Fret or forget? Digging for answers with Fair Lady in Breast Cancer Month

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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...

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Breast Cancer: Reducing your lifetime risk – the evidence

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As awareness of breast cancer increases, interest is growing around ways to prevent it. Breast cancer survivors are especially likely to make risk reduction a priority. Yet there is so much misunderstanding about “risk” which in public health is not merely an emotive word, but a statistical concept with a precise meaning. Some known risks cannot easily be controlled – such as your genes, the age at which you begin menstrual cycles, and the age at which you reach menopause. It is believed that inherited risk accounts for around 10% of all breast cancers. Other known risk factors such as the timing of pregnancy, birth and breastfeeding, often involve choice but – realistically – are not likely to shift in respect of what amounts to a relatively small improvement in lifetime breast cancer risk. On the other hand, information claiming to be authoritative about cancer prevention is often promoted to the public, despite offering little solid scientific support for interventions that may not only be inconvenient but also – often – quite costly. There is a clear need for researchers to sort through the facts, the myths and the concerns, for everyone’s sake. Research of this nature is difficult and expensive; large samples of women must be followed for long periods of time, after giving accurate, detailed accounts of health behaviours or environmental exposures. Nonetheless, the research is being done and the results are being made available. In 2011, the Institute of Medicine in the USA reviewed the evidence base for environmental risk factors associated with breast cancer. The entire report can be downloaded here. Six risk factors The following six risk factors emerged with strong research support from this review. 1. Ionising radiation. This radiation is involved in X-rays and CT scans. Ionising radiation separates electrons from their atoms, creating an intra-cellular electrical charge which is capable of breaking DNA, the machinery of cellular reproduction. Cells damaged in this way will mostly die or be repaired by the body’s own defence mechanisms, but some may continue to reproduce forming a cancer growth. Until recently, it was assumed that normal X-rays were not a significant source of radiation exposure, but researchers have found that the “dose effect” is to some extent cumulative. So a few X-rays done when really necessary are not of concern, but repeated X-ray imaging should be avoided. CT scans (Computerised Tomography) which build up a picture using multiple X-rays involve large doses of ionising radiation and are definitely cause for concern, especially in children – though despite the increased cancer risk the use of a CT scan may still be safer than alternatives such as exploratory surgery. The US Food and Drug Administration provides detailed...

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