A new push to lower your risk for breast cancer

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A regular mammogram isn’t enough to battle breast cancer anymore.

Researchers have found that a third of breast cancer cases may have roots in issues like obesity, alcohol use and inactivity.

Hospitals are parlaying that fact into new, personalized assessments that emphasize prevention and healthier life choices, along with other factors that increase or decrease risk. They’re using the results to guide follow-up and recommendations tailored to each woman.

These efforts are part of a wider trend toward personalized medicine. Such programs are too new to show impact on cancer diagnoses. But breast cancer experts say they are low-cost, do no harm and encourage women to live healthier lives. They also give women much-needed prevention guidance beyond their annual reminder to get a mammogram.

“Routine screening and early detection are important tools to defeating cancer, and yet we know there is room to improve upon how we assess risk and motivate healthy lifestyle choices,” says Dr. Marisa Weiss, a breast cancer survivor who is chief medical officer and founder of the nonprofit Breastcancer.org. “Individuals are much more likely to make and sustain daily healthy lifestyle choices when their risk profile and action plans are customized to their unique situation.”

Brigham and Women’s Hospital in Boston offers a program called B-Prep—for Breast Cancer Personalized Risk Assessment, Education and Prevention—to women who visit for breast complaints or abnormal tests. It’s also open to anyone who wants to learn about her own personal risk. (Heredity accounts for 5% to 10% of breast cancer cases, and dense breast tissue increases risk. Oral contraceptives and hormone replacement therapy may also play a role.)

As part of B-Prep, women fill out a survey to evaluate lifestyle, family history and other risk factors and receive a personalized evaluation of their risk with exercise and diet recommendations, free educational sessions and follow-up recommendations. Genetic counselors and physicians are available to discuss testing for inherited risk to those with a family history that increases the risk of breast cancer.

‘ It makes you stop and think about what your daily diet should be, and what you are putting in your body. ’

—A Boston-area woman who tried Brigham and Women’s B-Prep program.

Patients wanting help with weight loss are referred to a Brigham and Women’s weight-management program and can consult with the weight-loss surgery program. They’re also offered the chance to participate in clinical trials. One is testing whether a 12-week exercise regimen can change inflammatory and immune markers associated with breast cancer.

Kathy Wood, a 61-year-old dental-office manager in the Boston area, heard about the program after having her annual mammogram in June. Although the results were negative, she was concerned about risk from her dense breast tissue. Because it can make screening more difficult, additional imaging tests are sometimes recommended.

She filled out the B-Prep survey and had a follow-up ultrasound, which was also negative. Last weekend she attended a free, four-hour B-Prep forum, with presentations and Q&A sessions with experts on topics including lifestyle and the role of exercise and diet in reducing risk.

“I went in not knowing anything and learned so much,” Ms. Wood says.

She was happy to learn that her lifestyle might help lower her risk. She rarely drinks, maintains a healthy weight and exercises regularly. But she says she was unaware of dietary factors associated with several types of cancer discussed at the forum, including the role of carcinogens in some processed foods. “It makes you stop and think about what your daily diet should be, and what you are putting in your body,” Ms. Wood says.

Dr. Tari King is chief of breast surgery at the Dana-Farber/Brigham and Women’s Cancer Center and director of the B-Prep program. She says one aim is to put risk data into perspective. For example, the average woman has a 12% absolute risk of developing breast cancer over a lifetime. Drinking more than one alcoholic beverage a day increases that risk to between 14% and 15%.

“We are not trying to encourage excessive drinking, but we don’t want women to feel they can’t have a glass of wine or two after a particularly stressful day,” Dr. King says.

At Memorial Sloan Kettering Cancer Center in New York, a program known as Rise (Risk Assessment, Imaging, Surveillance and Education) creates a customized, long-term surveillance plan for women already determined to be at high risk for breast cancer. That includes those with a family history or previous radiation treatment to the chest wall. Participants fill out a detailed survey that includes lifestyle questions and can arrange sessions with a dietitian.

“We are trying to personalize screening recommendations and risk reduction strategies, not a one-size-fits all approach,” says Melissa Pilewskie, a breast surgeon and director of strategic planning and research for the Rise program.

A 2017 study led by Dr. Pilewskie published in the journal Breast Cancer Research found that 60% of high-risk women reported a possible area for risk reduction. Among 1,277 women who completed the survey, only half met national physical activity recommendations, 40% were overweight or obese and 18% reported consuming more than one drink a day. More than two-thirds qualified for genetic evaluation but 40% reported no prior testing.

Memorial Sloan Kettering’s Exercise Oncology Service is also researching the right level of exercise for cancer prevention. In one trial, women with abnormal changes in breast tissue that increase the risk of developing invasive breast cancer will be assigned to treadmill walking for six months, ranging from 75 minutes a week to 300 minutes. A control group will receive usual care with no prescription for exercise.

After six months, researchers will repeat a biopsy to evaluate whether the training lowers the expression of genes in the normal breast tissue that are known to promote breast cancer. They also hope to find the optimal amount of exercise to stimulate the changes.

“A lot of women come in and are anxious about risk and want to know what they can do, and we want to show them there is science behind these modifiable risk behaviors,” Dr. Pilewskie says.



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