Kudos to Fair Lady (October 2013) for kicking off Breast Cancer Awareness Month in style! They asked Cape Town breast cancer specialist Jenny Edge to share the latest evidence. What should we worry about? What shouldn’t we worry about? What should we do or not do to improve our chances of avoiding breast cancer?

Dr Edge says that the evidence is there for alcohol, hormone replacement therapy and (not) breast-feeding. There is a common element in these factors: the hormone oestrogen which has a close association with breast cancer. We’re going to review some of her comments for you – with a few of our own.

Alcohol alters oestrogen levels in the body – to break down oestrogens you need a fully functioning liver, not one that is battling to de-tox the alcohol you consume! More than two drinks a day for men or one for women, and your liver will have reduced capacity for other work. So any alcohol at all increases breast cancer risk, though not by much. According to Dr Edge in Fair Lady, one daily drink will raise your “absolute risk” by 7% – everyone has an ‘absolute risk’ which varies depending on our family history, age, number of children we have, and lifestyle. So if your ‘absolute risk’ is 1%, and you drink one drink per day, the overall risk goes up to 1.07%.

Hormone Replacement Therapy (HRT) lost its sparkle with the publication of a huge British study showing a definite increase in breast cancer risk for women who used HRT. “Combination” HRT (with both progesterone and oestrogen components) was seen as more harmful based on these results, whereas oestrogen-only HRT increased the risk while women were using it but only after several years. However, here at Bay Breast Care, we’re wondering if the news on HRT isn’t quite so bad. The results of this study have recently been re-analysed, raising doubts amongst experts – because even the biggest study can still come up with misleading results if there is bias present, and it’s not easy to control for all possible biases.

Professor Ian Fraser, Gynaecologist at the University of Sydney, wrote in the British Medical Journal last year:

“The epidemiologists have managed to raise fear among women in the general community about use of hormone replacement preparations, yet these therapies have an enormous impact on many aspects of well-being, such that the benefit-risk ratio for most individual women is very positive. I would really like to show the epidemiologists I know (who do not see any patients) the dramatic impact which this therapy can have on the quality of the lives of many menopausal women” (BMJ 2012;344:e513).

So although the link between HRT and breast cancer is real, if you are one of those women for whom the benefits will greatly outweigh the risks, you should talk to your doctor and not rule it out, although it’s not the ‘elixir of youth’ nor something you’ll want to be using for year after year.

Breast-feeding. For women and men to stay healthy, oestrogen must be held in check by other sex hormones – progesterone and testosterone. If a woman has children, and – better still – breast feeds her children, there is protection against breast cancer because the years of pregnancy and breastfeeding are years oestrogen activity is reduced. The absolute risk goes down 30% if you have kids, with a further marginal lowering for each year that you spend breast-feeding.

According to Dr Edge, being overweight is a “likely” risk. This also relates to oestrogen: fatty tissue produces oestrogen (but only after menopause, not before). Some experts think that oestrogen acts like a “fat magnet” – it attracts fat to the trunk area and therefore is the chief culprit behind middle-aged spread, and the reason why this type of fat is so hard to shift even with exercise and diet.

Smoking also falls into the “maybe” category. Since most women who smoke also drink alcohol, it’s difficult to tell where the added risk is coming from. However, the fact the smoking might not be guilty of causing breast cancer doesn’t make it innocent – it won’t help you much to have healthy breasts if you suffer from one of the many other life-threatening diseases that certainly are caused by smoking.

In the “forget it” category, we find several topics that have been discussed in recent years, often leading to needless worry.

Dr Edge suggests we stop sweating the small stuff about bruises to the breast, wearing under-wire bras (good news for the lift-and-separate aficionados), for breast implants (though these do limit your options for early detection of breast cancer), and fertility treatment. With the greatest relief, we also read that antiperspirants, with or without underarm shaving, have no relationship with breast cancer. Finally, stress in itself does not increase our risk of developing breast cancer – unless we evolve risky ways of coping such as alcohol consumption or if our over-stressed lifestyle deprives us of the joys and health benefits of breast feeding.

In addition to this handy guide to the latest in breast cancer risk, Fair Lady has included a guide to the art of breast self-examination: “Know Your Boobs”. But that’s enough from us – go out and grab your Fair Lady which is packed with ‘lift and separate’ this month, from a much needed lift as influential people tell us why their umbrella is still parked in South Africa’s colourful cocktail, to advice from the people who really know how marriages fall apart – top divorce lawyers.