How can I protect myself from breast cancer?

Follow these three steps for early detection:

  • Get a mammogram. The American Cancer Society recommends having a baseline mammogram at age 35, and a screening mammogram every year after age 40. Mammograms are an important part of your health history. Recently, the US Preventive Services Task Force (USPTF) came out with new recommendations regarding when and how often one should have mammograms. These include starting at age 50 and having them every two years. We do not agree with this, but we are in agreement with the American Cancer Society and have not changed our guidelines, which recommend yearly mammograms starting at age 40.
  • Examine your breasts each month after age 20. You will become familiar with the contours and feel of your breasts and will be more alert to changes.
  • Have your breast examined by a healthcare provider at least once every three years after age 20, and every year after age 40. Clinical breast exams can detect lumps that may not be detected by mammogram.

Can exercise help reduce my risk of developing breast cancer?

Exercise is a big part of a healthy lifestyle. It can also be a useful way to reduce your risk of developing breast cancer in your postmenopausal years. Women often gain weight and body fat during menopause. People with higher amounts of body fat can be at a higher risk of breast cancer. However, by reducing your body fat through exercise, you may be able to lower your risk of developing breast cancer.

The general recommendation for regular exercise is about 150 minutes each week. This would mean that you work out for about 30 minutes, five days each week. However, doubling the amount of weekly exercise to 300 minutes (60 minutes, five days each week) can greatly benefit postmenopausal women. The longer duration of exercise allows for you to burn more fat and improve your heart and lung function.

The type of exercise you do can vary — the main goal is get your heart rate up as you exercise. It’s recommended that your heart rate is raised about 65 to 75% of your maximum heart rate during exercise. You can figure out your maximum heart rate by subtracting your current age from 220. If you are 65, for example, your maximum heart rate is 155.

Aerobic exercise is a great way to improve your heart and lung function, as well as burn fat. Some aerobic exercises you can try include:

  • Walking.
  • Swimming.
  • Running.
  • Biking.
  • Dancing.
  • Hiking.

Pick an activity you enjoy and want to do over and over again. The more you like your activity, the more likely you’ll be to continue exercising day-after-day. You don’t have to do the same activity for all 300 minutes of your weekly exercise. You can mix it up and try different things throughout the week. The important thing is to keep moving.

Remember, there are many benefits to working more exercise into your weekly routine. Some benefits of aerobic exercise can include:

  • Lower cholesterol and blood pressure.
  • Increased endurance.
  • A lower resting heart rate.
  • Weight loss or maintenance of your current weight.
  • Stress relief.
  • Improved sleep.

Always talk to your healthcare provider before starting a new diet or exercise routine. It’s important to know if you have any limitations before you start exercising. Having an open and honest conversation about your exercise goals can help your provider guide you as you develop a fitness plan.

Medications to Reduce the Risk of Breast Cancer

If you are at increased risk for developing breast cancer, four medications -- tamoxifen (Nolvadex®), raloxifene (Evista®), anastrozole (Arimidex®), and exemestane (Aromasin®) -- may help reduce your risk of developing this disease. These medications act only to reduce the risk of a specific type of breast cancer called estrogen receptor-positive breast cancer. This type of breast cancer accounts for about two-thirds of all breast cancers.

How do tamoxifen, raloxifene, anastrozole, and exemestane reduce the risk of breast cancer?

Tamoxifen and raloxifene are in a class of drugs called selective estrogen receptor modulators (SERMs). These drugs work by blocking the effects of estrogen in breast tissue by attaching to estrogen receptors in breast cells. Because SERMs bind to receptors, estrogen is blocked from binding. Estrogen is the fuel that makes most breast cancer cells grow. Blocking estrogen prevents estrogen from triggering the development of estrogen-receptor-positive breast cancer.

Anastrozole and exemestane are in a class of drugs called aromatase inhibitors (AIs). These drugs work by blocking the production of estrogen. Aromatase inhibitors do this by blocking the activity of an enzyme called aromatase, which is needed to make estrogen.

How much do tamoxifen and raloxifene lower the risk of breast cancer?

Multiple studies have shown that both tamoxifen and raloxifene can reduce the risk of developing estrogen receptor-positive breast cancer in healthy postmenopausal women who are at high risk of developing the disease. Tamoxifen lowered the risk by 50 percent. Raloxifene lowered the risk by 38 percent. Overall, the combined results of these studies showed that taking tamoxifen or raloxifene daily for five years reduced the risk of developing breast cancer by at least one-third. In one trial directly comparing tamoxifen with raloxifene, raloxifene was found to be slightly less effective than tamoxifen for preventing breast cancer.

Both tamoxifen and raloxifene have been approved for use to reduce the risk of developing breast cancer in women at high risk of the disease. Tamoxifen is approved for use in both premenopausal women and postmenopausal women (women who have not had a period for one full year). Raloxifene is approved for use only in postmenopausal women.

Less common but more serious side effects of tamoxifen and raloxifene include blood clots to the lungs or legs. Other serious side effects of tamoxifen are an increased risk for cataracts and endometrial cancers. Other common, less serious shared side effects of tamoxifen and raloxifene include hot flashes, night sweats, and vaginal dryness.

How much do anastrozole and exemestane lower the risk of breast cancer?

Studies have shown that both anastrozole and exemestane can lower the risk of breast cancer in postmenopausal women who are at increased risk of the disease.

In one large study, taking anastrozole for five years lowered the risk of developing estrogen receptor-positive breast cancer by 53 percent. In another study, taking exemestane for three years lowered the risk of developing estrogen receptor-positive breast cancer by 65 percent.

The most common side effects seen with anastrazole and exemestane are joint pains, decreased bone density, and symptoms of menopause (such as hot flashes, night sweats, vaginal dryness).

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