Lifestyle Modifications That May Decrease Risk of Recurrence, Manage Treatment

Lifestyle modifications that may decrease risk of recurrence, manage treatment effects, and improve quality of life include:

A) Exercise-recommend 150 minutes of moderate aerobic exercise per week
B) Smoking cessation
C) Improving nutrition and limiting sun exposure
D) All of the above
Questions 5-7
Betty is a 43-year-old female with a history of ER+ breast cancer diagnosed at the age of 28 s/p right lumpectomy/axillary lymph node dissection, chemotherapy with Adriamycin and Cyclophosphamide every 2 weeks x 4 cycles followed by Paclitaxel every 2 weeks x 4 cycles and completed radiation therapy in 1999. She had a local recurrence in 2003 and was treated with re-excision and completed 10 years of endocrine therapy with Letrozole and Goserelin in 2014. Her family history is significant for a paternal aunt with breast cancer, paternal cousin with BRCA2 mutation and breast cancer at age 30. She presents to you with worsening, intermittent left rib pain for the past 6 months in spite of nonsteroidal anti-inflammatory drugs (NSAID) use or massage.