Reduce Your Risk

Understanding your personal level of risk is the first step. Next up: learning how to reduce that risk through lifestyle choices and other risk-reduction strategies.

Simple, Everyday Choices for Risk Reduction

There are easy things we can all do to lower our risk, starting with leading a healthy lifestyle. Your 20s and 30s are the ideal time to start adopting new habits that can reduce your lifelong risk of breast and ovarian cancer, so give the following lifestyle choices the consideration your body deserves. And these risk-reduction steps can benefit women at all risk levels. They apply to everyone!

While all of these activities can help reduce your breast and ovarian cancer risk, they do not eliminate it completely. Keep the tips in mind as you create a comprehensive plan, which should also include early detection.

Regular Exercise

Maintaining a healthy weight is crucial— there is a clear link between obesity and breast cancer because of the excess estrogen produced by excess fatty tissue. You’ve heard it before, but we’ll tell you again: being active is key. 30 minutes of regular exercise, enough to get your heart rate up or to break a sweat, on most days may reduce your risk by as much as 10-20%. Plus, it has lots of other benefits like lowering your risk for heart disease and reducing stress.

Eat Well, Live Well

Research has shown that the food you put in your body has a direct link to your health. Fill up on cancer-fighting fruits and vegetables, make sure you get all your vitamins, and avoid red meat—research has shown a 12% increase in breast cancer risk per 50g of red meat consumed on average each day.

Certain foods can actually help decrease your risk of developing cancer. These cancer-fighting foods are not only nutritious—they are usually inexpensive and a natural way to take action and manage your health. Here’s what to look for when you head to the grocery store:

  • Foods that provide Vitamin D, like fatty fish, fortified milk, beans, eggs, and nuts.

  • Low-fat foods—research shows a modest decrease in invasive breast cancer in women with a low–fat diet.

  • Vitamin A reduces risk for those who have a family history of the disease. Look for carrots, sweet potatoes, dried herbs, and leafy greens.

  • Vitamin E has been clinically proven to slow the growth of cancer cells in the ovaries by reducing the production of telomerase, a ribonucleoprotein that can increase the risk of developing ovarian cancer. Fill up on leafy greens such as swiss chard, spinach, and kale, as well as nuts, wheat, and tropical fruits.

  • Fiber is a rich nutrient found in whole grain, flax, certain cereals, beans, and vegetables shown to reduce estrogen levels—which in turn can slow the growth of cancer cells in the breasts. Consider swapping white bread with whole grain, white rice with brown, and sugary cereal for one rich in fiber and the vitamins listed above.

  • Fruits and vegetables carry the vitamins and nutrients that can help lower your risk of developing breast and ovarian cancer. Aim for at least five servings a day—try to include lots of cruciferous vegetables like broccoli and cauliflower, and dark, leafy greens like kale and spinach.

Research shows a 12% increase in breast cancer risk for every 50g of red meat consumed on average each day.

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Especially Vitamin D

Vitamin D is known to help reduce the incidence of breast and ovarian cancer by slowing the growth of cancer cells. Research shows a 2.5x increase in breast cancer in individuals with a Vitamin D deficiency, and a possible increase in ovarian cancer risk. Have your Vitamin D levels checked at your primary care physician’s office. If your levels are low, talk to him or her about the best ways to get those levels up – it can be surprisingly hard for those of us who live through long, dark winters inside, because the sun is our primary and best source of Vitamin D. If your levels are low, try to take in the sun in small doses (sunscreen will block production of Vitamin D) and also ensure that your diet or a Vitamin D supplement provides the rest. Fatty fish (such as salmon) is a good dietary source of Vitamin D, as can be milk, fortified cereal, orange juice, and eggs.

Excess Alcohol

Cut back on cocktails. Research shows a 10% increase in breast cancer risk for every 10g of alcohol—that’s one standard drink—consumed on average each day. Limit alcohol to one drink per day or eliminate it entirely.

Research shows a 10% increase in breast cancer risk for every 10g of alcohol consumed on average each day.

Stop Smoking

This one is simple, for a variety of reasons! There’s a known link between tobacco and many cancers (not just lung or other oral cancers). If you do smoke, commit to quitting today.

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Having Children and Breastfeeding

A woman’s childbearing history also influences her risk of developing both breast and ovarian cancer. Pregnancy transforms and stabilizes the cells that comprise milk-producing glands and ducts, so the earlier this transformation happens, the lower the risk of breast cancer. Some studies have shown that women with first pregnancies under the age of 30 have a 40-50% lower risk of breast cancer than women who gave birth later or who were never pregnant.

Pregnancy can also reduce your risk of ovarian cancer by eliminating some ovulatory cycles and therefore the number of chances for ovarian cells to “go rogue” during cell division.

Breastfeeding can also play a role in risk reduction strategy. If it makes sense for you, breastfeeding for 1-2 years—not necessarily consecutively—lowers your risk for both breast and ovarian cancer by decreasing estrogen levels and the number of times you’ll ovulate over the course of your life. It also may reduce a female baby’s overall risk of developing breast cancer later in her life.

Taking Birth Control

In addition to preventing pregnancy, studies have shown that oral contraceptives (birth control pills) can help prevent ovarian cancer. Taking birth control pills for 5 years—even non-consecutively—in your 20s and 30s can reduce your ovarian cancer risk by nearly half.

You may have heard that taking birth control can increase the risk of developing breast cancer. Many studies have shown that the increased risk of breast cancer risk related to birth control pills is very low—if it exists at all—temporary, and not associated with the most common, low-dose estrogen pills. The protective benefits of birth control pills when it comes to ovarian cancer risk are greater than the very slight associated increase in breast cancer risk.

That said, the decision to take birth control pills is a very personal one and there may be reasons why they aren’t the right choice for you. Your doctor can help you weigh the potential risks and benefits of using oral contraceptives to optimize and individualize your own proactive breast and ovarian health plan.

Environmental Factors

The chemicals in our environment play a role in altering our biological processes. We now know that exposures to toxic chemicals and radiation are connected to our breast cancer risk. Get to know the chemicals that have been linked to breast cancer and learn about what you can do in terms of personal, corporate and political action to limit your exposure, thereby reducing your risk of breast cancer.

Using oral contraceptives can reduce your ovarian cancer risk by nearly half.

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Risk Reduction for Increased-Risk Women

For women in the Increased-Risk category, following the healthy living guidelines listed above is the first step, but there are additional early detection and risk reduction tactics to consider. In addition to being Breast and Ovarian Self-Aware we encourage you to discuss the following options with your doctor.

Chemoprevention

Chemoprevention—the use of medications to prevent, suppress or reverse cancer—presents an option worth considering to women of increased risk. For those for whom there are no surgical recommendations for breast cancer risk-reduction, chemoprevention can be an important component of a comprehensive risk-reduction strategy.

You might not think of oral contraceptives as a type of chemoprevention, but they are, when used specifically to reduce the risk of ovarian cancer. As mentioned above, taking birth control pills for 5 years—even non-consecutively—in your 20s and 30s can reduce your ovarian cancer risk by nearly half, so if you’re at increased risk, having a conversation with your doctor about the potential risks and benefits of oral contraceptives is an important step in determining your risk management strategy.

SERMs (Selective Estrogen-Receptor Modulators) are a specific type of medicines that modulate how cells respond to estrogen. Tamoxifen is a well-known and the most commonly-prescribed SERM, best known as a drug used to help avoid cancer recurrence in women who have already been treated for breast and ovarian cancer. But it can also be used to reduce the risk of breast and ovarian cancer before they develop, so it’s a viable option to consider.

It’s important to know that chemoprevention can have some serious side effects, including possible damage to your ovaries, loss of fertility, and blood clots. Be sure to talk with your doctor about the pros and cons of this risk-reduction option.

Surgical Risk Reduction

Risk-reducing surgeries remove body tissue most likely to be at risk for cancer and are therefore a viable risk-reduction strategy for some women. Though most risk-reducing surgeries are thought to be appropriate only for women at high risk, it’s worth talking to your doctor about the “intermediate step” surgical options for ovarian cancer, below, to see if they might be appropriate strategies to reduce your increased-level risk. There are no surgical breast cancer risk-reduction recommendations for women in the Increased-Risk category.

Tubal ligation is a procedure in which the fallopian tubes are tied off or blocked, and is a viable option for increased-risk patients who aren’t ready to remove their ovaries. The procedure can reduce the risk of ovarian cancer by as much as 34%, likely because many ovarian cancers actually originate in the fallopian tubes. Salpingectomy is the surgical removal of the fallopian tubes and is recommended for any woman undergoing hysterectomy because of the benefit of reducing ovarian cancer risk without altering hormonal function.

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Risk Reduction for High-Risk Women

For women in the High-Risk category, following the healthy living guidelines listed above is the first step, but it’s crucial to engage in additional risk-reduction tactics, as described below, as well as increased screening strategies. We strongly encourage you to discuss the following options with your doctor.

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Chemoprevention

Chemoprevention is the use of medications to prevent, suppress or reverse cancer. For women at high risk, these chemoprevention options can be important components of a comprehensive risk-reduction strategy alongside surgical risk-reduction.

You might not think of oral contraceptives as a type of chemoprevention, but they are, when used specifically to reduce the risk of ovarian cancer. As mentioned above, taking birth control pills for 5 years—even non-consecutively—in your 20s and 30s can reduce your ovarian cancer risk by nearly half, so if you’re at High Risk, having a conversation with your doctor about the potential risks and benefits of oral contraceptives is an important step in determining your risk management strategy.

SERMs (Selective Estrogen-Receptor Modulators) are a specific type of chemoprevention that modulate how cells respond to estrogen. Tamoxifen is a well-known and the most commonly-prescribed SERM, best known as a drug used to help avoid cancer recurrence in women who have already been treated for breast and ovarian cancer. But it can also be used to reduce the risk of breast and ovarian cancer before they develop, so it’s a viable option to consider. One study shows that Tamoxifen decreased breast cancer occurrence by 62% in women with a BRCA2 gene mutation. (Unfortunately, there was no reduction in those women with a BRCA1 gene mutation.)

It’s important to know that chemoprevention can have some serious side effects, including possible damage to your ovaries and loss of fertility. Be sure to talk with your doctor about the pros and cons of this risk-reduction option.

Risk-Reducing Surgery

Many young women who are at high risk for breast and ovarian cancer decide, together with their medical team, to have one or more risk-reducing surgeries. This kind of operation removes body tissue most likely to be at risk for cancer and can be done on both breast and ovarian tissue.

These surgeries can never give you 100% protection from cancer, because it’s impossible to remove every single breast and ovarian cell. But, they can significantly reduce your chances of developing breast and ovarian cancer. This is a big, and very personal, decision, so be sure to learn as much as you can, and discuss all your options with your doctors.

It’s also important to follow through with increased screening recommendations for high-risk women if you’re deciding not to have a risk-reducing surgery, or until you do.

Some women who are at high risk for breast cancer have their breast tissue surgically removed through a prophylactic (or risk-reducing) mastectomy. Studies show you can reduce your risk of developing breast cancer by 95%, and you have options for reconstructive surgery afterward. You will also want to consider that you will likely lose normal sensation in the breast, and won’t be able to breastfeed. If you decide to have a risk-reducing mastectomy, you may find these tips helpful.

To make the best decision about whether to have a prophylactic mastectomy, you should understand your options for breast reconstruction. This surgery can closely rebuild the natural shape of your breast—though not exactly. It’s also important to understand that breast reconstruction is a major procedure that includes a series of surgeries. You and your doctor should work together to make decisions about the best procedure for you, including whether to use saline or silicone implants, or borrow tissue from somewhere else in your body.

There are also risk-reducing surgeries for women at high risk for ovarian cancer:

A prophylactic oophorectomy is the removal of one or both healthy ovaries. Surgeons should also remove the fallopian tubes (called a bilateral salpingo-oophorectomy, or BSO), due to the risk of similar cancer there.

Young, pre-menopausal women will go through menopause after the operation, which is a major side effect. So, to make the best decision for you, talk to your doctor about your unique situation and be sure to weigh all the pros and cons.

You may also want to talk to your doctor about fertility preservation options if you know or think you may want to have biological children in the future. These steps have to be taken before your ovaries are removed.

Interest has recently been piqued in the idea of salpingectomy (removal of the fallopian tubes) with delayed oophorectomy (removal of the ovaries) as an ovarian cancer risk-reduction strategy for high-risk women that would delay the onset of menopause. While appealing, this approach should still be considered experimental, given the lack of data from clinical trials that have assessed the risks and benefits in high-risk patients.

Some high-risk patients having their ovaries and tubes removed wonder if they should also have a hysterectomy–the surgical removal of the uterus and cervix—but current research does not support it for risk-reduction alone. Hysterectomy is an extensive surgery, with increased risk of complications and longer recovery times by comparison to salpingo-oophorectomy, so the pros and cons should be carefully weighed with your doctor when considering this procedure in addition to risk-reducing surgery.

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