Breast cancer and obesity: Explaining risks with compassion

Many risk factors tied to breast cancer are beyond the control of patients, including genetic factors.

But patients can reduce their risks by taking control of some factors, including maintaining a healthy weight.

Researchers say obesity is one of the risk factors tied to breast cancer, and patients can reduce that risk by getting regular exercise and having a healthy diet. Researchers have found that excess weight is a leading risk factor for other cancers, among women and men.

Doctors who treat patients acknowledge that having conversations about obesity as a risk factor can be tricky. Women regularly face body shaming and criticism regarding their appearance, reinforced by social media, advertising, and the entertainment industry.

Physicians stress the importance of having non-judgmental conversations with patients about breast cancer and connections to obesity. Dr. Karisa Beebe, a surgical oncologist at Penn State Health, says patients can see what their weight is on a scale and she doesn’t think it’s appropriate to tell them that they need to lose weight.

“I have never looked at a patient and told them that they needed to lose weight,” Beebe says. “I've simply just said it's an ideal thing if we're able to maintain a healthy body weight.”

Most breast cancers are fed by estrogen exposure, and even for patients that have gone through menopause, their fat cells are still producing estrogen, she explains. Obviously fat cells can’t be completely eliminated, but Beebe says it’s important for patients to do their best to try to be in better shape to reduce the risk of developing breast cancer or a recurrence of breast cancer.

“We can make sure we're not smoking. We can decrease the alcohol intake. We can make sure we're trying to stay fit. We have data out there that says that if you exercise three times a week, it doesn't matter what type of exercise it is, that it can decrease your risk of developing a breast cancer or recurrence of breast cancer, and then maintaining a healthy body weight is also one of those things,” Beebe says.

But she says she doesn’t see the value in admonishing patients about their weight.

“We don't need to isolate them and make them feel like they're less of a human or they're not compliant because of it,” Beebe says.

Plus, she adds, “There's a lot of women I have in my clinic who would fall in the ideal body weight category, who still have breast cancer. … There's a lot of factors that increase your risk of breast cancer, but you can do everything right, and you can still get breast cancer. And sometimes, I tell my patients, it's just bad luck.”

So Beebe explains to patients that they should try and maintain a healthy lifestyle.

“You don't have control over a lot of this,” she says. “We do what we can to have control over the things we do control.”

Alpa Patel, senior vice president of population science for the American Cancer Society, talked with Chief Healthcare Executive® this month about the risk factors for breast cancer and the uptick in cases among younger women.

“People are gaining weight at younger ages and carrying that weight for a longer period of time and throughout their life,” Patel says.

Women who stay physically active can reduce their risks of breast cancer, and Patel says she stresses that it’s not about being a certain size or even being skinny. She notes that some lean women aren’t necessarily fit.

“You want to be metabolically healthy, and that may look very different for different women,” Patel says. “And so it's important to focus on your health, not just based on your body image, but also your metabolic health overall. So that's something that I always like to remind women of … as it relates to breast cancer and many other types of cancer, for that matter. That's really important. There is more than just your body size.”

Plus, regular exercise brings significant benefits, even if it’s not reflected on the scale.

“We see that even in the absence of being at what would be considered an ideal body weight, women who are physically active are at lower risk of developing breast cancer than women who are inactive,” Patel says.

• Read more: Breast cancer and Black women: Gaps in care and research