Hello, Pinkies! 19 days until the launch of Dr. Lissa Rankin's book What's Up Down There? Questions You'd Only Ask Your Gynecologist If She Was Your Best Friend, on shelves September 28 (preorder here)!  If you have a question you'd like Dr. Lissa Rankin to answer in her blog, please join the What's Up Down There posse in our Owning Pink community, and be sure to check the book tour page and Team Pink headquarters for all the deets on Lissa's upcoming travels...

Q: I don’t have a history of breast cancer in my family, but neither did my best friend who was diagnosed last year. Her experience really rattled me. I do my best to exercise, eat healthy and go for annual mammograms. But I’d still like to know if there’s a way to gauge my risk. Any suggestions?

I’m so sorry about your best friend, and I can certainly understand why her breast cancer diagnosis shook you up. You may think you’re safe if you have no family history, but according to the NIH, only 20-30 percent of women who are diagnosed with breast cancer every year actually have a family history of the disease. That’s why breast cancer screening is important for every woman.

Testing other factors, like hormones, may be helpful in calculating breast cancer risk in women with or without a family history. There’s one hormonal test in particular that can gauge breast cancer risk: the 2/16 estrogen metabolism test. Estrogen is metabolized along two different metabolic pathways that result in two metabolic biproducts -- one called 2-hydroxyestrone (2-OHE1) and another called 16-alpha-hydroxyestrone (16-OHE1. All women have both estrogen metabolites, but those who have relatively higher levels of 2-OHE1 than 16-OHE1 appear to have a lower risk of breast cancer. Several studies show that women diagnosed with breast cancer have a lower ratio of 2-OHE1 to 16-OHE1 than age-matched disease-free women and that those with a higher 2/16 ratio may be at lower risk.

If you are concerned, you could ask your doctor to order a morning urine test to gauge your 2/16 ratio. The good news is that even if your ratio is less than desirable, it can be altered through diet and lifestyle measures. Studies done at the Institute for Hormone Research in New York showed that supplementing your diet with cruciferous veggies (like broccoli, cauliflower brussel sprouts, kale, arugula), which contain indole 3-carbinol, can shift the 2/16 ratio. Studies indicate the compound’s value as a chemopreventive agent for breast cancer through its estrogen receptor (ER) modulating effect. Ground flax seed and omega-3 fatty acids may also benefit the 2/16 ratio.

You’ll also want to limit meat, dairy, and eggs that may have hormones added. Also, choose organic veggies, free of estrogenic pesticides, when possible. Adding a calcium D-glucarate supplement may also help shift estrogen metabolism to lower the risk for breast cancer. This botanical extract, found in grapefruit, apples, oranges, allows the body to excrete used hormones, such as estrogen, before they can become reabsorbed. Because cruciferous vegetables can be hard to digest, some find it easier to supplement with diindolylymethane, one of the metabolites of Indole 3-carbinol, which has been demonstrated in clinical studies to induce a favorable 2/16 ratio.

A useful adjunct to the 2/16 estrogen metabolism test is breast thermography, an infrared study of the heat given off by the breast which may predict those with higher risk of breast cancer. When used together, in addition to mammography, your doctor can better gauge your breast cancer risk and help you implement a breast health program that will minimize your personal risk.

Hope this helps! Wishing you peace and guidance on your journey,

Lissa