Tag: Obesity

Breast Cancer: Do You Know Your Risks?

(Title image: Photo by Michael Shannon on Unsplash)

Since we’re creeping up on October, commonly known here as the very pink Breast Cancer Awareness Month, I thought it might be a good time to post the most common risk factors for breast cancer…and then explain the problem with focusing on them.

For reference, I used the risk factor list posted on the U.S. Centers for Disease Control and Prevention (CDC) website. The CDC’s list focuses on women, as they are the ones at greatest risk of developing breast cancer; a shocking 1 in 8 women (~12%) will develop breast cancer at some point in their lives.

But on to the list. The CDC divides breast cancer risk factors into two categories: risk factors that you cannot change and risk factors that you can change.

The ones that you cannot change are the following:

Age – The older you are, the greater the risk, with the majority of cases occuring in women aged 50 and above. Last I checked aging was still a thing, so we’re all heading in this direction.

Genes – BRCA1 and BRCA2 mutations put you at significantly greater risk for breast and ovarian cancer. This is one family heirloom that you’re better off not inheriting.

Age at first menstruation and menopause – Starting periods before age 12 and menopause after age 55 exposes you to higher levels of circulating female hormones for a longer time. The longer you steep in hormones, the more chance of developing the cancer. This is a little unfair, I think, because estrogen also helps maintain muscle mass, bone density and skin elasticity which are all good things, but that’s how it goes.

Breast density – The denser the breast tissue, the higher the risk. Denser tissue also potentially makes it more difficult to detect tumors. Dense breast tissue is less fatty and more fibrous and glandular…and more likely to occur in women with lower bodyfat, which is ironic considering it’s also better to leaner (see below).

Find out your family history of cancer and explore your genes.
(Photo by Antonino Visalli on Unsplash)

Personal and family histories of cancer and other breast diseases – Having had previous breast cancer yourself or in a close family member (including ovarian cancer) may raise your risk. This is a great reason to make health a family affair and encourage everyone around you to do what they can to reduce their risks.

Early exposure to radiation therapy – Having had radiation treatments to the chest prior to age 30 may raise your risk of developing a tumor later on. This is a double-whammy: survive one cancer (like lymphoma) by going through treatment…and get smacked with breast cancer.

Diethylstilbestrol (DES) – If you were given DES (to reduce chances of miscarriage; no longer prescribed) or your mother took this drug when pregnant with you, it may have increased your breast cancer risk. Again, proof that life isn’t fair.

The risk factors that you have some control over:

Physical activity – Being sedentary is associated with higher risk. If you ever needed a wake-up call to get moving, this is it (and while you’re at it, have your family members join you).

Postmenopausal overweight or obesity – Being an older woman with a higher bodyfat percentage may increase your risk, so menopause is a great time to reevaluate your diet and consider why you’re eating what you’re eating—is it just out of habit? Boredom? Depression?

Hormone replacement therapy – Taking hormones post menopause for more than five years may increase the chances of developing breast cancer (see “Age at first menstruation and menopause” above). So unfortunately, hormone replacement treatment to help with menopausal symptoms may end up working against you.

Pregnancy history – Never having a full-term pregnancy, getting pregnant after age 30 or never breastfeeding may all affect your risk. To be fair, these can be more difficult to control and no one should ever feel guilty about any of them.

Rethink your drink.
(Photo by Bermix Studio on Unsplash)

Alcohol – Drinking alcohol increases your risk of developing breast cancer. If you are using alcohol as a socially-accepted means of self-medication, consider quitting and using money you’d otherwise spend on drinks to find yourself a good therapist.

There are of course other, perhaps less well-established risk factors, but the above give an idea of the wide variety of different factors involved.

Okay, so what if you can say that you’re in the clear with most of these factors? I certainly did. Based on my lifestyle, I figured that breast cancer was something that I’d never have to worry about.

And I had reason to think this way. According to the National Cancer Institute’s risk calculator, at the time of my diagnosis, I had a 1.3% chance of developing breast cancer within the next five years. That is a very low percentage! And yet, I developed a tumor.

Does that mean the calculator’s answer isn’t meaningful or that risk factors don’t matter? Not at all. It means that your risk percentage is only that, your calculated risk. Everyone would be well-served to live as healthy a life as they can, keeping in mind that having a number of risk factors doesn’t definitively mean that you will get breast cancer.

At the same time, no one should assume that a low risk means you won’t get cancer. It’s still very important to get screened regularly and see your doctor about any lumps that you find, because while you might not be able to prevent breast cancer despite your best efforts, catching your tumor at an early stage provides you with the greastest chances for a positive outcome.

Invisible Effects: Body Image, Part 3

In Part 1 of this series I wrote about breast loss (which I ended up not having to deal with) and how strongly I equated breasts with being female. In Part 2, it was about my fear of having no control over my body and being susceptible to weight gain as a cancer survivor.

In Part 3, I’m writing that my body reacted in a way completely opposite of what I feared, and I managed to regain some semblance of control.

As mentioned, many women with breast cancer, particularly those whose tumors are hormone receptor positive like mine, put on weight. On top of the “my-out-of-control-body-is-killing-me” feelings brought about by cancer, the threat of runaway weight gain added to my frustration.

Yes, this was another example of how, throughout my fact-finding research, I took to heart what I read and immediately assumed that if it happened to others, it was also going to happen to me. Except that it didn’t. Just as how statistically I shouldn’t have gotten breast cancer, I also shouldn’t have ended up almost 10 pounds below where I started pre-diagnosis.

My body is quite reactive. If you’ve read my posts about how I respond to anxiety, you know that I shed weight quickly. I am not an emotional eater; I am an emotional non-eater, and more often than not don’t have to fight cravings. I have to fight a lack of appetite

As weird as this may sound, the resulting weight loss was one of the strongest indicators that I wasn’t completely out of control, that my body hadn’t completely turned against me. And more than that, it was another reminder that my situation was not typical. So by maintaining a very doable 6 day/week workout schedule, I broke through the mentality that what others experienced was necessarily what I would.

Right side of my ribcage. I can see my serratus and external obliques, but have to focus on building strength, not losing weight.

In addition, and arguably more important is the fact that cancer recurrence and episodes of lymphedema have been associated with higher weight levels (see this Susan Koman web article addressing this issue, including journal references). According to a bioelectrical impedance analysis (BIA) body fat monitor, I’m sitting at about 20% body fat. The actual number doesn’t really matter, since these monitors are notorious for being inaccurate. What matters is that those numbers are stable and that I’m able to build muscle.

What also matters is that with my level of activity both pre- and post-diagnosis, recovery has been quite good. I feel strong. I feel lean and fit. My sense of self-efficacy is high. And I’m finally able to exhale after holding my breath about all the things that were happening to my body.

Piece by piece, I’m reclaiming my physical self again. At that same time, I’ve still got a lot to sort out in my head. I know that keeping my body fat in check doesn’t mean that I’m protected from cancer, despite what numerous news reports suggest. It makes me uncomfortable being bombarded with that message, though. According to the December 20, 2018 National Health Statistics Report (Fryer et al. (2018)), the average woman in the U.S. is obese. In the interest of public health, the “lose weight” message is trumpeted constantly. Every time I’m exposed to that, my perfectionism kicks in and I have to fight the urge to clamp down on my fitness and nutrition.

Being an outlier doesn’t gain me much sympathy, and it does comes with its own challenges. In the process of sorting out everything that’s happened to me, I’m working to keep an even keel going forward and not go to extremes. As with everything, moderation.