Did failing to breastfeed give me breast cancer?
And other questions with which I torment myself at 4am
I was planning to write about tea today. It’s National Tea Day this weekend and, frankly, I could talk about tea all day long. But then I saw the new report from the Lancet Breast Cancer Commission and realised I can only write about that.
(I’ve also written about it in the Times.)
First, I know that lots of Well Well Well subscribers are here for the general wellness vibes, and I’ve been writing a lot about breast cancer recently, so please be assured that normal service will resume shortly. However, many of you have had breast cancer, having discovered me through my book, and this is just as relevant for those of you with no experience of the disease.
One in seven of us will get breast cancer in our lifetime - and that stat is rising - so information about prevention is important for every single one of us.
The Lancet Breast Cancer Commission report, part funded by Breast Cancer Now, has three key elements:
1. Showing that around a quarter of breast cancer cases could be prevented, and the evidence about the things that we can do to reduce our risk.
2. Explaining the cost of breast cancer. Not only to the NHS in terms of rising cases and ongoing issues after treatment, but also to the economy in terms of loss of income.
3. Addressing the issues faced by those with metastatic breast cancer, who are not counted in the statistics and often do not receive appropriate treatment.
The report highlights inequities in prevention, detection and treatment - with the risk factors more prevalent among people from lower socioeconomic groups.
Basically the main thrust of it is that governments need to do something to curb skyrocketing rates of breast cancer, if not for people’s health, then for economic reasons (the love language of politics).
Reducing your risk
My feature in the Times was about the first element: the modifiable risk factors that we can usually control in our lives, to either increase or reduce our risk of getting breast cancer in the first place.
This is a fraught and controversial area, since people often don’t want to hear that lifestyle choices may have contributed to their own diagnosis, or that of someone they love. And I get that, I really do. In the wake of my diagnosis, I certainly had sleepless nights stressing over the things I may or may not have done differently.
Reading that not breastfeeding for long enough can be a contributing factor made my defensive heckles rise. I really struggled with breastfeeding, and (with a lot of guilt and tears) gave up after a painful few weeks. So to hear that this may have contributed to my own diagnosis seven years later felt like a bit of a punch in the face.
However, when I actually read the report (rather than the slightly hysterical headlines), I saw that the increase in risk from not breastfeeding is actually very small.
The risk factors are: alcohol, obesity, inactivity, not breastfeeding and HRT. But the last two things on that list are far less risky, increasing your risk by 4% and 3% respectively.
Compare this to alcohol: women who have just one glass of wine a day are 9% more likely to get breast cancer than non-drinkers, while the heaviest drinkers are a staggering 60% more likely to get it. (People hate hearing that one, sorry.)
Genetics
I didn’t have space to go into genetic risk factors, so here’s my two pence worth on that:
The evidence suggests that a quarter of cases are caused by the above “lifestyle” factors. And statistics say that only around 10% of cases are caused by a hereditary genetic mutation, leaving a whopping 65% of cases that are put down to the infuriating phrase: “just one of those things.”
Anecdotally, there are situations where common sense would suggest a genetic component, but the tests come back negative. Such as in the case of the brilliant Caroline Kennedy Alexander, founder of LoveRose post-mastectomy lingerie, who was diagnosed with breast cancer alongside three(!) of her five sisters, none of whom tested positive for any of the known genetic mutations.
We used to think BRCA1 was the only breast cancer gene, then we discovered BRCA2, then others including PALB2, CHEK2 and ATM. My personal non-medical don’t-quote-me opinion is that, as the science evolves, we’ll learn about more.
Obesity
Another thing I didn’t have space to address in the Times feature is my discomfort with one of the risk factors being obesity; a nebulous term in my opinion.
In fairness, the evidence does show that excess adipose tissue (or fat, to you and me) increases levels of oestrogen and blood insulin, both of which are associated with breast cancer. The scientists who put together the report know what they’re talking about, and who I am to dispute it, really?
So, while I’m not disputing it, I would like to raise two points.
First: By what metric is it decided that a person is obese? Usually their BMI, which is extremely flawed. Fit people can have a high BMI because muscle weighs more than fat. And we all know very unhealthy people with slender bodies, in the same way that there are teetotal marathon runners who would be considered “obese”.
Second: It’s not helpful to blame obesity for anything, because the size and shape of a person’s body depends on many genetic, social and environmental factors. With the other risk factors, the advice is clear: drink less alcohol, move your body more. It’s not exactly productive to offer the advice of: don’t be obese.
Instead of blaming obesity (which simply leads to shame, and everyone knows that shame doesn’t ever lead to behaviour change), why not look at the causes of it? I was surprised that the report made no mention of ultra-processed foods, although there is reference to a lower survival rate among cancer patients who live in “food deserts” with little access to fresh, whole foods. And quite a telling line where they say: “Many of the alcohol and food industry strategies to increase consumption resemble those of the tobacco industry.” Suggesting that governments can use tobacco policies to inform how they might regulate the convenience foods and alcohol industries.
If you feel worried about breast cancer, you can assess your personal risk with an online questionnaire (this is a good one). Hopefully it’ll put your mind at rest. And, if your results are concerning, then show them to your GP. You may have access to early screening, genetic tests and in some cases medication to reduce your risk.
Anyway, despite bringing back triggering memories of my breastfeeding days, and setting me off on a short rant about the ineffectiveness of policies around obesity, I do feel that this report can only be a step in the right direction towards greater equality of care, awareness of the risk factors and - hopefully - fewer breast cancer diagnoses.
This week I’m…
Drinking tea! Although you didn’t get my full love letter to tea this week, I’d still like to share some of my favourites…
Known for being fairtrade, organic and not having microplastics in their tea bags, Clipper infusions are my afternoon staple.
Green tea usually makes me vom, but this organic matcha by Sana is so, so good.
Buddha Teas cleverly mix CBD in with their chamomile and peppermint infusions, making my evening cuppa even more zen.
I drink so much Earl Grey and, since my oncologist advised me to avoid caffeine for my bones, I’m very grateful to Twinings for making the decaf version just as delicious.
I breastfeed, one of our two almost a year. And I STILL was diagnosed with breast cancer in my late 60’s. The blame game needs to stop. There are a myriad of reasons anyone gets a particular disease. Most will NEVER be known! Eternally only maybes to be pondered. For every risk factor there are millions with everything on the list who never have an issue.
SO TRIGGERING. thought I had left all that stuff about not being able to breastfeed behind - it was just absolutely bloody impossible - and now this. makes me wild with rage how people assume it's some kind of choice!!!