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Reduce Your Risk

Five Plus ways to reduce your risk
Five Plus means... five steps plus early detection.

Women have the power to reduce their risk of developing breast cancer. But in spite of breast cancer’s high public profile, many women aren’t getting clear information about how to take action.

Now, BC’s leading breast cancer organizations have joined forces to show women how simple it can be.  Our team of experts has reviewed the best and most current research available and identified five key actions that women should take for better breast health.

You can be confident that each of the five actions:

• Is shown by many research studies to reduce breast cancer risk
• Applies to most women in their lifetime
• Is easy to understand and practical to follow

Five Plus addresses both prevention and early detection of breast cancer:

• “Five” recommendations are what every woman should know about how to reduce her risk of developing breast cancer;
• The “Plus” recommendations are breast screening steps that women should follow between the ages of 40 and 74.

Five Plus also recognizes the important role that others can play in supporting women’s health. We provide easy ways for family members to share this important breast health information with the women in their lives. You can find this in the FAQs section. We also reach out to health care providers to help them communicate the Five Plus steps to their patients.

The Five Plus campaign is part of a Provincial Breast Health Strategy, which unites government, health authorities and community partners to improve breast cancer screening, diagnosis and prevention across BC. 

Our Goals

Our goal at Five Plus is to offer BC women and their families the information they need to reduce the risk of breast cancer. To accomplish this, we educate all BC women about the five easy steps they can follow to reduce their risk of developing breast cancer.

In addition, we motivate women aged 40-74 to take their breast health a few steps further by knowing how their breasts look and feel so that they notice any changes, and by talking to their health care providers about mammograms.

Finally, we encourage everyone to step forward and share this important information with the women in their lives.


Five Plus



Keeping those extra pounds off - especially after menopause - can reduce your risk.

Research studies around the world have shown a link between weight and the risk for breast cancer after menopause. Maintaining a healthy weight throughout your life will help reduce your risk.

The research:
Fat cells produce estrogen and other hormones that cause your cells to divide. If you are overweight or obese, you will produce more of these hormones than your body needs. This increases the chance that cells in your breasts will become cancer cells.

Your risk of breast cancer rises if you are moderately to significantly overweight. Factors that increase your risk include:

a Body Mass Index (BMI) of 25 or more
a high percentage of body fat
extra weight around your waist and abdomen, rather than on your hips and thighs
weight gain later in life.

The research shows quite clearly that after menopause, overweight women have a higher risk of breast cancer. It is true that before menopause, excess weight appears to protect against breast cancer. However, because extra weight increases your risk of many other diseases, it’s always better to maintain a healthy weight throughout your life.

What you can do:
You can use a Body Mass Index (BMI) calculator to find out whether your weight falls within the healthy range for your height. A BMI of between 18.5 and 24.9 is generally considered normal.

Eating a healthy diet and getting regular exercise are the best ways to manage your weight. There are many resources available online that offer information and support to help you achieve and maintain a healthy body weight. You can also ask for advice from your doctor.

Learn more:


Physical fitness is good for your entire body - including your breasts.

Physical activity protects you against developing breast cancer, no matter how old you are. Even if you have never exercised before, it’s never too late to start.

The research:
Regular physical activity helps to keep hormones in your body at healthy levels. This is important because when you produce high levels of some hormones such as estrogen, your risk of breast cancer can increase.
Research has shown that regular exercise reduces the risk of breast cancer. This is especially true for younger women during adolescence, as well as older women after menopause. It’s estimated that if women in BC who don’t currently exercise became physically active, we could reduce the province’s breast cancer rate by 11%.
When it comes to reducing their risk of breast cancer through physical activity, studies suggest that certain women may benefit the most. This includes women who:
have previously given birth
have a healthy body weight
have no family history of breast cancer.

What you can do:
It is important to maintain regular physical activity throughout your life. Most experts agree that to effectively reduce your risk of breast cancer, you need to engage in moderate activity most days of the week. Vigorous activity is even better for your breast health.

Learn more:


When it comes to reducing your risk of breast cancer, less alcohol is better, and no alcohol is best.

Drinking alcohol increases your risk of developing breast cancer. The less you drink, the better, and no alcohol is best.

The research:
Drinking too much alcohol is a risk factor for many diseases, including breast cancer. While we still don’t know exactly how alcohol leads to cancer, it is thought that alcohol damages DNA in cells. DNA damage increases the risk of cancer.
 
There is a large amount of research showing that alcohol increases a woman’s risk for breast cancer before and after menopause. Studies also suggest that the more you drink, the greater your risk. Women who are heavy drinkers and who take hormone therapy for menopause symptoms are especially at risk for breast cancer.
It’s true that research has shown that drinking small amounts of alcohol every day may benefit your heart health. However, it’s important to recognize that when it comes to breast cancer, no amount of alcohol has been found to be “risk-free.”

What you can do:
If you don’t drink alcohol, don’t start.
If you do drink alcohol, consider reducing the amount you drink. Canada’s Low Risk Alcohol Drinking Guidelines recommend that to reduce their risk for several long-term health problems, women should limit their drinking to no more than 10 drinks a week, and no more than 2 drinks a day most days. Breast cancer experts recommend even less alcohol – less than one drink per day.

Learn more:


Several months of breastfeeding can reduce your risk of breast cancer.

Not every woman has the opportunity to breastfeed. However, all women should know that breastfeeding is not just best for baby’s health — it can also reduce a mother’s risk of developing breast cancer.

The research:
Breastfeeding causes changes in the body’s chemical balance, which may provide protection from breast cancer. It lowers pH levels and reduces the production of estrogen, which are both linked to lower breast cancer risk. Milk production may also help to “flush out” cancer-causing substances in breast tissue.

The more time a woman breastfeeds over her lifetime, the less her risk of breast cancer. Studies have shown that compared to women who have never breastfed, women who breastfeed for a total of three years have a 10-20% reduction in breast cancer risk. If you breastfeed for less time, you won’t get as much benefit, but your risk will still be lower compared to women who have never breastfed. The research also suggests that breastfeeding is especially protective for women who have a family history of breast cancer.

What you can do:
If you are planning to have a family, educate yourself about the many health benefits of breastfeeding for baby and mother. Look into the resources that are available to help you breastfeed successfully. If you are currently breastfeeding your baby, try to continue for as long as possible – ideally for at least several months.

Learn more:

Breastfeeding and breast cancer


Breastfeeding information and support


What’s good for your menopause symptoms may not be good for your breasts - talk to your doctor.

Menopause (when you stop having your menstrual period) comes with hormonal changes in the body that may cause symptoms such as hot flashes, poor sleep and mood swings. These symptoms may last for several years and can be very difficult for some women. Hormone therapy can be useful for relieving these symptoms. However, all women should know that long-term use of combined hormone replacement therapy (synthetic estrogen and progesterone) is known to increase the risk of breast cancer.

The research:
Research shows that combined hormone replacement therapy (HRT) increases certain health risks, and protects against others. Many studies around the world have looked at the connection between HRT and increased breast cancer risk. The results show that women who use HRT have a higher risk of breast cancer than women who have never used HRT, and that the risk increases the longer a woman uses these therapies. One study found that for women receiving combined HRT for five or more years, their breast cancer risk was 35% higher. There is even greater risk among HRT users who are also heavy alcohol drinkers.

The good news is that after women stop taking these hormone therapies, their risk of breast cancer will decrease again over time.

What you can do:
If you are considering taking hormone therapy to relieve your menopause symptoms, it’s important to understand that using combined hormone replacement therapy (HRT) increases your risk of breast cancer. Your doctor can help you weigh the different risks and benefits to decide what’s right for you. If you do decide to use this therapy, take the lowest dose possible, for the shortest possible time.

Learn more:




Know your breasts so if they change, you will know and can contact your doctor.

Know how your breasts normally look and feel so that you are more likely to notice if there are changes.

Watch for:
Breast lumps or swelling anywhere in the breast or underarm area
Nipple discharge – it may be clear or bloody
A change in how the nipples look or feel
A change in how the breast skin looks or feels
A change in breast size, shape or symmetry

What you can do:
If you notice any of these irregularities, see your health care provider right away.


Women 50-74 should get a mammogram every two years. Mammograms for women age 40-49 or over 74 can also be considered. Talk to your doctor. 

Have a mammogram when the time is right

Women at average risk for breast cancer should follow British Columbia’s recommendations for screening mammography.

What you can do:
While you can lower your overall risk of developing breast cancer, there is no way to prevent it. This is why early detection is so important. Mammograms help find cancer in its earliest stages, when there is a better chance for successful treatment.

The recommendations:
Age 40-49
If you’re in your 40s, you have some options around whether or not you should begin having screening mammograms. Talk to your health care provider to help decide what is right for you.

Age 50-74
If you’re aged 50-74, you should be having regular screening mammograms every two years, even if you think you’re not at risk for breast cancer.

Age 75+
If you are aged 75 or older, you have some options about whether or not to continue having screening mammograms. Talk to your health care provider to help decide what is right for you.
About the recommendations:
The Breast Screening Program’s recommendations for screening mammography were updated in 2014. Updated provincial screening policy recommendations result from an extensive review by BC Cancer of the most up-to-date evidence on the benefits and limitations of screening mammography.




There are some risk factors for breast cancer that a woman can’t control, such as a family history of breast cancer.

You might be surprised to learn that, for most women, lifestyle and behaviours are much more important factors for breast health than genetic influences. Only 5-10% of all breast cancers have a genetic cause; while up to 42% are linked to lifestyle factors.



FAQs


Tobacco use is strongly linked with many cancers. While there are mixed research findings about the link between smoking and overall breast cancer risk, what has clearly emerged in recent years is the importance of young women avoiding tobacco smoke.  Higher rates of premenopausal breast cancer are linked with tobacco smoke exposure during adolescence and young adulthood – either from direct smoking or exposure to environmental smoke.  There are positive general health benefits of not smoking, and not being around tobacco smoke also extends to breast cancer prevention. 
Should I be worried that ingredients of pesticides, cosmetics etc are increasing my risk of breast cancer?
In the last 10 years, greater attention has been focused on identifying links between toxic chemicals and pollutants in the environment and cancer. Some recent studies by Canadian researchers have found evidence of an association between the development of breast cancer and work in several industries including agriculture¹. These results need to be confirmed and replicated by other researchers before firm conclusions or recommendations can be drawn. While this issue understandably invokes a great deal of public concern, at this time research does not show a clear link between breast cancer risk and exposure to these substances.

¹ Breast cancer risk in relation to occupations with exposure to carcinogens and endocrine disruptors: a Canadian case–control study, Environmental Health November 2012 Brophy et al www.ehjournal.biomedcentral.com/articles/10.1186/1476-069X-11-87
Most studies have shown no significant increase in risk of breast cancer for women who take oral contraceptives when compared to women who do not take oral contraceptives. Some studies have suggested a small increase of in risk in women who have mainly used older types of oral contraceptives, which contained more estrogen than those commonly used today. Also, studies have shown that the risk goes down after a woman stops taking oral contraceptives.
Other types of contraceptives that are estrogen/progesterone based (topical, injectable, patches, implants, etc.) have been less well-studied. The risk may be similar to oral contraceptives but this has not been proven.

Yes. Screening mammograms are the international gold standard for detecting breast cancer early. Mammograms can usually find lumps two or three years before a woman or her health care provider can feel them. Finding cancer early can mean more treatment options and a better ability to recover. If you are a woman between the ages of 50-74, visit www.screeningbc.ca/breast for more information.

Mammograms are safe and require very small doses of radiation – the equivalent to six months of radiation exposure from daily living. The risk of harm from this radiation exposure is low, and the benefits of screening mammograms outweigh the risk.


Yes. Most women who develop breast cancer do not have a family history of the disease. Screening mammography is the best way to routinely detect breast cancer in average-risk women who do not have any symptoms. Screening mammograms are of particular importance for women aged 50 to 74, as more than half² of new breast cancers in Canada are diagnosed in this age group.

The term “average risk” refers to women who have not had breast cancer and do not have a family history of the disease in a mother, sister or daughter.

² Organized Breast Cancer Screening Programs in Canada: Report on Program Performance in 2005 and 2006.

Because your sister was diagnosed with premenopausal breast cancer at such a young age, you should start screening mammography 10 years younger than the age of your sister’s age of diagnosis, but not younger than 30.
Talk to your health care provider for more information.
Thermography has been around for several decades but no study has shown that it is an effective screening tool for breast cancer. Also, thermal imaging equipment is not approved for breast screening by Health Canada, and thermography is not recommended for use in breast screening by BC Cancer or any other provincial screening program in Canada.

Thermography uses sensitive infrared cameras to produce images of temperature variations. Areas with increased blood flow (producing higher temperatures) are considered suspicious. Thermography has a high false-positive rate, and can miss abnormalities that may need further investigation. Furthermore, a suspicious area discovered by thermography will need to be tested further with conventional methods such as diagnostic mammograms or ultrasounds.
Dense breast tissue is very common and is not abnormal. However many studies have established that breast density is a risk factor for breast cancer³.

³ Lusine Yaghjyan, Graham A. Colditz, Laura C. Collins, Stuart J. Schnitt, Bernard Rosner, Celine Vachon, and Rulla M. Tamimi. Mammographic Breast Density and Subsequent Risk of Breast Cancer in Postmenopausal Women According to Tumor Characteristics. J Natl Cancer Inst, July 27, 2011 DOI: 10.1093/jnci/djr225
Breast density is a reflection of the proportions of fat, connective tissue, and epithelial tissue in the breast. Women with higher amounts of epithelial tissue have higher breast density. Dense breast tissue can only be identified through a mammogram by a radiologist.
High dose radiation to the chest (like radiation therapy for lymphoma) is associated with an increased risk for breast cancer. Women who have had this treatment start screening mammography younger than age 40 and may also begin having annual breast screening MRI. But the very low doses used in screening mammography are safe and the benefits outweigh the theoretical risk.
There is growing evidence that vitamin D may reduce the risk of some types of cancer, particularly colorectal and breast cancers. You can get vitamin D from exposure to sunlight, in your diet (especially if you eat foods fortified with vitamin D), or by taking vitamin supplements. For more information, talk to your health care provider.
It’s important that women understand the possible benefits of mammography, such as early detection of breast cancer and the opportunity to get treatment sooner, and weigh them up against the possible harms. Harms include abnormalities shown on the mammogram that do not turn out to be cancer (a false alarm), but may result in potentially invasive tests such as a needle or open surgical biopsy as well as worry for the woman until the diagnosis is complete.

Your decision to get a mammogram should also be influenced by your chance of developing breast cancer –  your chances of developing breast cancer increase as you age.

Number of female breast cancers in 2011 for women 40-69

Cancer incidence in BC in 2011

40-49 18.1 per 10,000
50-59 26.5 per 10,000
60-69 42.9 per 10,000

* DCIS and invasive breast cancer reported per 10,000 each year, compared with about 470 women aged 40 to 49.

The Public Health Agency of Canada Decision Aid for Breast Cancer Screening in Canada can help women aged 40 to 79 make an informed decision. You may also choose to have a discussion with a  health care provider who can provide you with further information. 
All women can benefit from following the five steps for reducing the risk of breast cancer: maintaining a healthy body weight, maintaining an active lifestyle, limiting alcohol (less alcohol is always better, and no alcohol is best), breastfeeding if possible and weighing the risks and benefits of hormone therapy for menopause symptoms.

If you think you may have a family history of breast cancer, speak to your health care provider about your family’s cancer history and your personal breast cancer risk. If needed, your health care provider can help you access genetic counselling and genetic testing. You can also discuss options around regular screening for early detection of breast cancer.
If you have new or existing health problems, speak with your health care provider – they can help you determine if further testing or monitoring is required.

Breast implants do not increase the risk of breast cancer, but they can make early detection more difficult. Before getting implants, you are strongly advised to have a mammogram. These baseline images can be used to compare against future mammograms with your implants.
If you have implants, talk to your doctor about your options around screening for breast cancer. While screening mammography recommendations are the same for women with breast implants, you won’t be able to make an appointment directly with the Breast Screening program. Women with breast implants require special positioning and additional images. Contact your health care provider to refer you for a screening mammogram at a diagnostic imaging office.

If you notice any new changes in your breast such as a lump, a difference in the texture of your breast or nipple discharge, see your doctor immediately. Your doctor will help you determine if further testing is required.
If your doctor decides that you need testing, you will be booked for an appointment at a diagnostic imaging clinic. This process is different than regular breast screening, which is done for women who have no breast concerns or symptoms.

It is not unusual to get called back for additional tests - about 7% of women who have a screening mammogram will be called back for additional testing after their first mammogram or after their regular screening mammogram if changes are seen. Further tests will help determine what the changes are and if other treatment is needed. It's important to remember that about 95% of women who are called back for more tests do not have breast cancer.

The Breast Screening Program has a Fast Track system to reduce the wait for further tests. You will be called directly by the diagnostic imaging office nearest to you to arrange an appointment and your health care provider will be informed.

Further tests may include:
  • Diagnostic mammograms - further x-rays of the area of concern.
  • Ultrasound - uses sound waves to produce an image of the area of concern. It does not use radiation
  • Biopsy - a sample of tissue from the area of concern.
In BC, cancer care and treatment is provided through a unique provincial program. A team of health-care professionals will be involved in your care. Your care providers will follow a set of Cancer Management Guidelines for your type of cancer. These guidelines, developed by BC Cancer, are based on solid, scientific evidence and are used by health-care professionals throughout the province. This ensures that all British Columbians have access to the same, reliable, high-quality care.

To help you navigate the treatment options for breast cancer, you will receive a breast cancer information kit. The kit includes the Breast Cancer Companion Guide, which will direct you to the information needed at each step in the pathway.
As mothers, wives, sisters and daughters, women often take responsibility for making sure everyone is healthy. Sometimes, though, women don’t focus on their own health needs.

Five Plus recognizes the important role that family can play in supporting women to take steps that can reduce their risk of developing breast cancer. Learn about your role as a family member and discover the actions you can take to help the women you love stay healthy for life.

Important facts about breast health & breast cancer
  • A woman’s risk of getting breast cancer nearly triples between the ages of 40 and 70. About one in nine women in BC will develop breast cancer in her lifetime.
  • Most women who develop breast cancer don’t have a family history of the disease. Only 5-10% of all breast cancers have a genetic cause; up to 42% are linked to lifestyle factors.
  • Only 54% of BC women aged 50-69 currently go for a mammogram every two years as recommended.
  • Advances in early detection have increased survival rates. Today, 89% of women are alive five years after a breast cancer diagnosis.
  • Women in BC have one of the lowest breast cancer rates in the country and the highest survival rates in the country.
Your Role

Women value the support and encouragement of the people who love them.

In fact, women surveyed by Five Plus listed family and friends as one of the top factors that would motivate them to take steps to reduce their risk of breast cancer.

No matter who you are, you have a role to play:
  • f you’re a woman, make a personal commitment to look after your breast health. Remember that by taking care of yourself, you are in a better position to take care of the people you love
  • If you have a daughter, a sister, a mother or a wife, encourage her to reduce her risk through prevention and screening. Be there to support her healthier decisions.
Actions You Can Take

Here are some easy ways for you to help the women you care about to take action to reduce their risk of breast cancer.

1. Share this website with your friends and family so they can learn about Five Plus’ simple steps for healthy breasts
2. Print out the Five Plus steps to breast health as a one-page reference guide.




Resources

Patient

Download the Five Plus steps to breast health

Partner websites
Many of the partners contributing to the Five Plus website also offer useful breast health and cancer prevention information on their own website.

HealthLink BC (Province of British Columbia)

Canadian Breast Cancer Foundation

Canadian Cancer Society

BC Cancer

BC Women’s Hospital and Health Centre

Other useful websites

Public Health Agency of Canada
American Cancer Society

Health Professionals

Information for health care professionals:

Information for patients:

Breast health

Mammography – making an informed decision

Cancer

Healthy body weight

Physical activity

Alcohol consumption

Breastfeeding

Hormone therapy for menopause symptoms


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