Consider Signing Up for a Breast Cancer Clinical Trial: Here's How

Breastcancer.org, one of my favorite sites, has important information on clinical trials for breast cancer:

Clinical trials are research studies in which people agree to try new therapies (under careful supervision) in order to help doctors identify the best treatments with the fewest side effects. These studies help improve the overall standard of care.

Today, fewer than 5% of breast cancer patients receive treatment for their disease in a clinical trial. Why? One factor is that information about current trials and how to enroll in a trial are often not well understood. In this section, you can learn more about what clinical trials involve and how to join one. more. 

Cases of Hormone-Negative Cancers Decreasing

Good news for our daughters and granddaughters:

Women are increasingly more likely to have the less aggressive form of breast cancer, hormone-receptor-positive (ER-positive and PR-positive), with smaller tumors, according to research published in the March 2009 British Journal of Cancer.

Scottish researchers compared 420 tissue samples from 1984 and 1986 with 653 from 1996 and 1997. In that ten-year span, they found that the proportion of estrogen-positive cancers rose from 64.2 percent to 71.5 percent. More grade one tumors were also diagnosed.

The good news here is that these cancers are easily treatable, offering a more positive prognosis than estrogen-negative cancers.

Why?

Lifestyle changes could be one influence, as could better screening.  As usual, doctors say more research is necessary.   

Source: 

Brown, SBF, Mallon, EA, Edwards, J, Campbell, FM, McGlynn, LM, Elsberger,B, and Cooke,TG, “Is the biology of breast cancer changing? A study of hormone receptor status 1984–1986 and 1996–1997, British Journal of Cancer (2009) 100, 807–810. doi:10.1038/sj.bjc.6604934 www.bjcancer.com

Urine test can show spread of estrogen-receptor-negative breast cancer

Breast cancer spread—especially of estrogen-receptor-negative, including triple negative—can be detected through a urine test. 

This is according to research published online in Proceedings of the National Academy of Sciences February 23.   The urine test can detect tumors that are about to metastasize because they go through a process also seen in the development of human embryos, called epithelial to mesenchymal transition (EMT).  Phew!   A protein called lopcalin 2 (lcn2)  triggers the EMT in breast cancer and can be detected in urine. So a simple urine test for lcn2 could potentially predict the spread of cancer.  Women whose cancer has spread have especially high levels of lcn2.

“Lcn2 is among the genes most highly associated with estrogen receptor-negative breast tumors,” researchers Marsha Moses, Jiang Yang and colleagues at Children’s wrote.

Lipocalin 2 has been licensed to Predictive Biosciences,  in Lexington, Massachusetts for development of clinical use, which means the test may eventually be available for consumer use, although the process from laboratory tests to doctors' use can be slow and cumbersome.

Source:  

Jiang Yang, Diane R. Bielenberg, Scott J. Rodig, Robert Doiron, Matthew C. Clifton, Andrew L. Kung, Roland K. Strong, David Zurakowski, and Marsha A. Moses. Lipocalin 2 promotes breast cancer progression. Proceedings of the National Academy of Sciences, 2009; DOI: 10.1073/pnas.0810617106

Surviving Triple Negative Breast Cancer

If you’ve been diagnosed with hormone negative breast cancer, your doctor may have frightened you with the terms aggressive or lethal. Yes, this cancer is more on the march than estrogen positive, but it is survivable—and most women do survive it.  That fact too often gets lost in research reports.

Some stats.

63 percent of women with triple-negative status survive progression-free for three years, compared to 76 percent of hormone-positive women. That’s a lower number, but it still means most women survive. This comes from research in the International Journal of Cancer.

Women with hormone negative had a lower risk of recurrence at five years than hormone positive, according to research at the University of Texas M.D. Anderson Cancer Center. Five years after beginning therapy—chemotherapy, radiation, tamoxifen or all three—those with hormone negative disease faced a seven percent chance of recurrence, while those with hormone positive had a 13 percent chance. Or looking at it another way, 93 percent of those with hormone negative survived after five years while 87 percent of those with hormone positive did.

Docs say that, because more hormone-negative cases relapse within the first three years, women with this disease who are disease-free at five years have especially good odds. And at five years post-diagnosis, they have a better prognosis than women with the less lethal form of cancer.

Please support this site with your donations—that's what keeps it going.  Plus, if you donate just $25 you'll receive a copy of my book, Surviving Triple-Negative Breast Cancer. Click the Donate button on the right to donate through PayPal.   You'll then get an email from me asking if you want the book, how you want it signed and where you want it sent.  And if you just want to donate without receiving the book, that's wonderful. Thanks!  And hugs.   

Source: Bertucci F, Finetti P, Cervera N, et al: “How basal are triple-negative breast cancers?” International Journal of Cancer. 123:236-240, 2008.

Source: Brewster AM, Hortobagyi GN, Broglio KR, Kau SW, Santa-Maria CA, Arun B, Buzdar AU, Booser DJ, Valero V, Bondy M, Esteva FJ. “Residual risk of breast cancer recurrence 5 years after adjuvant therapy,” Journal of the National Cancer Institute, 100(16):1179-83. 2008.

Triple Negative Breast Cancer: Research Review 2

More take-outs from researchers Carey Anders, M.D., and Lisa A. Carey, M.D., in their research review of triple negative in the journal Oncology October 1, 2008. The entire article is available online.

Most, but not all, triple-negative breast cancers are basal-like.

Triple-negative breast tumors have been correlated with onset at a younger age, higher mean tumor size, higher-grade tumors, and, in some cases, a higher rate of node positivity.

 
Basal-like breast tumors were more likely among women who were younger at the onset of menstruation; have borne several children; were at a younger age at full-term pregnancy; had a shorter duration of breast-feeding; and higher body mass index (BMI) and waist-to-hip ratio (WHR), especially among premenopausal patients.

Women with triple-negative breast cancer were much more likely to develop a recurrence during the first 3 years following therapy with rapid declines thereafter. Translation: We can relax a bit after three years.

Patients with a “pathologic complete response”—meaning all traces of the cancer were eliminated— had excellent outcomes regardless of whether they were hormone positive or negative.

Source: C. Anders and L. A. Carey, “Understanding and Treating Triple-Negative Breast Cancer,” Oncology, Vol. 22, No. 11, October 1, 2008.

Nutrition Affects Hormone Negative Disease: An Overview

In her blog, Breast Cancer Information, Kim Dalzell, a doctor of holistic nutrition and registered dietitian,  offers insight into fighting hormone ngative breast cancer. Some of the points she makes:

Women who scored high on Harvard University's Alternate Healthy Eating Index had a lower risk of estrogen receptor negative breast cancer. The guidelines for this index: a daily intake of 9 servings of fruits and veggies, 7 or more grams of dietary fiber, 30-40 percent less saturated fat than polyunsaturated fats, less than 3 grams of trans fats and consuming 1 ounce of nuts. (February 2006, Journal of Nutrition.)

Women whose diets were deficient in folate, a B vitamin, had an increased estrogen receptor negative breast cancer risk. Folate-rich foods include: fruits like cherries, oranges and strawberries, beans and peas, and dark, green leafy veggies. (August 2005, Cancer Epidemiology Biomarkers and Prevention.)

Alcohol robs the body of folate and other B vitamins, so it's prudent to enjoy alcohol only occasionally, if at all. (August 2005, Cancer Epidemiology Biomarkers and Prevention.)

High intakes of linoleic acid were associated with more than a 300 percent greater risk of estrogen receptor negative disease than estrogen receptor positive disease. Linoleic acids are found in polyunsaturated fats like cottonseed, soybean, and corn oil as well as vegetable-based margarines. (The University of Texas MD Anderson Cancer Center research.)

Among premenopausal women, there was a reduced risk of both estrogen receptor negative and estrogen positive breast cancer for those women who consumed the highest lignan intake. Lignans are found in flaxseed, and to a lesser degree in sesame seeds and kale. (Breast Cancer Research Treatment journal, October 2006.)

New Breast Cancer Classifications

The American Cancer Society explains new classifications of breast cancer based on genetic research on its Web site. 

I quote them directly below.

The current types of breast cancer are based largely on how tumors look under a microscope. A newer classification, based on molecular features, may be better able to predict prognosis and response to several types of breast cancer treatment. The new research suggests there are 4 basic types of breast cancers:

Luminal A and luminal B types: The luminal types are estrogen receptor (ER)-positive, usually low grade, and tend to grow fairly slowly. The gene expression patterns of these cancers are similar to normal cells that line the breast ducts and glands (the lining of a duct or gland is called its lumen). Luminal A cancers have the best prognosis. Luminal B cancers generally grow somewhat faster than the luminal A cancers and their prognosis is not quite as good.

HER2 type: These cancers have extra copies of the HER2 gene and several other genes. They usually have a high-grade appearance under the microscope. These cancers tend to grow more quickly and have a worse prognosis, although they often can be treated successfully with targeted therapies such as trastuzumab (Herceptin) and lapatinib (Tykerb).

Basal type: Most of these cancers are of the so-called "triple negative" type -- that is, they lack estrogen or progesterone receptors and have normal amounts of HER2. The gene expression patterns of these cancers are similar to cells in the deeper basal layers of breast ducts and glands. This type is more common among women with BRCA1 gene mutations. For reasons that are not well understood, this cancer is also more common among younger and African-American women.

These are high-grade cancers that tend to grow quickly and have a poor prognosis. Hormone therapy and anti-HER2 therapies like trastuzumab and lapatinib are not effective against these cancers, although chemotherapy can be helpful. A great deal of research is being done to find better ways to treat these cancers.

It is hoped that these new breast cancer classifications might someday allow doctors to better tailor breast cancer treatments, but more research is needed in this area before this is possible.

Read more about TNBC in my book, Surviving Triple-Negative Breast Cancer.

Please consider a donation to Positives About Negative to keep this site going.  This work is entirely supported by readers.  Just click on the Donate button in the right of the page.  Thank you!

New Test Helps Predict Outcomes for Hormone-Negative

A new test can predict the most effective therapy for all women with breast cancer, including those with hormone-receptor-negative—estrogen-negative, progesterone-negative, Her2- negative, or a combination of all three, according to research conducted at Washington University School of Medicine in St. Louis and reported in advance of publication in the Journal of Clinical Oncology. Using a set of 50 genes, the test goes beyond the existing Oncotype DX test to offer diagnostic help that covers the four known types of breast cancer— luminal A, luminal B, HER2-enriched and basal-like. The last three types are generally considered types with a poor prognosis.  

Hormone-negative cancers, especially triple-negative, are most often basal-like.  Luminal A and B are hormone-positive; luminal B grows faster than luminal A.

"Unlike a widely used genomic test [Oncotype DX] that applies only to lymph-node negative, estrogen-receptor positive breast cancer, this new genomic test is broadly applicable for all women diagnosed with breast cancer," says breast cancer specialist Matthew Ellis, M.D., Ph.D., a member of the Siteman Cancer Center at Barnes-Jewish Hospital and Washington University.

In comparing the activity of the 50 genes to how well 133 breast cancer patients responded to chemotherapy, researchers found that the genetic test was highly sensitive and could predict chemotherapy response better than estrogen receptor status, progesterone receptor status or HER2 gene expression status.

Luminal A , a cancer that typically comes with a good prognosis, was not sensitive to chemotherapy, meaning that patients with that type can avoid chemotherapy in favor of hormone-based therapy. Among the poor-prognosis tumor types, basal-like breast cancer was the most sensitive to the chemotherapy and luminal B the least sensitive.

"Luminal B tumors are a very poor prognosis group, and none of the current conventional therapies are particularly effective against it," Ellis says. "The ability to identify luminal B tumors accurately makes it possible to develop better therapies for this type."

The researchers are investigating how each tumor type responds to the more than 50 drugs used for breast cancer. Because the gene set can be used with preserved tumor samples, the researchers plan to study tumor samples from breast cancer cases going back a decade or more. Patients in these cases have already been treated, which means the researchers can assess how well therapies worked for various breast cancer types.

NOTE:  The test is not yet available for consumer use.  I will research this and post additional information on when and where we might be able to have the test.

Hispanic Women Face Multiple Threat of Breast Cancer

Breast cancer in Mexican and Mexican-American women is likely to be

 

• detected at a later stage, leading to higher grade tumors; 

• triple-negative breast cancer, which is more aggressive. 

Mexican and Mexican-American women are also likely to have a family history of breast cancer, suggesting the BRCA gene mutation. 

This comes from preliminary results of a study led by Elena Martinez, Ph.D., of the University of Arizona and Arizona Cancer Center in Tucson and presented at the American Association for Cancer Research Science of Cancer Health Disparities Conference in Arizona. 

Of the 652 women in the study—309 living in the United States and 343 in Mexico—

• Only 22 percent reported that their cancers were found by mammography; the rest were found by palpable lumps, which often means a more advanced form of cancer.
• 28.1% of Mexican women and 19.3% among Mexican-Americans were diagnosed with triple-negative—Estrogen-negative, progesterone-negative and Her2-negative.

• most were overweight, with  high body-mass-indexes.

The limitation of this information:  

• the study has yet to be published—information was presented as an abstract only;
• the sample size was small;
• the sample did not include women without breast cancer for comparison.

Aspirin Doesn’t Reduce Breast Cancer Risk

A daily aspirin might aid the heart, but it offers little help in reducing the risk of breast cancer in premenopausal women, according to research data from the Nurses’ Health Study, published in the Archives of Internal Medicine. Use of other non-steroid anti-inflammatory drugs, or NSAIDs, also had no effect.

This is true regardless of dose, duration of use, and hormone-receptor status.

Earlier studies in mice had shown a preventive effect on breast cancer, but that so far has no translated to humans.

Source: Eliassen AH, et al "Use of aspirin, other nonsteroidal anti-inflammatory drugs, and acetaminophen and risk of breast cancer among premenopausal women in the Nurses' Health Study II" Arch Intern Med 2009; 169 (2): 115-121.

Surgery for Women with BRCA Gene Can Prevent Cancer

Removal of ovaries and fallopian tubes reduces cancer risk for women with BRCA1 and BRCA2 gene

Surgery to remove the ovaries and fallopian tubes has long been considered one of the most effective ways to decrease the risk of breast and gynecologic cancer for women with the BRCA1 or BRCA2 gene mutation. Now, research in the Journal of the National Cancer Institute underscores the effectiveness of the surgery. According to the research, an analysis of 10 independent studies, the risk reduction of this surgery—salpingo-oophorectomy—can be 80 percent for ovarian or fallopian tube cancer and 50 percent for breast cancer.

The BRCA genes are associated with triple-negative breast cancer, one of the most dangerous forms. Women with triple negative estrogen-negative, progesterone-negative, and Her2-negative.

Nevertheless, the researchers note that the  surgery is not the only route to risk reduction. Mastectomy and regularly MRI screenings have also been effective.

Source: “Meta-analysis of Risk Reduction Estimates Associated With Risk-Reducing Salpingo-oophorectomy in BRCA1 or BRCA2 Mutation Carriers,” Timothy R. Rebbeck, Noah D. Kauff, Susan M. Domchek, Journal of the National Cancer Institute, 101 (2), 2009, 80-87

Breast Cancer and the Economy

The economy is affecting all aspects of our lives, including cancer treatment. Breastcancer.org surveyed 500 breast cancer patients and survivors and found:

• 67% are concerned about how the economy will impact their breast cancer treatment or management.

• Among those who have finished treatment, 65% indicated that they’re concerned about how the economy might impact breast cancer management.

• 12% have had to alter their treatment plan because of a change in their financial situation or increasing costs: They have:

• Had to change s treatment plan. For example, they had to choose a shorter duration of treatment, select a less expensive treatment, or change a treatment location.

• Sought help from an assistance program, such as Medicaid or Medicare.

• Had to forgo treating another health condition in order to pay for breast cancer treatment.

• Have had to postpone treatment.

For a more analysis, insight, and suggestions for help, read breastcancer.org’s Breast Cancer Treatment and the Economy

Help for Maintaining a Healthy Weight

The January Calorie Count newsletter offers some good advice on maintaining your diet and exercise plan.  Check it out.  

Want to Beat Cancer? Exercise!

Research shows a strong correlation between exercise and reduction in breast cancer. In a 2006 study in the journal Cancer Epidemiol Biomarkers Prevention, researchers evaluated participants, ages 25 to 64 years, in Shanghai, China from August 1996 to March 1998. Women were given a questionnaire in which they reported their exercise patterns from adolescence through the ten years before the interview. The researchers determined:

• Exercise in adolescence and within the past ten years was also associated with decreased risk for receptor-positive and receptor-negative breast cancers s in both premenopausal and postmenopausal women. That means, basically, all women.

• Exercises benefited with a risk reduction of 30 to 60 percent over non-execisers. Again, this was true of premenopausal and postmenopausal women. As in, all.

• Activity during both adolescence and the last 10 years resulted in a risk reduction of 62 to 79 percent for receptor-negative breast cancer.

• Postmenopausal women benefited the most from exercise.

• Sweating during exercise within the last 10 years was also associated with decreased risk for receptor-positive and receptor-negative breast cancers among postmenopausal women.

So we mature ladies benefit from a little sweat. Researchers aren’t sure why.

SA Adams, CE Matthews, JR Hebert, CG Moore, JE Cunningham, XO Shu, J Fulton, Y Gao,and W Zheng, “Association of physical activity with hormone receptor status: the Shanghai Breast Cancer Study,” Cancer Epidemiol Biomarkers Prevention, June15, 2006, Volume 15, No. 6, 1170-8.

Triple Negative Breast Cancer: Research Review

Triple negative breast cancer, an especially aggressive form of the disease, is prevalent among young women and African-American women. Researchers Carey Anders, M.D., and Lisa A. Carey, M.D., published a thorough research review of triple negative in the journal Oncology October 1, 2008. The entire article is available online.

Key points:

• Triple negative breast cancer is a breast cancer subtype in which all hormone receptors are negative. That is, it is estrogen-negative (ER-), progesterone-negative (PR-) and negative for the human growth factor receptor Her2-neu.

• Estimates are that 172,000 women will have been diagnosed with triple-negative breast cancer in 2008.

• Most, but not all, BRCA1 breast cancers are triple negative.

• Triple negative responds well to chemotherapy, especially anthracycline and anthracycline/taxane.

• Triple negative does not respond to tamoxifen or aromatase inhibitors like Arimidex, so there is no standard follow-up treatment.

• Research on new treatments shows promise. These include epidermal growth factor receptor (EGFR), vascular endothelial growth factor (VEGF), and poly (ADP-ribose) polymerase (PARP) inhibitors, which are currently in clinical trials.

Source: C. Anders and L. A. Carey, “Understanding and Treating Triple-Negative Breast Cancer,” Oncology, Vol. 22, No. 11, October 1, 2008.

What's the proper follow-up after breast cancer treatment?

What type of treatment do you absolutely need once you finish breast cancer treatment? How much is too much? What’s too little? And what about diet and supplements?

Three doctors recently discussed helping patients stay healthy after breast cancer.  Their discussion, available through Medscape,  helps answer some of these questions. 

Participants were:

Antonio C. Wolff, MD, FACP, Associate Professor of Oncology, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, Maryland

Jennifer A. Ligibel, MD, Instructor in Medicine, Harvard Medical School, Boston, Massachusetts; Staff Physician, Dana-Farber Cancer Institute, Boston, Massachusetts

Anne F. Schott, MD, Associate Professor of Medicine, University of Michigan, Ann Arbor, Michigan; Staff Physician, University of Michigan Health System, Ann Arbor, Michigan.

My take-away points on all this:

• Most women with a diagnosis of breast cancer will survive their disease and go on to live full lives.

• Follow-up visits every 3 to 4 months for the first two years after completion of treatment is standard. This can be with an oncologist, radiation oncologist, surgeon, or a primary care physician. Usually it is a combination of the above.

• A mammogram at least yearly is recommended.

• The American Society of Clinical Oncologist guidelines recommend against “any surveillance blood testing or imaging studies in an otherwise-asymptomatic patient with a normal clinical exam.” Translation: If you do not have symptoms or problems, the recommendation is that there is no need for additional tests. Doctors often do testing to reassure women, although the reassurance, apparently, is not all that substantive.
That includes x-rays, PET scans and CT scans.

• Even though studies have not been conclusive, there’s enough evidence to support the benefits of low-fat diet and exercise in limiting risk of recurrence.   A low-fat diet is especially important for hormone negative breast cancer.

• Vitamin D is beneficial, even though research so far is not clear on its benefits to reduce risk of recurrence and on the dosage necessary. It has been shown to reduce bone loss.

• Carbohydrate-restricted diets like Atkins are not good for breast cancer survivors, especially those with ER-negative tumors.

Check Out the Triple Negative Foundation

The Triple Negative Foundation has an online replay of an educational teleconference on triple negative breast cancer. The foundation’s site also offers the opportunity to talk with experts and other women with triple negative breast cancer. The foundation was started in 2005 to honor Nancy Block-Zenna, who was diagnosed at age 35 with triple negative breast cancer and died in 2007. Nancy's friends launched the TNBC Foundation to raise awareness and support research on triple negative breast cancer. Check it out.

My Story: Weight Loss Through Diet Change

First: Don’t diet. Dieting implies a short-term change built on forcing yourself to eat unnaturally. A boiled egg for breakfast, yogurt for lunch, salad for dinner. Nobody can sustain that. You’re so hungry that when you see a Snickers, you head for a corner and snarf it down. And even if you conscientiously stick to the diet plan, you face trouble when you return to “normal” eating. Remember normal eating? That was what caused the weight gain to begin with.

Losing weight comes from changing your attitude toward food. Food is a source of energy and health, not a reward or a way to kill time. And eating healthy doesn’t mean you’ve ruined the social aspects of food. You can enjoy a convivial visit with friends over a well-balanced meal. And eating healthy can be every bit as satisfying as eating the fatty stuff.

The pleasures of overeating are fleeting, but the results long-lasting.

Some tips:

1. Create a spreadsheet and write down everything you eat. I focused only on calories, to simplify things, but I kept my eyes open to foods that were high in sodium or sugars. You’ll be surprised at how much the little things add up. Use a site like caloriecount.about.com to help you find nutrition information on the foods you eat. For example, that Snickers bar has 271 calories, 122 of those from fat. One bar has 26 percent of your daily recommended allotment of trans fat. It has a substantial 28.8 grams of sugar. Dieticians recommend that you keep sugar under 48 grams a day, so a Snickers gives you more than 50 percent of that. Think about it: Look at the fleeting pleasure, the lasting damage.

2. Be honest in the spreadsheet. If you have a glass of wine, look at the size. Five ounces of red wine have roughly 147 calories, according to the USDA. Yet, do you limit yourself to that small a portion? My wine glasses contain eight ounces, and I tend to fill them up, which raises the calorie count to 235. The larger glass then, has 88 more calories. In 40 days that extra wine will turn into a pound of fat. That’s nine pounds a year.

3. Remember the math. One pound equals 3500 calories. The average moderately active adult woman should consume 1800 to 2200 calories a day; moderately active adult males can consume 2200 to 2400 calories a day. If you cut 100 calories a day, you will lose one pound every 35 days. Likewise, if you add just 100 calories a day—about a third of a Snickers— you will add a pound every 35 days. I am here to tell you that it does add up, slowly, and with great chubbiness.

4. Replace high-fat habits with body-pleasing options. Before I turned healthy, I started each Sunday with two chocolate long johns and a Diet Coke. At the beginning of my weight-loss program, I cut this down to one long john and a Diet Coke. Eventually, I cut out both pastries and the Diet Coke. Instead, I now have whole wheat toast with cinnamon sweetened with Stevia. Cinnamon is an antioxidant, Stevia is a natural sweetener, and whole wheat can cut your breast cancer risk. I drink black cherry juice or decaffeinated coffee sweetened with natural agave juice. And I am fine with it. I do not feel like I am sacrificing treats at all.

5. Eat breakfast. The Weight Control Registry monitors people who have lost more than 30 pounds and kept it off for more than a year. Seventy-eight percent of respondents eat breakfast every day. Breakfast gets you going with energy, balances your metabolism, and keeps you from getting too hungry and overeating. I actually eat two breakfasts. I start with organic oats with blueberries and almond milk. In mid-morning, I drink a smoothie.

6. Smoothies are wonders. You can pack healthy goodies into a blender and make enough ahead of time for two to three days. I sip on the smoothie when others are drinking high-caffeine, high-fat coffee drinks. My recipe is simple: fat-free yogurt, a banana, green tea, black cherry juice, and whatever fruit I have on hand, usually some type of organic berries, either fresh or frozen.

7. Keep healthy snacks on hand. I have a mid-afternoon snack of organic broccoli dipped into hummus. I make a trail mix of pumpkin seeds, sunflower seeds, organic raisins, organic unsweetened dried cranberries, and almonds. You need no extra salt or sugar. I sometimes get fancy and buy yogurt almonds. I keep a Baggie of this in my purse for snacks whenever. Sometimes I mix it with broccoli for a truly yummy snack. I also like strips of green or red peppers, both powerful antioxidants high in Vitamin C and E

8. Keep unhealthy foods out of reach. Keep them out of the house if possible. I love peanuts and potato chips and tend to lose control when eating them. My husband has more sense and keeps them in his basement office drawer. I know where they are but have enough dignity to keep from stealing them from his office. I mean, really.

9. Eat at home. Restaurants are full of temptations, and there’s a reason they taste so good. Wonder why the pasta is so much better at your favorite Italian bistro than at home? Butter. Lots of it. You’re far more likely to maintain a healthy diet at home.

10. A low-fat diet can help reduce the risk of recurrence of hormone-receptor-negative (HR-)breast cancer, the type I was diagnosed with in 2006, according to the Women’s Intervention Nutrition Study (WINS). A low-fat diet—of 32 grams a day, or roughly 20 percent of your daily allotment of fat—caused women not only to lose weight, but to lower their risk of breast cancer. Those with HR- reduced their risk of recurrence by an impressive 42 percent. Women with hormone-receptor-positive breast cancer (HR+) also benefit from lower weight, according to a more recent study published in the November 26, 2008 issue of the Journal of the National Cancer Institute. The study, of 280,000 postmenopausal women, showed that the risk of breast cancer increased with weight gain.

11. Weigh yourself regularly. I do it daily and find it a significant motivator. If I am up more than three pounds several days in a row, I up my exercise and cut my calories until I get back down.

12. Exercise. Diet alone is usually not enough. Ninety percent of Weight Control Registry members exercise an average of an hour a day. I don’t do that much—I try for four hours a week.

My Story: Weight Loss Through Exercise

What I learned by using exercise as one tool to lose weight (with special thanks to the trainer who helped me succeed):

1. My pleasant strolls around the lake with my friend were lovely, but they were doing nothing for my cardiovascular system and were not helping me with weight loss. To be beneficial, exercise has to increase your heart rate. My goal was to get my heart rate up to 120 at least mid-way in a walk, and keep it there most of the way. That transformed my 45-minute stroll around the lake into a 30-minute workout.

Some tips on heart rate:

• Adults typically have a resting heart rate of 60 to 100 beats a minute. The lower the number, the better.

• On the other end of the spectrum is your maximum heart rate. Determine this by deducting your age from 220. I began my program at age 59, so my maximum heart rate was 161.

• When exercising, your aim should be reaching 60 to 80 percent of your maximum heart rate. My goal of 120 was about 75 percent of my maximum.

• It’s simple to measure your heart rate: Find the pulse point in your wrist or your neck until you can feel your pulse regularly enough to begin counting. Time yourself for 15 seconds. Multiply that by 4, to get the rate for a minute, or 60 seconds. If your rate is 30, your heart rate is at 120. A heart rate monitor can do this electronically, but your finger is cheaper and needs no batteries.

• Don’t overdo it. If you exercise at 85 percent or higher, you can do damage to your heart and your bones.

• Check with your doctor before getting started to make sure you have no health risks that would affect your exercise.

2. When I reached a goal, it was time to push myself more, not sit back and congratulate myself. If you want to continue losing weight, you have to keep increasing your exercise. Be reasonable. If you walk 30 minutes a day, add another five every two weeks or so. You can stop the increases once you have met your goal. At that point, keep exercising at the same rate to maintain that weight loss. Same thing with lifting weights. If you have been lifting 20 pounds at ten counts, gradually add more counts and more weights—first, go for 12 counts at 20 pounds, then 15 at 20 pounds. Then add five pounds and start the process again with ten counts at 25 pounds.

3. I had to listen to my body and do what it could handle. I tried jogging and liked it for a while—mostly I liked that I could do it. Eventually, though, my bones began to hurt and I had to be honest that it was just too jarring for my body. It helped me lose the weight, but I do not need it for maintenance. Occasionally, I run for a minute or two during a walk, just to get my heart rate up, but I do not try for any significant length. I am not opposed to jogging—for others. I just know it is not for me, and I know that if I hate doing something I will simply avoid it. I love walking and hiking, so that is my exercise of choice.

4. I don’t let myself get lazy. I stopped working with the trainer after a year, but I still have him in my head—it’s as though he’s sitting on my shoulder. When I am on a hike and think it is time to rest, or stop altogether, my interior voice tells me to keep going just a bit longer, push myself just a bit more. I have learned I can. And I am pretty doggone proud of that. And thankful.

My Story: Healthy Weight Loss

I weigh the same today as I did 25 years ago. In between, though, I gained and lost 50 pounds. Losing that weight, I am sure, helped me beat the breast cancer I was diagnosed with in 2006. And research shows that the exercise plan and low fat diet I adopted can help keep my cancer from returning.

So, yea for me for losing the weight. Why, though, did it take me so long to get to it?

The weight began creeping up in my early 40s when I started teaching. I loved the work, but it was exhausting while not being much of a workout; I spent hours at a time sitting and grading papers. I went home too pooped to exercise, but eager for a glass of wine and some comfort food. I went from a size 10 to a 12, 14, then 16.

I tried to diet. I would lose a few pounds, then gain them right back. It took me two months once to lose ten pounds. I regained it in two weeks. Clearly losing weight was impossible.

Then came my wellness exam of 2005. It did not go well. My blood sugar was high enough to put me at risk for diabetes, My cholesterol had spiked. And my weight was at an all-time high. My body mass index was 29.5—just .5 short of obese. I was a hair’s breadth away from being plain old fat and it was affecting my health.

I was 50 pounds overweight. I was carrying the equivalent of a four-year-old child of extra fat.

Plus, I was getting urinary tract infections as much as four times a year. I did research and was sobered by the fact that these can be a sign of immune system problems and diabetes. An out-of-whack immune system, I am sure, was one cause of my cancer.

When I got the written report than follows up the exam, nearly all of the ten pages listed one health risk I faced: diabetes, heart attack, cancer, stroke, you name it. Each page had the same reminder: “This would be improved if you would lose weight.”

Never before had I been given that message so blatantly: Lose weight if your health matters to you.

I considered my options. I wanted to focus on exercise as much as I could. I had always been active and enjoyed the outdoors and I wanted to enjoy hikes in the mountains again without puffing. But I knew I needed to eat less as well. And I knew I needed a system to keep me in line, to keep me in track.

Several friends recommended a personal trainer. One had lost 100 pounds working with him and was now running marathons. That had appeal, but the cost was high--$1500 for twice-weekly sessions for five months.

A colleague, though, reminded me that $1500 wouldn’t even cover my deductible if I had a heart attack. That was the permission I needed.

Rather than a luxury, I considered Tim Ives, my trainer, an investment in my health. He helped me drop the pounds gradually and, more important, keep them off.

And he taught me to change my perception of what I could do.

I learned that losing weight is a process that simply takes time and commitment. I began to actually work out—lifting weights, jogging, and walking briskly at least four hours a week. And I dieted. I limited myself to 1200 calories a day and kept track of them religiously. I usually lost weight consistently, but occasionally I would step on the scale and be a pound or two over. I was thrown, but I didn’t give up. I kept at it and the pounds dropped off.

I was paying a trainer good money. I was determined to show a benefit. Plus, I made a big deal out of the fact that I was going to lose weight. I had made a commitment in front of friends, family, and colleagues. And research shows that I did two things right: I got help, rather than trying to go it alone. And I went public. Both made me accountable for my weight loss.

When I signed up, I told Tim I wanted to lose 20 pounds. When I hit that level, I kept going because I had simply changed the way I lived. I plateaud  at 50 pounds and stayed there. It feels like I am where I should be.

There are far cheaper ways to do much the same thing, such as group trainers, online supports like caloriecount.about.com, and weight loss group like Weight Watchers. Tim was valuable, though, in educating me about how to benefit from exercise and how to keep from hurting myself. I had once tried a do-it-yourself exercise regimen and threw out my hip, sidelining me seriously for weeks and costing me a nice chunk of money for physical therapy.

Plus, Tim pushed me and didn’t let me slow down when things got tough. He showed me that I could do things I never thought possible. Bench press? Me? I was almost 60 and I had never lifted a weight in my life. High time, Tim said.

Tim weighed me every week and wrote down the results. With him watching and recording, I was embarrassed when I didn’t lose. More motivation.

The change in my diet was all my own.

On most days, I gave up butter, salad dressing, bread, dessert, fried foods, and cream sauces. I ate lots of vegetables and a good amount of fruit. I drank much water. Occasionally, though, I allowed myself a treat, because I could not stick to a diet that was too austere.

I never veered off the exercise, though. I took one day off a week, but adamantly laced up my running shoes on all other days.

I’ve lost that four-year-old child I used to carry everywhere and I’ve kept her off for nearly two years. As a result, exercise is easier and more fun. I hike quicker and easier, with far less puffing. This summer, I made it up the mountain by our Colorado cabin, my original goal when I began working with Tim. I was two years late, the cancer throwing me off a bit.

Exercise and eating right have become a new way of living, not a short-term change. I know I can never go back to my life of literally chewing the fat and spending my days in a desk chair. But feeling healthy and energetic and looking at myself in a size 10 is more important than the taste of any hot fudge sundae. Well, usually.

For details on how I did it, read My Story: Weight Loss Through Exercise and My Story: Weight Loss Through Diet Change.