Lifestyle-related Breast Cancer Risk Factors
Certain breast cancer risk factors are related to personal behaviors, such as diet and exercise. Other lifestyle-related risk factors include decisions about having children and taking birth control.
Drinking alcohol is clearly linked to an increased risk of developing breast cancer. The risk increases with the amount of alcohol consumed. Compared with non-drinkers, women who have 1 alcoholic drink a day have a very small increase in risk. Those who have 2 to 5 drinks daily have about 1½ times the risk of women who don’t drink alcohol. Excessive alcohol consumption is known to increase the risk of other cancers, too. The American Cancer Society recommends that women have no more than 1 alcoholic drink a day. A drink is 12 ounces of regular beer, 5 ounces of wine, or 1.5 ounces of 80-proof distilled spirits.
Being overweight or obese
Being overweight or obese after menopause increases breast cancer risk. Before menopause your ovaries make most of your estrogen, and fat tissue makes only a small amount. After menopause (when the ovaries stop making estrogen), most of a woman’s estrogen comes from fat tissue. Having more fat tissue after menopause can raise estrogen levels and increase your chance of getting breast cancer. Also, women who are overweight tend to have higher blood insulin levels. Higher insulin levels have been linked to some cancers, including breast cancer.
Still, the link between weight and breast cancer risk is complex. For instance, risk appears to be increased for women who gained weight as an adult, but may not be increased among those who have been overweight since childhood. Also, excess fat in the waist area may affect risk more than the same amount of fat in the hips and thighs. Researchers believe that fat cells in various parts of the body have subtle differences that may explain this.
The American Cancer Society recommends you stay at a healthy weight throughout your life by balancing your food intake with physical activity and avoiding excessive weight gain.
Evidence is growing that physical activity in the form of exercise; reduces breast cancer risk. The main question is how much exercise is needed. In one study from the Women’s Health Initiative, as little as 1¼ to 2½ hours per week of brisk walking reduced a woman’s risk by 18%. Walking 10 hours a week reduced the risk a little more.
To reduce your risk of breast cancer, the American Cancer Society recommends that adults get at least 150 minutes of moderate intensity or 75 minutes of vigorous intensity activity each week (or a combination of these), preferably spread throughout the week.
Moderate activity is anything that makes you breathe as hard as you do during a brisk walk. During moderate activities, you’ll notice a slight increase in heart rate and breathing. You should be able to talk, but not sing during the activity. Vigorous activities are performed at a higher intensity. They cause an increased heart rate, sweating, and a faster breathing rate. Activities that improve strength and flexibility, such as weight lifting, stretching, or yoga, are also beneficial.
Women who have not had children or who had their first child after age 30 have a slightly higher breast cancer risk overall. Having many pregnancies and becoming pregnant at an early age reduces breast cancer risk overall. Still, the effect of pregnancy is different for different types of breast cancer. For a certain type of breast cancer known as triple-negative, pregnancy seems to increase risk.
Oral contraceptives: Studies have found that women using oral contraceptives (birth control pills) have a slightly higher risk of breast cancer than women who have never used them. Once the pills are stopped, this risk seems to go back to normal over time. Women who stopped using oral contraceptives more than 10 years ago do not appear to have any increased breast cancer risk.
Birth control shot: Depo-Provera is an injectable form of progesterone that’s given once every 3 months as birth control. A few studies have looked at the effect of birth control shots on breast cancer risk. Women currently using birth-control shots seem to have an increase in breast cancer risk, but it appears that there is no increased risk in women 5 years after they stop getting the shots.
Birth control implant, IUD, skin patch, vaginal ring: These forms of birth control also use hormones that could fuel breast cancer growth. Some studies have shown a link between use of hormone-releasing IUD and breast cancer risk, but few studies have looked into the use of birth control implants, patch, and ring and breast cancer risk.
When thinking about using hormonal birth control, women should discuss their other risk factors for breast cancer with their health care provider.
Hormone therapy after menopause
Hormone therapy with estrogen (often combined with progesterone) has been used for many years to help relieve symptoms of menopause and help prevent osteoporosis (thinning of the bones). This treatment goes by many names, such as post-menopausal hormone therapy (PHT), hormone replacement therapy (HRT), and menopausal hormone therapy (MHT).
There are 2 main types of hormone therapy. For women who still have a uterus (womb), doctors generally prescribe estrogen and progesterone (known as combined hormone therapy or HT). Progesterone is needed because estrogen alone can increase the risk of cancer of the uterus. For women who’ve had a hysterectomy (those who no longer have a uterus), estrogen alone can be used. This is known as estrogen replacement therapy (ERT) or just estrogen therapy (ET).
Combined hormone therapy (HT): Use of combined hormone therapy after menopause increases the risk of breast cancer. It may also increase the chances of dying from breast cancer. This increase in risk can be seen with as little as 2 years of use. Combined HT also increases the likelihood that the cancer may be found at a more advanced stage. (This means it’s already spread from the place it started when it’s found.)
The increased risk from combined HT appears to apply only to current and recent users. A woman’s breast cancer risk seems to return to that of the general population within 5 years of stopping treatment.
Bioidentical hormone therapy: The word bioidentical is sometimes used to describe versions of estrogen and progesterone with the same chemical structure as those found naturally in people. The use of these hormones has been marketed as a safe way to treat the symptoms of menopause. It’s important to realize that because there aren’t many studies comparing “bioidentical” or “natural” hormones to synthetic versions of hormones, there’s no proof that they’re safer or more effective. More studies are needed to know for sure;. The use of these bioidentical hormones should be thought to have the same health risks as any other type of hormone therapy.
Estrogen therapy (ET): The use of estrogen alone after menopause does not seem to increase the risk of breast cancer much, if at all. But when used long term (for more than 10 years), ET has been found to increase the risk of ovarian and breast cancer in some studies.
At this time there are few strong reasons to use post-menopausal hormone therapy (either combined HT or ET), other than possibly for the short-term relief of menopausal symptoms. Along with the increased risk of breast cancer, combined HT also appears to increase the risk of heart disease, blood clots, and strokes. It does lower the risk of colorectal cancer and osteoporosis, but this must be weighed against the possible harms, especially since there are other ways to prevent and treat osteoporosis and screening can sometimes prevent colon cancer. ET does not seem to increase breast cancer risk, but it does increase the risk of stroke.
The decision to use HT should be made by a woman and her doctor after weighing the possible risks and benefits (including the severity of her menopausal symptoms), and considering her other risk factors for heart disease, breast cancer, and osteoporosis. If they decide she should try HT for symptoms of menopause, it’s usually best to use it at the lowest dose that works for her and for as short a time as possible.
Some studies suggest that breastfeeding may slightly lower breast cancer risk, especially if it’s continued for 1½ to 2 years. But this has been hard to study, especially in countries like the United States, where breastfeeding for this long is uncommon.
The explanation for this possible effect may be that breastfeeding reduces a woman’s total number of lifetime menstrual cycles (the same as starting menstrual periods at a later age or going through early menopause).
Last Medical Review: June 1, 2016 Last Revised: August 18, 2016
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