By Dr. Penny Stern

The words "breast cancer" have long been part of our lexicon. And few words are scarier. The good news is that prevention is now more possible than ever, thanks to the work of researchers like Dr. Christine Molmenti, who has spent more than a decade designing and conducting clinical trials focused on breast cancer. After a recent presentation, we spoke about practical advice for breast cancer prevention.

"Adopting a healthy lifestyle and knowing your family history are two of the most important steps you can take to avoid breast cancer," Dr. Molmenti said, noting that dozens of research articles have shown that the more healthy lifestyle recommendations are followed, the more breast cancer risk decreases. Her lifestyle recommendations include these:

• Physical activity. Engage in vigorous physical activity most days of the week to decrease risk of pre-menopausal breast cancer.

• Alcohol. Avoid consuming alcoholic drinks, because they increase the risk of pre- and post-menopausal breast cancer.

• Weight. Maintain a healthy weight to decrease the risk of post-menopausal breast cancer.

• Breastfeeding. Physical and hormonal changes during breastfeeding lower the risk of breast cancer.

• Diet. Focus on a plant-based diet with an abundant variety of fruits, vegetables, beans and whole grains.

"The American Institute for Cancer Research/World Cancer Research Fund (AICR/WCRF) provides ten cancer prevention recommendations, which every woman should try to adopt into her daily routine," Dr. Molmenti advises. "They hold the largest evidence-based source of scientific research on breast cancer prevention through diet, physical activity  and body weight," she adds. The recommendations are backed by powerfully persuasive data, "from 119 studies around the world. comprising more than 12 million women and 260,000 cases." These are:

• Healthy Weight. Keep your weight within the healthy range and avoid weight gain in adult life.

• Physically Active. Walk more and sit less.

• Health Diet. Make whole grains, vegetables, fruits, greens and pulses (legumes) such as beans and lentils a major part of your diet.

• Limit Fast Foods. Limit your consumption of fast and processed foods high in fat, starches and sugars to help limit caloric intake and maintain a healthy weight.

• Limit Red and Processed Meat. Eat no more than moderate amounts of red meat such as beef, pork and lamb. Eat little, if any, processed meat.

• Limit Sugary Drinks. Drink mostly water and unsweetened drinks.

• Limit Alcohol. For cancer prevention it is best not to drink alcohol.

• No Supplements. Aim to meet nutritional needs through diet alone.

• Breastfeed If You Can. Breastfeeding is good for both baby and mother.

• After A Cancer Diagnosis. Check with your health professional.

The guidelines are similar, and both mention exercise and alcohol. I asked Dr. Molmenti how exercise helps lower the risk of breast cancer. She said there are several potential ways: "Reducing overall and specific types of body fat (e.g., visceral fat) reduces insulin insensitivity, fasting insulin and c-peptide levels, which are associated with reduced breast cancer risk. Physical activity also reduces circulating estrogens and androgens, and improves immune function. Also, physically active women are more likely to be exposed to the sun (and maintain higher Vitamin D levels), all of which decreases the risk for breast cancer."

As to alcohol, she noted that many women are unaware of the connection between alcohol and cancer. "Alcohol is considered a human carcinogen and is causally associated with seven different cancers, Dr. Molmenti explained. "According to the AICR/WCRF, consumption of alcoholic drinks is a probable cause of pre-menopausal, and a convincing cause of post-menopausal, breast cancer. Binge drinking is particularly problematic for younger women as the 'window of susceptibility' for breast tissue is between menarche (first period) and first pregnancy. This is a time when breast cells are rapidly dividing and more susceptible to DNA alteration."

Dr. Molmenti is an assistant professor in the Center for Health Innovation and Outcomes Research and the Feinstein Institute for Medical Research And the Department of Occupational Medicine, Epidemiology and Prevention at Northwell Health in New York, as well as the Science Analyst for the AICR, among many other important credentials. Dr. Stern is a physician at Northwell Health, where she serves as Director, Preventive Medicine, at the Katz Institute for Women's Health and the Department of Occupational Medicine, Epidemiology and Prevention.