Almost 20 Years Later, Breast Fitness Is More Relevant Than Ever

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Title: Breast Fitness: An Optimal Exercise and Health Plan for Reducing Your Risk of Breast Cancer
Authors: Anne McTiernan, MD, PhD; Julie Gralow, MD; and Lisa Talbott
Publisher: St. Martin’s Press
Publication Date: October 2000 (first edition)
Price: $48.75, hardcover, 352 pages


The National Cancer Institute (NCI) has identified about 14 cancers associated with obesity, including breast cancer, which, excluding some types of skin malignancies, is the most common cancer among American women of all races and ethnicities. Although the metabolic and psychological processes that cause obesity are more complex than the calories in–calories out formula, dietary habits and lack of physical exercise play an important role.

In 2000, Anne McTiernan, MD, PhD, Julie Gralow, MD, and Lisa Talbott published Breast Fitness: An Optimal Exercise and Health Plan for Reducing Your Risk of Breast Cancer—a book as relevant now as it was then. “You are your own primary health-care provider. No health professional can provide the same amount of individual attention, focus, and energy that you can provide for your own health care,” write the authors in the introduction to this valuable book.

Organized in 23 chapters, Breast Fitness details how well-structured exercise can help reduce the risk of breast cancer and reduce the treatment-related symptoms faced by many women battling the disease. The authors use clear, accessible language and simple charts, drawings, and photographs to highlight their practical steps toward better breast health.

Although statistics and clinical trial data can cause lay readers to skim pages or close the book altogether, the authors use statistics wisely to bolster their guidance. In chapter 2, they offer some sobering numbers about breast cancer in the new millennium and these numbers hold true today: a new breast cancer will be diagnosed every 2 minutes, and a woman will succumb to the disease every 13 minutes. The authors, however, tell readers that due to scientific advances, breast cancer has become largely preventable and treatable.

Chapter 2 deftly outlines the current knowledge on the factors that increase and decrease a woman’s chance of developing breast cancer. Prior to that, the reader is offered a well-written and highly informative narrative on breast cancer, including the causes and risk factors, and a neatly drawn bullet-point summary.

Evolving Science

One challenge in writing about cancer is the field’s rapidly evolving knowledge base. For instance, the Human Genome Project began in 1986, but it did not release its completion of the human reference genome until 2003—3 years after this book was published. Massively parallel sequencing was introduced in 2004, demonstrating the feasibility of sequencing tumor genomes, putting the application of these tools on the horizon for routine research and clinical diagnosis.

Since then knowledge of genomics has skyrocketed in the oncology community. Chapter 4 discusses risk-reduction measures for all women, although some of the recommendations for mammography and self-breast examination might not concur with current standards set by the U.S. Preventive Services Task Force and other cancer organizations. The section on prophylactic mastectomy is thorough, and the advice remains timely, although a bit more on counseling would have been helpful. The section on breastfeeding and cancer-risk reduction is also current.

The Obesity-Cancer Connection

The book picks up steam in chapter 5, which describes the research demonstrating that regular exercise is associated with a reduced risk for breast cancer. One surprise is the prescient section detailing the relationship between obesity and cancer. Readers will note with dismay that this corollary was written about nearly 20 years ago, and during that period, obesity rates in the United States have only increased.

Although the discussions of prevention are central to the book’s theme, the authors do an exemplary job of including women with breast cancer as well, stressing that they should begin physical rehabilitation programs as soon as pain and other complications of their therapy are controlled. To that end, they detail the benefits of exercise in patients with breast cancer in several sections, including an excellent section on lymphedema.

Team Survivor

Chapter 13, “Team Survivor,” falls about midway through the book. At the time of publication, coauthor Lisa Talbott is National Director of Team Survivor, which promotes fitness by giving cancer survivors the support, skills, and knowledge needed to reach and maintain their health and fitness goals. Readers are treated to many compelling personal testimonials by Team Survivor members; they are not only heartfelt and inspiring, but also instructive for women with cancer and cancer survivors.

You are your own primary health-care provider. No health professional can provide the same amount of individual attention, focus, and energy that you can provide for your own health care.
— Anne McTiernan, MD, PhD; Julie Gralow, MD; and Lisa Talbott

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Dr. Gralow is Medical Director and team physician for Team Survivor Northwest, a nonprofit group focused on helping female cancer survivors improve their health through exercise. She is also the Founder of the Women’s Empowerment Cancer Advocacy Network (WE CAN), a group dedicated to empowering patient advocates in low- and middle-income countries, and Co-Chair of the Breast Cancer Initiative 2.5, a global campaign to reduce disparities in breast cancer care.

One challenging psychosocial issue that women with breast cancer may face is setting goals and structuring an exercise program. The authors spend much time helping women deal with obstacles to goal-setting, focusing on difficult areas such as fatigue and low energy levels. They provide a 12-point fatigue assessment chart, management strategies, and exercise tips.

For Oncologists and Patients Alike

This book is filled with value-added content. -Appendices include tools to calculate body mass index, a guide to estimate average calories burned per hour, a compilation of resources and recommended readings, along with a glossary. Although Breast Fitness was published in 2000, it remains fresh and current. The information in this book should be shared with oncologists and their patients. Considering the projected rise in cancer incidence the book’s central message about healthful living and exercise is now more important than ever. This book is highly recommended for readers of The ASCO Post