Reducing Breast Cancer Risk With BRCA: Lifestyle as Medicine
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Imagine this: You’re a 26-year-old doctor-in-training who unexpectedly discovers that you carry a genetic mutation that significantly increases your lifetime risk of cancer.
That was me. I was also starting out a career in palliative care, a field of medicine specializing in treating people living with serious life-threatening illnesses. I experienced waves of fear, anxiety, and uncertainty as I navigated this new diagnosis while simultaneously caring for people living and dying with advanced cancers.
This was an especially overwhelming experience for me. I had seen cancer up close when my mom was diagnosed with breast cancer for the first time at age 33, when I was just 13 years old, and then again when she was 47.
I encouraged my mom to undergo genetic testing, years after her diagnosis, which revealed that she carried the BRCA1 mutation, a genetic mutation that can increase a woman’s lifetime risk of breast cancer by up to 87 percent and ovarian cancer by up to 50 to 60 percent. Shortly thereafter, I received my own BRCA1 genetic mutation diagnosis as well.
My medical team, from the genetic counselor to the surgeons, armed me with the latest evidence on high-risk screening with MRIs to all the prophylactic surgical options that were in my future. While I was grateful for this information, I knew that surgery was still years away. I was soon to be married and wanted to think about starting a family. There was one question that kept coming up at each visit with every member of my medical team: What can I do with my lifestyle to reduce my risk of cancer?
I got very few answers from my medical team. In fact, some of them told me that lifestyle doesn’t matter at all. I ignored this, as one of my core beliefs is that there is always something you can do.
Soon thereafter, I came across the life-changing book How Not to Die, by Michael Greger, MD. What I discovered was both mind-blowing and empowering. It marked the start of my journey into the captivating world of lifestyle medicine, where I discovered compelling evidence supporting its role in reducing health risks and managing various chronic diseases, including cancer.
This pivotal moment forever altered the trajectory of my life as both a patient and a doctor.
The Power of Lifestyle as Medicine
Did you know that 30 to 40 percent of cancer cases can be attributed to lifestyle behavior? The World Health Organization highlights the significant impact that several modifiable lifestyle risk factors — such as tobacco smoking, alcohol consumption, being overweight, and physical inactivity — can have on the development of cancer, specifically breast cancer.
According to the American Cancer Society, approximately 5 to 10 percent of breast cancer cases are caused by inherited genetic mutations, like BRCA1, and in those cases, it has traditionally been thought that lifestyle changes would have minimal impact.
As a palliative care physician and a daughter of a two-time breast cancer survivor, I looked at my genetic mutation as a blessing in disguise, because I had the opportunity and the choice to proactively reduce my risk of cancer with screening and preventive surgeries that my mom and patients didn’t get. It was never a matter of whether I was going to get prophylactic surgeries, but rather, what else could I do to synergistically work alongside the medical interventions to minimize my risk of cancer while also taking back the control over my life that this genetic mutation had taken away?
The answer is lifestyle medicine. Lifestyle medicine is simply the use of evidence-based lifestyle therapeutic approaches, such as a predominantly whole foods plant-based diet, regular physical activity, restorative sleep, stress management, avoidance of unhealthy substances, and positive social connections, as defined by the American College of Lifestyle Medicine.
This powerful concept of lifestyle as medicine, which is not part of conventional medical training, is now gaining more recognition as a crucial part of reducing risk for multiple chronic diseases, particularly breast cancer, for which we have robust evidence.
Your Genes Don’t Determine Your Destiny
Soon after reading Dr. Greger’s book, I quickly became my first patient. I started by transitioning the way I was eating, from the typical South Asian–American diet to a whole-foods plant-based dietary pattern. And this did not happen overnight!
While doing my own research, I was inspired by the fact that although we may not be able to change the genes we were born with, we do have control over the switches that turn our genes “on” and “off”; this is known as epigenetics. I learned how lifestyle factors such as sleep, alcohol, diet, and physical activity, as well as the environment, impact our gene expression.
This was incredibly empowering, and my heartfelt message to others who live with genetic mutations like me is that our genes do not determine our destiny. They do not define us, and we have more control over our health than we are led to believe.
A 2020 study of 2,728 women with breast cancer found that those who adopted a healthier lifestyle, including exercise and low alcohol intake, and maintained a healthy weight, had “a reduced level of risk for breast cancer, even if the women were at higher genetic risk for breast cancer.” Studies like this reinforce the idea that the everyday things, such as the food we eat, the way we move our bodies, or the way we manage stress, have a much bigger impact on our risk of disease than we are often told, even for those of us living with genetic mutations.
Over the past seven years, I have undergone a beautiful transformation not only in lifestyle but also in my overall approach to living. My genetic mutation taught me that sometimes the bad things that happen in our lives put us directly on the path to some of the best experiences we will have.
Instead of being a victim to my genetic mutation, I choose to be an advocate for lifestyle and mindset as medicine, and to share its empowering message with others, as it truly has the power to change lives. And as a palliative care physician who has cared for many people near the end of this physical life, I can tell you that it is never too late to start making small but meaningful changes in our everyday lives — changes that may not only add years to our lives but life to our years!
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