Amazing news: The breast cancer death rate has declined by 38% since 1989. “Thanks to advances in detection and treatment, women aren’t just living longer; they’re requiring less-invasive surgeries and therapies,” says Therese Bevers, MD, medical director of the Cancer Prevention Center at MD Anderson Cancer Center in Houston. Learn more about these breakthroughs, plus moves that reduce your risk.
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Diet makes a difference
Postmenopausal women who most closely followed a Mediterranean diet were 40% less likely to develop estrogen receptor–negative breast cancer, according to a study published in March. And women who most closely followed a plant-based diet had a 15% lower risk of developing breast cancer, compared with women who followed it least closely, says a 2013 study in The American Journal of Clinical Nutrition. “This is probably due in part to the fact that a plant-based diet is rich in phytonutrients and antioxidants that may be protective against cancer,” says Dr. Bevers.
Bottom line: Load up on nonstarchy vegetables, fruits, legumes, and unrefined grains. (But you knew that already, right?)
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Not everyone may need surgery
More than 50,000 American women are diagnosed each year with ductal carcinoma in situ (DCIS), in which abnormal cells are found within the milk ducts in the breast.
It’s typically treated with a mastectomy or a lumpectomy (often, but not always, paired with radiation). But a 2015 study in JAMA Surgery found that women with low-grade DCIS who did not have surgery had survival rates comparable to the rates of those who did. And a new trial at multiple centers in the U.S. will compare outcomes in women with DCIS who have surgery with those who will be watched carefully, with regular doctor visits and mammograms (a method known as active surveillance).
“Women need to know that DCIS represents a spectrum ranging from a lower to a higher potential for progressing to invasive disease,” explains Grace Smith, MD, a radiation oncologist at MD Anderson Cancer Center. While most surgeons still recommend either a mastectomy or a lumpectomy for intermediate- or high-grade DCIS, some practitioners may allow active surveillance for low-grade DCIS.
Bottom line: “A mastectomy or lumpectomy is still considered the standard of care,” says Dr. Smith. “But when women are concerned about whether they are good candidates for surgery, they can consider talking further with their providers about the nonsurgical active surveillance options under investigation.”
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Mammograms still matter
Mammograms have been around for almost half a century, but they’re still mired in controversy, even though they’ve been consistently shown to reduce breast cancer deaths. While groups like the American Cancer Society, the U.S. Preventive Services Task Force, and the American College of Obstetricians and Gynecologists agree that women should have these lifesaving breast X-rays, they’re divided on when women should begin getting them and how frequently they should have them.
Bottom line: No blanket guideline can substitute for a specific recommendation from your doctor, taking your personal risk factors into account. So talk to your doc—at least by age 40, or earlier if you have a family history of cancer—about the pros and cons of getting a mammogram every year.
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New advances are saving lives
The hottest area of cancer research is immunotherapy, a type of treatment that harnesses the body’s own immune response to blast away cancer cells. It’s especially promising for treating triple-negative breast cancer, a particularly aggressive type. But other breakthroughs are already helping slash death rates, including targeted therapies for HER2-positive breast cancer (about 20 percent of women with breast cancer have this aggressive type) and a class of drugs called CDK4/6 inhibitors, which help ght one type of breast cancer in advanced stages by blocking cell proteins that enable tumors to grow.
Bottom line: These advances will likely boost survival rates for years to come.
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Who should get genetic testing?
Up to 10% of all breast cancers are due to mutations in two genes, BRCA1 and BRCA2, which have also been linked to ovarian, pancreatic, and prostate cancers. Genetic testing can also look for other gene mutations that increase the risk of breast cancer, such as PALB2. Doctors don’t recommend screening all women, but here’s when you should consider having it done, according to Mary Freivogel, president of the National Society of Genetic Counselors:
1. You were diagnosed with breast cancer before age 45, or with triple-negative breast cancer before age 60, or with ovarian cancer at any age.
2. You have a family member with a BRCA1/2 mutation.
3. You have any of the following in your family history: two or more relatives with breast or pancreatic cancer, one relative with ovarian cancer, a relative diagnosed younger than age 50, or a case of male breast cancer.
4. You’re of Ashkenazi (Eastern European) Jewish ancestry and have a close family member who was diagnosed with breast, ovarian, or pancreatic cancer.
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Don’t worry about it
Once and for all, these things will not up your breast cancer risk.
IVF. A 2016 study of more than 25,000 women found no increased risk in those who had undergone in vitro fertilization.
Drinking coffee. If anything, it may lower your postmenopausal risk, says a 2015 study.
Feeling stressed-out. Women who reported feeling frequently or continuously stressed over the previous five years didn’t have a higher risk than those who never or occasionally experienced stress, per a 2016 British study.
Your bra. It doesn’t matter what size, what type, or how often you wear it: A 2014 study looked at 1,044 postmenopausal women who’d been diagnosed with breast cancer and concluded that bra-wearing habits had no effect.