Let's get moving? Where? How?

So the data seems clear, doesn't it?  Women who exercise can expect a 20-30% reduction in the number of breast cancers.  There is evidence for other beneficial effects on: blood pressure, cholesterol, diabetes, stroke, depression, colon cancer, bone density, balance and cognitive decline, to name a few.  But one of the more positive impacts of physical activity was found in a report from www.nurseshealthstudy.org published in the Archives of Internal Medicine Jan 2010 among the five articles in that issue regarding the benefits of exercise.  Women with higher levels of activity were more likely to be "successful" survivors past 70 years.  They define "successful" survival as no chronic diseases, and no major physical, mental or cognitive dysfunction.  Wow!  If you haven't exercised yet today, kinda makes you want to right now!

Where?  How?  Those who have exercise buddies or trainers or a regular plan, know.  But for those who are convinced now to start there are guidelines.  There are websites, such as www.health.gov/paguidelines.com or www.smallstep.com for help or you can ask your doctor or come to see me.  Begin by increasing your level of activity.  If you get no activity or have a balance problem, then walk in place holding on to a chair.  If you get little activity then begin by walking 5 minutes once a day (every day), then twice a day after a few days, then more often or longer.  Even if it takes a month or two, work up to 15 minutes, then increase the pace to where you notice it is not quite as easy to talk while you walk.  After a while you can add another activity or be more vigorous.  You will feel so much better!  Try it!

For those weekend warriors who exercise only once or twice a week: regular is better with fewer orthopedic injuries and cardiac events (JAMA.2006;295:1399-1403).  If you play tennis Saturday, then walk Tuesday and Thursday.

For those who run regularly and worry about your knees "wearing out", they won't.  A recent systematic review in Medicine and Science in Sports & Exercise 2011; 43:432-442 was reassuring.  There was no increase in joint space narrowing, but rather healthier cartilage, with more volume and decrease in knee cartilage defects seen by MRI.  

So enjoy the weekend with physical activity a part of each day.   

The Plan for Prevention

So, did I convince you to get out and walk or go the gym today?  I did!  And I feel great! 

Let the numbers sink in and think of the opportunity.  

75,000 women prevented from developing breast cancer each year in the US!

In this blog we will consider many steps, and they are not all easy, that one can take to reduce the risk of breast cancer development.  We will consider exercise further, giving a plan to those who want to start, encouragement to those just beginning and reassurance of long-term benefits to those already working-out regularly.  We will consider other major topics that can be modified in the favor of preventing breast cancer from what to and what not to eat, how much to eat, to supplements and prescription drugs.  We will consider, for example: apples, other fruits, soy, aspirin, omega3, vegetables, red meat, alcohol, and other factors that one can change.  

This will be, as you have seen evidence-based.  Sometimes both pros and cons will be presented.  Sometimes controversies will be examined and even a contrarian opinion may be given, or a reaction to a news item. 

My goal is to help women avoid breast cancer.  I hope to show you how.  Please join me and ask your friends to follow along, too.

Now let's look at the breast cancer numbers.

Unfortunately, breast cancer is all too common.  Let's review the numbers.  Of all non-skin invasive cancers, 26% are breast cancers.  To personalize the numbers, we can look at the statistics another way.  1 in 8 women will get breast cancer in a lifetime.  That means 12.5% of women will ever be diagnosed with breast cancer.  Again, that is lifetime risk.  To personalize even more, we can look at risk by decade.  The chance of a 50 year old women developing breast cancer in the next ten years is 1 in 40 or a 2.5% risk in her 50's.  The risk increases with age to achieve the lifetime risk quoted so often of 1 in 8.  This data available online www.seer.cancer.gov.

Those risks given above translate into almost 210,000 women newly diagnosed with breast cancer in 2010 in the US.  70% are over 50 years old and 70% have no family history of breast cancer.  The median age at diagnosis is 61 years.  

If we look at the incidence in the last 25 years something interesting is uncovered.  The number of new cases in the US rose to a peak in 1999 and then began to slowly drop until 2006-2007.  Latest data (Cancer Epidemiol Biomarkers Prev published online Feb 28, 2011) show that the decline in incidence rates have leveled off.  The reasons that the breast cancer rates fell for a few years and now are no longer falling are not clear and will be the subject of many other blogs, but you get the idea of the magnitude of the problem.

Fortunately, we have made some advances in early diagnosis and treatment of breast cancer so that the number of women dying from the disease has been slowly and steadily decreasing since the early 1990's.  Treatments are more effective.  Although some think early detection is another key to this decline, we now have the opportunity to reduce the numbers of women who ever get breast cancer.  Exercise is one way to reduce the risk (yesterday's blog and many more to come) and we will see that there are others.  The American Institute of Cancer Research (www.aicr.org) estimates that 75,000 breast cancers a year can be prevented!

Let's get moving!

Good afternoon to all.   As promised, I am now blogging about breast cancer prevention.  We have made great strides against breast cancer, from treatment to early detection; but another opportunity avails us, that of prevention.  We will discuss the many steps that can be taken to reduce the numbers of breast cancers by beginning with physical activity and exercise.

There have been numerous studies reported that show a negative correlation between exercise and breast cancer development, which means: more movement equals fewer breast cancers.  Let's examine just three.  An extensive review of the literature in 2008 (Br J Sports Med 2008;42:636-647) found evidence for risk of breast cancer reduction with increased physical activity in the majority of studies, with an average reduction of 25-30%.  Stronger reductions were noted for lifetime or later in life activity.  Never too late to start moving!  The second review comes form the Nurses' Health Study (Arch Intern Med 2010:170:1758-1764 or online www.channing.harvard.edu/nhs/) which reports on 95,396 women in 20 years of follow-up.  During this period, there were 4782 breast cancers.  Women who were the most active (>1 hour per day walking) or those who increased activity at menopause were at the lowest risk.  Likewise, the Women's Health Initiative Cohort (JAMA 2003;290:1331-1336) demonstrated fewer breast cancers with increasing exercise among 74,171 postmenopausal women followed 5 years.  10 hours or more per week of "brisk walking" led to the lowest breast cancer rate.

We know that 75% of breast cancers occur in postmenopausal women, so how does exercise reduce the number of breast cancers in these women.  The answer is not entirely clear, but research suggests an effect on decreasing endogenous estrogen, decreasing inflammatory factors that may lead to breast cancer, increasing immunity (two other studies show fewer colds and flu-like illnesses in exercisers) or all of the above.

So the best you can do: get moving!  The worst thing: don't move!  An American Cancer Society study (Am J Epidemiol July 2010 online) compared people who spent at least 6 hours a day of their leisure time sitting to those who sat less than 3 hours a day.  The data from 69,776 US women 50-74 years old was astounding!  The increase in the death rate for the least active women was 94% or almost double!  So, LET'S GET MOVING!!