Becoming knowledgeable about this disease will help you ward off its most damaging effects.

A FEW MONTHS AGO, one of the nurses in my office announced she was participating in a walking marathon. She was garnering support from the physicians and staff members asking that we make a pledge in her name.

She shared with me her apprehension about the event. The date was fast approaching and, since she wasn't a regular walker, she was quite concerned about whether she'd be physically fit enough to meet the challenge. This event, the American Cancer Society's "Making Strides Against Breast Cancer" walk, held special meaning for her, and she was determined to participate, no matter what.

Her 46-year-old best friend died of breast cancer the previous year. She would be walking in this event with her friend's 19-year-old daughter. They would be donning T-shirts with her friend's name and smiling face on the front in commemoration of her life.

My associate succeeded in completing the walk, along with thousands of other participants whose lives were in some way affected by breast cancer.

October is Breast Cancer Awareness month. Throughout the country, women and men alike will wear pink ribbons and participate in a variety of events to honor survivors, remember the deceased, promote education and support research to find a cure.

Every 12 minutes a woman dies of breast cancer. Breast cancer comprises 15 percent of all cancer deaths in women, claiming more than 40,000 lives each year; second only to lung cancer.

But though lung cancer is now the most common cause of cancer death in women, breast cancer remains the most frequently diagnosed, with approximately 211,000 cases expected to be identified in women in 2005. Presently, more than 2 million women in the United States have been diagnosed and treated for this disease.

WHO IS VULNERABLE? There are several known risk factors for breast cancer. Clinically speaking, a risk factor is anything that can increase your chances for developing a disease.

Keep in mind, however, that many women who have one or more risk factors for breast cancer will never get the disease, and most women who develop breast cancer have no obvious risk. Nevertheless, it is still important for us to increase our knowledge by learning these various risks.

Breast cancer, like other diseases, has both risk factors over which you have no control and those that can be eliminated or changed. We refer to these as non-modifiable and modifiable risk factors, respectively.

Non-modifiable risks. These are the elements we cannot change that may put us at risk. Being born a female and growing older are certainly beyond our control, but they are definite risk factors for the development of breast cancer.

Women who began their menstrual cycles early (before age 12) or who went through menopause late (beyond age 55) have a slightly higher risk for breast cancer. A woman who has already developed breast cancer has a threefold to fourfold increased risk of developing another cancer in the other breast or in the treated breast, and women with abnormal (but non-malignant) breast biopsies may also have a slightly higher risk.

Another risk we cannot change is our family history. If you have two or more relatives with breast cancer; if it occurs in your mother or sister at any age; or if it develops in a mother, sister, aunt or grandmother before the age of 50, all result in an increased risk. Recent studies have determined that 5 percent to 10 percent of cases of breast cancer are hereditary.

Modifiable risks. Although a number of things are not within a woman's power to change, a few of the risks are potentially modifiable. The age a woman starts having children and the number of children she has will influence her risk.

Women who have no children or who delay childbearing beyond age 30 have a slightly higher risk for breast cancer, while those who get their families started at a younger age and have multiple pregnancies are at a lower risk. Breast-feeding may impart a protective effect, especially if the child is nursed for more than a year.

Alcohol consumption is certainly a modifiable risk factor. Studies show that women who have two to five drinks a day are 1.5 times more likely to develop breast cancer than non-drinkers.

The long-term use of hormones after menopause, particularly estrogen and progesterone combination therapy, increases the risk for breast cancer. This type of hormone replacement therapy will not only increase the likelihood of developing breast cancer, but it also increases the possibility that the disease, once discovered, will be at a more advanced stage.

If you are on this form of therapy for osteoporosis or to curtail hot flashes and other symptoms of menopause, discuss the risks and benefits of this treatment with your doctor. There are other effective ways to treat both osteoporosis and menopause that won't increase your chance of developing breast cancer.

Of course maintaining a healthy body weight and engaging in regular physical activity is beneficial to our overall health. Although we typically associate obesity and a sedentary lifestyle to an increased risk for cardiovascular disease, studies have consistently shown that being overweight or obese also increases the risk for breast cancer. This is especially true for women who have excessive fat in the waist area as opposed to the hips and thighs.

And evidence continues to mount connecting physical activity to a lower risk for breast cancer. In one large study, even modest levels of regular brisk walking reduced the risk for breast cancer by 18 percent.

Although there are no clear-cut ways to prevent breast cancer, it makes perfectly good sense to minimize those modifiable risk factors such as excessive alcohol consumption, hormone replacement therapy, inactivity and being overweight. This is especially the case since these are all associated with a host of other illnesses and diseases.

Beyond risk factor modification, the next approach in curtailing the burden of breast cancer is through early detection. As a general rule, the earlier a cancer is diagnosed, the better the outcome in terms of treatment and survival.

KARA DAVIS, M.D., is a doctor of internal medicine and a former assistant professor of medicine at the University of Illinois. She is also the author of Spiritual Secrets to Weight Loss (Charisma House).

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