argue that the expense and trauma of treating even a 'non aggressive ' breast cancer - surgery, radiation, plausibly chemotherapy is equivalent to taking a pill for 5 years and gaining a life time reduction in risk thereafter is not so obvious to me. we rarely hear these discussions about statins which are far less [relatively] productive and can also have very serious side effects.
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Drugs, drugs and more drugs are not the answer. A polluted environment was not even mentioned in the article. All the pesticides, herbicides and fungicides sprayed on our food, pollution in our waterways, and poor air quality all contribute to many kinds of cancer.
Lawn services have exploded over the past couple decades using tons of pesticides. There is evidence that cancer in dogs has also increased along with chemicals on lawns.
Re-read the book Silent Spring and think about the toxic environment we all live in.
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@Jacquie Pollution was mentioned in the article. Yes drugs were mentioned but so were all the other preventative suggestions like exercise, weight control and eating less red meat.
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@Kathleen stay away from cheese.
@Kathleen
Yes drugs were mentioned but so were all the other preventative suggestions like exercise, weight control and eating less red meat.
*
On the contrary, excess weight is protective for pre-menopausal women: https://www.frontiersin.org/articles/10.3389/fonc.2021.705911/full.
There aren't any rules or practices or anything anyone can do to control something uncontrollable, no matter how much some people want there to be. And I say that as a breast cancer survivor.
I am surprised there is no mention of environmental exposures. The thousands of chemicals in our water, air, and food surely have some impact.
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@Suzanne You are right, for instance take potatoes which when ready, the plants die off and potatoes are ready to harvest. Instead of waiting, companies spray herbicides all over the plants to kill the foliage and then harvest the tubers which would be covered in chemicals. The same thing happens to oats which are sprayed with chemicals before harvest and are then saturated with chemicals when you eat them.
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@Suzanne There is a reference to: "body fat stores environmental pollutants".
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Fourteen years ago (I was 52), I had a mastectomy and 6 months of chemotherapy for breast cancer that was confined to the breast. My oncologist recommended that I take Tamoxifen for five years as my tumor was an estrogen-feeding cancer. I took Tamoxifen for about 4 weeks and then refused to continue. During those four weeks I experienced life-altering stomach pain and nausea, as well as deep joint and muscle pain. When I discontinued the drug, these problems cleared up. The tamoxifen side effects were worse than the chemotherapy side effects. On top of this, I knew that tamoxifen is an estrogen-suppressor. At the age of 52 with osteopenia, the last thing I needed was for my body to be stripped of estrogen -- at the very least, women need estrogen to fight off osteoporosis. My message to anyone who is urged to take Tamoxifen is to thoroughly research what can happen to your body when you take it. The most enfuriating aspect of cancer treatment is the down-playing of dangerous side-effects. (Looking at you, chemotherapy) I'm not saying that Tamoxifen doesn't fulfill its purpose -- I'm saying that it can also make you sick in whole new ways that require yet more drugs to treat the side effects. I know that other people with more advanced breast cancers do not have the choice that I had. But for those who do have that choice, arm yourself with information, talk to other people undergoing treatment, and do not feel like you have no part in the decision-making.
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@ehhs Tamoxifen is actually NOT purely an estrogen suppressor. It blocks certain estrogen receptors, and stimulates others.
While it blocks estrogen receptors in the breast and prevents some breast cancers, it stimulates them and is associated with preservation (not loss) of bone mineral density.
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@ehhs, I agree with you about Tamoxifen. In 2007, I was diagnosed with estrogen-receptor-positive breast cancer. It was detected very early, and I only needed radiation -- no chemo. I decided against taking Tamoxifen because I was (and still am) more afraid of the potential side effects of the drug than I was of the breast cancer. The side effects that were most off-putting to me were the potential for heart problems and blood clots which could result in a stroke. I don't have heart problems, and I was told that there was no test that could be done to find out if blood clots were forming. I didn't want to survive a comparatively mild case of breast cancer only to develop lifelong heart problems or have a stroke.
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@ehhs My experience with Tamoxifen, following an ER-positive cancer involving surgery and radiation, was a month or so of mental chaos but no joint pain, muscle pain, or other side effects once I adapted to the drug. The side effects of Aromatase class were far worse. I am glad to have the recurrence data be so low and in hoping to continue my work in health, I will continue with Tamoxifen.
We do need to partner with our doctors. Mine were willing to see me through my initial panics following Google searches on cancer drug side effects. They walked me through their data, recommended a cancer group where I could speak with other women vs read the internet in isolation. I learned that there are blogs and sites that draw commentary from those whose experience with Aromatase inhibitors and Tamoxifen was very bad but do not ask women who have somehow managed to comment. I needed to find balance. So far I am ok; there are some memory issues but I'm willing to tolerate them to reduce recurrence risk.
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Drugs and more drugs. That is the establishment way.
Stanislas Tanchou pointed out in the 1840s that it is only in the context of a "civilized diet" that we see significant cancer death rates. The evidence suggests that there are several contributing reasons for the steady growth of cancer death rates. Since Tanchou's time:
1. We are certainly better at diagnosing a variety of cancers than we were 170 years ago.
2. Our consumption of cereal grains and dairy products, which contain opioids, probably down-regulated our natural killer cell function which is our fist line of defense against malignancy.
3. Our enormous increases in sugar consumption, led to predominantly high blood glucose which is the only substance that provides energy for the reproduction, growth, and spread of malignant tissues.
4. With increasing mechanization of farming, grains, dairy, and sugar are much cheaper and are therefore constituting an increasing portion of our diets.
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In 1842, a French physician name Stanislas Tanchou presented a paper titled "Memoir on the Frequency of Cancer" to the Paris medical society. He claimed that he could predict the exact cancer rates in every major European city over the next 50 years based on the extent of "civilization" of the city. Tanchou showed that the rates of cancer were higher in cities and lower in rural populations. He predicted that as civilization increased, the rates of cancer would increase. One of the factors involved in industrialization and the infiltration of civilization is a higher consumption of processed food products containing sugar and grain. Dr. Tanchou predicted that cancer would never be found in hunter-gatherer societies. Hunter gatherer tribes known around the world then were being studied, and various researchers reported remarkably that no cases of cancer were found. It was only after these populations adopted a Western grain/sugar based diet (the diet of civilization) that cancer appeared.
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@Don Wiss Citation, please for the presence of opioids in dairy?
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@smj Hi -- yes please let us know the references you have consulted to say that opioids are present in dairy?
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Oh but this so unpopular although prevention is key in almost every disease process from diabetes to dementia. No fun changing your diet and lifestyle.
Fine but always remember there's no free lunch.
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@Mary Rivkatot There is a free lunch every day in public schools for children who qualify for free or reduced price lunch. That is where the prevention needs to begin! It is typically full of unhealthy fat, carbohydrates and salt and
devoid of the fruit, vegetables, and fiber needed to help prevent disease. And hello Jane Brody, aren't cruciferous vegetables and their cancer fighting sulforaphane worth a mention?
Don't hold your breath waiting for the pink pom-pom people
to offer to fund prevention studies unless they will line the pockets of big pharma.
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Very little has changed in the true number of survivors over the past 40 years. The statistics Jane Brody presents are misleading. Because we now catch potential possible cancers so early the rate of "survivorship" is raised by a huge amount. Many of these patients have indolent pre-cancers that would not have become malignant, and the patient will die of something else altogether eventually.
Statistics in the breast and prostate cancer business are massaged this way and that. Only when you read the source material and get a good sense of the quality of the analysis can you form a conclusion. The conclusion I have formed is that there has been only negligible improvement in outcomes even when cancer is caught early.
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@Artaserse, you're correct. Given the negligible improvement in outcomes with early detection, I've decided that the risks of repeated mammograms (with respect to both false positives and cumulative radiation exposure) exceeds the benefits in my particular case. Absent any symptoms, I'll have one every 7-10 years going forward (I'm 60 now, with no familial or individual risk factors other than age). I think each person should make her own determination about screenings involving radiation exposure based on her particular characteristics.
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@Artaserse Having completed radiation treatment for prostate cancer - Two points regarding Radiation : 1. IMRT https://en.wikipedia.org/wiki/Radiation_therapy#Intensity-modulated_radiation_therapy_(IMRT) treatment uses photons, not a radioactive substance. 2. The sessions are brief, about 10 minutes in my case, painless, and boring. Practice mediation.
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@Artaserse
Excellent point. Additionally, the number of women (and men) with earlier stage diagnoses who eventually develop metastatic/Stage IV cancer is still around 30%, and it's the metastasis that kills you, usually within 2-3 years (5-year survival 27%). I just lost a friend this way---like watching a slow-moving tsunami with nowhere meaningful to run. Additionally, while the death rate is dropping for older women, it's not budging for those under 50yo.
http://www.metavivor.org/awareness/
https://www.cancer.org/cancer/breast-cancer/about/how-common-is-breast-cancer.html
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I read your article with trepidation, Ms. Brody. I was diagnosed three years ago when I was 45, after many years of so called prevention. I started early since my mother had breast cancer in her 50s, the risk factor that can’t be controlled. I am a healthy weight, was a runner and regular yoga practitioner. However, the surgery, radiation and subsequent hormone therapy have taken its toll. It’s easy to write about taking a pill daily and suggest that prevention is so simple. However, while the side effects are non existent for some, they can be unbearable for others. I’m somewhere in between. My quality of life is not what it was before the roulette wheel came up with my number. I’m taking the same drug my mother took 25 years ago when she was diagnosed. Perhaps we need advances in the treatment of this not so easily prevented disease.
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@Dee This quote from the article says all you need to know -- "Dr. Lydia E. Pace of Brigham and Women’s Hospital said that “a lot of studies of preventive medication have shown a moderate reduction in risk of developing breast cancer.” But, she added, the drugs reduce the risk of those breast cancers that are generally the most curable and the least likely to cause death and have yet to be shown to reduce the overall risk of dying from the disease."
So you are exposing yourself to lots of aches and pains and side effects in the hope of reducing your risk. But it's just hope you are buying, not actual reduced risk. It's misleading.
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@Artaserse as someone precisely in this position, being asked to start hormone blocking drugs in a few weeks, follow radiation, reading the comments here make me feel
- I will die soon of breast cancer despite what my oncologist has told me which is the opposite
- the fact that the Onco type gene test says it has a low rate of recurrence was no cause for relief and I will die of it anyway
- I may as well have an aggressive breast cancer, as the indolent one I am told I have, that will not kill me and likely won’t return, is probably nonsense
- I won’t live to see our home renovations complete let alone any grandchildren
I am more confused than ever but starting to accept the inevitability of my breast cancer death in a more calm and willing fashion that I ever thought possible
Thanks everyone
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The results of papers is all about statistics. There is no “drug” that prevents breast cancer 100%. People who do everything to prevent cancer sometimes do get cancer.
The results of chemo (all types of tumors together) are not good at all. In 2004 a paper came to the conclusion in a meta analasis that the 5-years survival was 2,4 %
The best advice parents can give to their daughters in puberty: go into the sun (vitamin D).
Get enough sun but don`t burn the skin.
The conclusion of a paper was that the risk of getting breast cancer later in life is reduced bij 50% if the girls would follow that advice.
If people (men and women) do aim at a vitamin D blood level of 50-70 ng/ml the risk of getting cancer (and many other miseries) is very much lower (40-50% +/-) and the prognosis is much better as cancer comes.
In my country (The Netherlands; 17 million people) it was calculated that in that case there would be 25.000 less deaths from all causes.
In almost all papers about prevention and survival exercise is on top.
And a Chinese saying is: cancer comes into the body through the mouth.
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