My mother, great-grandmother and great-aunt all had breast cancer, and I worry often about getting cancer. I have become a strict vegetarian, and I exercise several times a week. However, I am large-breasted and worry that a tumor may not be found on a mammogram. Would breast reduction surgery help? Am I worrying too much? Are there other things I should be doing to help prevent this from happening to me?

--Lisa

Certainly a low-fat vegetarian diet may help reduce risk of breast cancer. Avoidance of alcohol is another step you can take. Not smoking cigarettes is a big help in reducing the risk of many cancers, including breast cancer.

Unfortunately, there is nothing you can do to change the genes you were born with. Some cases (about 10 percent) of breast cancer are due to a faulty gene. Testing is available to see whether any of the known faulty genes runs in your family. Your gynecologist may be able to refer you to a center that does the test, as well as the counseling that must be done beforehand. Interpreting the results can be complex; having the gene does not mean you will absolutely get breast cancer, nor does absence of the gene absolutely guarantee you will not. It merely gives you more information about your odds.

As for breast reduction, there are many valid reasons to have this procedure, such as decreasing back, neck and shoulder pain from large breasts. Breast reduction, however, will not necessarily make mammograms easier to interpret. In fact, scarring that may result from a breast reduction may cause shadows on a mammogram that can be confusing. Breast size does not make mammograms more or less difficult to do, but if the breasts are dense, as they are in younger women, regardless of size, it will be harder to see a small abnormality. Monthly breast self-exam is an important way for you to become familiar with your breasts so that you may possibly pick something up early. Make sure that your yearly physical exam includes a thorough breast exam by the physician. Ask your doctor to show you how to do a proper self-breast exam. For some people at risk, the screening recommendations will be different, talk to your doctor about this too.