234: What You Can Do to Reduce the Risk of Developing Breast Cancer with Dr. Amy Comander

[00:00:00] Dr. Amy Comander: Lifestyle medicine does play a key role, and then getting back to nutrition, we all promote guidelines for a healthy diet. I usually like to talk about a healthy diet pattern, thinking of the quality of the diet, which involves lots of fruits and vegetables, whole grains, and really thinking about a protein source, certainly, we favor plant-based protein sources.

[00:00:25] Maya Acosta: You have more power over your health than what you've been told. This is a Healthy Lifestyle Solutions podcast. I'm Maya Acosta and I'm passionate about finding healthy lifestyle solutions to support optimal human health. If you're willing to go with me together, we can discover how simple lifestyle choices can help improve our quality of life.

[00:00:46] Maya Acosta: And increased longevity in a big way. Let's get started. Breast cancer is a pandemic concern, and the numbers prove it. Every year we identify 1.7 million new breast cancer cases worldwide with over 300,000 in the US. In the United States alone, one in eight women will be diagnosed with breast cancer at some point in their lives.

[00:01:11] Maya Acosta: Interestingly, incidence rates vary fourfold globally ranging from 27 per 100,000 in middle Africa and Eastern Asia to 93 in the US and 112 in Belgium. Most women believe that family history and genetics determine who gets breast cancer. But for most, they don't, inherited mutations like the B R C A, only cause five to 10% of breast cancer.

[00:01:39] Maya Acosta: This is an excerpt from Dr. Kristi Funk's Breasts: The Owner's Manual. Today my guest, Dr. Amy Comander, an expert breast oncologist and Director of Breast Oncology and Survivorship at the Mass General Cancer Center in WE and Newton Wellesley Hospital is here to answer our questions. She will explain the difference between non-modifiable risk and modifiable risk factors and what we can do about them.

[00:02:09] Maya Acosta: We would learn how to reduce our risk of breast cancer. As always, you can find the full bio and the links for each of my guests on my website, healthylifestylesolutions.org. Welcome back to another episode of the Healthy Lifestyle Solutions podcast. I'm your host, Maya Acosta. So we're in the month of October, and this is when we visit again the topic of breast cancer.

[00:02:32] Maya Acosta: And I'm so excited to have Dr. Amy Comander, who's been on the show a couple of times. She's a Breast Oncologist at the Massachusetts General Hospital Cancer Center. She's now the Director of Lifestyle Medicine at Mass General Cancer Center. We have so much to talk about today. Make sure that you visit the website and I'll include in the show notes the link so that you can read her full bio because she's very involved.

[00:02:57] Maya Acosta: She actually has collaborated with Dr. Beth. Frates and Dr. Michelle Tollefson on launching Paving the Path to Wellness, a lifestyle medicine-based program for breast cancer survivors. And recently, Dr. Comander, Dr. Beth Fra,tes and Dr. Michelle Tollefson have published The Paving the Path to Wellness Workbook. So that's even more exciting.

[00:03:19] Maya Acosta: We can talk about that as well. Dr. Comander practices what she preaches, and she recently ran her ninth consecutive Boston Marathon to support the Ellie Fund. Wow. Congratulations and welcome, Dr. Comander. 

[00:03:34] Dr. Amy Comander: Thank you. It's so great to be with you again. Nice to see you as well.

[00:03:37] Maya Acosta: Yeah, this is wonderful. So last time, the first time you came on the show, we sort of started talking about your experience with marathons.

[00:03:45] Maya Acosta: And so now in 2022, you've completed nine. Consecutive Boston Marathons. So that's amazing.

[00:03:54] Dr. Amy Comander: Thank you so much. It's definitely my passion and I'm so excited for the next one in April 2023.

[00:04:01] Maya Acosta: Wow. I heard it's addictive. You know, that people can really get hooked once you start running and participating this way, it just becomes something you look forward to every single time, so that's wonderful.

[00:04:13] Maya Acosta: For sure. So I also wanna say to my listeners, After the first time that you came on this show, just having this conversation and doing my own research, I decided to go ahead and follow through and book a Wellness exam. So I did my annuals, but I also went ahead and did a mammogram many years ago. I was afraid of mammograms, and we'll talk a little bit about that, and I had a little bit of a scare.

[00:04:37] Maya Acosta: And the reason that I wanna bring this up is because this is why we're talking about breast cancer during the month of October. We want women to take control of their health and not allow those fears to put us at a higher risk. So let's talk about that first. And by the way, so what ended up happening with me is there was a small mass that was found on one of my breasts.

[00:05:00] Maya Acosta: So I had to do a biopsy. And the entire time that I'm waiting, and I'm going through all of this, I'm, I'm saying to myself like, I'm sure a lot of women do is why me? And how did this happen? And I remember it was during the pandemic, so I was by myself. And also, I wonder if during this conversation we can talk about how sometimes some individuals that are financially limited or don't have the resources cannot follow through and pay the cost of say, a biopsy. So even though I had insurance, it was expensive to do all the other follow-up work. Turns out it was a cyst. That can happen sometimes. Yes, and I hope we could talk about that too, that these things can happen.

[00:05:45] Maya Acosta: After that, Dr. Comander, I've decided every year I'm going to get a mammogram, and so I wanna encourage women to go ahead and take care of yourself. So let's start with that. Can you tell us, Dr. Comander, why is Breast Cancer Awareness Month important and what do you say about the role of Screening?

[00:06:04] Dr. Amy Comander: First of all, I just wanna thank you for sharing your personal story with those who are listening, because I think hearing that from you that you were scared to go, but you went, you got your mammogram, and unfortunately you did have to go through that further workup and a biopsy, and thank goodness it turned out okay.

[00:06:23] Dr. Amy Comander: I think it's really important for women to hear that from you and for women to share their stories with sisters, friends, family members, because yes, getting a mammogram is scary. I will acknowledge but I get my mammogram. I'm not like jumping up and down and looking forward to doing it either, and I actually don't tell the mammogram technician that I'm Dr. Comander. I try to lay low. And be like any other woman getting her mammogram and treated the same as everyone else. And it is a scary experience. And those mammogram technicians, they deserve a high five cuz they're amazing right? for what they do. So thank you. I just wanna say that, but I do think while we can debate whether there's too much pink around in the month of October, I think we can all acknowledge that breast cancer awareness is important.

[00:07:13] Dr. Amy Comander: Because this does provide an opportunity for us to really focus on steps we can take for risk reduction, the importance of screening, and just general education about steps that women can take to help reduce the risk of breast cancer. And therefore, that's why I do think this month is important and I'm really glad to have the opportunity to discuss this with you.

[00:07:37] Maya Acosta: And thank you for being here, I feel that sometimes with certain months when we focus on a topic, sometimes we sort of focus on the wrong things. And so you did say that we see a lot of pink people start to purchase the products that are promoting Breast Cancer Awareness, and we focus on that, the wearing the pink and the celebrating and drinking.

[00:07:58] Maya Acosta: Pink drinks or whatever it may be and then I ask myself, Okay, but are we actually scheduling an appointment to get our mammogram? Because we know that that's the first thing that we can do to get ahead of this prevention. So I'm very excited that you're here to talk about that. And your passion really is to work with Breast Cancer Survivors, and that's what we will talk about as well.

[00:08:22] Maya Acosta: First, since you do specialize in lifestyle medicine, you're part of the Women's Health Interest Group for American College of Lifestyle Medicine. I wonder if you can speak with us about risk factors, and I will tell you one of the things that I no longer do is I no longer drink alcohol, and I wanna thank lifestyle medicine for educating me on that because while I'm interested in many areas of health, I just really never understood in my younger years that drinking alcohol can actually put us at risk, increase our risk for breast cancer, as well as probably age or going through menopause.

[00:08:59] Maya Acosta: So maybe you can speak with us about that too. Is it true that as we get older, our risk increase? Or is it also the genetic component of it? Genetic factors?

[00:09:09] Dr. Amy Comander: Right. These are such excellent questions. I do wanna address your question about risk factors, cuz I think that's a really important topic to focus on for education and we'll definitely talk about alcohol.

[00:09:22] Dr. Amy Comander: So when we think about risk factors, we think about. The non-modifiable risk factors, the things that we really can't change, and then we can think about the modifiable risk factors. What are things that we actually can change? So let's first focus on the non-modifiable risk factors. An obvious one is being a woman that does increase her risk of breast cancer.

[00:09:45] Dr. Amy Comander: Increasing age is a risk factor. We are all getting older, which actually is a blessing, but you know, it is a risk factor. Other risk factors include things like thoracic wall radiation. So if a woman had, unfortunately, let's say a type of cancer at a younger age that required radiation to the chest wall, that is a risk factor.

[00:10:07] Dr. Amy Comander: Certainly we are using that less often now as we treat cancer. But in the past, radiation was often used to treat diagnoses such as Hodgkin's lymphoma. Breast density actually is a risk factor. Strong family history is important. And then obviously thinking about the role of genetic mutations, which we can talk a little bit more about that.

[00:10:29] Dr. Amy Comander: And then reproductive risk factors. We're thinking about factors such as Age of Menarchy when the period started. When periods may end, how many pregnancies a woman may have if she does have a pregnancy. So that's another important component to thinking about risk. And then finally, the last one is whether a woman's ever required a breast biopsy that showed an atypical breast lesion that's not a cancer.

[00:10:55] Dr. Amy Comander: But could increase risk. So I know I laid out a lot of things there. I should say, if one of your listeners wants to look into a little bit more, the American Cancer Society website actually does a beautiful job outlining these non-modifiable risk factors so that a woman can read that and really have a good understanding of each of those factors and how they could contribute to her risk.

[00:11:17] Dr. Amy Comander: Wonderful. And then when we get to the modifiable risk factors, this is the part that we should also be very interested in cuz these are the things we can actually change, right? And that's where often lifestyle medicine can play a role. So one of them is tobacco use. We often think of smoking as associated with lung cancer, but actually tobacco use can also be associated with an increased risk for breast cancer.

[00:11:41] Dr. Amy Comander: So that's an important one to know about. Other factors that we can modify include physical activity. Our reproductive history, whether we're able to breastfeed or not, and alcohol consumption, which you mentioned. And then for postmenopausal women, obesity is a risk factor. Interestingly, obesity is not a risk factor, and premenopausal women and researchers are still trying to.

[00:12:08] Dr. Amy Comander: Figure out exactly the mechanism for that. But I think I do wanna focus on the alcohol topic, cuz you mentioned that earlier. That message is not really well conveyed to the public that alcohol, unfortunately, is a carcinogen and can increase the risk of not only breast cancer but other cancers. So we do strongly encourage women.

[00:12:30] Dr. Amy Comander: And men to limit alcohol consumption. Certainly in the ideal scenario, a person would not drink at all, but certainly, if there are special occasions and things like that. I encourage individuals to really limit alcohol consumption to really know more than three to four drinks a week

[00:12:46] Maya Acosta: Thank you for that. So I have a question about breast density, and you did say that we can visit the American Cancer Society's website and I'll add a link in the show notes so we can read more about all of these non-modifiable factors. But can you tell us just a little bit about what you mean by breast density? Is this also related to weight?

[00:13:07] Dr. Amy Comander: That's a great question. So breast density is a complicated topic and really what does that refer to? Sort of the appearance of the breast tissue on the mammogram when the radiologist is interpreting a woman's mammogram. And there's certain factors that they look at in terms of, you know, what does the breast tissue look like, how much that is present, etc.

[00:13:28] Dr. Amy Comander: And certainly breast tissue that is more dense can. You know, a little bit more difficult to interpret on the mammogram if there is potentially a small cancer lurking there. But studies also show that just having breast density can also potentially be associated with an increased risk of breast cancer.

[00:13:45] Dr. Amy Comander: So teasing these things out can be complicated, and in some women who are good to have increased breast density, it is possible that. Additional screening modality may be recommended in some cases of breast ultrasound or in some cases of breast MRI. So certainly these are important factors to evaluate that a patient can discuss with her primary care physician or her gynecologist, and certainly, the obesity factor does play a role.

[00:14:13] Dr. Amy Comander: In terms of risk for breast cancer, but really in postmenopausal women. So it is a really interesting question why that is not seen in the premenopausal population, and certainly, lots of researchers are really looking into that further.

[00:14:27] Maya Acosta: It is interesting going back to alcohol. Because this week as of the time that we're recording this episode, I was featuring a group, but really the leader of this group that endorses or offers support for sobriety, many of her members are female, and we talked about how women have been marketed to when it comes to alcohol, that we are sort of.

[00:14:51] Maya Acosta: I don't wanna say brainwash, but what we see in terms of marketing is that we deserve that extra drink. We deserve the Mommy Juice. We have so many responsibilities. We work hard every day, so we just need a glass of wine. So she's designed a group to offer support to anyone who's ready to put down the glass.

[00:15:09] Maya Acosta: And that's sort of where the conversation came up about alcohol being a carcinogen. And this was the first time that I learned that the World Health Organization labeled alcohol, and I think it was in 1980. Something like that labeled alcohol as a carcinogen. Wow. And I said to myself, Well if I know that today like I didn't know that before, but we have like mixed messages in the media about whether it's heart healthy to drink wine or whether it's not.

[00:15:36] Maya Acosta: We hear about Alzheimer's associated, you know, the risk go up when we consume alcohol as well. So it just seems like the right thing to do, or at least the easy thing to do is just not drink.

[00:15:48] Dr. Amy Comander: I would agree. Yeah, and it is unfortunate that that message is prominent in our culture. I totally agree with you and alluding to something you mentioned earlier in our conversation when thinking about Breast Cancer Awareness Month and all the merchandise that is out there, that is pink.

[00:16:05] Dr. Amy Comander: The thing that bothers me the most is those pink drinks. Like, go to this bar and get a pink martini. Or a beer that's in a pink can, that's just wrong. Okay. Like really, I don't care if a percentage of sales goes to support breast cancer research. Really, there's no way that marketing alcohol in any way should be something we should be doing to support Breast Cancer Awareness Month.

[00:16:28] Dr. Amy Comander: So, yes. Anyway, I'm glad that you mentioned that earlier too, and I think it's a really important message for your listeners.

[00:16:34] Maya Acosta: Yes, and we will talk about the role of education, of how important it is. The more we become informed, the more we can empower ourselves. And as always, when you're on, I'd like to showcase some of the books by the Women's Health Group.

[00:16:47] Maya Acosta: So I'm gonna pull this one up. And also you work closely with Dr. Beth Frates, the Livestock Medicine Handbook. I wanted to just share again with our listeners that it's available, and I've said before that you can buy it on Amazon as well as PAVING the Path to Wellness. I believe that, yeah, it's there as well and Improving Women's Health Across the Lifespan.

[00:17:08] Maya Acosta: This one as well, and I know that it's designed really for health professionals that work closely with women, but I've gone through as many chapters as I can. Like, whenever someone's coming on the show, I wanna learn about their contributions, but I've learned the power of education. The more that I learn, the more that I can improve my health and the more that I can help others as well.

[00:17:29] Maya Acosta: And so please tell us more about what you do to help inform your patients, whether it's lifestyle, medicine, and what they can do to prevent or once they're diagnosed. How do you incorporate that education when it comes to lifestyle modifications?

[00:17:44] Dr. Amy Comander: Thank you, by the way. I love and admire your passion for learning, and I love that you're showing me all these books.

[00:17:51] Dr. Amy Comander: I have all those books too, and they're all great resources and I'm sure you'll include them so your listeners can check them out too. But I am totally one who accumulates many books. Too many in fact. Anyway, this is one of my favorite topics. Certainly. I am a breast cancer oncologist, so I treat women and men with breast cancer.

[00:18:13] Dr. Amy Comander: This is what I do, and I certainly love taking care of my patients and I will do anything for my patients, but I also tell my patients I would also. Anything to help prevent them from getting a breast cancer in the first place? I would be happy to prevent all breast cancers in the world and find another job that would be the best outcome.

[00:18:33] Dr. Amy Comander: So what are some of the things, when we mentioned those modifiable risk factors, what are some of the things that we can do to potentially reduce our risk? And I use the term reducing risk as opposed to prevention, cuz. While I wish I could use the word prevention, we do know that cancer is complicated.

[00:18:52] Dr. Amy Comander: There are so many factors that contribute to the developments of a cancer that it really boggles the mind when you really dive into these papers to look into the mechanism behind what causes a cancer. But we do know that there are studies that suggest that perhaps 40% of all cancer are related to lifestyle factors that we could potentially modify.

[00:19:15] Dr. Amy Comander: So what are those factors and what can we do to improve our health? So just starting with one that we've already touched on, alcohol, again, getting that message out that alcohol is a carcinogen. It is linked to breast cancer and many other cancers, and I think it's really important that we all limit alcohol.

[00:19:35] Dr. Amy Comander: Again, I don't tell people to completely eliminate it because that is very challenging for most people, but really saving it for special celebrations. And again, limiting it to no more than three to four drinks a week. The American Institute of Cancer Research is a great source of evidence-based information and actually has lots of data about alcohol.

[00:19:56] Dr. Amy Comander: I will say that the AICR comes down really hard and just says, No alcohol. Period, which is the ideal situation. But for those who really do enjoy their glass of wine each night, sometimes it's hard to go from that to nothing. So I try to say, just get down to three to four, and then we can work on it from there.

[00:20:13] Dr. Amy Comander: So alcohol's number one. Number two. Try to get moving. One of the consequences of the Covid pandemic, if you look at so many studies that have been published recently, we, Americans have become much more sedentary. We already wore couch potatoes. Now we're. I don't know. We're more couch potatoes, what can I say?

[00:20:36] Dr. Amy Comander: So that is just a consequence of people, unfortunately, being, staying at home, having the opportunity to work from home, which is good in many ways, but really just not getting out, not going to gyms, not feeling comfortable doing a lot of the activities that we used to do. So we've really, as a society, become much less physically active even over the past two and a half years.

[00:20:59] Dr. Amy Comander: So physical activity is really important, certainly. For breast cancer risk reduction, and actually, it's shown to help lower risk of other cancers as well. So I really encourage your listeners to like, get out, get active. Walking with your friend is exercise, you know what I mean? You don't have to like put on the outfit and go to the gym and have that scheduled session with a trainer.

[00:21:21] Dr. Amy Comander: Just walking outside on a nice day is great and we really encourage individuals to achieve ideally 150 minutes of moderate aerobic physical activity each week. And moderate aerobic physical activity really means. Maya, you and I going for a walk together and chatting, getting our heart rate up a little bit, but we're able to have a nice conversation together.

[00:21:44] Maya Acosta: Okay, and can you say a little bit more about that? How exercise can reduce our risk? Is it because we're maintaining, you know, we're reducing our weight a little bit? Or is it that we're helping the body to detox or balancing our hormone? What's that component? That exercise.

[00:22:02] Dr. Amy Comander: Yeah, that's such a really interesting question as well.

[00:22:05] Dr. Amy Comander: Like what is the mechanism by which exercise does help reduce the risk of cancer or in those who've had cancer, potentially reduce the risk of recurrence? And there's certainly many brilliant scientists looking into the actual mechanisms of this. Often in animal models where you can study an animal and see what's happening with hormonal levels.

[00:22:26] Dr. Amy Comander: Levels of things such as insulin, insulin, like, growth factor, etc, and really trying to understand what is going on in terms of inflammatory pathways in an organism or in a human, um, that help explain the mechanism for the benefit of exercise. So I do think it's multifactorial. I don't think we fully understand exactly what is the true cause of the benefit, but I think it's definitely an area of active interest that I am following closely as well.

[00:22:55] Dr. Amy Comander: So it's not just weight. Cuz that's interesting. A person can still be, not necessarily lose weight, but that physical activity still does convey significant benefits.

[00:23:04] Maya Acosta: Thank you. And I'm thinking just in the field or just thinking about mental health in general and what exercise does or just getting, mm-hmm.

[00:23:12] Maya Acosta: Walking the blues away, at least for me, spending time in nature not only improves my mental health, but then I want to eat healthier. It's just this thing that happens as a result of being in nature and being physically active. 

[00:23:26] Dr. Amy Comander: So I definitely agree with you, and I feel like personally, during the course of the pandemic, I found that the physical activity piece, my running or whatever I was doing, definitely helped me manage my own stress and anxiety with going to work and whatever I was going to encounter that day in the hospital.

[00:23:41] Dr. Amy Comander: And we do know, again, at a scientific level, There's so many fascinating studies looking at changes in our neurotransmitters, in our brain, and other growth factors that really play a role in our mood, and it's another really interesting area, but I completely agree with you on that one.

[00:23:58] Maya Acosta: Yes. So what else can we do?

[00:24:00] Maya Acosta: You talked about exercise, and I think you were continuing on with lifestyle medicine, things that we could do. Yeah.

[00:24:06] Dr. Amy Comander: So yeah, we talked about not smoking, limiting alcohol. Trying to not be sedentary and be more active. Just another point on the sedentary behavior, again, with many of my patients who are still working from home and they're actually very happy to do so, and I understand that, but they're finding that they're in front of a computer all day, maybe on Zoom or other platforms.

[00:24:30] Dr. Amy Comander: So we really try to strategize about ways to incorporate movement into the day, and it is challenging one easy solution. Figuring out a way to have a standing desk. And certainly, you can purchase a standing desk, which obviously can be costly or I've seen lots of creative standing desks, like taking a bunch of books, stacking them up, and putting your laptop on top.

[00:24:52] Dr. Amy Comander: And there's lots of fun ideas on the internet for how to create a standing desk, but that's one easy example. Maya, I bet you have a standing desk.

[00:25:00] Maya Acosta: Don't. It's so funny, Dr. Comander, that you should say that, but it's not a standing desk. But I literally stand like this. Oh yes. Like when I'm editing, I stand because this is actually, it's, I don't know what you would call this piece, but I bought it from a store. Anyway, it's something that you can have in your dining room space, and it seemed perfect for the work that I do.

[00:25:21] Maya Acosta: But yes, I get tired of sitting. As you know, I'm sitting now and the advantage of working from home is that I have a dog and he needs to get out. And so in between when I'm working, whether I'm editing or doing anything on the computer or doing interviews, I get up and I take him for a walk and I do power walks.

[00:25:41] Maya Acosta: I love it. Because I need the exercise or I get up in between and I start cooking or I do laundry, I just start doing something because honestly, my legs do not like to sit for very long. It's just something that I just don't like the feeling of being stiff, for example.

[00:25:57] Dr. Amy Comander: Yeah, that's absolutely true. Yes, dogs are a great solution for those who feel like they're maybe not getting enough activity during the day. Dogs and children, little children running around, but. But another idea, I'm just thinking of strategies I've discussed with my patients. Um, I don't know if you're into Yoga Maya, but there's a lot of yoga positions or postures that one can do even at a desk or standing up for a few minutes in between Zoom meetings or things like that.

[00:26:25] Dr. Amy Comander: And that can be a nice way to kind of take a little break in between meetings and get some physical activity in. There's just so many creative ways you could incorporate physical activity throughout the day for working from home, and I just think that's important cuz when you look at some of these studies about how sedentary behavior has just.

[00:26:42] Dr. Amy Comander: Really increased over this time. It's pretty crazy actually. And we know that that's a risk factor not only for cancer but for other chronic diseases that, of course, you talk about a lot in this podcast. So in terms of heart disease, etc.

[00:26:53] Maya Acosta: Yes. I found it interesting if I can kind of interject it a little bit, but. Sure. As I've been thinking about being more physically active in the things that I like to do, so one of 'em is dance. I love to dance and I love to take classes. And as things are getting a little bit, well, things. Almost normalizing. And so I thought, you know, I'm gonna look into a studio nearby where I can take classes.

[00:27:16] Maya Acosta: But the other things that has really interest me that I think became even more popular during the pandemic was roller skating. People are going back to roller skating, people of all ages and backgrounds, even Wow. Younger people. As you and I probably grew up, you know, we had that in our background at some point in our lives.

[00:27:33] Maya Acosta: I think, at least for me, that was a thing. Roller skating, rollerblading, and. You see that all the time in places. So I said, that's on my list.

[00:27:43] Dr. Amy Comander: I love it. That's a great idea. And now you just need to find a buddy who wants to do it with you, and then it's perfect. You get your exercise, you'll get outside, you'll get time with a friend.

[00:27:53] Dr. Amy Comander: It's perfect. But I don't think you'll see me roller skating. I did try to college roller bbl, I should say, with my husband who loves it. and I am definitely not the most coordinated person when it comes to that, but I totally get it. I can see how other people would love it. So that's a great novel way to get in physical activity.

[00:28:13] Dr. Amy Comander: Yeah. So be creative. I think that's a really great suggestion that you just. Stated because it's funny, one of the patients I saw earlier today, I was asking her about exercise, and guess what she did before the pandemic? She took flying trapeze classes that was working. So it was a great workout to do a flying trapeze.

[00:28:33] Dr. Amy Comander: And the thing she said she really missed about it like you just said, was getting together with this other group of individuals who are like really into the flying trap piece. So that social connection piece with whatever type of exercise you enjoy is great and really helps with compliance too and making it fun.

[00:28:50] Maya Acosta: Yes. Wonderful.

[00:28:54] Dr. Amy Comander: So the final point I'd like to make is really certainly. Well, we can, Well, there's two more nutrition and healthy body weight, and obviously, these are challenging ones. Let's just focus on the body weight topic first. We know that particularly in postmenopausal women, obesity can be a risk factor for breast cancer.

[00:29:14] Dr. Amy Comander: And we do also know that losing weight is beneficial in terms of lowering risk, but certainly we know weight loss is a challenge for many. And I know you've probably had many discussions with other colleagues on your podcast about strategies for weight loss, but I do think that unfortunately, I mean, no matter what study you look at, obesity rates in the United States and around the world are increasing each year, and we really do need to.

[00:29:39] Dr. Amy Comander: Innovative and mindful and thoughtful about how we are going to address this with our patients because certainly obesity is a risk factor for so many health conditions, including breast cancer for postmenopausal women. So, and this is another topic I discussed with my own patients each day, because those who have had breast cancer who need to lose weight, you know, that's really important for them too.

[00:30:01] Dr. Amy Comander: And certainly lifestyle medicine does play a key role there. And then getting back to the nutrition, I think we've touched on this a little bit earlier as well. The American Cancer Society, the American Institute of Cancer Research, A C L M. We all promote guidelines for a healthy diet, and I usually like to talk about a healthy diet pattern, thinking of the quality of the diet, which really, as we know, involves lots of fruits and vegetables.

[00:30:29] Dr. Amy Comander: Whole grains and really thinking about a protein source that certainly we favor plant-based protein sources, but if an individual is not a hundred percent plant-based, thinking about fish and chicken and really limiting the consumption of red meat is important. And we know that there are so many great plant-based protein sources too, including beans, tofu, tempeh, I could go on and on. And by the way, it is safe to eat tofu, so hope for to follow up on any of that.

[00:31:03] Maya Acosta: That's great. Yes. I feel like that's a topic we always address is what about tofu and breast cancer? But it actually, I think I've heard, but please tell me if you know this, that if you consume.

[00:31:14] Maya Acosta: Earlier in your years, at least from what the data has shown that Asian women who mm-hmm, consume tofu at a younger age have a significantly lower risk of developing breast cancer. What about as we get older? Yes. Does it do anything for us? Is there a protective aspect to it?

[00:31:32] Dr. Amy Comander: Yeah. That study from Asia is absolutely right.

[00:31:34] Dr. Amy Comander: That consumption of tofu or soy products at a young age has been shown to be associated with a reduced risk of breast cancer. Mm-hmm, you know, that's interesting. Looking at a population in the United States where maybe our tofu has a slightly different consumption or what it's comprised of, like slightly different, but, so we don't have, but we do basically think it's safe.

[00:31:54] Dr. Amy Comander: You know, it is a plant-based estrogen. Different properties that are own endogenous estrogen, and it is a good source of plant-based protein. So, and you really can't overdose on tofu like you have a serving like in a stir fry or in whatever type of meal you're preparing. But we do feel that the evidence suggests that that's safe.

[00:32:14] Dr. Amy Comander: And another great resource to really look into, the primary references for this, if you want to dig into the data, would be the American Institute of Cancer Researches site.

[00:32:23] Maya Acosta: Thank you. So we've spoken about, and I like how you kind of rephrase that. We don't necessarily wanna say that we can prevent breast cancer because there are many components to all of this.

[00:32:35] Maya Acosta: But instead, the best way to say it is that we wanna reduce our risk. And so we talked about non-modifiable things that we can do, and then the importance of screening and having this education, understanding the components of lifestyle medicine to reduce our risk. And I know you're very, very passionate about supporting breast cancer survivors so I was wondered if you can talk about that.

[00:32:59] Maya Acosta: You know, it was, when I spoke with you that I learned that, you know, women in general, when they receive a diagnosis, depending, and I don't know all the details of it, but they receive a, a team of specialists who will work with them. Not received, but you know, there will be a team of specialists that would work with them.

[00:33:16] Maya Acosta: Tell us a little bit about that and then what happens once treatment has happened and where does this whole paving the way come in? Because I know that's something that you wanted to continue to offer support for survivors.

[00:33:29] Dr. Amy Comander: Yeah. So great questions. I love all of them. So I would like to first start with, as inquired about how we treat breast cancer. It really does require a team approach and I think I feel very grateful to work where I work, where we really do have a multidisciplinary team that a patient is able to see on day one to really meet all the individuals who'll be playing a role in her care.

[00:33:57] Dr. Amy Comander: And so obviously that include. A breast surgeon, a radiation oncologist, a medical oncologist, which is what I do, but also many other team members such as a genetic counselor. Social worker, nutritionist, psychologist, physiatrist, physical therapist. I hope I'm not missing someone. I'm probably missing someone.

[00:34:19] Dr. Amy Comander: Our nurses are wonderful. You know, our administrative assistants, everyone on the team plays such a key role. Of course, the radiologists too, so I feel very privileged to work with such a great group of people and our patients do feel. They're like, Wow, I have this amazing team caring for me, looking at me each step of the way, and they're very grateful for that.

[00:34:40] Dr. Amy Comander: So certainly at the time of diagnosis. A woman or man, men can get breast cancer too. I wanna say that in the United States there's about 280,000 new cases of breast cancer predicted for this year, and about 2,700 of those will be in men. So I think it's just important to acknowledge that as well. But when receiving a new cancer diagnosis, again, certainly it's very overwhelming.

[00:35:04] Dr. Amy Comander: And that support piece that you mention. Is really key. So I always talk to my patients about, can I refer you to our social worker to get some support and link to resources in the community that can help you. Would you like to meet with our psychologist? Would you like to meet with a peer mentor? We actually have a new mentoring program where a patient can meet with a woman who's recently been down this road and kind of get advice and support that way.

[00:35:31] Dr. Amy Comander: So the support piece is so key and I. Tell my patients, no matter how many resources you have, that you could always use more help and just to let people help you, you know? I think that's just such an important message. Because it is, as you stated, having just what you went through yourself. Thankfully it turned out okay, but that support piece is just, you can't replace that.

[00:35:55] Dr. Amy Comander: Right. So what I noticed in caring for my patients with breast cancer who go through so much again with their treatment sort of near the end of treatment, you know, the primary treatment, whether that's surgery, radiation, chemotherapy, all of the above. Sometimes we'll tell our patient, Great, you're done with your treatment.

[00:36:13] Dr. Amy Comander: I'll see you in three to four months for a follow-up visit. Bye. And you can imagine our patients are like, Of three to four months, like they're so used to coming to our cancer center and having, you know, seeing all of us all the time and having these intense discussions about the next steps in their treatment, etc.

[00:36:33] Dr. Amy Comander: And then they're just told to like, see you in three to four months, which we think they're grateful for that they don't have to come back to the hospital. But often that leaves people feeling. Very uncomfortable. Like, Oh my goodness, like I have breast cancer, and now what? And that's really where this program was born from the PAVING the Path to Wellness. Cuz I realized there was such a need to provide further support for individuals with a cancer diagnosis that also education women. We asked lots of questions. We wanna know everything, you know, what should I like be eating after a breast cancer diagnosis. What should I do about my sleep habits?

[00:37:08] Dr. Amy Comander: How can I manage stress? What is the role of exercise? What is the role of my community? And so that's really what this program was designed to address. And I've talked a lot, so I'm gonna stop and let you ask a question.

[00:37:21] Maya Acosta: No, I thought you were doing a great job. I'm just listening to this going Yes, as a matter of fact, I've heard you say, So the goal is to support the survivor initially because she suddenly is by herself, depending on, you know, we don't know, but the team was very supportive.

[00:37:36] Maya Acosta: So suddenly here she is at. And expected to live her normal life. So part of me wonders how easy it is for loved ones family members to support a cancer patient. Just in general, like do we know how to speak to the individual or what to offer, how to offer support? That was one question that I had. The other one was, I've heard you say that the longer the individual goes on from after the cancer has is in remission, the longer the time passes, the higher.

[00:38:08] Maya Acosta: Goes as time passes there's a higher risk for a recurrence. Is that right?

[00:38:14] Dr. Amy Comander: Well, just to address that. Um, great question. I should just say, and maybe I should have said this earlier cuz I usually try to explain it this way. Breast cancer obviously is not one cancer. There's many different subtypes of breast cancer, which I just wanna make sure I can clarify that.

[00:38:31] Dr. Amy Comander: And not to get into too many details, but there's many subtypes of breast cancer, depending. Hormone receptors, something called the HER two status and other subtypes that we look at. So the subtype of breast cancer is really important, along with the stage for assessing a patient's prognosis and likelihood for experiencing a recurrence.

[00:38:53] Dr. Amy Comander: So it really depends on so many different factors. It is true that some types of breast cancer potentially can recur. Many years later, sometimes even more than five years out after diagnosis. But I do wanna say, I wouldn't say the risk increases, but it doesn't go to zero. I wish it went to zero. Right? I always tell my patients, I wish I could say it was a 0% chance, but we know in life nothing's ever a 0% chance.

[00:39:20] Dr. Amy Comander: So it's really important for individuals to really think about making healthy changes in their lifestyle that can help them optimize their health. During that first five years out and beyond, because certainly all of these changes we're talking about with lifestyle medicine are things that we really are working on one step at a time to really improve our health in the long run.

[00:39:41] Dr. Amy Comander: PAVING the Path to Wellness, Right? There you go. 

[00:39:43] Maya Acosta: Yes. Yes. And you're right in terms of survivor, What you're doing those first five years to optimize her health. I have a friend who is a breast cancer survivor, and she said one day, I don't know how the topic of alcohol came up, and she said, I would be stupid to have a glass of wine today after what I've been through.

[00:40:03] Maya Acosta: And at first I thought, Oh, well you survived this. But you know what? The more that I learned, the more that I know that you still have to take care of your health. You know, and I'm glad that you address that. There are various types of cancers, so it's not just the various, the diversity, I don't know how you would say that, but it's not just the type of cancer, but also, like you said, how advanced it is.

[00:40:24] Maya Acosta: So again, The importance of screening so that we can catch these things early. So that's one thing and I was wondering, since you're on that topic, if you can talk about the BRCA gene and how some women now is becoming more common, that women are being tested, they're seeking this out to see if there's something they can do on the preventative end to reduce their risk.

[00:40:46] Maya Acosta: So I've often wondered if you can address that. I've wondered. If an individual is diagnosed or has the gene, the BRCA gene, and then they do the bilateral can thing today, I'm sorry, I love mastectomy.

[00:41:00] Dr. Amy Comander: Don't worry. Yes. I'm like, this is my lingo I use every day, but I wouldn't expect you to.

[00:41:06] Maya Acosta: Right. So she does have the mastectomy, right?

[00:41:09] Maya Acosta: Did I say that right? Cause I'm talking bilateral mastectomy at that point. Is her risk for breast cancer? Zero.

[00:41:17] Dr. Amy Comander: Okay. These are great questions. I love talking about genetics, by the way, because this is another area of great interest. I thought I would do research in this area back when I was in my training, so I still follow this field very closely.

[00:41:30] Dr. Amy Comander: So when we think about breast cancer, if you think about a pie, We'll talk about pie, really, of all the breast cancers. Let's just think about the United States. 280,000 cases diagnosed in 2022. Only five to 10% of that pie are due to genes that we can now test for in 2022. And the most common genes you already mentioned are BRCA 1 and BRCA 2.

[00:41:55] Dr. Amy Comander: So those are the ones that really account for about 50%. Of that five to 10% of the pie. Okay. So that's why we've heard about those the most. And actually, the person who really brought that gene, I guess to everyone's attention was actually Angelina Jolie. So I forget what year it was now, but a number of years ago, she wrote a piece in the New York Times noting that she had this mutation and that she chose to have a prophylactic bilateral mastectomy, which is also what you just asked about.

[00:42:25] Dr. Amy Comander: And you know what? There is something called the Angelina Jolie Effect after that was published. There was definitely a surge and interest in genetic testing and women wanting to empower themselves to have that knowledge and act on it if they did indeed have the gene. So, I do not know Angelina, but I'm actually thankful to her for that.

[00:42:45] Dr. Amy Comander: Cuz again, whatever we can do to eliminate breast cancer is a good thing. Getting to your question though, so let's say a woman finds out she has that mutation. And chooses to have a bilateral prophylactic mastectomy, which is a very reasonable thing to do after consulting with her doctor. I should say.

[00:43:03] Dr. Amy Comander: Not everyone chooses to do that, and that is okay. A woman does not have to do that. A woman might choose instead to have a more aggressive screening approach with mammograms alternating with breast MRI. So I don't want anyone to feel that. Oh my goodness, I could never imagine doing that surgery. It's not for everyone, but if someone chooses to have that surgery, your question was, does it a hundred percent reduce the risk of having a breast cancer?

[00:43:31] Dr. Amy Comander: And I think the answer really is, I would say 99%. Why do I say that? It's interesting. But when doing these surgeries to remove the breast tissue, there may be like, A little bit of breast tissue left behind. And I know I'm not a surgeon, so I'm not gonna explain that as well as a surgeon would. But there is theoretical chance that there's a small amount of breast tissue left behind.

[00:43:53] Dr. Amy Comander: So in theory, But practically speaking, it would be extremely highly unlikely for a woman to develop a breast cancer after having a prophylactic bilateral mastectomy. So I hope that answers your question.

[00:44:06] Maya Acosta: Oh, yes. It's such a personal decision for sure. And yeah, and one that I do not want to judge or encourage people to judge because it's so personal when you're faced with, Well if you do like this genetic testing and you're told.

[00:44:24] Maya Acosta: You definitely could develop breast cancer as a result of this. It's such a personal decision. I can imagine the fear, but also the empowerment, like you said, like, I'm gonna take control of this. It's not gonna get me, you know, And to part with our breasts, which is just, it's gotta be a difficult decision. Right.

[00:44:43] Maya Acosta: By, I applaud women who are wanting to do this for themselves and wanna take control. And so Now I did ask you this before because you just said it's only about five to 10% of mm-hmm. breast cancer, diagnosis, Yes. Of the entire pie. So it's not necessary for all of us to go and get tested. Well, that's a great question.

[00:45:04] Dr. Amy Comander: I should talk more about that. So again, think about our 280,000 cases a year, five to 10% are due to genes that we can test for in 2022. There are still patients, I see many families where there's a lot of breast cancer, but we have not yet found the gene. Even with all the brilliant smart scientists at MIT and Harvard down the street for me, wherever they are, we still haven't found every single gene that can account for breast cancer.

[00:45:30] Dr. Amy Comander: So I will say that another. You know, 15-20 % of breast cancers in this pie are due to, we call it familial causes. So there is a definitely strong family history in that group, but we can't identify the gene yet. Or maybe it's a number of genes that in concert can increase the risk for breast cancer. We do not know.

[00:45:53] Dr. Amy Comander: So we're still doing lots of research to help figure this out, and we've made major strides, I would say, even over the past 15 years, which is pretty incredible. So who should get testing? I will say if any of your listeners are of Ashkenazi Jewish ancestry, those individuals I feel should all get tested because all individuals of Ashkenazi Jewish ancestry have a one in 40.

[00:46:15] Dr. Amy Comander: Risk of carrying a BRCA mutation regardless of family history. So that is one group of individuals that really should talk to the doctor about seeing a genetic counselor or pursuing other ways to do the genetic testing otherwise. I think every woman who's listening should know her family history, not just on the maternal side, but also the paternal side.

[00:46:38] Dr. Amy Comander: There is sometimes this misconception, Oh, no one on my mother's side of the family ever had breast cancer. The father's side matters. So really just knowing is there any breast cancer in my family? If so, what age was it diagnosed? Is there any ovarian cancer in my family? Because with BRCA, it's breast and ovarian cancer that tend to associate most strongly.

[00:47:00] Dr. Amy Comander: So I think it's really important for individuals to know their family history when it comes to cancer.

[00:47:06] Maya Acosta: Thank you for that. And I did ask about how we can best support our loved ones who are going through breast cancer. So I'm not looking for an answer on this one, but I have a cus. She's very young, extended family member cousin.

[00:47:20] Maya Acosta: She was 23 when she was diagnosed with breast cancer and it was, you know, she survived. We were all shocked. And, she lives in Arizona, so I don't have a lot of access to her, but you know, my family reached out and offered support. So I was wondering, what do you recommend the rest of us do? Of course, take care of our health.

[00:47:41] Maya Acosta: Self-care. Make sure that we get our annual exams and our mammograms to really be on top of this. But then if we have a loved one who has breast cancer, what are some best practices? What are the things that we can do to offer support?

[00:47:55] Dr. Amy Comander: Right. I think that's such a great question and important question, and I myself, certainly I do this every day caring for my patients, but recently I've had a few close friends receive a breast cancer diagnosis.

[00:48:06] Dr. Amy Comander: So certainly being there to listen and just with these friends of mine, I certainly called them and wanted to hear what was going on and how I could be helpful and made sure these two individuals live far away from me too, but, Ordering dinner. Don't even ask, just say, I'm ordering your dinner. What's your address?

[00:48:27] Dr. Amy Comander: Any food allergies? It's going to your house. It's like when someone has a baby, just send the food. They will be appreciative. You know, I also sent my friends a copy of the book, PAVING the Path to Wellness, cuz I just wanted them to have that and send a book, send magazines, send whatever would cheer that person up.

[00:48:45] Dr. Amy Comander: I think it just, Just do something to show that you care and. Obviously, every person's different in terms of what they want in terms of support. If it was someone local, I think just showing up to do something. Let me take your kid over to my house for a play date so you can get a nap in today. You know, just doing things, a strong believer and just doing things, not really saying, How can I help?

[00:49:08] Dr. Amy Comander: Just do it. Because sometimes when that person is in that position, it's hard for someone to learn how to ask for help if they're not used to that. So I just say, send the book, send the dinner. Offer the play date. Be proactive and helpful, however, you can. 

[00:49:21] Maya Acosta: That's great. Those are great tips. Easy to do. I would love that from time to time.

[00:49:26] Maya Acosta: Send me some food. No, I'm just kidding. So if an individual is five years out, 10 years out, they are survivors. What is the best way to have conversations with this individual? Cuz I know not everybody wants to be seen as a, as a victim. So what's the best way to speak with someone who's thriving in life?

[00:49:46] Maya Acosta: And doing well. Do we check on them? Do we bring up the topic? Do we say, How are you today? 

[00:49:52] Dr. Amy Comander: Yeah, I mean, I think that's such a great question and especially poignant. Currently, there's close to 4 million women living in the United States with a history of breast cancer. And thankfully, due to the advances in treatment, that number is gonna continue to grow.

[00:50:10] Dr. Amy Comander: So survivorship care and how we speak to our survivors and those who are friends as well is really important. I always think it's important to acknowledge it. I love what the words you. Thriving after five years after a breast cancer diagnosis, celebrating life, celebrating those birthdays. You know, I think it's just great to acknowledge, you know, to your friend, like, I think it's amazing that you're doing so well.

[00:50:35] Dr. Amy Comander: It's wonderful. Let's go roller skating together if they're into that like you are. But I just think it's great to acknowledge that. Because even if an individual's not really talking about it, she's always thinking about it. I had breast cancer. At least that's what my patients tell me. It never really leaves your mind that you have been through that.

[00:50:54] Dr. Amy Comander: So I think the support and acknowledgment is really important and helpful.

[00:50:58] Maya Acosta: Yes, and I admire those women who are survivors, who then go on to develop programs, podcasts, support groups, to empower other women. I love that. It's like they're just really continuing. To not only offer support for themselves, cuz I think that it benefits them, but also they're empowering other people.

[00:51:16] Maya Acosta: They're just helping other individuals so that they don't have to suffer as badly as perhaps they did.

[00:51:22] Dr. Amy Comander: That reminds me of a quote that I really wanna share with you that I actually posted yesterday, my own Instagram, because I saw this quote and I really loved it, but it really applies to you, Maya. So I'm gonna read it.

[00:51:36] Dr. Amy Comander: Okay. Since you get more joy out of giving to others, you should put a good deal of thought into the happiness that you are able to give. And that was from Eleanor Roosevelt.

[00:51:46] Maya Acosta: Wow. That's beautiful. Thank you so much. And Dr. Comander, are you going to the Lifestyle Medicine Conference this year? And is there anything going on with the Women's Health Interest Group?

[00:51:57] Maya Acosta: Because I think in 2021 they did some pre-conference workshops or something like.

[00:52:03] Dr. Amy Comander: Yes, so I'm so excited to attend my first Lifestyle Medicine Conference in person this November. I will be getting there a little bit late cuz we have a special family event the weekend before. It's actually my son's bar mitzvah, but, I will arrive at the conference on Monday.

[00:52:20] Dr. Amy Comander: I'm thrilled and I'm really excited to be giving a workshop actually along with Dr. Beth Brady and Dr. Michelle Tollefson, and we're gonna be discussing strategies from lifestyle medicine that can help address physician burnout. Actually, I shouldn't say that. Burnout and healthcare workers in general, cuz it's not just physicians or are burned off these days, we know it's affect.

[00:52:43] Dr. Amy Comander: Individuals and many professions. But, so I'm really looking forward to that. And I know the Women's Health Group also has a great workshop, and I think it's the weekend I'm not there, but you should definitely check it out. There's a lot of really great information that'll be presented at that conference.

[00:52:58] Maya Acosta: Wonderful. I think your topic is very important. I think that it's only until. Physicians learn about fields like lifestyle medicine, that they begin to self-care and begin to see a different perspective in terms of how they can practice medicine in general. And I've said this often that my husband, his perspective change, his energy, and the way that he does, he works with patients.

[00:53:20] Maya Acosta: Completely changed once he discovered Lifestyle Medicine. That's wonderful. So yeah, I definitely wanna encourage people if they go to the Lifestyle Medicine Conference to visit your, is it a panel discussion? Or a workshop?

[00:53:33] Dr. Amy Comander: Yeah, it's actually a post-conference workshop on Wednesday. That was the time I could do it cuz I knew I was getting there late.

[00:53:39] Dr. Amy Comander: So, but it'll be a really fun way to conclude the conference.

[00:53:43] Maya Acosta: Yes. Wonderful. And again, thank you so much for coming on the show. I always love when you're here. Thank you. Yes, because what you're doing is wonderful. To be able to equip your patients and really support them through this journey is wonderful.

[00:54:00] Maya Acosta: And I'm gonna encourage all my listeners to share this episode with another woman who can really benefit from the content that we talked about and also if individuals are interested in purchasing the copy of PAVING the Path to Wellness. Should we put a link to it? 

[00:54:16] Dr. Amy Comander: Sure. I'm happy to share that with you, but Okay. Maya, I just wanna thank you. We all appreciate you and the hard work you do to bring this information out to everyone, so thank you so much.

[00:54:26] Maya Acosta: I truly mean that. Thank you so much. Thank you again for spending. I know that you're very busy, so thank you for giving us an hour of your time. Thank you. If you're a woman concerned about breast cancer, you're probably already familiar with the importance of screenings.

[00:54:42] Maya Acosta: Now you know that lifestyle factors can also play a role in reducing your risk. In this episode, Dr. Amy Comander discussed the importance of breast cancer awareness month and shared tips on reducing the risk of breast cancer. Dr. Comander recommended that we limit alcohol consumption. As we previously discussed in 1988, the World Health Organization categorize alcohol as a carcinogen.

[00:55:08] Maya Acosta: We can assume that no amount of alcohol is the safest. In a previous episode, Janet Gourand, the founder of Tribe Sober, joined us to discuss how she supports people in putting down the glass and in taking control of their health. Janet is also a breast cancer survivor. Visit episode 225 if you'd like to learn more about living a sober life.

[00:55:33] Maya Acosta: Dr. Comander went on to explain that maintaining a healthy weight reduces our risk for breast cancer. We do not know why overweight postmenopausal women have a higher risk of developing breast cancer. However, she advises that we work towards reducing extra weight by exercising and eating a plan forward.

[00:55:52] Maya Acosta: Diet, regular screenings are essential to catch potential problems as early as possible. We discuss fears that women have about being exposed to radiation. I shared my story of having a scare that led to a biopsy. I now plan for a yearly mammogram. To reiterate Dr. Comander's recommendations, here are the steps that you need to follow to reduce your risk of breast cancer.

[00:56:17] Maya Acosta: Number one, educate yourself on risk factors. Number two, modify your lifestyle. Number three, get regular screenings. Number one, educate yourself on risk factors. The American Cancer Society's website is an excellent resource for information on breast cancer risk factors. You can start by reading up on the topic.

[00:56:37] Maya Acosta: You can also talk to your doctor or a breast cancer specialist to learn more about your risk factors. Non-modifiable risk factors are being a woman. Increasing age radiation to the chest wall, breast density, strong family history, genetic mutations, and reproductive risk factors. It is important to remember that even if you have one or more risk factors for breast cancer, it does not mean that you are guaranteed to get the disease.

[00:57:06] Maya Acosta: Many women with risk factors never develop breast cancer while others with no known risk factors are diagnosed with the disease. Number two, modify your lifestyle. 40% of all cancers are related to lifestyle factors that we could modify. Modifiable risk factors are things that we can change, such as quitting, smoking, physical activity, alcohol consumption, and obesity, and postmenopausal women.

[00:57:32] Maya Acosta: Number three. Get regular screenings. Cancer screenings can help detect cancer early when it's most treatable. Talk to your doctor about which screenings are best for you and when you should get them. Finally, we spoke about supporting cancer survivors. Close to 4 million women in the United States have a history of breast cancer after their treatments.

[00:57:54] Maya Acosta: And once the patients are in remission, they're encouraged to go live their lives. Suddenly they find themselves without the support team and the specialists that they once had. Dr. Amy Comander and Dr. Michelle Tollefson, who also has been on the podcast several times, developed the PAVING the Path to Wellness Program to further support their patients.

[00:58:17] Maya Acosta: Please email me if you have any questions about today's episode at plantbasedmaya@Gmail, my friends. I hope that you share this episode with one remarkable woman in your life who can benefit from the information that we covered. Make sure that you get your screenings and take good care of yourselves.

[00:58:35] Maya Acosta: Thanks again for being listeners. You've been listening to the Healthy Lifestyle Solutions Podcast with your host Maya, if you've enjoy this podcast, do us a favor and share with one friend who can benefit from this episode. Feel free to leave us an honest review on Apple Podcast that helps us to spread our message.

[00:58:55] Maya Acosta: Thanks for listening.