Mrs. Matsui is a 56 year old post menopausal Japanese woman who presents today for her annual physical exam. She expresses to you that she is somewhat worried about developing breast cancer, as many of her friends are either going through treatment or have friends/family members who are.She states that she has never practiced self breast exams nor has she had a mammogram as rates of breast cancer in Asian women tend to be lower than Western women.Mrs. Matsui states that she has had Pap smears in the past and they were all normal.

Mrs Matsui reports a history of hypothyroidism x 13 years, for which she is currently taking Levothyroxine 100 micrograms PO QD.She has two daughters, both born vaginally without any complications.She breast fed both up to about a year of age.Her age of menarche was at 11 years of age.She has never used hormonal contraceptives.

Mrs. Matsui reports that both of her parents are still living in Japan, and are relatively healthy.She comments that their diet is key to their health and since immigrating to the US in her 20s she has adopted a Western diet of high fat and high calories.She is currently overweight, does not smoke or drink, and consumes little fruit or vegetables.She states that she tries to get some exercise, but that she has become very sedentary over the years. She cooks with vegetable oil and eats lots of processed food.

Based on the background information, how would you proceed to counsel Mrs. Matsui regarding her lifestyle and risk factors for breast cancer?You must list sources for your arguments.