Almost 25 percent of women diagnosed with breast cancer will eventually die of that disease (SEER Cancer Statistics Review, 1975-2015, National Cancer Institute, published online April 2018). This week, Dr. Wolfgang Janni presented data showing that breast cancer patients who received a weekly telephone call recommending healthful lifestyles had:
• a 35 percent greater two-year survival rate than women who were told of the benefits of a healthy lifestyle in preventing recurrences of breast cancer, but were not called weekly
• a 50 percent higher two-year survival rate than breast cancer patients who were not informed of the benefits of a healthful lifestyle (San Antonio Breast Cancer Symposium, December 7, 2018)
His team followed 2,300 early-stage breast cancer patients who had been treated with chemotherapy. The patients were reminded to eat an anti-inflammatory diet, exercise and restrict dietary fat. Exercising regularly and getting rid of excess body fat appear to be the most important lifestyle changes to prolong the lives of women diagnosed with breast cancer.

Belly Fat Increases Breast Cancer Risk
In another study, researchers measured body fat amount and location in 3460 post-menopausal women, ages 50-79. Those who had 10+ pounds of excess body fat had a 35 percent increased risk of breast cancer, and those who had "normal body weight" but had excess fat in their bellies had a 56 percent increased risk for developing estrogen-dependent breast cancer (JAMA Oncology, December 6, 2018). The fatter women had higher levels of insulin, C-reactive protein, interleukin 6, leptin, and triglycerides and lower levels of HDL cholesterol, all of which are markers for increased risk for cancers and heart attacks. Fat cells make the female hormone, estrogen, and the more fat you store, the more estrogen these fat cells produce.

The most harmful place to store extra fat is in your belly. Having excess fat in your belly usually means that you have excess fat in your liver. A high rise in blood sugar after eating can cause the sugar to stick to the DNA of cells to cause uncontrolled cell growth, which is cancer. To protect you from a high rise in blood sugar after meals, your pancreas releases insulin that lowers high blood sugar by driving sugar from the bloodstream into the liver. However, if your liver is full of fat, it does not accept the sugar and blood sugar levels rise even higher to increase risk for damage to cells throughout your body.

Breast Cancer Risk Factors
Lifestyle factors associated with increased risk for breast cancer include:
• excess body fat, particularly in the belly
• weight gain, particularly in middle age
• lack of exercise
• smoking
• alcohol in any amount
• high intake of dietary fat and mammal meat
• not having breast-fed
• night-shift work
(Electron Physician, Jul-Sept 2014;6(3): 894–905).

Survival rates after being diagnosed with breast cancer are improved by:
• losing excess weight
• exercising every day
• eating a Mediterranean-type diet
• avoiding alcohol
• avoiding smoke
• having hydroxy vitamin D levels above 30 ng/ml
(CMAJ, Feb 21, 2017;189(7):E268–E274). This reference has a comprehensive review of the scientific literature on lifestyle factors that help to treat breast cancer.

Lose excess body fat: Gaining weight during or after treatment for breast cancer increases risk for premature death (Nutr Cancer, 2015;67:197–202). Excess body fat raises insulin, estrogen, and inflammation that increase cancer risk (Cancer Causes Control 2016;27:459–72).

Reduce high blood pressure, high blood sugars and high triglycerides, and raise HDL cholesterol: Breast cancer appears to be associated with many of the same risk factors as those for heart attacks (Breast Cancer Res Treat, 2014;147:159–65).

Try to exercise every day: Exercise helps to prevent death from breast cancer by reducing inflammation, insulin resistance, and estrogen levels (Acta Oncol, 2015;54:635–54). Exercising for at least 30 minutes every day offers greater survival rates (Cancer Prev Res, 2011;4:1409–18). The exercise should be both aerobic (such as walking, running, cycling or swimming) and strength training (using strength machines or free weights). The only effective way to help prevent arm swelling and arm infections after lymph node surgery for breast cancer is to do continuous arm exercises lasting 10 minutes or more every day.

Get enough vitamin D: A deficiency of any vitamin can weaken your immunity and increase risk for cancer recurrence. Lack of vitamin D is associated with breast cancer recurrence (Cancer Epidemiol Biomarkers Prev, 2014; 23:917–33), so everyone should try to keep their blood level of hydroxy vitamin D above 20 ng/ml and those who have had breast cancer should probably keep levels above 30 ng/ml.

Avoid alcohol: I can find no data to show that giving up alcohol prolongs survival in breast cancer, but there is data to show that women who take in less than two drinks per day are at reduced risk for developing breast cancer (Adv Exp Med Biol, 2015;862:177–92). Alcohol is a potent carcinogen and I believe that it should be avoided by people with any type of cancer (Int J Cancer 2016; 138: 2088–97).

Avoid smoking and smokers: Women who develop breast cancer after years of smoking are at significantly increased risk for dying from that cancer (J Clin Oncol, 2016; 34:1315–22). However, women who quit smoking after breast cancer diagnosis have a higher survival rate, compared to those who continue to smoke. It is prudent for women diagnosed with breast cancer to avoid being exposed even to second hand smoke (Breast Cancer Res Treat, 2012;136:521–33).

My Recommendations
As soon after a woman is diagnosed with breast cancer as she is able, she should make the lifestyle changes listed above. I recommend an anti-inflammatory diet, which is basically a plant-based diet with seafood, and if weight control is an issue, I recommend intermittent fasting. Start a daily aerobic exercise program and three-times-a-week strength training program, avoid alcohol and smokers and know that these efforts are helping you to prolong your life.