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Understanding Modifiable Risk Factors for Breast Cancer

Susan Distasio speaking with a patient.
Susan DiStasio, DNP, APRN, discusses with a patient ways to potentially lower her risk for developing breast cancer, and improve her overall health and well-being during and after treatment for breast cancer.

While no complete list exists, and there is no sure way to prevent breast cancer, many risk factors have been identified. Some of these factors are out of our control, such as gender, age and genetic predisposition–things that cannot be changed. Other risk factors are lifestyle-related and can be impacted by our actions. Susan DiStasio, DNP, APRN, a nurse practitioner in the Comprehensive Breast Program, Radiation Oncology at Dartmouth-Hitchcock’s Norris Cotton Cancer Center shares some of the biggest modifiable risk factors that can affect new cases of breast cancer, recurrences and secondary cancers, and how to adopt these healthy habits into your life.

Tobacco use

There is growing evidence that smoking increases the risk for many initial and recurrent cancers including breast cancer, especially in premenopausal women. “Those who continue to smoke after radiation to the chest and the breast also have a higher risk of developing heart disease and lung cancer. If you are ready to quit smoking there are lots of resources for you. You can talk to any provider—primary care, your nurse—anyone,” encourages DiStasio.

Alcohol consumption

According to the American Cancer Society, the risk of developing several different cancers increases with the amount of alcohol consumed. Women who have two to three drinks a day have about a 20 percent higher risk of developing breast cancer compared to women who do not drink alcohol. Consumption should be limited to no more than one drink per day (a drink being five ounces or less of wine).

Healthy eating and obesity

It is no secret that a nutritious diet offers a multitude of health benefits. Obesity is a body mass index (BMI), calculated from height and weight, of greater than 30. Obesity is a known breast cancer risk factor, especially after menopause. Obesity also increases risk for hypertension, heart disease, diabetes and increased lymphedema. The recommended BMI is between 18.5 and 24.9. “I would ask you to think about whether you know what your BMI is,” suggests DiStasio.

Recommendations for preventing obesity include a plant-based diet (fruits and vegetables) and whole foods high in fiber such as whole grains and legumes (beans, peas, chickpeas, lentils). Healthy fat sources include nuts instead of chips, olive oil instead of butter and fish instead of red meat. Women who have gone through treatment for breast cancer are also at a higher risk for heart disease. There is some evidence that eating a diet like this may increase survival and lower risk for heart disease.

Exercise (avoiding a sedentary lifestyle)

In addition to diet, exercise impacts obesity. “Some studies are showing that obesity rates are actually rising in breast cancer survivors, greater than in the general population, which may be due to decreased activity as well as hormonal changes from treatment. Some women never return to their baseline activity level,” says DiStasio.

The American Cancer Society acknowledges growing evidence that shows that regular physical activity reduces breast cancer risk, especially in women past menopause. The current recommendations from the National Comprehensive Cancer Network of the American Cancer Society is 150 minutes of moderate exercise, 75 minutes of vigorous exercise, or a combination of the two, spread out over the week. Moderate exercise means you can talk while you’re exercising but you can’t sing. Vigorous exercise means you can say a few words without stopping to catch your breath but have a hard time maintaining a conversation. The important part is getting your heart rate up. Strength training and stretching of all major muscle groups twice a week is also recommended, as is weight-bearing exercise for bone density, especially if you’re on medications that thin your bones. “Exercise and maintaining a healthy weight is associated with a decreased risk of recurrence and improved quality of life,” says DiStasio. “Exercise also decreases fatigue, depression and arm swelling from lymphedema, and improves mobility and self-esteem, as well as upper body strength, which can often be compromised by certain breast cancer treatments.”

Studies show that an estimated 17–37 percent of breast cancer survivors actually adhere to these recommendations. That low number may be because survivors don’t always see the value in exercising, or they find it difficult to make it a priority given all the other demands on their time. “There are opportunities for providers to educate their patients about the value of exercise during and after treatment, for cancer centers to make oncology rehabilitation programs more accessible and also for patients to educate themselves about the value,” says DiStasio.

The best strategy for increasing activity both during and after treatment for breast cancer is finding what works for you. Find activities that you love. “Exercise does not mean you have to go to a gym. If you don’t like being on a treadmill then don’t do it. How many times do you see exercise equipment for sale? Or for free? We live in such a beautiful area where there are many easy hiking trails, bike routes and cross country ski paths. Being out in nature can give you a boost and make you feel good, and meanwhile you get in your exercise,” notes DiStasio.

Another strategy is to have a friend or family member join an exercise program with you. “I once had a patient who volunteered in the babysitting room of her local gym. In return she earned a free gym membership. She and her daughter would spend time at the gym together, which made it more fun and special than going alone,” says DiStasio.

Know yourself

One final important habit is to know your body and be vigilant about breast cancer detection. If you notice any changes in your breasts, such as a new lump or skin abnormalities, tell your health care provider. Also, discuss with your provider when to begin mammograms and other screenings based on your own personal circumstances and history. Making decisions that benefit your health may not only reduce your risk for breast cancer and other diseases, but will improve your overall physical and mental well-being.


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