I know that sometimes breast cancer behaves like a demonic bolt out of the blue and seems totally unexplainable and blithely unresponsive to medical treatment. It also seems that most breast cancer obeys recognized rules — it's the unwelcome result when factors promoting the illness overcome the host's resistance to the illness. We don't know all the factors, but that doesn't stop my interest in raising the odds. I want to maximize resistance to the more orderly forms of the disease.

I admit to being a bit hypervigilant when it comes to research findings about breast cancer risk. I pursue any lead that might suggest a healthy intervention with some hope of reducing breast cancer risk. Everything I recommend has some basis in medical observation, but many lack the support of medical consensus. Bottom line, though, without evident harm, a potential prevention is worth incorporating and recommending.

What first caught my eye long ago was the observation that although significant alcohol use (more than one drink a day) raises the risk of breast cancer, those women who drank a little more and supplemented with 1 mg a day of folic acid shared the lower risk enjoyed by lesser drinkers. Although folic acid has acquired some controversy recently, it has long been respected as an essential prenatal vitamin. The main sources of folic acid (leafy greens and other vegetables) have to this date an unblemished safety record. So, I recommend to women who drink more than minimally to supplement with 1 mg of folic acid daily and, assuming a less than stellar compliance rate, to eat salads and other vegetables. Foolproof? Hardly! Safe? Yes. Possible other benefits? Yes. Passes the test for me, and goes on my list of recommendations.

My list keeps changing. Some of these are no-brainers; others you might want to discuss with your own physician before considering. Each suggestion has been a study for me and could be a long conversation in its own right. Read to the end for the most important one.

• Don't smoke. Enough said.
• Exercise, enough to make conversation difficult, at least 20 minutes three times a week.
• Remember what you weighed at 18? Stay within 30 pounds of that. And what you weighed at menopause? Stay within 22 pounds of that.
• Sleep is so important. Sleep like a baby in a dark room seven hours nightly (I wish!). Shift workers have low melatonin levels and higher breast cancer risk. Whether it's your own or taken as a supplement, melatonin promotes healthy sleep. (An interesting revelation recently is that melatonin promotes healthy estrogen metabolism. Clever little substance.)
• Freshly ground flax seeds confer multiple health benefits, as do most healthily prepared nuts, legumes and whole grains.
• Eat cruciferous vegetables! Here's a fun fact: Three or more servings of cabbage a week reduce risk significantly. That's a lot of cabbage — luckily, sauerkraut counts too. (And if it's lacto-fermented sauerkraut, it helps your immune system and likely promotes healthy bones as well.)
• Eat real eggs; egg yolks contain valuable choline.
• I struggle with the next one: Two or more doses a week of aspirin or anti-inflammatories reduce the risk of cancer, but — they increase the risk of gastrointestinal bleeding. Admitting I don't know for sure, I still presume that non-medicinal anti-inflammatories help as well, such as turmeric and fish oils. But I don't feel so bad if I take aspirin for a headache.
• Conventional hormone replacement therapy increases breast cancer risk, but recent research suggests that bioidentical HRT may lower risk. We could talk for hours just about this issue.
• Iodine! Iodine protects against hormone-related tumors. Food grown on inland soil and diets low in seafood are deficient in iodine. Do you have enough iodine?

Some modern chemicals wreak havoc with your immune and endocrine systems. Don't heat food in plastic, and use BPA-free water bottles. Chlorine is wonderful in our water supply, but not in our drinking water. Filter it out.

And, finally, my good friend Vitamin D. Higher Vitamin D levels are associated with decreased risk. If you caught my Oct. 30 column on the flu, you'll know that an optimal Vitamin D level (Sun without burning! Supplemental D3! Cod liver oil!) seems protective against many diseases. (People have asked if I named the vitamin, as I like it so much. No, but it is a nice coincidence.)

Sitting back, happy with this long list of actions to take, I know that even perfect compliance provides no guarantee. What about mammograms?

Deborah Gordon, M.D., is fully trained in family practice and specializes in classic homeopathy and preventative medicine in Ashland, where she has lived for 23 years.