Illustration: Cybèle Young
We all want to know what we can do to avoid breast cancer, a disease that claimed the lives of 5,000 Canadian women last year. There is no easy answer, but the experts agree there are things we can do to reduce our risk.
Breast cancer is the most common form of cancer among Canadian women (excluding nonmelanoma skin cancers) and the second-leading cause of cancer deaths. "Although the incidence of breast cancer can be concerning, the vast majority—80 to 90 percent—of women will be long-term survivors, and the outlook is growing better every year," says Dr. Eva Grunfeld, vice-chair of research in the department of family and community medicine at the University of Toronto and director of the knowledge translation research program at the Ontario Institute for Cancer Research.
Although the statistics aren't bad news, per se, confusion and concern around the disease never seem to subside. "Breast cancer is a scary thought for many women," says MJ DeCoteau, director and founder of Rethink Breast Cancer, a Canadian organization that advocates for young women with breast cancer. "The site of the disease, being in the breast, affects women in a personal way," she says. "Breasts are connected to your femininity, sexuality, body image, motherhood—all of those things." As a result of the fear and confusion around breast cancer, young women tend to overestimate their risk, says DeCoteau. "Just five percent of new diagnoses are women under 40."
At the same time, older women don't fully understand their risk, either, and tend to underestimate the ways in which they can proactively reduce their chances of getting the disease. "In my clinical experience, as well as my research experience, most women don't know that some of the lifestyle factors theyʼre aware of for other chronic diseases can also have an impact on breast cancer risk," says Dr. Grunfeld. The bottom line: Don't worry—but be informed and take action.
WHAT ARE MY RISK FACTORS?
The two most significant risk factors for breast cancer—sex and age—are, of course, out of your control. Thankfully, there are some things you can do to reduce your chances of developing the disease, which impacts one in eight Canadian women during their lifetime. "It's estimated that 30 to 50 percent of breast cancer cases are related to preventable risk factors," says Shawn Chirrey, senior manager of health analysis at the Canadian Cancer Society. The benefits of modifying certain lifestyle factors can't be denied—and should serve as an encouragement to women. Here's what you can do to reduce your risk.
Watch your weight
It's unclear whether carrying a few extra pounds will affect your chances of developing breast cancer, but research does show that being obese ups your risk. According to the 2015 Canadian Health Measures Survey, more than one in three adults are obese and may require medical help to manage their illness. Obesity, considered a chronic disease by many health organizations, can be measured using the body mass index (BMI) and is classified as abnormal or excessive fat accumulation that may impair your health. If your BMI categorizes you as obese, ask your doctor for advice and resources that can help you get to a healthy weight range.
Skip the Cabernet Sauvignon
"One of the factors people are less aware of is alcohol consumption," says Chirrey. "We know it's a carcinogen that's particularly sensitive for breast cancer." Even a moderate alcohol habit can increase your chances of developing the disease. There's no defined "safe" amount you can sip, but the Canadian Cancer Society advises that women keep it to less than one drink a day. "The less alcohol you drink, the more you lower your risk," he says.
Detox your cabinets
Although there are no studies showing a direct link between household chemicals and cancer, some experts recommend erring on the side of caution. "This revolves around the precautionary principle," says DeCoteau. "If something has not yet been proven safe, exercise caution or avoid wherever possible."
According to the Environmental Defence organization, Canadians are exposed to endocrine-disrupting chemicals in their household-cleaning and personal-care products that may be linked to breast cancer, among other diseases and disorders. The organization is lobbying for full ingredient disclosure and health-warning labels to be mandatory on product packaging so consumers can make informed purchasing decisions. In the meantime, consider incorporating eco-certified soaps, sprays and cleaners and personal-care products into your routines, where possible.
When it comes to possibly scratching potentially harmful chemicals off your grocery list, the Environmental Working Group's (EWG) Dirty Dozen list of the 12 fruits and vegetables with the highest amounts of pesticide residue (including strawberries, apples and spinach) can help provide insight as to when it may be most important to buy certified organic. Since eating strictly organic can be expensive, DeCoteau also recommends using EWGʼs Clean Fifteen guide, a list of conventionally grown produce that doesnʼt have significant residue (including corn, broccoli and avocados).
Get your move on
Research shows you can lower your risk of breast cancer by being physically active. "The current evidence is showing 30 to 60 minutes a day of moderate to vigorous physical activity will do it," says DeCoteau. This doesn't have to mean hitting the gym every day, but you do need to be consistent, she says. "Maybe you do yoga twice a week or a heavy boot-camp class on the weekend and, throughout the week, you ride your bike to work—all that exercise adds up. It's important to commit if you want to see the maximum benefit of risk reduction for breast health."
AM I TREATING THEM RIGHT?
You are your breasts' best friend—and advocate. We asked Dr. Grunfeld a few breast-health questions to help you get to know your breasts a little better so you can give them the care they deserve.
Sometimes, my breasts are really sore. Is that normal?
Breast tenderness is common around menstruation and, generally, not cause for concern. But what if you experience discomfort not related to your menstrual cycle? "Breast pain isnʼt an indicator of breast cancer," says Dr. Grunfeld. Pain in the breast area is often caused by other structures in the chest and around the breast, such as the muscles, she says. Trying a new move in yoga class or even carrying a heavy purse on the same shoulder every day can lead to strain in the muscles and the cartilage under your breasts, resulting in some discomfort. If the problem is severe and persists, you should check with your doctor to rule out other potential medical concerns—hormonal changes that may require treatment.
Is squishing my breasts into a sports bra bad for them?
There's no reason to think any style or shape of bra is better than another or that bras are related to the health of your breasts, says Dr. Grunfeld. But your bra can play into how your breasts feel. "Pain can be associated with a poorly fitting bra," she says. If you have discomfort or chafing from your bra, or you wear a larger cup size, consider getting professionally fitted to ensure that your breasts are properly and comfortably supported.
Does the skin on my chest need sun protection?
"Definitely, sunscreen is vital," says Dr. Grunfeld. Apply SPF 30 daily to exposed skin on your chest, just like you would for your face and your neck. And don't neglect your décolletage when moisturizing the rest of your body at night or after a shower. The skin on your chest is delicate and prone to signs of aging, including age spots and wrinkles, so it should be treated with care.
Do I need a mammogram?
Although the benefits of mammography have been hotly debated in recent years, due in part to overdiagnosis, regular screening is recommended. "We still feel that the benefits for the individual woman outweigh the risks," says Dr. Grunfeld, referring to the possibility of needing additional testing, such as breast biopsies, which can cause added stress. Canadian women of average risk between the ages of 50 and 69 should have a mammogram every two years. Mammography for women under 50 is less reliable (because younger women tend to have denser breast tissue, which makes it more difficult to detect lumps), but if youʼre considered high risk (because of a strong family history or the presence of certain gene mutations, for example), you and your doctor can discuss the possibility of an early or more intensive screening program.
IS THERE ONE PROPER WAY TO CARE FOR THEM?
"We want women to understand that their breast health has to be about them," says MJ DeCoteau of Rethink Breast Cancer. Until now, breast cancer prevention has been thought of in terms of general guidelines, but that's changing, she says: Personalized care is the next frontier. "There's currently a research study looking at how we can stratify risk better so thereʼs more personalized screening," says Shawn Chirrey of the Canadian Cancer Society. This could involve genetic testing, as well as looking at an individual's risk factors in more detail as a determination of risk and how often screening should occur. "We're going to see a shift to more informed consent; women are having this conversation with their doctors or nurse practitioners, so they know the benefits and limitations of screening," he says. In the meantime, take good care of your body, including your breasts, and talk to your doctor about your risks for breast cancer, especially if you have a family history. "That's the best thing you can do to reduce your risk," says Chirrey.
HOW OFTEN SHOULD I DO A BREAST SELF-EXAM?
Dr. Ruth Heisey, chief of family medicine at Toronto's Women's College Hospital, says, "It's important to know your breasts so you can easily detect changes. Examine your breasts every two to three months during showering or bathing, being sure to cover all of the tissue, including up to the collarbone and into the armpit, using the flat part of your fingers—not your fingertips, which are too sensitive. You're feeling for lumps or bumps in the breast or armpit or any persistent thickenings or fullness present on one side only. Look in the mirror while drying off; check for indentations, significant changes in the shape of the breast, any one-sided nipple discharge that occurs without squeezing, or crusting or thickening of the nipple and areola. Avoid examining your breasts around the time of your period, when they tend to feel fuller and lumpier. If you notice any changes, visit your health-care provider and discuss whether imaging should be performed. Some women with relatives with breast and/or ovarian cancer may be at a substantially higher risk for both cancers and should consider genetic testing and high-risk screenings (mammogram and MRI) and, for those who are found to carry a genetic mutation, possibly preventive surgeries.