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If there’s anything possibly more devastating than hearing that you have breast cancer, it’s finding out the disease has returned. The statistics on relapses vary according to the type of cancer you have. For instance, with ductal carcinoma in situ (DCIS), a form of noninvasive early-stage cancer that strikes around 20 percent of women, the odds could be as low as 1 to 2%. For women whose cancer was very aggressive the first time around, there’s a much higher risk of cancer returning—sometimes as high as 50%.
Overall though, the news about staying a breast cancer survivor is good. “More than 80% of women will never experience a recurrence of the disease,” says John Link, MD, medical director of oncology with Breastlink, a network of breast health centers in California and NYC, and author of The Breast Cancer Survival Manual.
Whatever your risk of breast cancer recurrence, it’s natural to want to do everything you can to lower it. Taking action to prevent a recurrence isn’t just a potential boon to your physical health though, says Ellen Warner, MD, co-author of a 2017 review that identified lifestyle changes that can reduce the risk of breast cancer recurrence and death.
“Making positive changes can also be psychologically beneficial because it empowers patients, and the feeling of loss of control is one of the biggest challenges of a cancer diagnosis,” she says. To regain some sense of being in charge of your health, protect yourself against the return of your breast cancer, and improve your overall wellbeing, consider adopting these healthy cancer-fighting habits.
Of all lifestyle factors, physical activity has the most robust effect on breast cancer outcomes—reducing breast cancer recurrence by a whopping 40%, Warner concluded in the review, which was published in the Canadian Medical Association Journal (CMAJ).
Even the self-described lifelong exercise “nut” was quite surprised by how strong a protective effective exercise had against breast cancer recurrence. “It’s similar to therapies like hormones and chemotherapy,” she says. Exercise seems to help keep breast cancer at bay in several ways: Besides making it easier to control your weight (see more on that below), exercise helps regulates hormone levels, improves insulin resistance, and reduces inflammation.
To reap these benefits, aim for 150 minutes of moderate to vigorous exercise (a goal only 10% to 13% of women with breast cancer attain) or 75 minutes of vigorous exercise a week, along with two to three weekly sessions of strength training.
How to get moving if you haven’t been active? Start slowly, Dana-Farber Cancer Institute oncologist Jennifer Ligibel, MD, suggested in this Q&A. “Make a plan to start with walking at a moderate pace for 10 to 15 minutes three times a week and gradually increase to every day, and then for longer periods of time.”
“Not only does obesity increase the risk of breast cancer, it also increases the risk of it coming back, specifically in women with hormone receptor-positive disease,” which is very common, says Elisa Port, MD, chief of breast surgery at Mount Sinai Hospital’s Dubin Breast Center and author of The New Generation Breast Cancer Book. Weight gain doesn’t have to be huge to have serious consequences: Research shows that gaining more than 10% of your body weight (that’s 15 pounds if you weigh 150 pounds) after a breast cancer diagnosis can increase death from breast cancer and any other cause.
Unfortunately, many women gain weight with breast cancer treatment—most add five to 10 pounds, but some may gain as much as 50. It’s not known whether losing weight after having breast cancer lowers the risk of recurrence (studies are ongoing), but it’s still encouraged.
“Overweight women will certain feel better physically and psychologically if they can lose even a moderate amount of weight,” says Dr. Warner. Need to drop a few pounds? “People are most successful when they start with an attainable goal,” says Ligibel, who notes that even losing 5-10% of your starting body weight has many benefits.
Women with breast cancer are often advised to *avoid* soy products, such as edamame, tofu, tempeh, and miso soup, because it’s theorized that the plant protein contains estrogens that can promote the disease or interfere with cancer treatment drugs like tamoxifen.
But according to Dr. Warner, there’s no evidence to support that recommendation—in fact, she says, soy products may be protective against breast cancer. For instance, in one analysis of five studies that included more than 11,000 women, researchers concluded that the intake of soy food was associated with reduced mortality and recurrence, especially for ER negative, ER+/PR+, and postmenopausal women.
Another Tufts University study published last year in the journal Cancer that examined more than 6,000 ethnically diverse women with breast cancer concluded that higher dietary intake of isoflavone, the major phytoestrogen in soy, was associated with a 21 percent decrease in death in some patients—implying that soy may not interfere with drug treatments. It didn’t take much soy to see these benefits: just 1.5 milligrams, or about one serving of soybeans a week. Read about other healthy reasons to eat soy here.
There is strong evidence that alcohol—even as little as a few drinks a week—increases the risk of getting breast cancer. But whether alcohol affects the risk of breast cancer recurrence is not as clear. One of the best studies to date, according to Dr. Link, is the Life After Cancer Epidemiology Study, which was published in 2010. While study results seemed to indicate that there was a higher risk of breast cancer recurrence in women who drank more than six ounces of alcohol a day, when results were more closely examined it was only postmenopausal obese women who were at greater risk, he reports. Premenopausal and postmenopausal women with a BMI less than 25 had no increase in breast cancer recurrence risk.
“I interpret this to mean that moderate alcohol consumption is not a major risk factor for cancer and it may not be a risk factor at all—and that the culprit may well be obesity,” says Dr. Link. Still, until more is known about the connection, the American Cancer Society advises that women who’ve had breast cancer limit their alcoholic intake to no more than one drink a day.
Research may not have yet discovered a direct link between breast cancer—or breast cancer recurrence—and cigarette smoking, but that shouldn’t deter you from quitting. Indeed, considering that recent evidence shows a strong association between a history of smoking and dying of breast cancer (they’re not called cancer sticks for nothing!), kicking the habit may just save your life. Need another reason to stop lighting up? Compared with women who continue to smoke after learning they had breast cancer, those who quit had a higher overall survival and possibly better breast cancer-specific survival. The CMAJ study also reported that breast cancer survivors who smoked were more likely to die and more likely to develop blood clots when taking tamoxifen, a drug commonly used to prevent breast cancer recurrence.
Reviewed by: Preeti Parikh, MD . Review date: April 25, 2018