Mindfulness Apps I Love: “The Breathing App”

In my last post, I mentioned yogi Eddie Stern’s breathing app. If there were ever an app that exemplified the beautiful simplicity of mindfulness, this is is!

There are several things that make this mobile app perfect: (1) it does one thing and does it well, (2) it is uncomplicated, and (3) it’s absolutely free, with no in-app purchases.

This app is designed to help guide you in breathing. It is based on the concept of resonance frequency breathing, which is deep, slow, diaphragmatic breathing, between about 4-7 breaths a minute, depending on the individual — true resonance is considered to be six breaths a minute. Resonance breathing, “where oscillations in heart rate (HR) and breathing synchronize” (Pagaduan et al., 2019), has been shown to improve heart rate variability (HRV), which is “a key marker of health, mood, and adaptation” (Steffen et al., 2017). You may be familiar with HRV if you’re in training for a sport.

Set the timer, choose your breath intervals…

As Eddie Stern describes in his app and on his website, “by breathing at resonance, we enter into an even balance between the two branches of our autonomic nervous system, the sympathetic…and the parasympathetic…” The sympathetic is known as “fight-or-flight” and parasympathetic as “rest-and-digest”, and in our everyday lives, we tend to spend too much time with the sympathetic nervous system in charge.

…and inhale.

The Breathing App helps us balance out the two systems via resonance breathing. There are several elements to this app: (1) an informational page, with instructions on setting up and using the app, including info on the science and creators; (2) the breathing ball, which helps you visualize the breath; and (3) the sound breath guide, which provides a tone that guides your inhales and exhales.

You set the timer from 1 to 30 minutes, choose your inhale:exhale ratio (2:3 or 4:4 [for kids]; 4:6, 5:5, 6:6 [true resonance] or 5:7), and decide whether you’ll watch the ball or look at a starry sky, with or without the sound.

And that’s it.

There’s nothing to buy and practicing with it is simple. Of all the mindfulness/meditation apps that I use, this is one of my favorites and I use it to augment my yoga practice. Give it a try!

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Fun fact: some well-known names are credited as participating in the development of this app, including Deepak Chopra and musician Moby!

Online Classes: Yoga and Science – Putting It All Together

Please note: I’ve included links to various items below, none of which I’m compensated for. If I’m writing about them, it’s because I think they’re excellent and worth recommending to others.

In my never-ending quest to bring more peace into my life, and with the extra time I’ve found in COVID-19 lockdown, I’ve been taking advantage of online class on platforms such as edX and Coursera, and have been impressed with the breadth of courses that are available.

Currently, I’m mid-way through a class on Coursera from New York University (NYU) connecting yoga and science, called “Engineering Health: An Introduction to Yoga and Physiology,” and I am thoroughly enjoying it. This class can be audited for free, or $49 gets you access to the quizzes, a certificate once you’re done (that can be posted on LinkedIn) and no time limit on access to the materials.

The course is taught mainly by three individuals: (1) Prof. Alexandra (Ali) Seidenstein, lecturer and research scientist in the Chemical and Biomolecular Engineering Department at NYU, who is also a yoga teacher; (2) Eddie Stern, NYC-area yoga teacher and author, co-founder of the international Yoga and Science Conference and creator (along with Deepak Chopra, Sergey Varichev and musician Moby) of the highly-rated Breathing App for mobile devices; and (3) Prof. Tommy Lee, senior lecturer in the Chemical and Biomolecular Engineering Department at NYU. In addition, there are interviews with other scientists who have studied or made use of yoga in their research. For me, as someone who’s always looking for scientific validation, this combination of yoga and physiology is very gratifying.

First and foremost, the class teaches basic physiology. If you took survey classes in high school and college, the material will be familiar, and it’s presented in a clear manner with lots of visuals. Topics include physiological systems such as nervous, respiratory, cardiovascular, immune, digestive and much more. Additionally, there are discussions of homeostasis, epigenetics, and the effect of stress on human physiology.

As a cancer survivor, I find it so empowering to see the science behind how yoga affects my physiology, especially strengthening my immune system!

But woven in between all of these topics are instructions on breathwork and yoga movements for beginners, and this is what really ties the course together for me. The yoga is expertly taught by Eddie and Ali, both of whom make the experience very positive and not intimidating. With each lesson, they take the time to connect the physiology topics with what is being taught in the yoga class. This is a novel approach that I have found very empowering: there is a direct link between the work being done in the yoga lessons with functioning of the body.

For me, making that connection leads to a sense of self-efficacy and patience with myself, as it is with consistency of practice that we make change. Even more than that is the feeling that I can affect my immunity against disease (and cancer?) by keeping my stress levels in check. I have always felt that stress played a role in the development of my cancer, and although I cannot prove this, knowing that there is good science behind using such relaxation techniques as yoga and meditation in prevention of inflammation and subsequent disease gives me a sense of control in a situation that has often felt completely outside my control.

As mentioned, I am only at the midpoint of this class. I look forward to the second half and will report back about my overall impression once I am finished. In the meantime, if this post has piqued your interest, I highly encourage you to check the class out!

When You’re The “Default”, You Don’t See The Problem

While it might not seem like a cancer/meditation/mindfulness blog is the place to bring up the issue of racial disparities, I feel this is exactly the right place for it. Because we should all be talking about this in every situation.

I am white. I grew up with people on television who looked just like me. I had dolls that looked just like me. Companies marketed their products to people who looked like me, using advertisements with actors who looked like me. Even the crayon color called “flesh” looked like my skin, and I didn’t question it. I had school friends who were black, but I didn’t understand their experience. So I really understood nothing. As a child, I didn’t see the problem.

But the problem is massive and we haven’t made much progress since the days of the 20th Century civil rights movement. The main thing that’s changed is that we now have video phones so we’re bearing witness to events that have been going on all along, but unseen by the white community.

You cannot turn 400 years of oppression around with non-discrimination laws, congratulate yourself and proclaim everyone “equal” (read: shouldn’t be complaining), because the inequality has been in our system for so long that it’s what the country runs on. It lubricates the gears of society. And there are people in power who like it that way.

This needs to change and it needs to change now.

If you don’t think that being white infers an automatic privilege, try being a black teen in a hoodie, walking through an affluent white neighborhood.

We Need Mindfulness Now More Than Ever

If there were ever a time to open yourself up to being more mindful, it’s in the midst of a global pandemic. We are in foreign territory, in an unsettled state where we’ve lost our footing. Mindfulness can help us find a path through this.

Stay Healthy

Being mindful is critical now that we’ve got to remain more aware of how we move through space.

Stop. Where are your hands now?

There are things that we do automatically. Consider how often you touch your face. Don’t do that! It’s important to notice where your hands are. Are you wearing a face mask? Don’t touch the front of it. When you inhale, you’re creating suction around the mouth and nose, and if you’ve come into contact with viruses, it is more likely that the cloth covering those areas will be contaminated. Remove the mask only using the ties on the back of your head or elastics around your ears.

Going to the store? Be aware of which hand you’re using to do what, even if you’re wearing gloves. Touching door knobs or packages with one hand? Use the other to get your wallet out of your pocket or purse.

What hand are you holding your phone with? Which finger are you touching the screen with? The COVID-19 situation necessitates a focus on what you’re doing. Take a deep breath…and then disinfect everything when you get home.

Lessen Anxiety

Living mindfully, in the present, helps us let go of fears surrounding what may happen, and in the midst of unprecedented uncertainty when , most of us have those thoughts. But you don’t have to let them take you over.

Stay grounded in the moment. No one knows exactly what the future will bring, but the possibilities can be scary. Right now, however, you are safe. Feel what part of your body is in contact with the seat or floor. Come down from the frightening thoughts and listen to your breaths. Those imaginings of the future are not happening now. At this moment you are standing or sitting, breathing. Feel into your hands and feet. Can you feel the blood pulsing through them? Feel yourself being supported by the earth. Breathe.

You can meditate without twisting yourself into a pretzel.

If you don’t yet meditate, this is a chance to start, and it’s a habit that will benefit you for years to come. The good news is that you don’t have to get it “right” the first time. In fact, there is no “right”. There is just consistent practice.

What does meditation look like for you? It doesn’t have to be sitting in lotus position and chanting mantras. There are other ways to meditate. Stay in the moment. Keep your attention on your breath, noticing the quality of the inhales and exhales. When your mind wanders, as soon as you notice your loss of focus, bring yourself back to the breath. Resist jumping down rabbit holes of tempting thoughts. Just stay with your breath. That’s all.

If you need to bring yourself down to a more peaceful state, you can try a more structured breathing technique, such as the 4-7-8 “relaxing breath” espoused by Dr. Andrew Weil: inhale for 4 counts, hold for 7, exhale for 8. It is more important to maintain that ratio rather than to have a count last for a specific amount of time. Do several cycles of this, then return to natural breaths.

Does this feel too forced for you? Your meditation might be listening to a complex piece of music — truly listening to how the instruments blend together, gliding through the different layers of sound — and feeling into the sensations that it invokes in your body.

Perhaps it’s looking at nature through a window, holding a cup of warm tea, immersing yourself in the subtleties and complexities of the world.

Or constructing a jigsaw puzzle, diligently looking for pieces to match a color or pattern. Focusing on the satisfying click when they snap into place. Apparently, this is a stress reducer for many, many people, given how quickly puzzles disappeared from Amazon!

Find your own meditation. Let go of what you think it “should” be and focus on what works for you. There will not be a quiz.

Calm Stress Eating

For those prone to emotional or stress eating, a stay-at-home order can result in weight gain. This is the time to practice awareness of what goes in your mouth. Do you respect yourself with nutritious food or treat your body carelessly? Are you truly hungry or do you eat out of habit or boredom? Are mealtimes a mechanical process for you?

Slow down and savor your food.

Allow yourself the opportunity to halt other distractions and focus on what you’re eating. In a busy household, this can be difficult, but as with all mindful things, there is no “perfection”. There is simply practice: doing, and doing again.

Look at your food. Savor the aromas. Listen to yourself chew. Taste the flavors. Feel the textures. Close your eyes. Slow everything down. See if you can sense when your hunger has subsided, instead of stopping simply when you’ve eaten everything on your plate.

Create a Calming Space

Now that we’re sheltering in place, it’s not as easy to overlook cluttered spaces. Living in the midst of disorder can be very stressful, but trying to balance remote work and childcare, or beating back concerns about no longer having a job, while trying to maintain a cleaning routine is also anxiety-provoking. There is nothing normal about the situation we are in, so allow yourself the latitude to prioritize.

Mindfulness takes the drudgery out of cleaning. Stop and look. Breathe. Decide what you can take on and then go for it. Focus on one spot and stay present as you work on it. Set a timer for ten or fifteen or thirty minutes and see what you can get done within that time. I guarantee you that you will find yourself in a better place than if you hadn’t done anything at all.

Ha! I WISH my kitchen were this big. But even a small kitchen, clean and organized, can feel spacious.

This is not a punishment. It’s an opportunity to create a positive environment in which to ride out the pandemic. I spent Easter Sunday bleaching my kitchen, which seems so antithetical to what we expect to do on a holiday. But for me it was a gift, being present and scrubbing counters and appliances bit by bit, no expectations. Yes, there are still many loose papers on the dining room table, but when I enter the kitchen, I breathe a sigh.

I could say, “it’s not enough,” but you know what? It is more than enough. It’s a semblance of order in a situation that felt out of control, just as the COVID-19 situation is out of our control. We all need some grounding, and I promise you, a clean, uncluttered room lowers stress levels. When I went into the kitchen to get coffee this morning, I thought I was in heaven.

This sense of calm is still with me, even as my son has decided to bake cookies…

What a good time to take some relaxing breaths.

Don’t Call It “Social Distancing”

By now, I’m hopeful that we all understand the importance of putting physical space between ourselves and those outside of our household in order to avoid transmission of the coronavirus. According to the BBC and its broom trick, you should be able to hold out a broom and not be able to twack another person with it. That means about six feet of distance, as everyone’s been repeating.

But socially distancing ourselves in this time of uncertainty is the last thing we need. In fact, we need to be reaching out to others, trying to bridge the social isolation gap.

It should be easy enough to strengthen our social ties with all the technology that we have available, like Zoom meetings and FaceTime sessions. But all those require at least a little planning, especially when we’re living in comfy clothes, forgoing haircuts and not necessarily getting made up to go out. What we’re missing are all those little interactions that we have in our daily lives: impromptu water cooler conversations, brief chats with a cashier, a quick joke with the server who brings your lunch. There are many ways that we touch each other’s lives than we’re likely conscious of, and those have abruptly stopped.

So if you’re feeling a strange emptiness in your life, there’s a good reason for it.

Got the toilet paper, got the gas mask…but missing the human contact.

And this social isolation is significant. Research has shown that in times of stress, social support is particularly helpful in coping and resilience (for example: Ozdemir & Taz Arslan, 2018; Ozbay et al., 2007), and individuals who are socially isolated have negative health consequences (again, an example: Cacioppo & Hawkley, 2003).

Now, consider that people are being isolated at a time when many are losing their jobs, worrying about being able to pay their bills, fearing for their health and wondering when all of this is going end. The financial and health concerns are immediate and frightening, but it’s the unknown extent of the damage that continues to keep people up at night.

This is the time when we should be reaching out to our friends and family members, checking in with loved ones and re-establishing our social connections. While “we’re all in this together” might seem like a hackneyed slogan, it is a perfect description of this new reality. As distant as we might feel, particularly those who are forced to shelter-in-place alone, we are experiencing a global pandemic. Never in my own life have I been able to share in such collective concerns, ones that are literally reverberating throughout this entire planet.

This should be something that ties us together. So as you do your best to be safe and keep your distance for the sake of health, please don’t forget to bridge the social and emotional distance that this unique situation has bought upon us.

Emergency Preparedness, Inside-Out

We have spent the last couple of weeks in various hunting-gathering trips in preparation for a possible coronavirus lockdown. Yes, we got enough toilet paper, but not multiple mega packs, as there is no place to store them. We bought a little extra frozen food, but space is limited in the freezer, just as it is in the fridge.

When in doubt, bidet!

Being a mainly vegetarian family, we consume a lot of fresh fruits and vegetables, and those have to be procured on a frequent basis. Hoarding is not a real possibility at our place: we have no garage, basement or pantry. And I don’t consider a 30-roll pack of TP to be proper living room furniture.

Luckily, we have ample soap and I have the large bottle of hand sanitizer that I kept at work when I was going through chemo (think: it’s been a few years). Also thanks to cancer: a generously-sized box of surgical face masks that we will be dipping into, should one of us start feeling ill.

Finally, in a “clouds parted and a ray of light shone down”-type of serendipitous luck, we found a bag of N95 respirators in the back of our coat closet. Usually one finds old tennis rackets or worn shoes. We find items that someone might strangle us for.

One of my brothers had stocked up on the respirators during the devastating fires in Northern California, only to unload them on us during a visit here. I always complain when he leaves stuff at our place, but I’m feeling much more accepting of it now. My kids are planning to sell them to finance their college educations. (kidding!)

So we’ve prepped as much as we can, for the amount of space that we have. And while it’s not a lot, I believe it’s enough for several weeks.

But where I’m engaging in some serious “hoarding” is greedily protecting my daily meditation time. If there were ever a time to practice mindfulness, it’s now.

This is not the end.

Consider this: during a trip to Costco a week ago, people were going nuts with toilet paper, as if it were a finite commodity and if we didn’t get it now, we’d be wiping our butts with tree leaves and old homework assignments for the rest of our lives.

It’s easy to laugh, but I myself felt a sudden bolt of urgency watching people squeeze nine months’ worth of toilet paper into their cars. It was difficult to resist.

Many people were operating as if with blinders on. At that same Costco, the check-out line for one cashier stretched all the way back to the bakery section. If you’re familiar with these enormous warehouse stores, you know that baked goods are way in the back. That is a crazy-long line!

What those shoppers didn’t realize was that the lines for the other cashiers were only one or two people long. But few people looked through the aisles enough to realize that. They simply saw a line and got in it, assuming that everyone else knew what they were doing.

Clearly, they didn’t

This is a perfect example of the need to slow down, take a deep breath and spend the time to understand what’s going on. In the face of unprecedented events, panic seems like a decent option. But just doing something–ANYTHING–isn’t the same as doing something useful.

Relax. You’ll use less toilet paper that way.

Look, I get it. This is scary. As a cancer survivor, my white blood cell count remains depressed, and although my oncologist doesn’t think I’m in danger of dying from COVID-19, that doesn’t mean I can’t contract it. If I did, maybe it would tax my system more and send me to the hospital. There are so many uncertainties that I have to live with. The best thing I can do is to be mindful of what’s going on, accepting of what I can’t change, and rational about the rest.

So my wish for all of us going through surreal times for which we have no operating instructions is to listen to reputable sources, drop the conspiracy theories, pause and think. Don’t rush simply because everyone else is. Breathe. When this pandemic has subsided, there will be more toilet paper. I promise.

Who Knew a Grapefruit Could Create So Much Confusion?

A few days ago, I decided to eat a grapefruit. We had gone to a Korean market earlier that day, and the citrus fruits beckoned to me with an enticing fragrance. I couldn’t resist.

So as I was finishing up one of the most delicious grapefruits that I’d had in a long time, I started thinking. Back when I was taking tamoxifen, I’d come across an admonishment not to eat grapefruit because it could interfere with absorption of the medication. But I wasn’t taking tamoxifen anymore, I was taking letrozole. Could the same be true?

I started googling, first on my phone. And as the search results came in, I had to switch to my computer because things were looking confusing. Many sites said “NO” in no uncertain terms. Grapefruit can prevent the letrozole from breaking down in the body completely, leading to higher levels remaining than could be safe.

It wasn’t that the grapefruit was hindering the efficacy of the letrozole, it was that grapefruit could set up a dangerous situation of “overdose”.

Of course, googling often results in messages that are big on warnings and short on details. So I dug further and happened upon forum posts where other women were asking the same questions.

I read the following exchange: one woman said she’d spoken to two different hospital pharmacists, both of whom had given her the okay to eat grapefruit. A number of other women (like, everyone else) chimed in on how they had unequivocably been warned to stay away from grapefruit (for the above mentioned reasons). The first woman reiterated that she had been told by HOSPITAL PHARMACISTS that she could each grapefruit with impunity…and so it went.

Do I LOOK like I know what I’m doing?

What really bothers me about this is that so many websites suggest that, it really it best to avoid grapefruit due to possible interactions with letrozole. But I slogged through the entire bloody informational insert from the manufacturer of my drug and NOWHERE did it mention that I shouldn’t eat grapefruit. There was also nothing on the bottle itself, nor did my oncologist say anything about that.

However, WebMD’s grapefruit interactions webpage, while not mentioning letrozole by name, did suggest issues with estrogen and also Cytochrome P450 substrates (of which letrozole is one, but I just happen to know that; others wouldn’t necessarily). WebMD’s letrozole info pages made no mention an issue with grapefruit. I mention WebMD mainly because many people consider it a reputable site and may go there for information.

If it truly is that dangerous to eat grapefruit while taking letrozole, why is that not explicitly stated on the container? Why would any woman think to google a random fruit or vegetable, like, “I think I’ll eat an artichoke and shiitake mushrooms today, but first I’ll do an internet search to make sure they don’t affect my medication.” Who plans their meals like that?

The bottom line is, the effect the grapefruit has depends on a variety of factors. It depends on when you’re eating and how much you’re eating, and how many days in a row. But all of that is so unsatisfying to me, who wants a concrete answer. Cancer is not about answers, however, it’s about getting comfortable with living with the unknown.

So, back to the grapefruit. Spooked, I skipped the medication that evening, although I’m sure I could have taken it and still lived through the night. I’ll ask my oncologist about it during my next visit, but I expect that his answer will be, “just don’t overdo it.”

And there’s another fragrant grapefruit sitting on the counter, which I will eat at sometime in the future, maybe half at a time. Here’s to living with uncertainty!

A New View of Stress That Can Save Your Life

I’ll be the first to admit that I have a history of not handling stress well.

A recent PubMed search on the connection between stress and proliferation of cancer didn’t help, as I found sufficient evidence to show that the two may be closely linked, and that is a disconcerting thought for a cancer survivor. Finding ways to relieve everyday stress has become one of my highest priorities. But would I be better served by focusing on stress as a positive force?

In her 2013 TED Talk, health psychologist Kelly McGonigal offers a new view of stress, not as a horrible experience, but instead as a state that primes your body for better dealing with hardships.

This is a novel and intelligent way of looking at something that, unfettered, could otherwise harm us. Why not turn it into a positive instead?

McGonigal points out that our attitude towards stress is critically important. A study from the University of Wisconsin (Keller et al., 2012, Health Psychol) demonstrated that people who experienced high levels of stress and were convinced that stress was harmful to their health were 43% (!) more likely to die during the eight-year study period. Note, these are correlational (not causational) findings, although it was striking how that belief predicted an earlier demise.

McGonigal describes research at Harvard (Jamieson et al., 2012, J Exp Psychol Gen) to discover whether changing someone’s attitude about stress can change their response to it. The study was designed to invoke anxiety in the subjects via a “social stress test”. But one group of participants was primed with information about how sensations associated with anxiety were actually beneficial for their performance: pounding heart = preparing the body for action; breathing faster = getting more oxygen to the brain for clearer thought.

Test subjects taught to reappraise their responses reacted differently to the stressors than might have been predicted. They felt energized, more confident and ready for the challenge. But what was even more surprising was that their physiological response was more positive, because they didn’t experience the tightening of blood vessels commonly associated with chronic stress and thereby with cardiovascular disease. Rather, the blood vessels stayed relaxed, as happens during periods of “joy and courage.”

What if effectively dealing with stress is as simple as changing the way you view it?

This is a much healthier physiological reaction. As McGonigal puts it, “How you think about stress matters.” It may make the difference between a long life and an early death.

McGonigal goes on to describe another positive benefit of a healthy stress response: the release of oxytocin, the “cuddle hormone”, which results in people seeking out social support during times of stress. Says McGonigal, “Your biological stress response is nudging you to tell someone how to you feel, instead of bottling it up.” In addition, this results in an increase of empathy so that you are more likely to help someone else who’s experiencing stress.

Further, oxytocin acts as an anti-inflammatory and protects the heart from potential negative effects of stress.

But most telling is a study (Poulin et al., 2013, Am J Public Health) that examined the connection between high levels of stress, risk of dying and amount of time that people spent supporting those around them. As might be expected given the above information,”people who spent time caring for others showed absolutely no stress-related increase in dying. …Caring created resilience.”

For me, McGonigal’s talk stood my belief about stress on its head. Can I learn to view the stress response differently? Yes, I believe I can. And what about social support? That is the path my life is taking: finding a more meaningful existence though supporting others.

This is a “win-win” of the highest degree.

“Don’t Drink the Water and Don’t Breathe the Air”: A List of Breast Cancer Risk Factors

After some intense research on the risk of developing breast cancer, I’ve come to the conclusion that the factor with the greatest causal relationship to the disease is, quite frankly, life. In fact, I sometimes wonder how people manage to NOT get cancer.

For your reading pleasure, I surveyed a number of reputable sites to compile a list of commonly accepted breast cancer risk factors (links to the info): American Cancer Society, Mayo Clinic, Memorial Sloan Kettering Cancer Center, Dana Farber Cancer Institute, Centers for Disease Control, National Breast Cancer Foundation, World Cancer Research Fund and WebMD. There are some emerging risks that most sites didn’t list and although I have seen the research studies in support of those factors, I opted to exclude specifics for now. Perhaps that’s for a future post.

Here you go, not in exact order of importance:

  1. Being born female (well that covers about 50% of us)
  2. Getting older (um, inevitable…)
  3. Drinking alcohol (even moderate drinking has been shown to be harmful – find a different hobby)
  4. BRCA1 and BRCA2 gene mutations, which everyone talks about, but certain mutations in the following may also increase cancer risk, although to a lesser extent: ATM, TP53, CHEK2, PTEN, CDH1, STK11, PALB2
  5. Personal history of breast cancer (get it once and you’re a moving target)
  6. Family history of breast cancer (including both close and distant relatives)
  7. Personal history of breast lesions (even stuff that seemed benign-ish)
  8. Radiation exposure, specifically to the face and chest, before the age of 30
  9. Obesity (but mainly for postmenopausal women, see here; it’s complicated)
  10. Having dense breasts (sometimes this is considered a top risk factor)
  11. Beginning your period before age 12
  12. Going through menopause after age 55
  13. Having your first child after age 30
  14. Never having kids (remember that when you’re paying for their college)
  15. Taking hormone replacement therapy (HRT)
  16. Certain hormonal birth control methods
  17. Family history of ovarian cancer, especially before age 50.
  18. Being white (at least in the U.S., although the rates of African-American women are catching up, often with a worse prognosis)
  19. Having received diethylstilbestrol (DES) to prevent miscarriage, given either to you or your mother
  20. Being inactive (honestly, exercise is critical – don’t overthink it – MOVE!)
  21. Not breastfeeding (not only does nursing lower your risk, if you do get breast cancer, you’re less likely to get the aggressive triple-negative type)
  22. Being taller (this may have to do with faster growth at an early age)
  23. Doing night shift work (this may affect your hormone patterns, not to mention make you cranky during the day)
  24. Smoking (the evidence for this has been deemed “suggestive, but not sufficient”, but inhaling smoke sounds like a bad idea regardless)
  25. Exposure to cancer-causing chemicals (that’s, like, just about everything out there, and the connection remains unclear)
  26. Diet choices (this is unclear, although there have been some links drawn to both macronutrient proportions and some vitamins, but more research must be done)
Oh, for the day when we can be guaranteed that what we’re doing is helping (or hurting) us!

In a word, we really don’t know, but living a healthy lifestyle gives you the best chance for survival.

Finally, the things that seem to have no reasonable link (per WebMD and echoed on other sites):

  1. Antiperspirant (no need to stink)
  2. Bras, underwire and regular (feel free to support yourself)
  3. Abortion or miscarriage
  4. Fibrocystic breast changes
  5. Multiple pregnancies
  6. Coffee/caffeine (raise your mug in celebration!)
  7. Hair dye (unless it’s really radioactive, but come on, that would be silly)

Judging from the above info, it can feel like cancer is waiting around the corner to pounce on the next unsuspecting victim that wanders by. I thought I had ZERO risk factors, but I can easily pick out several there. At the same time, I know people who seem like they’d have a gazillion risk factors and they never get zapped. So.not.fair. But that’s cancer for you.

And the more we find out about the disease, the more we see how complex it is. We are all different, reflected by our DNA, so it’s not out of the question that we might be affected in unique ways by these risk factors. Research is uncovering new connections all the time, and it may be that in order to find a cure for cancer, we’re going to have to look at the disease in ways that we never have.

Pre- vs. Postmenopausal Breast Cancer Risk: There’s a Difference, But Does It Matter?

You’ve probably seen those plastic breast self-exam cards you hang on your showerhead as a reminder to feel for lumps on a monthly basis. I have one myself, and would read it over and over when I was trying to decide whether my lump was worrisome, reviewing the “reduce your risk” tips the card offered.

However, there are two points that I wasn’t aware of at the time that I was diagnosed: (1) we know little about causal factors, as most studies that examine risk are only correlational; and (2) there’s a difference between being premenopausal vs. postmenopausal when talking about breast cancer.

Okay, there’s a third one too: (3) risk factors don’t mean squat when I’m talking about my personal diagnosis.

First, a well-known fact: postmenopausal women make up the majority (approximately 2/3) of these cancer cases, so it’s not surprising that the focus is on them.

I, however, was premenopausal when I felt the lump in my left breast.

Imagine my surprise, then, when I learned that while being overweight or obese is a significant risk factor for postmenopausal women, being overweight as a premenopausal woman seems to offer protection against the disease. Whereas I thought I didn’t have any risk factors for breast cancer, as suggested by that plastic card in my shower, perhaps I did.

There’s not much talk about that protective element of weight for premenopausal women. You would be hard-pressed to find a popular website that mentions it. And no doctor would encourage a premenopausal woman to carry extra weight on the off chance that it might lower her risk of breast cancer; it’s too much of a liability for other health issues, including other cancers.

This explains why, if you’ve gone to a gathering of newly-diagnosed breast cancer patients, you’ll see some younger, remarkably fit women looking a little dazed and wondering what they’re doing there.

The weight risk factor is often posed in the following way (from the Mayo Clinic site): “Overweight and obese women have a higher risk of being diagnosed with breast cancer compared to women who maintain a healthy weight, especially after menopause.” Well, that’s not wrong, but it doesn’t tell the entire story.

Harvard Health Online puts it differently, with a caveat: “Being overweight or obese has been linked to breast cancer risk, especially for women after menopause, but the relationship is complicated. It may be that risk is increased in women who gain weight in adulthood but not in those who’ve been overweight since childhood.” That seems even more confusing and less reassuring.

It’s true that everything about cancer is complicated. If it were straightforward, we would have found a cure by now. Furthermore, when it comes to guidelines to follow, people don’t want details, they want sound bites. But simplification cuts out information. For example, this CDC webpage about what you can do to lower your breast cancer risk posts recommendations geared for older women, including maintaining a “healthy weight”, but the photo that’s shown is clearly of two younger women.

Even a cursory glance at the research reveals what a difference menopausal status makes. In addition to extra weight seeming to have a protective effect in premenopausal women (Cold et al., 1998, Eur J Cancer; Lahmann et al., 2004, Int J Cancer), it’s also been determined that greater red meat consumption in adolescence is significantly associated with increased risk of breast cancer in premenopausal women (Farvid et al., 2015, Int J Cancer). Interestingly, higher quality diets have a more beneficial effect on the risk of postmenopausal women and seemingly no effect on premenopausal ones (Haridass et al., 2018, J Nutr). I would expect that a more exhaustive search would yield even greater differences.

Live as if your life depends on it.

So what does this tell us? This is less about the specific differences between pre- and postmenopausal breast cancer risk, and more that there simply is a difference. At this point in our knowledge, we are still putting together pieces of the cancer puzzle.

Additionally, many studies that offer preventative guidelines are based on other studies–they may be meta-analyses of previously collected data from a broad range of subjects. The data may be self-reported, which may result in recall error. And when you have a sample size of ~30,000 women, you’re talking about general risks for populations, not a specific risk for a specific, and very unique, individual: you.

All this sounds exasperating, but one concept holds true: no matter what your risks, the healthier you are before you’re diagnosed with cancer, the better your outcome compared to someone with less healthful habits, should you get the disease. Instead of obsessing about possible risk factors, give yourself the respect you deserve–put the effort into improving lifestyle habits to grant yourself the best chance for survival. In the end, that’s what matters.