Simply being female puts all women at risk for breast cancer. That and age, race, family history, personal history, genetic make-up, when they had children, when they reach menopause, and a whole host of other possible factors.

Now U.S. doctors are officially calling body mass index, breast density, and alcohol consumption predictors of the disease, says Therese Bevers, medical director of the Cancer Prevention Center, at the University of Texas M.D. Anderson Cancer Center in Houston.

Bevers helped write updated guidelines for the prevention of breast cancer and presented them at the 12th annual National Comprehensive Cancer Network in Hollywood, Florida on Friday.

The guidelines, featuring the revised list of risk factors, also offer treatment options for women -- including bilateral mastectomy for women who have tested positive for the genes BRCA1 and BRCA2 as well as possible medical treatments with drugs such as tamoxifen and raloxifene.

The January issue of The Journal of Clinical Endocrinology & Metabolism reported that once a week treatment with Risedronate prevents bone loss in breast cancer patients who underwent treatment with chemotherapy.

Risedronate, a bisphosphonate used to strengthen the bone, is shown to increase bone mineral density (BMD) in the spine by 1.2% after one year of treatment. Markers of bone resorption decreased significantly in the treatment group compared with the placebo group.

The authors noted "These results have important clinical ramifications for breast cancer survivors who go into remission after aggressive therapy. Because of the long-term survival of this cohort, they are at risk for bone loss and osteoporosis. Skeletal integrity needs to be assessed and considered as part of their long-term management."

Some other topics on The Cancer Blog concerning bisphosphonates:

Premenopausal breast cancer patients and bone loss

Postmenopausal Breast Cancer Survivors at Risk for Osteoporosis

A drug commonly used to minimize the toxic effects of chemotherapy has been shown in mice to cause bone loss and promote tumor growth, according to the results of a recent study.

This drug, granulocyte colony-stimulating factor (G-CSF) -- also known as Neupogen, Neulasta, and Granocyte -- helps restore white blood cell counts that take a beating during chemotherapy, protecting cancer patients from an increased risk of infection.

According to researchers, G-CSF -- essentially a growth factor -- encourages bone breakdown. And any therapy that decreases bone density can enhance tumor growth in bones. So doctors are urged to closely monitor their patients during chemotherapy with regular bone density scans. They can also prescribe medications to prevent bone loss if necessary. And patients can protect their bones by consuming enough calcium and vitamin D and engaging in regular exercise.

Currently, research on cancer patients treated with G-CSF have not yielded the same strong results researchers found among mice.

The details of this study appear online in the journal Blood, and will be published in an upcoming print issue.

Zometa can help prevent bone loss in premenopausal breast cancer patients says a study published in the Journal of Clinical Oncology.

Young women that have estrogen receptor positive breast cancer can be treated with hormonal therapy. Some of these treatments can cause the loss of bone density. Treatment with drugs called bisphosphonates may be able to prevent this bone loss.

Zometa, a bisphosphonate, was studied to evaluate two different approaches to hormonal therapy. The patients received either Zoladex plus Tamoxifen or Zoladex plus the aromatase inhibitor, Arimidex. Half the women were treated with Zometa.

Women who did not receive the Zometa during hormonal therapy experienced significant loss of bone mineral density. Bone loss was worse for women treated with Zoladex and Arimidex than for women treated with Zoladex plus Tamoxifen. The women who did receive Zometa along with hormonal therapy had stable bone mineral density.

Bisphosphonates, the researcher concluded, should be considered for patients at risk of bone loss due to hormonal therapy.

Previous posts on the topic of bisphosphonates and Zometa:

Halting the spread of breast cancer to the bone

Prostate cancer and bone loss

Novartis cancer drug may cause jaw damage

Breast Cancer: Pain control improved for bone metastasis

There are various risk factors that can contribute to the development of breast cancer. Being female is the single biggest risk factor that on its own puts all women in jeopardy. But there are other risks -- many beyond our control and some more significant than others -- that can help explain why some women are diagnosed with the most common cancer in women in the United States. And why others are not.

Breast density has something to do with breast cancer. This is not really news. It's clear there is some kind of link, some kind of relationship, some kind of risk related to breast density for both pre- and post-menopausal women. It's just not clear how exactly breast density -- how much fat tissue fills the breast compared to other tissue -- contributes to breast cancer risk. But once it is clear, medical professionals will have a whole new arsenal of power in the fight against this deadly disease.

Cancer News in Context, a regular series of podcast commentaries produced by the Harvard Center for Cancer Prevention, highlights two recent studies that add weight to the fact that breast density is an important tool in breast cancer prediction and identifies two areas that with futher study might help determine why breasts that are very dense are associated with higher risks for breast cancer -- and why density may be as important a factor as age in determining risk.

Currently, mammograms are the chosen method for measuring breast density. But measurement is not required, and there are no national standards for how to measure. Once federal groups issue requirements and direction on how to classify density, women will receive more accurate assessments of their personal risk.

There is also speculation that altering breast density through hormonal therapy may lower risk. Perhaps genetics are the strongest indicator of risk, making short-term solutions ineffective, but perhaps certain interventions can override genetics, helping women protect themselves from breast cancer.

There are many issues that must be ironed out before we really understand how breast density affects breast cancer. There is no doubt that density, when added to other risk factors, will surely help improve the accuracy of prediction. It's one tool, among many, that is poised to open all sorts of doors.

Double the hormone, double the risk. Or so says one study of older women who take hormone pills. When estrogen and testosterone are combined, women face twice the chance of getting breast cancer, according to a study of more than 70,000 nurses. This type of combination therapy may help with mood, libido, and bone density -- but the possible risk of breast cancer may just outweigh these benefits. These findings, published in Monday's Archives of Internal Medicine, add to the evidence that certain types of hormone supplements -- like estrogen-progestin pills -- increase risk of breast cancer, strokes, and heart attacks in women. Other research points to a link between breast cancer and high natural levels of testosterone.

Women's natural levels of estrogen and testosterone decrease with menopause. Use of supplements has climbed over the past 24 years, perhaps putting more women at more risk. Estrogen-testosterone pills are sold under the brand names Estratest and Estratest H.S. and appear on a Washington-based advocacy group's "Worst Pills" list because of breast cancer risk.

I have tried to exercise most of my adult life -- at times because I felt obligated to participate in what I knew was good for me and at times to justify eating my favorite foods while maintaining an appropriate weight and at times because I wanted to actually have a toned, healthy body.

At this exact time in my life, I exercise with all of these motivations in mind -- plus a few more. I like to sweat and know I am accomplishing a physical feat. I like the mental release I get when I push my body to perform. I like the time to myself, the loud music I hear on my MP3 player, and the results I see from a little bit of hard work. And lately -- as a result of a new weight training program -- I know I am benefiting my body more than ever before.

The following are just seven of the many gifts that come from weight training. Gifts that will make me a happier, healthier cancer survivor.

Noticeable physical results -- Mostly, walking and occasional jogging have been my methods of exercise. And I've seen results from this type of workout -- leaner legs, more defined calf muscles, and the knowledge that I am increasing my cardiovascular health, as confirmed by the technician who performed an ultrasound on my heart in preparation for my Herceptin treatment for breast cancer. He told me he could tell I exercised regularly because of my low resting heart rate. But until I started weight training a few months ago, I never witnessed quick results. Yet after a few weeks of resistance exercise -- lifting 20-pound weights for my arms, shoulders, back, and chest -- I could see definition and tone that clearly would not have resulted from my purely cardio workouts.

Improved strength and endurance -- Lunges and squats and jumping with resistance bands have strengthened my legs. Lifting weights has strengthened my arms -- and I can now lift heavier weights than when I first started my new routine. I can do more push-ups now too -- not girl push-ups on my knees but real push-ups -- than I ever could have imagined doing when I could barely lower my own body weight and would crash to the floor on my stomach. My strength has improved. My endurance has improved. I feel more powerful.

Increased energy -- Fatigue (or maybe it's laziness) sometimes prevents me from happily jumping up to begin exercising. But when I push myself and exert myself and get lost in my exercise routine, my energy returns -- and not just during my workout but for some time afterwards too. Some say energy increases from strength training because it contributes to loss of fat which means we have less to lug around each day.

Burning of more calories -- Weight training raises basal metabolism which causes more calorie burning over a 24-hour period of time. Calories even burn during sleep as a result of weight training.  For every additional pound of muscle you gain, your body burns 50 extra calories every day -- 50 more calories than the few hundred that might burn from aerobic exercise. Research shows that regular resistance training can increase your Basal Metabolic Rate by 15%. So for someone who burns 2000 calories per day, that's upwards of 300 extra calories burned every single day. 

Decreased onset of illness -- Weight training can reduce the risk of adult onset diabetes and the risk for developing colon cancer and can improve the functioning of the immune system and the efficiency of the heart. It decreases the risk of low-back injuries, decreases resting blood pressure, increases good cholesterol (HDL), and improves posture. The list goes on -- and so does healthy living if weight training becomes a way of life. As a young person already having experienced a life-threatening illness, this comforts me.

Prevention of osteoporosis -- My recent bone density test revealed that I am not at this moment at risk for developing osteoporosis. I don't want this to change. Strength training can help me maintain this status because it can significantly increase bone mineral density -- which is important because we naturally lose bone density as we age. Strength training helps protect against osteoporosis. And age should not be a deterrent. Individuals who begin training late in life -- at age 65, for example -- can restore bone loss.

Improved outlook on life -- As a result of toning and shaping my body, burning calories, enjoying greater strength and energy, and working toward a disease-free future, weight training gives me an improved outlook on life. And weight training has recently been reported to significantly improve the quality of life of women recently treated for breast cancer. A May 2006 study indicates six months of twice weekly exercise was enough to improve the overall physical and emotional condition of patients.

Twice weekly is my weight training goal. I will continue to walk and run -- and bike on occasion too -- but strength training will be my priority. Because health is a priority.