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One of the most important discussions I have with my patients is about breast cancer risks, and most importantly, prevention (refer to my last post on, and you can listen to my teleconference on breast cancer prevention on my website .  

So what can we do to find out about our individual risk?      

1.Knowing how our body detoxifies estrogens is very important, and I recommend that all women 20 and above have an overnight urine test to look at the 2/16 OH Estrone ratio.  Why are some women susceptible, but not others?    

Researchers at Rockefeller University have found that the body metabolizes estrogens into several different forms that can impact cancer development. One form, 2-hydroxyestrone (2-OHE1), tends to inhibit cancer growth. Another, 16-a-hydroxyestrone (16-a-OHE1), actually encourages tumor development. A woman's "biochemical individuality" determines how much of each form is produced. Studies have shown that measuring the ratio of these two forms of estrogen provides an important indication of your risk for future development of breast cancer. The studies also show that this risk can be modified!  

The Estronex 2/16 Test is a measurement of these two important forms of estrogen: 2-OHE1 (the "good" estrogen) and 16-a-OHE1 (the "bad" estrogen). The ratio of "good to bad estrogen" is determined from a single urine specimen.  

Studies have shown that women with low Estronex 2/16 ratios have much higher rates of breast cancer. Low Estronex 2/16 ratios also indicate increased long-term risk for other estrogen-sensitive cancers, including uterine, ovarian, cervical, prostate, and even head and neck cancers.        

What can we do to improve our ratios and decrease our risk of breast cancer?      

Consume more cruciferous vegetables such as cauliflower, brussel sprouts, broccoli, etc.
Consume 1 – 2 tbsp. of fresh ground flaxseed each day
Consume high quality Omega-3 fish oil and moderate amounts of soy isoflavones ( I prefer the fermented forms such as miso and tempeh.

The following may contribute to your risk of developing estrogen-sensitive cancers:

• Prolonged use of oral contraceptives

• Synthetic hormone replacement therapy

• Family history of breast cancer

• Obesity or sedentary lifestyle

• Consumption of 2 or more alcoholic drinks per day

*Certainly we need to know our family history. These are two familial syndromes in which genetic testing may be recommended:*

• Hereditary Breast and Ovarian Cancer Syndrome (HBOC)

• Breast cancer before the age of 50

• Ovarian cancer at any age

• 2 or more breast cancers in an individual or family

• Both breast and ovarian cancer in an individual or family

• Male breast cancer

• Ashekenazi Jewish patients with personal or family history of breast or ovarian cancer

• Hereditary Nonpolyposis Colorectal Cancer (HNPCC) or Lynch Syndrome

• Endometrial cancer before the age of 50

• Colorectal cancer before the age of 50

• Combinations of colorectal, endometrial, ovarian, and gastric cancers in an individual or family

• People with the above risks may decide on testing for BRCA genes. More info on these genetic tests at 

Additionally, the key to treatment is early detection.


  1. Mammograms.
    The American Cancer Society has established guidelines on screening mammograms. While mammograms do not prevent breast cancer, they can save lives by detecting early disease. Mammograms have been shown to lower the chance of dying from breast cancer by 35% in women over 50 years old.
    We currently recommend a baseline mammogram at age 35 years old for women and then yearly after age 40 years old.  Mammograms are not perfect however, and dense breast tissue can sometimes mask true disease.  If you or your doctor feel a lump or see an abnormality on self or physician exam, be persistent.  You are your best advocate.  Sometimes diagnosis requires additional views by mammogram, breast sonogram, or a needle biopsy.
  1. Breast Self Examination.

Step 1:  The first step to breast self exam is always visual inspection.  Yes, this requires looking at your body naked in the mirror.  Raise your hands above your head and look for any pulling or dimpling of the skin or inversion (pulling in) of the nipple.  Look at any changes to skin color, redness, swelling, change in nipple direction, or a lump.

breast exam


Step 2:  Keep looking, now push your hands together over your head and then bring your arms down and push in at your waist using your chest muscles.  This contracts the pectoral muscles.  If a tumor is growing under the skin it will attach from the connective tissue over the muscle to the connective tissue under the skin.  Let your doctor know if there is any change, dimpling, irregularity to the skin.      

breast exam

Step 3:  While seated or standing in the shower (soapy wet skin makes it easier to feel), examine your breasts with one hand over your head, feel with the opposite hand above your clavicle and under your arm for any lumps, bumps, irregularities, tenderness, and note any discharge.  It is best to use the soft pads of your three middle fingers and use soft, medium and deep pressure.  Be sure to examine the whole breast, from under the arm to the midline of your chest, then change sides and do it again.  You can use a circular motion, up and down, left to right, it does not matter as long as you are consistent and do your exams the same way each time, and you will detect a difference should a problem occur.


breast exam

Step 4:  Finally lay down, take your time and repeat the breast exam as you did when standing.  

breast exam

Step 5:  Report any abnormal findings to your doctor and follow up!  This leads us to physician examination.

*1.*Physician examination.  Your physician should examine your breasts yearly and take you through the same steps as above, inspection, exam seated and lying.  Any abnormalities are usually followed up with a mammogram, ultrasound, and or biopsy as described above.  These appointments are important and please follow up with them.  Your doctor may feel or see something you do not.  Some patients have twice yearly or more frequent exams with their physician based on personal and family history.  

Always discuss with your doctor any concerns or questions you may have.  Write them down before you go into the office so you will not forget.  Take an active role in your health care and your families.

October is breast cancer awareness month – spread the word!  I hope you find this advise useful and will take these steps to create the healthiest you possible!


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