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...