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How to talk about lifestyle and breast cancer risk

Alcohol consumption and other lifestyle choices get plenty of attention for their role in increasing the risk of breast cancer and other diseases. But that doesn’t mean they’re easy to discuss with patients.

“We sometimes worry about offending a patient or seeming inappropriate, but we have a responsibility to let our patients know the facts about breast cancer risk,” says John Turner, MD, a breast surgeon at WellSpan Health in Lewisburg. “Then they can decide what is important for them and what lifestyle modifications they want to make.”

WellSpan Health offers a CME course that highlights important research on diet, alcohol consumption and other breast cancer risk factors and suggests ways to share the information so patients feel empowered, not ashamed. Below are five lifestyle factors linked to breast cancer risk, along with key points that may resonate with your patients.

ohn Turner, MD

John Turner, MD

Keeping a healthy weight

Patients who are overweight or obese typically know they should lose weight, but they often don’t know that excess fat is linked to breast cancer, particularly for women after menopause. It can increase inflammation and produce estrogen, which can spur breast cancer development.

What to discuss with patients:

  • Breast cancer risk increases as BMI increases after menopause.
  • Diet has the biggest effect on your weight.
  • A recent study found that people eating a diet of processed foods gained 2 pounds in two weeks, while those eating unprocessed foods lost 2 pounds.(1)
  • Aim for at least two unprocessed meals a week. They can be simple and satisfying, such as overnight oats, salads and whole-grain pasta.

Staying physically active

Exercise supports a healthy weight and has been shown to reduce estrogen levels and boost the immune system, all of which may help decrease breast cancer risk.

What to discuss with patients:

  • Regular exercise can reduce the risk of breast cancer by 10%–20% for women of all ages.(2)
  • Aim for 2½ hours of moderate exercise (walking or yoga) or at least one hour of intense exercise (jogging or swimming) per week.
  • Prolonged sitting can harm overall health, even if you exercise enough. Try to break up long periods of sitting by standing or taking short walks.

Limiting alcohol intake

In 2025, the U.S. Surgeon General named alcohol consumption the third leading preventable cause of cancer, after tobacco and obesity. Alcohol can increase estrogen levels in the body, damage DNA and block absorption of cancer-fighting nutrients.

What to discuss with patients:

  • More than 100 studies have found a link between drinking alcohol and breast cancer.
  • One alcoholic drink per day can increase the risk of breast cancer by about 10%.
  • Some studies have found that one to two drinks per day increases breast cancer risk by 30%–50%, as much as having a close relative with breast cancer.(3)
  • A general best practice is to limit yourself to no more than three drinks per week.

Breastfeeding

For women who plan to have children, breastfeeding appears to give some protection against breast cancer. It may be because breastfeeding reduces estrogen levels and causes breast cells to mature, making them less likely to become cancerous.

What to discuss with patients:

  • When possible, exclusive breastfeeding for the first 6 months of life or longer helps to reduce the mother's risk of breast cancer.
  • One study found that every 12 months of breastfeeding — with one child or several — reduces the risk of breast cancer by 4.3%.(4)

Getting screened

Regular screening reduces the risk of late-stage breast cancer. We recommend annual mammograms for healthy women starting at age 40. At WellSpan Health, all mammogram patients receive a personalized screening plan based on a risk calculator that takes into account their personal and family history. For those at higher-than-average risk, we may also recommend breast MRI and genetic testing.

Learn More:

For more information on how to talk with your patients about lifestyle choices and breast cancer risk, please see our Breast Cancer Prevention CME course.

Other considerations: Pregnancy age and breast cancer risk

  • Deciding when or whether to get pregnant is a personal decision based on many factors.
  • Research shows that having a first child before age 30 lowers breast cancer risk, while having a first child after age 30 raises risk, compared with women who do not have children.
  • The increased risk after age 30 is likely due to hormone changes and breast growth during pregnancy.
  • Women who have their first child after age 30 may consider other lifestyle factors to help reduce their risk.

References

  1. Hall KD, Ayuketah A, Brychta R, et al. Ultra-Processed Diets Cause Excess Calorie Intake and Weight Gain: An Inpatient Randomized Controlled Trial of Ad Libitum Food Intake. Cell Metab. 2019;30:67–77.
  2. Kehm RD, Genkinger JM, MacInnis RJ, et al. Recreational physical activity is associated with reduced breast cancer risk in adult women at high risk for breast cancer: a cohort study of women selected for familial and genetic risk. Cancer Res. 2019;80:116–125.
  3. Terry MB, Zhang FF, Kabat G, et al. Lifetime alcohol intake and breast cancer risk. Ann Epidemiol. 2006;16:230–240.
  4. Collaborative Group on Hormonal Factors in Breast Cancer. Breast cancer and breastfeeding: collaborative reanalysis of individual data from 47 epidemiological studies in 30 countries, including 50302 women with breast cancer and 96973 women without the disease. Lancet. 2002;360:187–195.