I'm a Doctor and Here's How to Never Get Breast Cancer

Kelly Preston, actress and wife of John Travolta, has died. She was 57. "It is with a very heavy heart that I inform you that my beautiful wife Kelly has lost her two-year battle with breast cancer," wrote Travolta on Instagram. "She fought a courageous fight with the love and support of so many."

Inspired by that fight, Eat This, Not That! Health reached out to doctors, nutritionists and other health professionals and asked them for their best tips for battling breast cancer. Read through to arm yourself, and stay healthy for life.

While being genetically female is the largest risk factor for breast cancer, your lifestyle plays a major role, as well. "We do have a lot of data about other risk factors, and, as a result, there are things that women (and men) can do to reduce their risk of breast cancer," says Dr. Robert Coke, an intensive care and internal medicine practitioner at McMaster University. "We have evidence from multiple studies showing that excessive alcohol intake and smoking increase risk." Besides lowering your risk of breast cancer, there are other tremendous benefits of ditching booze.

Diane Kazer, a Functional Diagnostic Nutrition Practitioner and life coach, says that diet can play a major role both pre- and post-surgery, recommending that people at risk for breast cancer, or those who have a cancer diagnosis limit or eliminate sugar from their diet.

Dr. Coke says that keeping your weight in a healthy range can seriously reduce your risk of developing breast cancer, too. "Women with a BMI over 30 kilograms per square meter are also at an increased [breast cancer] risk."

Dr. David Shafer, a double board-certified plastic surgeon and founder of Shafer Plastic Surgery in New York City, says that staying active is key to reducing your risk of a breast cancer diagnosis. "With or without a family history of breast cancer, it is important to decrease your risk by reducing factors such as sedentary lifestyle."

Dr. Anne McTiernan of the Fred Hutchinson Cancer Research Center says that progesterone-based therapies used to combat menopause symptoms may increase your cancer risk. "Menopausal hormone therapy increases risk for breast cancer. If you must take hormones to manage menopausal symptoms, avoid those that contain progesterone and limit their use to three years." Of course, you should always consult your medical professional before starting or stopping any medication.

Coke says that environmental radiation may increase your risk of breast cancer, and those whose jobs put them at risk, from radiology technicians to miners to pilots, should do whatever possible to limit their exposure.

While we can't always choose the hours we work, Dr. Coke mentions that night shift work may put you at an increased risk for a breast cancer diagnosis. In fact, research published in the May 2012 issue of Occupational and Environmental Medicine found that women in the Danish military who worked the night shift were as much as 40 percent more likely to develop breast cancer than those who didn't burn the midnight oil.

"If you have a family history, then it's important to have testing and discuss the results with your doctor to determine if monitoring or proactive preventive surgery is the best course of action," says Dr. Shafer.

Dr. Coke says that, while there are plenty of lifestyle changes you make to reduce your risk, getting regular screenings is your best option for detection. Among women with a family history of breast cancer, regular mammograms on a doctor-prescribed schedule—which may mean starting before age 40—are particularly important. "Evidence suggests that although these risk factors may not be modifiable, these women could reduce their risk of developing metastatic disease by being screened regularly," says Dr. Coke.

"If you have a strong family history of breast cancer—meaning your grandmother, mother, and possibly a sister have been diagnosed before the age of 50—you should certainly talk to your doctor about whether you fit the precise medical criteria for genetic testing," Dr. Susan Love, president of the Susan Love Research Foundation, tells Redbook.

Even if you do carry the gene for breast cancer, that doesn't mean a mastectomy is a foregone conclusion. "Many times, we can alternate a mammogram with an MRI every six months to watch for any indications of cancer developing," says Dr. Love.

Being thin isn't enough to lower your risk; keeping your body fat percentage low may help you get diagnosed sooner. Mike Doelha, president and CEO of fitness and nutritional coaching company Stronger U, says that a lower body fat percentage can make smaller lumps more noticeable, potentially expediting diagnosis and treatment.

Breastfeeding is one of the few things that can actually help you reduce your risk of developing breast cancer, and the longer you do it, the better says Jenn Sullivan, a Certified Lactation Consultant, Certified Breastfeeding Specialist, and owner of New York's Waddle n Swaddle chain. In fact, research from the Collaborative Group on Hormonal Factors in Breast Cancer reveals that every 12-month period spent breastfeeding reduced breast cancer risk by 4.3 percent.

A family history of breast cancer isn't the only predictive factor; your body may clue you into whether or not you have an increased risk of developing the disease. "There are also hormonal risks such as early menstrual periods [and] late menopause," says Dr. Shafer.

Dr. Shafer cautions that exposure to certain hormonal medications can potentially increase your risk of developing breast cancer as well, so make sure you're clear on the side effects of any birth control or other hormonal medications before you fill your prescription.

Leaky gut syndrome, while often brushed off by doctors, is real and may contribute to your risk of chronic disease, including many forms of cancer, according to Kazer. "Toxic waste that should never leave the digestive tract can get into the bloodstream, causing inflammation and cause unpredictable cellular responses," she says.

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"We should be really mindful of what we're putting around our breast, and near our lymph nodes," says Kazer, specifically citing the use of heavy metals in deodorants and cosmetics as potentially harmful. "Things get stored there, and it becomes a constant drip of toxins into the bloodstream, potentially fueling cancer growth."

Dr. Kolker says that more women are being screened for the BRCA gene than ever, and that's in large part to Angelina Jolie's disclosure about her mastectomy in 2013.

Dr. Coke recommends taking precautionary measures to limit insulin spikes. This can be achieved through both physical activity and modifications to your diet. Insulin spikes can lead to other hormonal changes, such as increases in your androgen or estrogen levels, potentially upping your risk of developing breast cancer in the process.

"Breast cancer awareness has been increasing substantially, which I think is really terrific," says Dr. Kolker. "Women are much more educated and knowledgeable about their options today, which is so important."

"A sense of belonging and need to be in a tribe are essential for humans," particularly those going through a difficult emotional period. Kazer posits that emotional unrest may even contribute to immune health issues, potentially increasing one's risk of disease.

After you find a lump, it's time to talk to your PCP. "I recommend follow-up with your primary care provider, who can order an age-appropriate screening mammogram and counsel you on cancer screening," says Dr. Manish Dave, an expert hematology and oncology physician who practices at Northern Westchester Hospital Cancer Center and Putnam Hospital Center.

Many pregnant and breastfeeding women mistake potentially-cancerous lumps for hormonal changes, but any change in your breast tissue merits a trip to the doctor. "I have had a few clients go to the doctor thinking they have a clogged duct, only to leave with a breast cancer diagnosis," says Sullivan.

"[A biopsy] can be done using either ultrasound mammogram or a Magnetic Resonance Imaging (MRI)," says Dr. Lyda E. Rojas Carroll, MD, FACS, a breast surgeon at Caremount Medical. "This radiographic testing along with a breast exam can tell you the size of the tumor and if lymph nodes look or feel abnormal. The biopsy will reveal the type of cancer and whether the cells are sensitive to estrogen progesterone and HER-2/neu. Very rarely an open surgical biopsy is necessary.

"If your breast is very dense or you have been diagnosed with invasive lobular cancer, an MRI of the breast may help plan your surgery," says Dr. Rojas Carroll.

Dr. Fremonta Meyer, a clinical psychiatrist from the Dana-Farber Department of Psychosocial Oncology and Palliative Care, says that exercise can help fight the memory-depleting effects of chemotherapy. "Regular exercise is helpful for alleviating chemo brain symptoms," she explains. "Chemo brain" is a term used to describe foggy thinking and memory problems that can occur after cancer treatment.

Melissa Buerkett, a Licensed Mental Health Counselor and professional career counselor, says that it's important to prioritize your mental health when you choose to reveal your diagnosis to others.

"A lot of clients need support planning how to disclose the diagnosis to employers and family members. Each disclosure is like another traumatizing experience because they have to witness the reactions of those around them." Buerkett recommends treating the disclosure of your diagnosis the way you would any other trauma, including getting professional help when necessary.

"Most times the medical oncologist appointment occurs after surgery but there are instances were chemotherapy or anti-endocrine therapy can be given first," says Dr. Rojas Carroll.

Be prepared to get close to a big group of medical professionals. "The treatment of breast cancer is a team approach and one that includes the breast surgeon, radiologist, pathologist, medical oncologist, plastic surgeon and radiation oncologists," says Dr. Rojas Carroll.

"Seventy-five percent of cancers diagnosed in the United States are considered early stage, either stage 0, I, or II, and these stages are generally viewed as curable," Dr. Amber Guth, a breast surgeon and associate professor of surgery at NYU's Langone Medical Center, tells Health. "While phase III doesn't have as high a cure rate, there are many promising treatments available today for more advanced breast cancer."

Dietitian Suzanne Gerdes, MS, RDN, CDN of Memorial Sloan Kettering Cancer Center says, "Supplements are definitely something we want our patients to avoid most of the time because they're taking so many medications, we don't know what's going to interact with them."

"A consult with a RD (Registered Dietitian) can be helpful with managing nutrition needs that are unique for patients going through chemotherapy or radiation as these both can change the taste buds and create gastrointestinal issues," says Lewis-Huebel.

"There is no shame reaching out to a therapist or counselor to help with cognitive restructuring, learning valuable visualization/ meditation techniques, and simply having a non-judgmental ear to listen during cancer treatment," says Lewis-Huebel. "Your oncologist may be able to recommend some local mental health professionals that have experience working with people who have been diagnosed with cancer."

"Self-care must be the foundation of an oncology treatment journey," says Lewis-Huebel. "Self-care means making it a point to take time to journal, meditate, pray, engage in art/expressive therapy, do what brings joy to your life."

Dietician Christina Stella, RDN, CDN of Memorial Sloan Kettering Cancer Center says that retaining muscle mass is critical, especially for those undergoing chemotherapy. "We really want patients to hold on to their muscle mass because research has told us there are poorer prognoses for patients who lose their lean body mass at a very rapid rate."

"Cancer treatment is stressful and exercise is one of the most underutilized form of stress management. You may not feel like going to the gym for a workout during chemotherapy or radiation but even just walking can make a difference in your mood. If you are unable to walk for long periods of time due to fatigue do what you can," says Lewis-Huebel.

"Many cancer patients fear losing their hair and are concerned about how breast cancer will change their appearance," says Lewis-Huebel. "There is a fantastic organization called 'Look Good Feel Good' through the American Cancer Society that is free and will link patients with cosmetology volunteers who are trained to guide participants how to care for their skin, cope with hair loss, and provide suggestions with clothing and ways to feel comfortable and good about yourself.

"Just as chemotherapy and radiation appointments are scheduled schedule an appointment with yourself after each treatment to be kind to yourself and engage in meditation, guided breathing, yoga, massage, art, or whatever makes you feel good," says Lewis-Huebel.

Reconstructive surgery has come a long way. "The way they've been able to restore tissue is amazing," says Sullivan. "Doctors can do amazing things with tonal matching for skin grafts from other parts of the body, and tattoos can help create an incredibly natural look for areolas."

"There is a saying, 'It takes a village to raise a child,' but I believe it also takes a village of support professionals to guide someone through a treatment journey who has been diagnosed with breast cancer," says Licensed Mental Health Counselor Maureen Lewis-Huebel. "It can be very overwhelming when the oncologist shares the diagnosis and the patient may go through some stages of grief and loss like when someone dies.

One thing I would encourage [for] a patient who has just been diagnosed is to ask their oncologist for a referral to a social worker to connect with resources for oncology patients including support groups for breast cancer patients; it can be helpful to talk with people who are going through the same thing you are."

While the mental cloudiness of chemo brain is a real problem, Dr. Meyer suggests that you get tested for other ailments that could be causing the same symptoms. "It's also important to make sure you're receiving treatment for any depression, anxiety, or sleep problems (including sleep apnea)." Similarly, energy- and mood-regulating hormones and vitamin deficiencies could be at play. Dr. Meyer also recommends you "make sure you also have had your thyroid, vitamin D, and B12 levels checked."

"If surgery such as mastectomy is required, there are many excellent plastic surgery procedures and you should discuss with a board certified plastic surgeon when the time is appropriate as part of a team approach with your medical team," says Dr. Shafer.

"The most important thing is taking care of the cancer," says Dr. Adam Kolker, a New York City plastic surgeon, associate clinical professor of surgery at the Icahn School of Medicine at Mount Sinai, and a member of the Dubin Breast Center team.

However, once the cancer has been removed, there are often more reconstructive options than patients realize. "There are certain times when people get a diagnosis that says they are a potential candidate for treatment in a variety of ways," says Dr. Kolker. "Some people may be candidates for breast conservation therapy, some may be candidates for mastectomy."

"If someone has a choice between a lumpectomy and a mastectomy, it's not uncommon that they'll consult with a reconstructive plastic surgeon," says Dr. Kolker, noting that most people don't meet with a plastic surgeon until later in the process. "Having multiple surgeries, like those involved in a full mastectomy, is a much different consideration than having a lumpectomy," says Dr. Kolker. The recovery period for a full mastectomy and reconstruction former is generally significantly more involved than that required for a lumpectomy.

"More women are leaving their diagnosis without a full mastectomy," says Sullivan, but for those who do undergo surgery, it's important to make your needs known.

"Our generation is more vocal. Now more than ever, women are empowered to talk about their diagnoses and be up front about their experiences with breast cancer. Women should feel comfortable saying 'This is what I want my body to look like,' and feel like they're being heard."

"There has been a significant advance in the types of implants we use. It has to do with the shaping of the implants — they're teardrop shaped and more natural," says Dr. Kolker, who also points to the improvement of techniques like fat grafting in creating a more natural look post-surgery.

"The role of the plastic surgeon in this process is to restore that sense of self, that sense of balance. It's much more than an issue of simply replacing that tissue that's been removed," says Dr. Kolker.

"Plastic surgery has a tremendous impact on preserving a person's self-esteem," says Dr. Kolker. "For people with some form of breast asymmetry or droop [prior to their diagnosis], they may feel better than before the surgery."

"Microsurgical techniques are absolutely spectacular in terms of autologous surgery," meaning reconstructive surgery that uses a patient's own tissue. However, your likelihood of being able to use your own tissue instead of an implant has to do with your existing body type. "Some may have no extra tissue to work with, some have more extra tissue," says Dr. Kolker.

For most women who have reconstructive surgery, implants aren't the first and final step. "We put in a tissue expander first, then an implant. It's part of a 2-stage implant reconstruction, which is more common. Direct-to-implant reconstruction can be considered, although that's less commonly done," says Dr. Kolker.

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