Diet

“Eating well is an important part of improving your health and reducing cancer risk,” says Dr. Jennifer Iacovelli Malone, MD, MS, founder of Tree of Life Medical and a member of the Arizona Medical Society, the American College of Obstetrics and Gynecologists, the International Menopause Society and the International Society for the Study of Women’s Sexual Health. “Read food labels to become more aware of portion sizes and calories. Low-fat or non-fat does not necessarily mean low-calorie. Eat smaller portions when eating high-calorie foods.” She recommends eating at least two and a half cups of vegetables and fruits each day, and choosing whole grains instead of refined grain products. “When you eat away from home, choose food low in calories, fat and added sugar and avoid eating large portion sizes.” Limiting red meat consumption is also a good diet choice.

Dr. Vershalee Shukla of 21st Century Oncology recommends an anti-inflammatory, anti-cancer regime based on the Mediterranean diet, which includes vegetables, oily fish, legumes, fruits, spices, herbs, nuts, seeds, olive oil and other foods with healthy omega 3 fatty acids. “Antioxidants protect our cells, and the genetic information inside them, from free-radical attacks that could otherwise lead to cancerous cell change.” Dr. Shukla continues, “Carbohydrates that push our blood glucose levels sharply higher also increase our risk of developing cancer and can fuel the growth of tumors that are already present. This is not only because sugar is a favorite source of energy for cancer cells, but also because every time our blood-sugar levels rises, our body produces insulin and insulinlike growth factor (IGF-1), which both fuel the growth and spread of tumors.”

Dr. Iacovelli Malone also says it is important to limit your intake of sugar-sweetened beverages, including soft drinks, sports drinks and fruit-flavored drinks. And keep an eye on how much alcohol you intake each day, if any. “Excess drinking can increase the risk of breast cancer,” says Dr. Cynthia Lynch, medical director of the breast center and medical oncologist at Cancer Treatment Centers of America at Western Regional Medical Center. “In general, women who have two or more glasses of alcohol appeared to have a higher risk of breast cancer.”

Physical Activity

Dr. Lynch says that, though some areas have been examined more than others, studies show evidence that physical fitness allows a reduction in risk for the development of cancer, with it being particularly helpful in the reduction of breast, colon and endometrial cancers.

Sedentary behavior, like sitting at your computer or watching TV, should be limited. “Physical inactivity impacts crucial biological factors known in the pathway to cancer development, progression and recurrence,” says Dr. Shukla. “These are directly related to sex hormone levels, insulin resistance, inflammation and obesity. New research shows the amount of time you sit each day—even if you are regularly physically active and not overweight—is associated with physiologic changes (e.g. insulin resistance and inflammation) that increases your risk of developing cancer and other chronic conditions and even dying early from any cause. The longer you sit, the greater your risk. Even just 30 minutes of walking, five days per week is all it takes to reduce your risk of cancer.”

Even if a woman takes on a fitness routine and doesn’t see drastic changes in her weight, Dr. Lynch says to keep up the good work. “If you are exercising and not seeing a change in weight, still stay encouraged because even with a stable weight, we still see the benefits in risk reduction.”

Stress

“There isn’t a lot of good data to demonstrate that stress can cause cancer,” says Dr. Lynch. “It is hard to say that stress alone can contribute to the development of cancer, but if someone is stressed, they may smoke more, they may overeat, so those other factors that go along with stress many contribute. They may be less likely to participate in regular exercise. It may have a negative impact, but not directly [cause cancer].” Dr. Iacovelli Malone agrees that though stress can cause health problems that range from headaches to digestive issue, anxiety to sleep problems, the evidence that stress causes cancer is weak. However, she says those experiencing it can take on risky behaviors, like drinking or smoking. “In contrast, people who are able to use effective coping strategies to deal with stress, such as relaxation and stress management techniques, have been shown to have lower levels of depression, anxiety and symptoms related to the cancer and its treatment,” says Dr. Iacovelli Malone.

Family History

If a family history of cancer is present, Dr. Shukla says it is important to gather as much specific information about your family history as possible. “This includes the types of cancers, age of diagnosis, age of death and if the death was related to the cancers,” she says. “The more information you can provide, the better it is. The next step would be to see a genetic counselor to see if genetic testing is appropriate and any anticipated treatment following the results. Finally, knowing the ages of the family member with a diagnosis of cancer usually qualifies for 10 years of earlier screening.” For instance, if a family member was diagnosed with colon cancer at age 50, screening should start at age 40 or even younger. “I hate to see someone who comes in with cancer who has a very strong family history and it hasn’t been recognized by anyone,” says Dr. Lynch. “Had it be recognized early, maybe that patient could have had screenings to identify it early or even undergone treatment to reduce the risk of developing that cancer altogether.”

“I hate to see someone who comes in with cancer who has a very strong family history and it hasn’t been recognized by anyone,” says Dr. Lynch. “Had it be recognized early, maybe that patient could have had screenings to identify it early or even undergone treatment to reduce the risk of developing that cancer altogether.” 

Regardless of a family history of the disease, screenings are the best way to discover cancer at an early stage, when it is perhaps most treatable. According to Dr. Lynch, a woman should adhere to the following guidelines, though there are always exceptions. From ages 25 to 39, women should have a breast cancer risk assessment, risk reduction counseling and a clinical breast exam every one to three years. Annual mammograms should start at age 40. Starting at age 21, a woman should start having PAP tests and continue every three years, in general. Colonoscopies should start at age 50 and continue through age 75. From ages 76 to 85, screenings should be individualized and include a risk/benefit assessment with a primary care physician (PCP), and rescreening is dependent on findings from the exam. Though most screenings are not preventative, Dr. Lynch says that if polyps are found during a colon exam, they can potentially be removed before they become malignant.

The Skin You’re In

Skin cancer is one of the most common cancers that affect women—and no one is exempt from being concerned about it. “In general, the lighter your skin, the more probable you are to burn,” says Dr. Stephen Lynch, primary care/intake physician at Cancer Treatment Centers of America at Western Regional Medical Center. “Melanin, which causes darker skin tones, has a protective effect. Having darker skin, however, has been shown to lead to delayed diagnoses in some types of skin cancer. Hence, everyone needs to minimize skin damage from the sun.”

Dr. Lynch recommends a sunblock with a Sun Protection Factor (SPF) of 30, and it should be reapplied at least every two hours, though one should apply more frequently when swimming or sweating excessively. When it comes to choosing which sunscreen to use, “you want to look for a brand that has broad spectrum protection. There are different types of UV rays and you want protection from all of them.”

When spending a day in the sun, avoid loosely woven clothing and opt for clothing with UPF (Ultraviolet Protection Factor), says Dr. Lynch. A swim shirt, a broad hat and sunglasses are also key pieces of attire, keeping in mind that cancer can occur in the eye as a result of sun damage. And don’t be fooled by a cloudy day. “You can still get burned. Also, be careful of areas where you may be in the shade but UV rays are being reflected toward you.”

The Self Check

Though a self-exam cannot prevent breast cancer, it can catch it at its earliest stage. Here, Dr. Jennifer Iacovelli Malone, M.D., M.S., founder of Tree of Life Medical, provides a step-by-step self-exam guide. She says: “Finding cancer early, before it has spread, gives you the best chance to do something about it.”

Step 1:  Look at your breasts in the mirror with your shoulders straight and your arms on your hips. Note the following: Are breasts their usual size, shape and color? Are breasts evenly shaped without visible distortion or swelling? Do you see any of the following changes (if yes, bring them to your doctor's attention)?

• Dimpling, puckering or bulging of the skin
• A nipple that has changed position or an inverted nipple
• Redness, soreness, rash or swelling

Step 2: Raise your arms and look for the same changes.

Step 3: While at the mirror, look for any signs of fluid coming out of one or both nipples (watery, milky, or yellow fluid or blood).

Step 4: Feel your breasts while lying down, using your right hand to feel your left breast and your left hand to feel your right breast. Use a firm, smooth touch with your first few finger pads, keeping fingers flat and together. Use a circular motion. Cover the entire breast from top to bottom, side to side—from your collarbone to the top of your abdomen, and from your armpit to your cleavage. Follow a pattern to be sure you cover the whole breast. You can begin at the nipple, moving in larger and larger circles until you reach the outer edge of the breast. You can also move your fingers up and down vertically, in rows, as if mowing a lawn. Be sure to feel all tissue from the front to the back of your breasts: for the skin and tissue just beneath, use light pressure; use medium pressure for tissue in the middle of your breasts; use firm pressure for deeper tissue. When you've reached the deep tissue, you should be able to feel your ribcage.

Step 5: Feel your breasts while you are standing or sitting. Cover your entire breast, using the same hand movements described in step 4.

Dr. Iacovelli Malone recommends doing a formal exam every three to four months. “After [having] a breast exam in the office would be a good time to do a ‘first exam’ if they have never done one before. That way they will know what their ‘normal’ feels like, assuming the office exam of them is normal.”

Pros to Know

21st Century Oncology 21co.com.         

Cancer Treatment Centers of America at Western Regional Medical Center cancercenter.com/western.

Tree of Life Medical treeoflifemedical.net.