Memory improvement: Exercise keeps your mind sharp

Stop searching for that secret supplement or magic pill that promises memory improvement as you age. Studies show that one of the best things you can do for memory improvement is physical exercise. In case you needed one more reason to get off the couch, researchers have found that exercise can increase your brainpower, help put off normal aging-related memory loss and, perhaps, even prevent dementia and Alzheimer's disease.

How much exercise do you need for memory improvement?

Studies haven't been consistent on this topic. What is clear, however, is that even small amounts of exercise can help you stay mentally sharp. And exercise is most beneficial for memory improvement when it's done regularly — at least three times each week.

Your ultimate goal should be to exercise at least 30 minutes a day most days of the week, as this is best for your heart. Several studies have found 30-minute exercise sessions are beneficial for your brain, too.

If you're just getting started, don't worry about the time. One study found 15-minute exercise sessions a few times each week reduced older adults' risk of dementia. The benefit was greatest to those participants who hadn't exercised previously. So if you're reluctant to exercise, remember that it won't take a great time commitment to reap the rewards. Break up your exercise sessions throughout the day, for instance into 10-minute periods of activity. Once you get going, you may find that adding more exercise time brings even more benefits for your health.

When can you expect results?

Normal aging-related memory loss occurs very slowly. Don't expect to be winning trivia contests after only a few weeks of exercise. But you can expect subtle changes over time. One small study found older adults who began walking for exercise improved their ability to multitask after six months.

The key is to be consistent and to keep at it. To stay motivated, try to:

• Set yourself up for success. Set small goals that you know you can achieve at first. Walk for 10 minutes at a time a few days a week. Once you reach that goal, add a few minutes to your exercise sessions every few weeks. Keep track of your activity so that you can see how far you've come. Post your goals somewhere visible — such as on the refrigerator — so you'll see them and be reminded of them every day.
• Join a group or start your own. You may find that exercise buddies keep you motivated. Join a walking group in your neighborhood or at your workplace, or start your own.
• Find a reliable location. If bad weather keeps you from getting outdoors, find a reliable indoor location that makes it easy to stick to your exercise routine. Health clubs are one solution, though they can be expensive. Shopping malls offer protection from the rain, cold or sun for walking.
• Find an activity you enjoy. If walking sounds boring, try swimming or riding your bike. Join a health club where you can try a variety of fitness classes.

If you aren't currently active, check with your doctor before beginning an exercise program. He or she can recommend types of exercise that may be safe for you.

Symptoms

DCIS usually has no outward signs or symptoms. However, some women may have a breast lump or nipple discharge associated with DCIS. Most often, though, DCIS is found on a screening mammogram, in which a radiologist identifies microcalcifications — tiny groups of calcium deposits — that indicate the presence of breast cancer. The microcalcifications appear on a mammogram as irregularly sized and shaped clusters of white spots.

Breast anatomy

Breast anatomy

Each of your breasts contains 15 to 20 lobes of glandular tissue, arranged like the petals of a daisy. The lobes are further divided into smaller lobules that produce milk during pregnancy and breast-feeding. Small ducts conduct the milk to a reservoir that lies just beneath your nipple. Supporting this network is a deeper layer of connective tissue called stroma. DCIS begins in the milk ducts of the breast.

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Breast calcifications

Breast calcifications

Calcifications are small calcium deposits in the breast that show up as white spots on a mammogram. Large, round, well-defined calcifications (left column) are more likely to be noncancerous (benign). Tight clusters of tiny, irregularly shaped calcifications (right column) may indicate cancer.

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Risk factors

In general, the factors that put you at risk of developing DCIS are the same as risk factors for developing invasive breast cancer.

Things that increase your risk of DCIS include:

• Older age
• Personal history of benign breast disease, such as atypical hyperplasia
• Family history of breast cancer
• Never having been pregnant
• First pregnancy after age 30
• Genetic mutations, such as in the BRCA1 or BRCA2 genes

It's unclear whether postmenopausal hormone therapy puts you at greater risk of developing DCIS, but most reports haven't found an association between the two.

Tests and diagnosis

Mammography is the most beneficial tool in identifying DCIS. Because DCIS may be present in your breast even though you can't feel it, getting regular mammograms can help identify microscopic breast changes that might be associated with DCIS. The American Cancer Society recommends screening mammograms once a year for all women beginning at age 40.

If your radiologist identifies suspicious areas on your mammogram, such as shadows or bright white specks (microcalcifications), he or she will likely recommend a breast biopsy to evaluate that breast tissue.

You may undergo one of these biopsy procedures:

• Core needle biopsy. A radiologist or surgeon uses a hollow needle to remove tissue samples from the suspicious area. As many as 15 samples, each about the size of a grain of rice, may be taken then sent to a lab for analysis.
• Stereotactic biopsy. This type of biopsy also involves removing tissue samples with a hollow needle, but with the help of stereo images — mammogram images of the same area obtained from different angles — in finding (localizing) the area of concern.
• Surgical biopsy (wide local excision or lumpectomy). If results from a core needle biopsy or stereotactic biopsy show areas of increased cell growth (atypical hyperplasia) or DCIS, you'll likely need a surgical biopsy to remove a wider area of breast tissue for analysis. Surgical biopsy for DCIS can determine whether or not you also have invasive breast cancer.

Core needle biopsy

Core needle biopsy

During a core needle biopsy, your doctor inserts a special needle into the suspicious area of your breast and withdraws several small, solid cores of tissue to send for testing.

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Coping and support

Any cancer diagnosis can be overwhelming and scary, even if it's a noninvasive, treatable form of cancer, such as DCIS. To better cope with your diagnosis, it may be helpful to:

• Educate yourself. The more you know about DCIS and your treatment options, the better prepared you'll be to make the best choices. Asking questions of your doctor or other members of your medical team is a good place to start. There are also excellent books on breast cancer and many reputable resources on the Internet. Be sure to look for the most current information because breast cancer treatments change rapidly. It may also help to talk with women who have been through a similar experience.
• Get support when needed. Don't be afraid to ask for help or to turn to a trusted friend when you need to share your feelings and concerns. Talk with a counselor or medical social worker if you need a more objective audience. Join a support group — in real life or online — of women going through a situation similar to yours.

It may take time to sort through your emotions, but you can still be in charge of your life and participate actively in decisions about your treatment.

Diet and exercise as breast cancer prevention strategies

Among the easiest things to control are what you eat and drink and how active you are. Here are some strategies that may help you decrease your risk of breast cancer:

• Limit alcohol. A strong link exists between alcohol consumption and breast cancer. The type of alcohol consumed — wine, beer or mixed drinks — seems to make no difference. To help protect against breast cancer, limit alcohol to less than one drink a day or avoid alcohol completely.
• Maintain a healthy weight. There's a clear link between obesity — weighing more than is appropriate for your age and height — and breast cancer. This is especially true if you gain the weight later in life, particularly after menopause. Excess fatty tissue is a source of circulating estrogen in your body. And breast cancer risk is linked to how much estrogen you're exposed to during your lifetime.
• Stay physically active. Regular exercise can help you maintain a healthy weight and, as a consequence, may aid in lowering your risk of breast cancer. Aim for at least 30 minutes of exercise on most days of the week. If you haven't been particularly active in the past, start your exercise program slowly and gradually work up to a greater intensity. Try to include weight-bearing exercises such as walking, jogging or aerobics. These have the added benefit of keeping your bones strong.
• Consider limiting fat in your diet. Results from the most definitive study of dietary fat and breast cancer risk to date suggest a slight decrease in risk of invasive breast cancer for women who eat a low-fat diet. But the effect is modest at best. However, by reducing the amount of fat in your diet, you may decrease your risk of other diseases, such as diabetes, cardiovascular disease and stroke. And a low-fat diet may protect against breast cancer in another way if it helps you maintain a healthy weight — another factor in breast cancer risk. For a protective benefit, limit fat intake to less than 35 percent of your daily calories and restrict foods high in saturated fat.

Birth control pills and breast cancer prevention: No easy answers

There's no evidence of an across-the-board link between birth control pill use and breast cancer risk. Analysis of combined data from many older studies suggests a slight increase in risk of premenopausal breast cancer. The pills used in these studies, however, include preparations that contained higher estrogen doses than what is available in preparations prescribed today. The analysis of these older oral contraceptives also showed that women who took the pill for four or more years before their first full-term pregnancy had a larger increase in premenopausal breast cancer risk. Still, experts analyzing all the risk data estimate that birth control pill use causes, at most, 4.7 out of 10,000 cases of premenopausal breast cancer.

New directions in research

Scientists are continually making new discoveries that may impact breast cancer prevention. Among the most promising agents are retinoids and flaxseed.

• Retinoids. Natural or synthetic forms of vitamin A (retinoids) may have the ability to destroy or inhibit the growth of cancer cells. Unlike other experimental therapies, retinoids may be effective in premenopausal women and in those whose tumors aren't estrogen-positive. Research is ongoing.
• Flaxseed. Phytoestrogens are naturally occurring compounds that lower circulating estrogens in your body. Flaxseed is particularly high in one phytoestrogen, lignan, which appears to decrease estrogen production and which may inhibit the growth of some breast cancers.

Do what you can

In addition to lifestyle changes, be vigilant about early detection of breast cancer. Start having yearly mammograms at age 40. If you notice any breast changes, such as a new lump or skin changes, make an appointment to see your doctor for evaluation.

Nothing you do can guarantee your life will be cancer-free. But if you practice healthy habits and consult your doctor about extra measures you can take, you may at least reduce your risk of this potentially fatal disease.

Who should consider genetic testing?

Out of the 212,920 new cases of breast cancer diagnosed in the United States last year, only 10,000 to 20,000 cases were inherited — and only a fraction of those were linked to BRCA1 and BRCA2 mutations. This small number means that for the majority of women who develop breast cancer, the cancer occurs sporadically and isn't caused by hereditary factors.

The picture changes if two or more of your first-degree relatives — parents, siblings, children, or one of each — have developed breast or ovarian cancer. In that case, genetic counseling is recommended. Genetic counseling is a communication process between you and a genetic counselor. The genetic counselor takes a detailed family and medical history, assesses your risk of developing cancer, discusses risks and benefits of genetic testing, and determines your options. A genetic counselor can help you develop an appropriate strategy for dealing with your cancer risk in the context of your individual situation.

If, through genetic counseling, you discover that your risk of carrying a BRCA1 or BRCA2 mutation is high, you may decide to undergo genetic testing to see if you actually do have a mutated gene.

How much higher is your risk of cancer if you have a BRCA mutation?

If you have a BRCA mutation, your chances of developing breast or ovarian cancer during your lifetime are substantially higher than are the rates for the general population.

Many factors come into play in risk estimates, including differences in the gene mutation, the location of the mutation and the woman's ethnic background.

A study of more than 1,000 women of Ashkenazi Jewish descent provides what could be a clearer picture of the breast and ovarian cancer risks for women with BRCA mutations. Researchers identified a lifetime risk of breast cancer mutations of 20 percent by age 40, 55 percent by age 60 and 80 percent by age 80 in Ashkenazi Jewish women with BRCA. The lifetime risk of ovarian cancer was 54 percent for women with BRCA1 mutations and 23 percent for women with BRCA2 mutations.

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