L.J. Rohan

L.J. Rohan

Certified Gerontologist

Ninety-Nine Bottles of Beer on the Wall...

October 21, 2019

I’m not much of a beer drinker, but I do love red wine, and I’m married to a wine lover. I also have really cut back on my alcohol consumption, wine included, since I learned about the connection between alcohol and breast cancer.

From the Breast Cancer News website:

Just one alcohol-containing beverage a day — less than a standard drink — is sufficient to increase a woman’s risk of breast cancer, according to a new report by the American Institute for Cancer Research (AICR) and the World Cancer Research Fund (WCRF).

This mega-report, “Diet, Nutrition, Physical Activity and Breast Cancer,” brought together 119 studies and included information from 12 million women, 260,000 who had breast cancer. The study found that there is a 5% increase in risk for women before menopause, and a 9% increase for women after menopause. That doesn’t sound like much, but if there is a family history of breast cancer, or if a woman has had breast cancer, the risk more than doubles. Double-digit risk of anything is enough to give a person something to think about before she orders that frozen strawberry margarita.

In another study, The Women’s Health Initiative Observational Study, researchers at the Fred Hutchinson Cancer Research Center looked at 87,000+ postmenopausal women without a prior history of breast cancer and found that the more drinks a woman had per week, the more her risk of invasive breast cancer increased. Again, if a woman has a family history or previous diagnosis, her risk more than doubled at 14 drinks per week, or two glasses of wine a night. Eek!

 Now for the good news (whew!) There are ways to lower one’s risk. I don’t want to sound like the proverbial old harpy, but our trusted friend, exercise, is showing up as a great way to lower our risk. In the mega-report mentioned above, pre-menopausal women who participated in vigorous exercise like running, biking fast, HIIT—High Intensity Interval Training (see my blog, Slowing Down the Aging Clock  from February 26, 2018), lowered their risk by double digits, 17%, to be exact. Postmenopausal women who Just Did It with vigor, lowered their risk by a full 10%. Moderate exercise lowered a woman’s risk when compared to women who weren’t active. For younger women of childbearing age, breastfeeding the wee ones gave these women added breast cancer protection at all stages of later life.

The American Institute of Cancer Research estimates that one in three cases of breast cancer can be prevented if a woman will cut out alcohol and be physically active every day. That’s good news to think about.  It’s also something we can control!

Until next time…Be Vibrant!

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Great Information on Breast Cancer Prevention

October 14, 2019

  • Can breast cancer ever be cured? What is the percentage of return if contracted before menopause? After menopause?

Using the word “cure” is problematic because it doesn’t answer the question of WHY the cancer developed in the first place. A better way to look at this is “what do we know about preventing breast cancer recurrence?” The number of breast cancer survivors in the United States continues to increase. A review article quoted that there were 2.5 million breast cancer survivors in the United States in 2012 and showed the number expanded to 3.4 million in 2015. This is happening because of improved early detection, improved chemotherapy options both during treatment and after treatment is completed, and a better understanding of hereditary breast cancer with the use of proactive “prophylactic” surgeries. If breast cancer is detected before menopause, we know there is an increased risk of a second cancer whether it is in the same breast in the same location (considered a recurrence) or in a different location in the same breast or in the opposite breast (considered a second primary cancer) over that patient’s lifetime. Why is this? Again, as I said before, one of the biggest risk factors is age. Increasing age will increase the risk of cancer. The percentages of recurrence or, a second primary cancer, is difficult to pin down. We know that one in five women will develop either a recurrence or, a second primary cancer, after completion of five years of post-treatment adjuvant therapy (tamoxifen for example). Recurrence rates are related to:

  • The initial stage of cancer (how far it had spread)
  • The type of breast cancer or grade (what the cells look like or what part of the breast tissue is involved)
  • The family history or presence of a gene associated with increased risk
  • Other treatment related factors such as radiation therapy
  • Post treatment anti-estrogen therapy
  • The use of granulocyte colony-stimulating factors (such as Neupogen™, Granix™ etc.) during treatment

BUT NOW let’s talk about what we know that reduces the risk of recurrence!  Increasing good carbohydrates (fruits, vegetables, legumes, beans/lentils, whole grains, and natural soy products) and good fats (flaxseed, omega-3 fatty acids and nuts) are associated with improved survival. (Conversely, decreasing animal protein such as beef and pork along with trans-fats used in fried food will decrease your risk.) Increased exercise of 30 minutes five days a week is protective. Stress management techniques such as heart rate variability training (HeartMath™), meditation and decreasing body weight to less than 30 kg/m2 is protective. Avoiding tobacco use completely (both smoking and “vaping”) and limiting alcohol consumption to one drink/day is also protective.

  • Are there any symptoms to watch for?

Screening for breast cancer comes down to knowing your body and taking advantage of the technology that exists for screening. Watch for a lump in the breast or chest wall or armpit area. I often use the analogy of a grain of rice dried and stuck to the countertop when I teach women to detect their own cancer with their fingertips. Cancer is often (but not always) fixed or “stuck”, irregular to touch and associated with a skin dimple where it is pulling on the supportive ligaments of the breast. Nipple retraction, nipple discharge either clear or bloody, redness, scaling or thickening of the nipple can also be found. A rash on the breast that is unresponsive to antibiotics should be evaluated. Symptoms of recurrence can be new-onset localized bone pain, persistent chest pain, persistent cough, persistent abdominal pain, unintended weight loss, persistent headache, personality changes, new-onset seizures or loss of consciousness.

  • Does contracting breast cancer before menopause increase the risk of getting it again after menopause?

The short answer is yes. Cancer incidence increases with age – likely due to a cumulative effect of cell damage and less efficient repair. See the survivorship answer in question seven…

Breast cancer rates are increasing. Why? Is that for both pre and post- menopausal women?

 Actually, the risk of being diagnosed with breast cancer in the United States began decreasing in the year 2000 after increasing for the previous two decades. The risk dropped by 7% from 2002 to 2003. One theory is that this decrease was partially due to the reduced use of hormone replacement therapy by women after the results of the large study called the Women’s Health Initiative that showed a connection between hormone therapy use (specifically conjugated equine estrogen or Premarin™ and synthetic progestagens Provera™) that was published in 2002.  Reasons for the increased rates in the 1980’s and 90’s is likely related to improved screening techniques and increased numbers of women receiving screening.

  • Is post-menopausal breast cancer hereditary?

Although post menopause breast cancer can be hereditary about 10% of the time, most women with a genetic mutation causing breast cancer develop the tumor statistically earlier in their lives.

I am very grateful to Claudia for her thoughtful answers to some of the most pressing questions women have regarding breast cancer. I hope you have found them helpful, I know I have.

Until next time…Be Vibrant!

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Straight Answers on Breast Cancer

October 7, 2019

This month we join the Pink Wave and talk about breast cancer, but I hope not to rehash the same old lettuce. We will begin by answering some of the most frequently asked questions by women 55+. Since I am a gerontologist, and breast cancer is not an area I can speak about with authority, I went to an expert in the field, Dr. Claudia Harsh.

Claudia Harsh, MD is board certified in ob-gyn, was fellowship trained in integrative medicine through the University of Arizona and is trained in medical acupuncture. She worked in surveillance and survivorship at the Sammons Cancer Center in Dallas, Texas for Texas Oncology until December 2017 and now practices in Charlotte, NC.

Here are some of the most frequently asked questions about breast cancer at mid-life. Dr. Harsh’s answers are in italics.

  • Can a woman get breast cancer from going through menopause?

I think this question is asking: does menopause increase our risk of getting breast cancer? We know that our risk of breast cancer increases as we age. About 95% of breast cancers occur in women over age 40. We also know our lifetime risk of getting breast cancer is 1 in 8 but if we break that down by decades it looks like this:

 At age 30 we have a 0.44% or a chance of 1 in 227

 At age 40 1.47% or a chance of 1 in 68

 At age 50 2.38% or a chance of 1 in 42

 At age 60 3.56% or a chance of 1 in 28

 At age 70 3.82% or a chance of 1 in 26

 But, these chances are averaged across all women of all ethnicities. Maybe the question we should be asking is “who doesn’t get breast cancer and why?” and that’s where a lot of the interest in lifestyle medicine and nutrition, can help change the conversation and the risk numbers.

  • I don’t have a family history of breast cancer. Why did I get it?

About 10% of people who get breast cancer have a family history of the disease. (Or, put another way, 90% of people with breast cancer do NOT have a family history!) We’ve known for years that some families have an increased risk of breast cancer and once we analyzed the human genome (the genetic “book of life” that resides in our cells – one half from our mother and one half from our father), the first gene associated with breast cancer was BRCA1. This was identified in the early to mid 1990’s and has been shown to be a gene that codes for proteins that repair damaged DNA. For this reason, it is known as a tumor suppressor: if there is a mutation in this gene, it is unable to repair damage and the cell can grow and divide without control and form a tumor. This field of study is exploding with information – now there are dozens of genes that may impact our risk of breast, ovarian, endometrial or colon cancer (to name just a few!). Genetic counseling makes sense if cancer plays a strong role in your family. It is because of this that the term “previvor”[sic] has been developed for someone who found out they have a high risk genetic mutation and took proactive measures such as having a mastectomy or oophorectomy (removal of breasts or ovaries) to reduce their lifetime risk of the disease.

  • What are the most important risk factors for breast cancer?

Again, this is an area that is exploding with information. I mentioned before that our risk increases with age. This implies that there is a hormonal association (post menopause vs. pre menopause). Another important risk factor is family history (genetic mutations) – accounting for approximately 10% of all breast cancers. Mammographic breast density is a risk factor. Women with denser breasts (more ducts, glands and connective tissue) have an increased risk of cancer mostly because the tumors are harder to see on mammogram. Personal history of breast cancer increases a woman’s chance of developing a recurrent cancer. Biopsy findings in the ducts can develop into cancer. Previous radiation therapy to the chest prior to age 30 for cancers such as Hodgkin lymphoma has been shown to be a risk factor. Reproductive/menstrual history: Starting menstrual cycles before age 12 and/or concluding menopause after age 55 are both associated with an increased risk of breast cancer. Long-term use (more than 5 years) of postmenopausal hormonal therapy is associated with an increased risk of breast cancer. Ethnicity may be a risk factor for breast cancer. To date more cancer is found in Caucasian women than in African American/black, Hispanic/Latina, Asian/Pacific Islander or American Indian/Alaska Native women. The degree to which this is due to increased screening in the white population is still being determined. Research continues into sleep cycles and their association with breast cancer incidence, nutrition, vitamin and nutritional supplementation (especially Vitamin D), and stress management.

  • How does age at menopause effect breast cancer risk?

As mentioned before, our risk of breast cancer increases with chronologic age. Two strong factors are likely the culprits here – increased cell DNA damage over time and a change in our hormonal production. If we look at the hormonal question, we know that reproductive hormones estrogen and progesterone are produced by a woman’s ovaries and serve to stimulate cell growth in her breasts to prepare for nursing and her uterus to prepare for pregnancy. Anything that prolongs the duration and/or levels of exposure to this stimulation (late age at first pregnancy or never having given birth) increases breast cancer risk. On the flip side, anything that shortens the duration of exposure (pregnancy or breast feeding itself for example) reduces breast cancer risks. There is a theory that breast feeding causes the cells in the breast to change or differentiate and they then become more resistant to becoming transformed into cancer cells.

  • Will breast cancer show up in a blood test or in blood work?

 No. Although there are types of specialized testing that are designed to pick up circulating cancer cells, at this point there is no well-researched commercially available blood test to detect breast cancer. Having said this, there are several measurements called “tumor markers” that can be checked in someone with a cancer diagnosis. Examples such as CA27-29 or CA125 are markers that can be elevated in some cancers. It is the standard of care to measure a variety of markers at the time of diagnosis to see if the blood tests can be used to mark the presence or recurrence of disease. Similarly, some traditional blood chemistries such as calcium level, liver enzymes and electrolytes help point to the health of liver, kidneys and bone both at the time of diagnosis and throughout treatment.

In my next post we will return to answer more questions about breast cancer and some good news about prevention!

Until next time… Be Vibrant!

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Third Quarter Blog Recap

September 30, 2019

July 8, 2019—Set in Our Ways

This behavior is happening in the US in greater numbers and is becoming a growing concern for seniors’ friends and family. More and more these seniors refuse to hear anything that defies their set beliefs, or their worldviews.

July 15, 2019—Tapping into a Better Brain

The latest research cites dancing as one of the outstanding ways to lay down new tracks in our aging brains and grow new brain cells along with sleeker muscles. I’m a work in progress but my personal experience with tap class has enriched my life.

July 22, 2019—It’s Never Too Late to Help Our Aging Brain

Telomeres, the protective end caps of our chromosomes, are found in every cell in our bodies. The longer and stronger our telomeres are, the higher functioning our brains and minds will be, and the less our bodies will decline and age. Exercise looks like the number one magic bullet to lengthen and strengthen our telomeres.      

July 29, 2019—Food For Thought

Our telomeres become shorter when fat accumulates around our middles, and the focus of our choices needs to be on our metabolic health by maintaining ideal levels of blood sugar, triglycerides, good cholesterol, blood pressure, and waist circumference. A delicious upside for you: choosing fresh, whole (unprocessed) foods will ensure better metabolic health.

August 5, 2019—Your Brain on Food

For a longer, healthier life follow a Mediterranean diet rather than the traditional American diet of refined carbohydrates. Eating organic fruits and vegetables whenever possible and cutting back on sugar consumption will also ensure better gut and brain health.

August 12, 2019—Best Brain Foods for Memory, Concentration and Brain Health

Based on the latest research, here are a dandy dozen of the best things to “feed” your brain to help it, and you, function at your most vibrant.

August 19, 2019—Sugar Land

Knowing I was eating too much sugar, I decided to drop it from my diet for the days between Thanksgiving and Christmas. The resulting weight loss was beneficial, but more importantly, I was free of the sugar pull, free from wanting sweet things. That was empowering, very empowering, a sensation I continue to relish.

August 26, 2019—The Gut Brain Connection

Researchers have found a strong connection between the health of the gut and the general health of the rest of the body, most importantly for this discussion, the brain. By eating better, adopting a regimen of vitamins, and making a few lifestyle changes, we can strengthen our brains by lowering inflammation in our guts.

September 2, 2019—Let Me Sleep on That

Adequate sleep each night enhances every facet of our health and aging process. It strengthens different types of memories, clears waste products from the brain, offers immune protection against infections, and may lower the possibility of weight gain, depression, and the development of Type 2 diabetes.

September, 9, 2019—Sleep and Women at Midlife

The National Sleep Foundation Senior Health website recommends for adults 65 and older, 7-8 hours of sleep per night for better cognition, mental, and physical health. Seniors, especially women, suffer from sleep deprivation due to trouble falling asleep, tiredness, and the perchance for napping. Sleep issues affect as many as 25% of senior women.

September, 16, 2019—Sleep Suggestions, Part One

Setting a sleep schedule—and sticking with it is the number one suggestion for improving one’s sleep. Keeping a sleep journal, taking time to relax, reviewing medications, and monitoring caffeine and alcohol also help.

September, 23, 2019—Sleep Suggestions, Part Two

Several other hints for achieving the best sleep possible include cool bedroom temperatures, soothing books or music, monitoring light and outside noise, yoga, pillow position, and maintaining a mentally stimulating life.

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Sleep Suggestions, Part II

September 23, 2019

Continuing our discussion from last time on good ideas for getting our much needed shut-eye (https://www.ljrohan.com/blog/good-sleep-suggestions-part-i/ ), here are more for you to consider:

8. Listen to a bedtime story.

Load a familiar audiobook on your iPod—one that you know well, so it doesn’t engage you but distracts your attention until you drift off to sleep, suggests Dr. Shives. Relaxing music works well, too.

9. Stay cool.

Experts usually recommend setting your bedroom thermostat between 65° and 75°F—a good guideline, but pay attention to how you actually feel under the covers; if you are still experiencing a variety of menopause sleep problems, it may need to be a bit cooler. For optimal rest, once you’ve settled in to bed, you shouldn’t feel cold or hot—but just right.

10. Use a white noise machine to drown out city noises.

Unless you are lucky enough to live in a rural area, free of urban noise.

11. Eliminate sneaky light sources.

“Light is a powerful signal to your brain to be awake,” explains Dr. Shives. “Even the glow from your laptop, iPad, smart phone, or any other electronics on your nightstand may pass through your closed eyelids and retinas into your hypothalamus—the part of your brain that controls sleep. This delays your brain’s release of the sleep-promoting hormone melatonin. Thus, the darker your room is, the more soundly you’ll sleep.”

12. Check your pillow position.

Your head and spine need to be in a straight line to keep your body fully relaxed for restorative sleep. I have seen miraculous changes in people’s quality of sleep from just making this one change.

13. Contrary to popular belief:  Stay put if you wake up.

“The textbook advice is that if you can’t fall back asleep in fifteen minutes, get out of bed,” says Dr. Shives. “But I ask my patients, ‘How do you feel in bed?’ If they’re not fretting or anxious, I tell them to stay there, in the dark, and do some deep breathing or visualization.” But if lying in bed pushes your stress buttons, get up and do something quiet and relaxing (in dim light), such as gentle yoga or massaging your feet until you feel sleepy again.”

14. Spray a sleep-inducing scent.

Certain smells, such as lavender, chamomile, and ylang-ylang, activate the part of the brain which leads to relaxation and helps you sleep more soundly. Mix a few drops of essential oil and water in a spray bottle and give your pillowcase a spritz.

15. Take up yoga.

Doing yoga during the day, or adding a decompressing yoga routine before bed, slows down the body physically, and turns down the volume on noise in our heads, so we can sleep.

16. Add music to your nightly routine.

Soothing music (lovely classical or Gregorian chant) or nature sounds–I like beautiful birdsong,–are two easy ways to bring on peaceful slumber. Try listening to the music and doing some slow, deep belly breathing to help downshift everything from head to toe.

And last, but not least…

Keeping life interesting and mentally stimulating also promotes good sleep and slows telomere aging, as Chiara Cirelli, MD, PhD from the Department of Psychiatry, University of Wisconsin-Madison noted in her research.

Dr. Cirelli said “[Our] need for sleep is strongly modulated by the amount of brain plasticity during our day. The more we learn and adapt the more we need to sleep. A chronic decrease in sleep need could be due to reduced opportunity to learn and be exposed to novel experience, rather than, or in addition to, problems in the neural circuits responsible for sleep regulation.”

I know there are even more ways to call on the sandman, and I welcome any and all useful suggestions!

Until next time…Be Vibrant!

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