Preventative measures for breast cancer, and how we view risk

The Lancet has run a Consensus Statement about preventing breast cancer. They say

“Many risk factors have been established for breast cancer, the most informative of which are family history of the disease, especially at a young age, increased mammographic breast density, some menstrual and reproductive factors, and proliferative benign disease. Various models have been developed to predict individuals’ breast cancer risk and are available online,[76] and [77] but more accurate tools are needed if preventive therapy is to be focused on the women most likely to benefit and least likely to experience toxic effects. The identification of biomarkers to improve prediction of response after a short period of treatment, as is currently done in osteoporosis (bone-mineral density) and cardiovascular risk (lipids or blood pressure), was deemed to be of paramount importance by the meeting panel. At present, no surrogate biomarker has been validated clinically, although mammographic breast density seems promising.10 The panel agreed a 10-year risk of 4–8% to be appropriate for initiation of preventive therapy. The biggest subgroup in this high-risk population comprises women with high mammographic breast density values and those with a family history of breast cancer. The panel recognised, however, that any recommendation for an individual would also depend on personal concerns about specific side-effects and risk factors.Breast cancer screening represents an opportunity to provide advice about cancer risk and preventive activities. The panel felt strongly that individual risk assessment and advice on how to modify risk should become an integral part of screening programmes.”

Virtually the entire statement, however, is about pharmaceutical products which are possible preventative agents, from tamoxifen to statins. I think it’s a shame to have such focus on things we could take soley to prevent one cancer and de-emphasise the things we can do to prevent many cancers as well as heart disease and stroke, and improve quality of life: the same old stuff, exercising, eating well, keeping weight reasonable, and drinking alcohol at less healthy levels.

This non holistic way of looking at things disadvantages us. If we wanted to be brave we could also look the reasons why, for example, breast feeding (a protective factor against breast cancer) rates are still not great, realise that all the high-pressure sales to breastfeed don’t work and make us feel guilty instead, stop preaching  and start helping women practically instead.

The disjointed way of looking at and addressing risk is frustrating. I found myself rather cross with this years Red Nose day, which publicised itself with Walkers crisps very prominantly advertised to children. The event also gave money to children’s charities. Children aren’t helped by obesity, though. I’d rather they didn’t advertise high fat high salt merchandise at all; where is the balance of harm?

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