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  • Health & Medicine

Why are breast cancer rates increasing?

by Henry Scowcroft | Analysis

4 February 2011

49 comments 49 comments

More cancers are being detected by screening, particularly among older women.

Although more and more women are surviving, breast cancer is the most common cancer in the UK and it has been on the rise for several years.

In 1999, 42,400 women were diagnosed with the disease. The odds that a woman would develop breast cancer during her lifetime were one in nine.

In 2008, 47,700 women were diagnosed. Taking into account the changing size of the population, this is an increase of around 3.5 per cent in the breast cancer incidence rate. As a result, we’ve calculated that the lifetime risk of developing the disease is 1 in 8. 

This increase raises the obvious question: why have rates gone up?

Unfortunately there’s no simple answer to this. Breast cancer is a complicated disease with a variety of different causes. Many aspects of our lives swing our risk in one direction or another. Some of these can be controlled, while others are largely out of our hands.

Let’s take a look at some of the possible explanations.

Screening

In recent years, breast cancer rates have risen especially quickly among women aged 65-69. This probably coincides with the inclusion, from 2004, of women in this age group in the national breast screening programme. An increase in the number of women attending screening would be very likely to lead to an increased number of cancers being detected.

In many ways, this is to be expected. Screening programmes are meant to detect cancers at an early stage when they’re too small to cause any symptoms. At this point, they are easier to treat successfully. So you would expect rates to go up when a new group of women is invited for screening.

The screening programme has attracted a lot of recent controversy. Critics say that it picks up a large number of cancers that would never go on to cause a woman any problems. These include a type of cancer called ductal carcinoma in situ (DCIS) – a ‘pre-cancerous’ type of tumour that has not yet started to spread. But our new analysis doesn’t include cases of DCIS, so these non-invasive tumours can’t explain the rising breast cancer rates in women aged 65-69.

Lifestyle

Several aspects of our daily lives can affect the risk of breast cancer. We know that alcohol can cause breast cancer, and even drinking small amounts can increase the risk of this disease. Alcohol boosts levels of oestrogen in the blood, and abnormally high levels of this hormone have been linked to breast cancer.

Large studies have found that drinking an extra unit every day (and remember there are two units in a medium-sized glass of wine) can increase the risk of breast cancer by around 10 per cent. That’s not a big effect, but because the disease is so common, it translates to a surprising number of extra breast cancer cases.  For example, the Million Women Study estimated that if everyone drank one extra unit a day, we would see 11 extra breast cancers in every thousand women. The study calculated that 11per cent of breast cancers in the UK are caused by alcohol.

After the menopause, women who are overweight or obese have a higher breast cancer risk than those who have a healthy weight. The Million Women Study also looked at body weight, and calculated that obesity accounts for 7 per cent of the UK’s breast cancer cases. The nation’s expanding waistline could be contributing to the rise in breast cancer rates.

Body fat is surprisingly active, pumping out oestrogen and other hormones that affect how our cells grow and divide. This source of oestrogen becomes increasingly important after the menopause when the ovaries stop producing the hormone.

On the flipside, keeping physically active could reduce the risk of breast cancer by anywhere from 20 to 40 per cent. Researchers are still trying to find out exactly what causes this effect, but again, the evidence points to our hormones.

HRT

We know that hormone replacement therapy can increase the risk of breast cancer although it’s not clear how much this accounts for the recent trends.

The use of HRT rose sharply in the UK between 1992 and 2001. At that point, around a quarter of women aged 45-69 were using HRT. However, the medication’s popularity soon plummeted as it became clear that it was linked to breast cancer.

We know that the longer a woman takes HRT, the higher her risk of breast cancer becomes, and it takes around 5 years for that risk to return back to normal after stopping. So the recent climbing rates could partially reflect the aftermath of prolonged HRT use.

Children

People often forget this when talking about breast cancer, but having children protects against the disease. Women are less likely to develop breast cancer if they have their first child at an earlier age. Their risk also goes down the more children they have and the longer they spend breastfeeding.

These simple associations can explain a lot of the differences in breast cancer rates between developed and developing countries. One study calculated that if women in the Western world had the same number of children as women in the developing world (and breastfed as long), the rates of breast cancer would halve.

Age

People are living longer now than ever before. And one of the risks for most cancers is simply getting older. But it should be noted that the 1 in 8 figure is a lifetime risk – and that during a lifetime, risk changes. For breast cancer, risk increases sharply from around the time of the menopause – see the table below:

Up to and including age Risk (women)
29 1 in 2000
39 1 in 215
49 1 in 50
59 1 in 22
69 1 in 13
Lifetime risk 1 in 8

Other possible explanations

There are many other potential causes of breast cancer – some are myths, others have some truth to them. We’re only going to touch on some of them briefly here, but you can click through for more information.

The Pill probably hasn’t had a big effect on breast cancer rates. It only slightly increases the risk of breast cancer. Women take it at a young age when their natural risk is low, and that risk disappears quickly when women go off the Pill.

Our diet can affect our risk of cancer. But despite hundreds of studies and countless books or magazine articles, there’s no clear advice for eating your way to a lower breast cancer risk (other than cutting back on alcohol and keeping a healthy body weight). Studies have looked at everything from fruit and vegetables to dairy products and they have either refuted a link to breast cancer, or found inconsistent results.

Working on night-shifts could affect the risk of breast cancer, according to the International Agency for Research into Cancer. Many scientists are now trying to work out if this is actually true. The problem is that few of the studies to date have accounted for other things that can affect breast cancer risk, like number of children or body weight.

Vitamin D is a hot topic but despite repeated claims, the evidence linking it to breast cancer is uncertain. Recently, several groups have gathered all the available evidence and when they considered the best studies, they found no link between vitamin D and breast cancer.

Deodorants were originally linked to breast cancer in an email hoax, and there’s no convincing evidence that they could cause the disease. Nor is there solid evidence for other types of cosmetic products.

Stress can alter the levels of hormones in the body and affect the immune system. But there’s no consistent evidence that these changes could lead to breast cancer. However, stressful situations can make people take up unhealthy behaviours such as smoking, heavy drinking or overeating that can themselves increase the risk of cancer.

Chemicals in our environment probably don’t play a significant role. There’s been a lot of controversy over the role of man-made chemicals that can mimic oestrogen and, theoretically, cause breast cancer. This is an active area of research and debate, but at the moment there’s not enough evidence from studies in humans to suggest that these chemicals play a significant role in increasing rates of breast cancer.

Large organisations like the World Health Organisation (WHO) and the International Agency for Research into Cancer (IARC) have estimated that pollution and chemicals in our environment only account for about 3 per cent of all cancers. Most of these cases are in people who work in certain industries and are exposed to high levels of chemicals in their jobs.

The good news

While it’s worrying that women are now more likely to develop breast cancer than they were a decade ago, there is good news too.

Survival rates have also shot up. Figures released in 2019 revealed that the number of people dying from breast cancer has fallen by 44% compared with 30 years ago, when breast cancer death rates were at their highest. That’s the equivalent of over 130,000 deaths avoided, thanks to improvements in treatment and diagnosis.

And more than three-quarters of women diagnosed with breast cancer survive for at least 10 years or more. Research has been at the heart of this progress – and it will continue to play a vital role in beating the disease in the future.

Henry

Further reading

http://info.cancerresearchuk.org/spotcancerearly/cancersymptomvideos/spotbreastcancerearly/


    Comments

  • David R. Cowan
    24 February 2012

    I was doing some research – investigating the ley line system in Perthshire – and was walking a few hundred yards north of Loch Rannoch when a huge inky black cloud came over me and soaked me in a heavy downpour. This, I discovered later, was from Chernoble, and the area I was walking was later put under quarantine – no sheep or cattle were allowed to be sold.

    Four years ago I discovered that I had male breast cancer, behind one nipple, although I had surgery and radiation treatment very quickly after the initial diagnosis. I have no idea how much radiation I received from that cloud.

    I am male, and was 70 years old at the time of the fallout.

  • David R. Cowan
    24 February 2012

    I was doing some research – investigating the ley line system in Perthshire – and was walking a few hundred yards north of Loch Rannoch when a huge inky black cloud came over me and soaked me in a heavy downpour. This, I discovered later, was from Chernoble, and the area I was walking was later put under quarantine – no sheep or cattle were allowed to be sold.

    Four years ago I discovered that I had male breast cancer, behind one nipple, although I had surgery and radiation treatment very quickly after the initial diagnosis. I have no idea how much radiation I received from that cloud.

  • Elaine
    24 February 2011

    I found Dr Grant’s website harm from hormones a very interesting read, however the link she gives does not appear to work – I googled harm from hormones and got the site that way.

  • Dr Ellen Grant
    18 February 2011

    The breast cancer epidemic is mostly due to use of progesterone-type hormones whether given for contraception as pills, jabs, implants or in some IUDs, or for fertility or pregnancy treatments, or for HRT. Increases and decreases in breast cancer incidences match changes in such use over the past 50 years.* Taking progesterone-type hormones can cause huge weight gain and also increase addiction to alcohol and tobacco smoking. Women who have their first pregnancy in their 30s or 40s have increased risks because most have used contraceptive hormones for longer and then are more likely to take fertility drugs and HRT. Both the Million Women Study and the Women’s Health Institute randomised control trial underestimate risks and duration of risks for current and past users of hormones for any reason because past users of hormones were included in control groups.
    A review lecture of my clinical and research work on hormones since 1960s is available at http://www.harmfromhormone.co.uk.* Free papers are available in PubMed under grant ec.

  • Nicola
    14 February 2011

    So there is no information on whether breastfeeding reduces the risk of BC if a woman experiences regular mentrual cycles whilst (exclusively) breastfeeding (see
    February 5, 2011 at 11:08 am
    )…?

  • Dora
    11 February 2011

    I looked at Straight Statistics and saw there that the Cancer UK website says “The recent steep rise in rates for women aged 65-69 is almost certainly caused by the introduction of national breast cancer screening for this age-group”.

    Catherine Thomson, of Cancer UK, implies that the rise is due to DCIS and not significantly to invasive cancer, but this does not fit with the references given in my earlier posts.

  • Henry Scowcroft
    11 February 2011

    Hi everyone,

    We’ve been looking into the available data on survival rates for different types of breast cancer, as Irene North and Wendy Green (grade 3 breast cancer) and Jules610 (triple-negative breast cancer) asked. We’ve also done some digging into the radioactivity question several of you were concerned about.

    Unfortunately, it’s not possible to say anything about how national survival rates for different grades of breast cancer have changed over the last ten years. This is because this information hasn’t been collected and recorded consistently across the NHS over this period.

    We also looked at a similar measure, breast cancer stage (this is a measure of how far a cancer has spread, whereas grade is essentially a measure of how quickly it’s growing), but again, there’s not enough data to give an indication of how survival rates have changed across the England over the last decade. All of the cancer registries collect data on stage, but this is known to be inconsistent across the country.

    There has been a big push over the last few years to improve data collection across the NHS, led chiefly by the National Cancer Intelligence Network (NCIN). There have been substantial improvements, and there are more in the pipeline, with a commitment made by the new Government within its new cancer plan (Improving Outcomes: A Strategy for Cancer) for nationally consistent staging data to be available within two years. So in future we will hopefully be able to examine survival changes nationally over time in detail.

    The NCIN will be helping to make this commitment a reality, and we believe it’s crucial that data collection and reporting of good quality cancer data are protected from cutbacks.

    Likewise, for similar reasons, there is sadly no data about nationwide rates of triple-negative breast cancer over this period.

    Readers might be interested in the ‘Prognosis and outlook for breast cancer’ page on CancerHelp UK, which explains a lot of these concepts in more detail:

    http://cancerhelp.cancerresearchuk.org/type/breast-cancer/treatment/statistics-and-outlook-for-breast-cancer

    On the matter of radioactivity/Chernobyl: we’ve had a good look but there is currently no evidence that UK breast cancer rates were affected by radioactive fall-out from the 1986 Chernobyl explosion – but as ever we are keeping a keen eye on evidence as it emerges.

    Evan/Dora – you may find our responses over at Straight Statistics helpful.

    Henry

  • Dora
    11 February 2011

    Henry Scowcroft responds that “Our analysis excludes DCIS cases, so overdiagnosis is not likely to explain much of the rise in cases we’ve seen.” If so why is this different from all other experience?

    In response to Evan Harris the US National Cancer Institute (see my previous post)also says:

    . . investigators differ in their assessments of overdiagnosis regarding how and whether to adjust for characteristics such as lead-time bias.[18,19] As a consequence, the magnitude of overdiagnosis due to mammographic screening is controversial, with estimates ranging from 7% to 50%.[18-21]

    References

    18)Duffy SW, Lynge E, Jonsson H, et al.: Complexities in the estimation of overdiagnosis in breast cancer screening. Br J Cancer 99 (7): 1176-8, 2008. [PUBMED Abstract]

    19) Gøtzsche PC, Jørgensen KJ, Maehlen J, et al.: Estimation of lead time and overdiagnosis in breast cancer screening. Br J Cancer 100 (1): 219; author reply 220, 2009. [PUBMED Abstract]

    20) Gøtzsche PC, Nielsen M: Screening for breast cancer with mammography. Cochrane Database Syst Rev (4): CD001877, 2006. [PUBMED Abstract]

    21)Zackrisson S, Andersson I, Janzon L, et al.: Rate of over-diagnosis of breast cancer 15 years after end of Malmö mammographic screening trial: follow-up study. BMJ 332 (7543): 689-92, 2006. [PUBMED Abstract]

  • Evan Harris
    11 February 2011

    J Doherty and Margaret Chappell have essentially asked “excluding DCIS, what is the estimated contribution of screening overdiagnosis to the increase in the 65-69 group?”

    And I would add “To what extent is the recent increase in incidence of non-DCIS cases in 65-69 group responsible to the overall increase in lifetime risk?”

    I don’t think this has been fully addressed by Henry Scowcroft’s response which just says “Our analysis excludes DCIS cases, so overdiagnosis [which he had explained covers the issue raised by Doherty and Chappell] is not likely to explain much of the rise in cases we’ve seen.”

    Can you provide support for that assertion and also clarify to what extent it is known whether the over-diagnosis in non-DCIS cases has had an impact.

    Put another way what is the minimum amount of over-diagnosis artefact from the 65-69 group which would reduce the increased lifetime risk below the significance level, and can we sure that amount is not present?

    Thanks.

  • Dora
    9 February 2011

    It looks like screening increases breast cancer rates in most places.

    This is what the US National Cancer Institute (www.cancer.gov) says:

    Several observational population-based comparisons consider breast cancer incidence before and after adoption of screening.[22-26] If there were no overdiagnosis—and other aspects of screening were unchanged—there would be a rise in incidence followed by a decrease to below the prescreening level, and the cumulative incidence would be similar. Such results have not been observed. Breast cancer incidence rates increase at the initiation of screening without a compensatory drop in later years. For example, in Sweden, the age-specific incidence rates doubled between 1986 and 2002 for all age groups participating in screening.[22] Another study in 11 rural Swedish counties showed a persistent increase in breast cancer incidence following the advent of screening.[23] A population-based study from Norway and Sweden showed increases in invasive breast cancer incidence of 54% in Norway and 45% in Sweden in women aged 50 to 69 years, following the introduction of nationwide screening programs. No corresponding decline in incidence in women older than age 69 years was ever seen.[27] Similar findings suggestive of overdiagnosis have been reported from the United Kingdom [24] and the United States.[25,26]

    References

    22) Hemminki K, Rawal R, Bermejo JL: Mammographic screening is dramatically changing age-incidence data for breast cancer. J Clin Oncol 22 (22): 4652-3, 2004. [PUBMED Abstract]

    23)Jonsson H, Johansson R, Lenner P: Increased incidence of invasive breast cancer after the introduction of service screening with mammography in Sweden. Int J Cancer 117 (5): 842-7, 2005. [PUBMED Abstract]

    24)Johnson A, Shekhdar J: Breast cancer incidence: what do the figures mean? J Eval Clin Pract 11 (1): 27-31, 2005. [PUBMED Abstract]

    25)White E, Lee CY, Kristal AR: Evaluation of the increase in breast cancer incidence in relation to mammography use. J Natl Cancer Inst 82 (19): 1546-52, 1990. [PUBMED Abstract]

    26)Feuer EJ, Wun LM: How much of the recent rise in breast cancer incidence can be explained by increases in mammography utilization? A dynamic population model approach. Am J Epidemiol 136 (12): 1423-36, 1992. [PUBMED Abstract]

    27)Zahl PH, Strand BH, Maehlen J: Incidence of breast cancer in Norway and Sweden during introduction of nationwide screening: prospective cohort study. BMJ 328 (7445): 921-4, 2004. [PUBMED Abstract]

  • Irene North
    7 February 2011

    Thank you so much for your very measured information and advice.
    I have always attended for breast screening and was shocked to find a very large grade 3 aggressive tumour, only six weeks after a “clear” mammogram. This was in November 2008 but the care and treatment I have received in Lincoln have been second to none.

  • Henry Scowcroft
    7 February 2011

    Thanks everyone for your comments and questions – we’ve tried to clarify as much as we can below, and apologies for the length of this comment!

    Firstly, genetics. A number of you have mentioned that family history and genes are extremely important, and this is indeed the case. But the figures we discuss above relate to changes over the last ten years. As Underblog correctly points out, it’s extremely unlikely that the genetic make-up of the UK population would have altered enough over that period. So, while genes and family history are extremely important in setting an individual’s breast cancer risk, they’re probably not linked to the recent rise in rates we talk about above.

    Underblog, although it’s true our population is ageing, and that breast cancer is much more common among older people, our calculations have accounted for the effect of an ageing population, so that’s not an explanation for this rise.

    Jules610 raises an interesting point about ‘triple-negative’ breast cancers. These cancers account for about 12-17 per cent of all breast cancers, but only a few studies have compared risk factors for them with other types, and it’s hard to be sure which lifestyle changes affect the risk of triple-negative cancers. In fact, the picture’s rather murky and more research is needed to find out what’s going on: for example, while being overweight after the menopause increases the risk of other types of breast cancer, research suggests that being overweight before the menopause might slightly increase the risk of triple-negative breast cancer. We’re doing a bit of deeper digging into the stats and will get back to you in the next day or so about whether rates of this form of cancer have increased over the last ten years.

    On a similar note, several of you asked whether the increase in survival rates applies to women with more aggressive tumours – again, our stats team is looking into the data in this area and we’ll clarify this in the next few days.

    J Doherty asks about ‘overdiagnosis’ – i.e. people diagnosed with breast cancer through screening, but whose cancer would not have grown quickly enough to cause problems. The issue of overdiagnosis is the subject of much debate and is very hard to pin down. But overdiagnosis is most likely to happen with a type of condition called DCIS (ductal carcinoma in situ), which may or may not progress into invasive cancer. Our analysis excludes DCIS cases, so overdiagnosis is not likely to explain much of the rise in cases we’ve seen. There’s more info about breast screening here http://info.cancerresearchuk.org/spotcancerearly/screening/breastcancerscreening/.

    m adams asks about breast cancer rates in male alcoholics. There’s very little research looking into this so it’s difficult to say. There’s information about known risk factors for breast cancer in men on CancerHelp UK http://cancerhelp.cancerresearchuk.org/type/breast-cancer/about/types/breast-cancer-in-men

    Another common question you had was about smoking. This is an interesting one – many studies have looked at the links between smoking and breast cancer. It currently looks like there is a small effect, but – crucially – nowhere near as severe the effect that tobacco smoke has on other parts of the body. There’s an excellent article on the American Cancer Society’s blog discussing this which is worth reading if you’re interested.

    Several of you, including Jules, Harold Hobbs and Ann, are concerned about substances in our environment that are, or can act as, hormones, such as growth hormones or soya. As we say in the post, there’s not enough evidence that these are linked to breast cancer, nor that they’re to blame for the increase, and plenty of evidence pointing to other things. Interestingly, a recent paper looking at soy found that it had no effect in western populations and even decreased breast cancer rates in Asian populations. Here’s a link to the paper on PubMed and there’s more information on hormones and cancer risk on our website.

    M Wright, Isabel and self-confessed ‘Green troll’ Ben Samuel are concerned about radioactivity, particularly regarding the 1986 Chernobyl power station explosion. This is a complex question and our stats team are looking into it – we’ll get back to you some more info shortly.

    Gesa Behrens and Sheila Price ask why we discount the Pill as a significant cause, yet highlight hormone replacement therapy (HRT). Here’s why: HRT is generally taken to *replace* a woman’s oestrogen once she’s stopped producing it herself, and this usually happens at an older age, when breast cancer risk is higher. So women taking HRT are taking extra oestrogen and prolonging their exposure. Conversely, the contraceptive pill is taken by premenopausal women who have far lower risk of the disease. So although the pill does very slightly increase the risk of breast cancer, the overall contribution of pill-linked breast cancers to the increase we’ve seen is probably very small in numerical terms compared to the effect of HRT. There’s more info about the Pill and cancer here: http://info.cancerresearchuk.org/healthyliving/hormones/thepill/

    Amette Ley asks about a controversial topic – abortion. There has been lots of research about induced abortion and breast cancer. But the findings have been inconsistent and while some studies have found a link, many others have not. Recent studies that have found a link asked women with breast cancer whether they’d previously had an abortion, and all came from countries with strict laws about abortion. Scientists have expressed concern that in these countries, women may be less likely to admit that they had an abortion because of its controversial nature, but that breast cancer patients are actually more likely to do so because they may be trying to explain their disease (see e.g. http://www.ncbi.nlm.nih.gov/pubmed/8944006, http://www.ncbi.nlm.nih.gov/pubmed/15051280). This would exaggerate any links and make them look stronger than they actually were. Many studies which followed up healthy women over time, and one which used medical records to make sure the responses couldn’t be biased, found no link. (see, for example, http://www.ncbi.nlm.nih.gov/pubmed/17452545, http://www.ncbi.nlm.nih.gov/pubmed/18477486, and http://www.ncbi.nlm.nih.gov/pubmed/16646050).

    In 2003, the National Cancer Institute in the USA gathered a group of over 100 experts on pregnancy and breast cancer to review the existing scientific evidence. They also concluded that having an abortion does not increase a woman’s risk of breast cancer. And in 2004, a team of scientists analysed the results from all the 53 previous studies in this area. They too found no link.

    Helen: re. electricity pylons – you might find this page of our website of interest: http://info.cancerresearchuk.org/healthyliving/cancercontroversies/powerlines/

    And finally, even though the disease is far more common amongst older women, as Ingrid points out, it can occur at any age, to anyone. That’s why it’s important to be ‘breast aware’ and know what’s normal for you. That way you’ll be more likely to notice anything unusual that could be a sign of cancer. Screening can also help spot the disease at an early stage, and it’s intended for people without any symptoms, as it’s meant to spot the disease at a very early stage before any symptoms have developed (Rose Kenny).

    Thanks again for your questions, and we’ll get back to you on the other issues in due course,

    Henry

  • Richard Stanley
    7 February 2011

    There many things we do not know about in situ breast cancer (DCIS) which is being diagnosed frequently compared to 25 even 20 years ago. Do they always progress to invasive cancer, do some regress left on their own do some remain always as DCIS? How mant cases of DCIS have an invasive element missed by the pathologist. The same may be said of very small cancers =< 0.5cms, do they always grow or do some regress on their own? There is a fundamental flaw in breast screening in that half of all 1 mm, yes 1mm, tumours will have acquired a blood supply and can metastasise long before the screen detected lower limit of 0.5cms, it is only those 3% or so at the right hand end of the gaussian size/frequency distribution curve that have not acquired a blood supply that are potentially curable, this is a very small percentage and by far the geat majority of screen detected breast cancers will have already metastasised, hence the need for radiotherapy to the breast in lumpectomy, radiotherapy treatment of the axilla where there are positive node(s)and adjuvent chemotherapy
    Unfortunately we cannot do the necessary trials, that is treatment vs no treatment for DCIS and small tumours to find out whether these screen early cancers will progress to lethal cancer.
    Smoking can also have an effect, in fact it is probably a much bigger risk factor than alcohol

  • Rivka J
    7 February 2011

    Hi I was diagnosed with a stage 1 grade 3 breast cancer with no lymph node involvement in November 2009 and had a lumpectomy. I am 57 and a life long vegetarian who grows her own veg organically, is a non smoker and teetotal, exercises regularly (runs the race for life every year)is not overweight and fell into the very lowest breast cancer risk category. After due consultation with my breast surgeon and the consultant oncologist and doing a lot of research into adjuvant therapies I decided to opt only for minimal surgery and no chemo or radiation or drugs like arimidex. As a result I am as fit and healthy as I’ve always been. I know every case must be judged on it’s own merits but you do not have to have all the treatments if you don’t feel they are right for you. Yes I agonised over if I should have them or not and I just felt personally I couldn’t poison my body in that way. I also know it’s early days for me in the scheme of things but I have no sign of recurrence or spread to date. Too often treatments available may stop you dying from cancer in the interim but have horrendous side effects that too many women are not aware of since they are not told. I also hate the use of catergorisation into cancer victim and cancer survivor since I don’t see myself as either I’m just a woman who had an illness that was treated and now I get on with my life.
    Actually what we really need is a cure not treatments that may extend your life but at the cost of destroying your quality of life.
    So what we need is research into a vaccine against breast cancer to be paramount and for more treatments with fewer side effects to be put through the long drawn out process of ratification much faster.

  • Richard Stanley
    7 February 2011

    A significant part of my comment has been left out, in that 1 mm tumours can acquire a blood supply and can metastasise long before the screen detected lower limit of 0.5cms, it is only those 3% or so at the right hand end of the gaussian size/frequency etc

  • Richard Stanley
    7 February 2011

    There many things we do not know about in situ breast cancer, DCIS, which is being diagnosed frequently compared to 25 even 20 years ago. Do they always progress to invasive cancer, do some regress left on their own do some remain always as DCIS? The same may be said of very small cancers 0.5cms at the right hand end of the gaussian frequency distribution curve that have not acquired a blood supply that are curable.
    Unfortunately we cannot do the necessary trials, that is treatment vs no treatment for DCIS and small tumours to find out whether these screen early cancers will progress to lethal cancer

  • ben
    7 February 2011

    Is breast cancer exclusive to females? Or are males also susceptible to the disease?

    Also for all who have suffered or are suffering from the disease please stay strong

  • underblog
    7 February 2011

    Genes are a risk factor, but this article is about possible causes of the increase in breast cancer rates. Breast cancer genes have probably not become more common in the population over just 10 years, so they probably don’t explain the increase.

  • Clare Moynihan
    7 February 2011

    Thank you for this information – extremely clear and well put. I may have missed this but the genetic factor hasn’t been mentioned. I know that genes are relatively low on the breast cancer risk scale but nevertheless a family history is part of the picture and can be monitored. Is there a reason for not including genetic BRCA 1/2?

  • underblog
    7 February 2011

    It should be possible to work out what contribution demographic changes have made to the increase. Without this it’s impossible to tell if we should be concerned about other risk factors. Perhaps our aging population is responsible for the entire increase in breast cancer rates?

  • Elaine
    7 February 2011

    just a quick message to Irene North – I had grade 3 aggressive bc 4 in 2006, radiotherapy and chemo and am still fine and disease free as far as i know! have met many in the same position – survival rates are improving for all bc – know a lady who had a very similar diagnosis to my own who is still disease free after 15 years! think I have learned that although you can look at stats prognosis is a very individual thing with many factors involved and on the positive side new advances are being made almost daily. like many on here i had a very low risk rate – never smoked, healthy diet never been overweight do drink alcohol but in moderation, on the pill for abt 12 mnths in 70’s came off as it did not agree with me!! had 2 children (born when i was 28 and 32) both breast feed for abt 9 mnths (however i did have a daughter who died at 3mnths and a miscarriage at 20 wks so was interested in annettes contribution.)I do worry that putting too much emphasis on the idea that getting cancer can be self inflicted is a bit counterproductive for those who go on to develop it with low risk factors – i know we need to be made aware of the risks we are taking so that we can make informed choices but in my experience many with low risks do develop the disease and some of the choices we are being encouraged to make today in our lifestyles could be found to be detremental in the future. so whilst the current publication of the information about the risk factors is helpful as others have mentioned i am not sure there is as much publicity being given to the other less personally accountable risks such having taken the pill!

  • Ann
    6 February 2011

    I was wondering about the effects of soya as it is reputed to have oestrogen mimicking properties. Any thoughts?

  • dave warren
    6 February 2011

    please get up dates comming tome thanks

  • Isabel
    6 February 2011

    Everybody has the answers it seems! Though i do feel that perhaps we bloggers might be getting away from the scientific reasons for over fast cell renewal. Sexual activity outside the confines of marriage is hardly likely to be the real cause of breast cancer. The lung cancer and bowel cancer, and the myriad of other types of cancer people may scoff at us hormonal girls over this! However it has been known for many years that the cervix is vulnerable to cancer when it has been exposed to semen very often. But i am guilty of diversion. I have always understood that the pill reduces the risk of breast cancer because it mimics pregnancy and controls the over production of oestrogen.
    Sheila i love the fact that you are 80 and have such wonderful views, i wish my mum had embraced the modern world as you do. But i am worried that it was the enthusiastic scientists of previous generations that encouraged the pollution of our world, and continue to do and so this is the real cause. The children of Chernoble are our evidence. My own father’s blood cancer was due to radiation poisoning from his work at Aldermaston. My own breast cancer ( 6 years ago) has no known reason (apart from your theory that it might be due to multiple sexual partners!) and my sons thyroid cancer at the age of 12 was …why? Probably due to Chernoble cloud again!

  • Sheila Price
    6 February 2011

    I believe that the German medical student is on the right track. Sadly my husband is not alive to confirm what I have to say, but as a Vet. he always said that he knew if a dog owner had used the pill for their bitches, by the unhealthy look of the uterus when he operated on them. He would not allow me to use the pill as a young woman, we chose to be sensible and control ourselves. I have 3 wonderful children and so far had no side effects (I am now 80 years old).It is time a proper survey was carried out on all young women patients to see if they have been on the pill. And we should also stop mothers giving their young teenagers the morning after pill. Interference with the natural functions of the body can be dangerous. I never used any treatment when I had the menopause despite Tessa Jowel extolling the virtues of this treatment. We never had cases like this when I was a youngsterl There has to be a reason and it certainly is not alcohol. Self discipine in sexual activity outside marriage should be encouraged. This is meant to be an exptression of absolute love for one another within a lifelong partnership and offers the possibility of creating a new life. As my husband forecast it would, the adaptation of the pill originally desiged for canines, has caused a disaster amongst the current female population. But of course it earns huge profits for pharmaceutical firms !!!!

  • Gesa Behrens
    6 February 2011

    It has been proven that women taking estrogens for osteoporosis prophylaxes do have a much higher risk of getting breast cancer. How can it be, that younger women, taking exactly the same hormons (estrogen and gestagen) in form of the pill, do not have an increased risk?????? This is not plausible. Furthermore, the increase of breast cancer in the recent years fits well to the time, that the pill has been introduced in the 70s. As the pharma industry would have huge disadvantages of this risk being proven, of course there is no research about this. But clearly thinking, this has to be one of, if not THAT major risk for breast cancer. Regards from Gesa, medical student from Germany.

  • Wendy Green
    6 February 2011

    Like Irene, I had Grade 3 BC 3 years ago and would be interested to understand the survival rate for me – not the average across the board. Incidentally, I have never drunk much alcohol, never smoked, always been good weight (except since my illness) been fit and healthy but did have hrt for 5 years. No history of any cancers in family.

  • Ben Samuel
    6 February 2011

    Sorry to be a Green troll but, Cancer Research UK have not even mentioned radiation from nuclear fallout, waste etc.. Are we to believe that there is “not enough evidence”.

  • Helen
    5 February 2011

    I would be interested to know if there is any link between living under electricity pylons during childhood and breast cancer. I lived directly under pylons until age 20. I was diagnosed with an aggressive grade 3 tumour at age 40 and then another unrelated(in the other breast)two years later. My next door neighbour had breast cancer , as did another nearby neighbour,at the same age as me,- both sadly died.This seems a huge coinsidence to me!

  • J Doherty
    5 February 2011

    Thank you Margaret Chappell for your helpful response and the link to the useful BBC article.

    However, if “not all the “cancers” diagnosed through screening would ever have caused symptoms” then surely screening must cause an increase in breast cancer diagnoses.

    JD

  • kay Light
    5 February 2011

    I think it comes as no surprise, nearly everyone of my age seems to be on HRT. (59) Also with all the conflicting advice that constantly comes out about what to eat what not to eat and breastfeeding the nation is confused. Genetics surely play a major part, but manufacturers of HRT and other drugs must surely be another major factor in this rise.

  • Jules
    5 February 2011

    I have a personal theory about the sudden rise in breast cancer. Many years ago poultry farmers were known to inject the poultry with hormones. To do what? to make the breasts larger as that is the part that sells. I know several dear people that have died from breast cancer and in each case I either asked or knew that they ate a lot of chicken in their weekly diet as it is less fatty. These ladies were very fit, very diet conscious and ate mostly organic food, but did buy their chicken from supermarkets where the source was mass produced. It will be interesting to see if the levels of breast cancer come to a point of decreasing as the time lapse of hormone injections decreases. I do hope that some research is done on my theory! – I may be completely wrong but it does seem to fit. I am sure there are many other factors too but I wouldn’t be surprised if this theory is a valid one.

  • Nicola
    5 February 2011

    RE Breastfeeding reducing risk of breast cancer

    I read that breastfeeding reduces the risk of breast cancer because most women have few, if any, menstrual cylces (same applies for pregnancy) whilst (exclusively) breastfeeding.

    But what if a woman has regular periods (despite exclusively breastfeeding) from the day the babies were born. Will the, say, 6 years of breastfeeding have any risk reducing effect in this case?

    Would love to know you opinion on this!

  • Amette Ley
    5 February 2011

    You haven’t mentioned the link shown in several studies between the non-spontaneous abortion of a first child, resulting in high oestrogen levels without a pregnancy to support. [This is not usually linked to spontaneous abortion (miscarriage) as the hormone level would have gradually decreased beforehand.]

  • Ingrid
    4 February 2011

    I have a healthy diet, regular exercise, drink very rarely and have no family history of breast cancer, however, at the age of 23 I got diagnosed with breast cancer. It might be rare in my case, however, there are no statistic to support the under 29 year old woman that get diagnosed with breast cancer.
    I found my lump in August 2010, after seeing consultation from three different GPs I was then referred for tests on the lump. In December 2010 I got diagnosed with breast cancer and can now finally get the right treatment.
    With the time it took for me to be diagnosed, I now have to go through a longer more rigorous treatment. If I had been older I feel that it would have been dealt with quickly and more seriously.

    I just want to make women aware of the fact that being young, healthy and fit does not mean that you are exempt from this awful disease.

  • susie.
    4 February 2011

    I would just like to reassure some of the women that have contributed, that there are other women on study progammes into the courses of breast cancer.One study is about weight,alcohol,genes,lifestyle.Hopefully some results made be out in the spring. There is also the million women study which was mention in an email, This is still ongoing. I was also her2pos’ and have given regular blood samples to continue with the research. They are always looking for people to join study progammes when funds allow. The more that join in the better the research.

  • Isabel
    4 February 2011

    Yes, radioactivity is of HUGE interest to me. My son was diagnosed with thyroid cancer in 2001. He was 12. He is now 22 and thriving. But, the BC i had 3 years later could be due to the massive stress, IF stress were a risk factor, which it isnt…. apparently….We dont live near any known radioactive hot spots here in Dorset. Apart from the EDF plant across the sea in Normandy.

  • M Wright
    4 February 2011

    Have any studies been conducted on the possibilty that when the UK was covered in radioactive fallout following Chernobel that all cancers have been on the rise?

  • Isabel
    4 February 2011

    I had BC (grade 2 DCIS that had spread a bit and 1 affected lymph node) in 2004, I was 44. I had double mastectomy(from choice) and chemo. BUT i had none of the risk factors: I had 3 babies before the age of 33, and breast fed them all, i hardly drank a drop of alcohol then, and none now. I love healthy food, but was always between 8 1/2 and 9 1/2 stone prior to diagnosis. I have never ever smoked any type of ‘tobacco’. But would have been a passive smoker as a child. Your article doesn’t mention smoking at all. Why is this? Are we really 100% sure that nicotine/cannabis and other narcotics have no part to play in causing healthy breast cells to turn cancerous?
    I would love to know!!!!

  • Rose Kenny
    4 February 2011

    Could anyone tell me if at 51 you should have a breat screening, if you do not have any symptons

  • Irene North
    4 February 2011

    I had a grade 3 aggressive breast cancer two years ago. Is the increased survival rate applicable to the more severe tumours that required chemotherapy?

  • Kevan Gelling
    4 February 2011

    they found no link between vitamin D and breast cancer

    Both meta-analyses found that, in the case-control studies, higher vitamin D levels reduced breast cancer incidence (by 17% and 41% respectively). There were unable to say that the results were conclusive, but they found a link. The 2nd meta-analysis concluded that “further studies are needed”.

    A randomised control trial in 2007 found that vitamin D supplementation reduced breast cancer by 37%.

    A new 10 year study (E3N cohort – PMID 21127286) suggested that “vitamin D exposure from both sun and diet is required to prevent [breast cancer]”. Another (PMID 21160130) concluded “vitamin D had a protective effect against breast cancer in premenopausal women of normal weight in subtropical Taiwan”

    Breast cancer is more common at higher latitudes, women with breast cancer have lower levels of vitamin D, in the lab vitamin D has been shown to inhibit breast cancer cells, etc.

    The evidence may be uncertain, but there definitely is a link.

  • Cherub
    4 February 2011

    For years I’ve been reading about the link between alcohol and breast cancer, but what I’d really like to see is some decent research into what causes the over expression of growth hormone leading to a diagnosis of Her2 positive cancer. I was diagnosed with this 4 years ago and feel a lot more research is needed.

  • Harold Hobbs
    4 February 2011

    Breast cancer is increasing because all cancers are increasing. The reason for this is our increasingly toxic chemical filled environment.

  • m adams
    4 February 2011

    What is the rate of breast cancer among alcoholics? Do male alcoholics get breast cancer?

  • Margaret Chappell
    4 February 2011

    @ J Doherty. Cancer Research UK hase not included breast screening itself as a cause of the increase in diagnoses of breast cancer. Note that I used the word diagnoses – not all the “cancers” diagnosed through screening would ever have caused symptoms during life (due to low risk of growth and spread and death from other causes before significant tumour growth). There are also difficulties in the way statistical findings are presented. See this interesting article on the BBC News Magazine.

    http://news.bbc.co.uk/1/hi/magazine/7910011.stm

    Sorry link not worked and you will have to cut and paste the address.

    Diagnosis of tumours without serious malignant potential could also have contributed to the apparent increase in survival, as women are included who would not have died even if left untreated. The increase in survivial is undoubtedly related to better treatment but this unfortunately has side-effects which are sometimes dangerous as well as unpleasant. All to be considered in the complicated business of figuring out quite how helpful screening is.

  • Lisa
    4 February 2011

    I think more women should hear the message that breastfeeding for the recommended period of time can reduce breast cancer risks. Many women are simply unaware. Also – it seems to have been found that their daughter’s risk (of breast cancer) is reduced!

    Made my day this morning to hear Dr Kat Arney including lengthy breastfeeding in a discussion of how a few simple steps can markedly reduce the risk of breast cancer… and then to hear it all over again a few minutes later on the news on R4 Today.

    Thankyou!

  • J Doherty
    4 February 2011

    Dear Editor,

    Re Screening.

    Excluding DCIS, what is the estimated contribution of screening overdiagnosis to the increase in the 65-69 group?

    Thanks,

    JD

  • Jules610
    4 February 2011

    Could you please let me know how these findings relate to breast cancer patients or future patients that are “triple negative”? There seem to be little (published) reports in the UK about this section of suffers who, I believe, are a not insignifacant section of those diagnosed. Although obesity and alcohol are not good things, I feel that people should be aware of other factors.

    Comments

  • David R. Cowan
    24 February 2012

    I was doing some research – investigating the ley line system in Perthshire – and was walking a few hundred yards north of Loch Rannoch when a huge inky black cloud came over me and soaked me in a heavy downpour. This, I discovered later, was from Chernoble, and the area I was walking was later put under quarantine – no sheep or cattle were allowed to be sold.

    Four years ago I discovered that I had male breast cancer, behind one nipple, although I had surgery and radiation treatment very quickly after the initial diagnosis. I have no idea how much radiation I received from that cloud.

    I am male, and was 70 years old at the time of the fallout.

  • David R. Cowan
    24 February 2012

    I was doing some research – investigating the ley line system in Perthshire – and was walking a few hundred yards north of Loch Rannoch when a huge inky black cloud came over me and soaked me in a heavy downpour. This, I discovered later, was from Chernoble, and the area I was walking was later put under quarantine – no sheep or cattle were allowed to be sold.

    Four years ago I discovered that I had male breast cancer, behind one nipple, although I had surgery and radiation treatment very quickly after the initial diagnosis. I have no idea how much radiation I received from that cloud.

  • Elaine
    24 February 2011

    I found Dr Grant’s website harm from hormones a very interesting read, however the link she gives does not appear to work – I googled harm from hormones and got the site that way.

  • Dr Ellen Grant
    18 February 2011

    The breast cancer epidemic is mostly due to use of progesterone-type hormones whether given for contraception as pills, jabs, implants or in some IUDs, or for fertility or pregnancy treatments, or for HRT. Increases and decreases in breast cancer incidences match changes in such use over the past 50 years.* Taking progesterone-type hormones can cause huge weight gain and also increase addiction to alcohol and tobacco smoking. Women who have their first pregnancy in their 30s or 40s have increased risks because most have used contraceptive hormones for longer and then are more likely to take fertility drugs and HRT. Both the Million Women Study and the Women’s Health Institute randomised control trial underestimate risks and duration of risks for current and past users of hormones for any reason because past users of hormones were included in control groups.
    A review lecture of my clinical and research work on hormones since 1960s is available at http://www.harmfromhormone.co.uk.* Free papers are available in PubMed under grant ec.

  • Nicola
    14 February 2011

    So there is no information on whether breastfeeding reduces the risk of BC if a woman experiences regular mentrual cycles whilst (exclusively) breastfeeding (see
    February 5, 2011 at 11:08 am
    )…?

  • Dora
    11 February 2011

    I looked at Straight Statistics and saw there that the Cancer UK website says “The recent steep rise in rates for women aged 65-69 is almost certainly caused by the introduction of national breast cancer screening for this age-group”.

    Catherine Thomson, of Cancer UK, implies that the rise is due to DCIS and not significantly to invasive cancer, but this does not fit with the references given in my earlier posts.

  • Henry Scowcroft
    11 February 2011

    Hi everyone,

    We’ve been looking into the available data on survival rates for different types of breast cancer, as Irene North and Wendy Green (grade 3 breast cancer) and Jules610 (triple-negative breast cancer) asked. We’ve also done some digging into the radioactivity question several of you were concerned about.

    Unfortunately, it’s not possible to say anything about how national survival rates for different grades of breast cancer have changed over the last ten years. This is because this information hasn’t been collected and recorded consistently across the NHS over this period.

    We also looked at a similar measure, breast cancer stage (this is a measure of how far a cancer has spread, whereas grade is essentially a measure of how quickly it’s growing), but again, there’s not enough data to give an indication of how survival rates have changed across the England over the last decade. All of the cancer registries collect data on stage, but this is known to be inconsistent across the country.

    There has been a big push over the last few years to improve data collection across the NHS, led chiefly by the National Cancer Intelligence Network (NCIN). There have been substantial improvements, and there are more in the pipeline, with a commitment made by the new Government within its new cancer plan (Improving Outcomes: A Strategy for Cancer) for nationally consistent staging data to be available within two years. So in future we will hopefully be able to examine survival changes nationally over time in detail.

    The NCIN will be helping to make this commitment a reality, and we believe it’s crucial that data collection and reporting of good quality cancer data are protected from cutbacks.

    Likewise, for similar reasons, there is sadly no data about nationwide rates of triple-negative breast cancer over this period.

    Readers might be interested in the ‘Prognosis and outlook for breast cancer’ page on CancerHelp UK, which explains a lot of these concepts in more detail:

    http://cancerhelp.cancerresearchuk.org/type/breast-cancer/treatment/statistics-and-outlook-for-breast-cancer

    On the matter of radioactivity/Chernobyl: we’ve had a good look but there is currently no evidence that UK breast cancer rates were affected by radioactive fall-out from the 1986 Chernobyl explosion – but as ever we are keeping a keen eye on evidence as it emerges.

    Evan/Dora – you may find our responses over at Straight Statistics helpful.

    Henry

  • Dora
    11 February 2011

    Henry Scowcroft responds that “Our analysis excludes DCIS cases, so overdiagnosis is not likely to explain much of the rise in cases we’ve seen.” If so why is this different from all other experience?

    In response to Evan Harris the US National Cancer Institute (see my previous post)also says:

    . . investigators differ in their assessments of overdiagnosis regarding how and whether to adjust for characteristics such as lead-time bias.[18,19] As a consequence, the magnitude of overdiagnosis due to mammographic screening is controversial, with estimates ranging from 7% to 50%.[18-21]

    References

    18)Duffy SW, Lynge E, Jonsson H, et al.: Complexities in the estimation of overdiagnosis in breast cancer screening. Br J Cancer 99 (7): 1176-8, 2008. [PUBMED Abstract]

    19) Gøtzsche PC, Jørgensen KJ, Maehlen J, et al.: Estimation of lead time and overdiagnosis in breast cancer screening. Br J Cancer 100 (1): 219; author reply 220, 2009. [PUBMED Abstract]

    20) Gøtzsche PC, Nielsen M: Screening for breast cancer with mammography. Cochrane Database Syst Rev (4): CD001877, 2006. [PUBMED Abstract]

    21)Zackrisson S, Andersson I, Janzon L, et al.: Rate of over-diagnosis of breast cancer 15 years after end of Malmö mammographic screening trial: follow-up study. BMJ 332 (7543): 689-92, 2006. [PUBMED Abstract]

  • Evan Harris
    11 February 2011

    J Doherty and Margaret Chappell have essentially asked “excluding DCIS, what is the estimated contribution of screening overdiagnosis to the increase in the 65-69 group?”

    And I would add “To what extent is the recent increase in incidence of non-DCIS cases in 65-69 group responsible to the overall increase in lifetime risk?”

    I don’t think this has been fully addressed by Henry Scowcroft’s response which just says “Our analysis excludes DCIS cases, so overdiagnosis [which he had explained covers the issue raised by Doherty and Chappell] is not likely to explain much of the rise in cases we’ve seen.”

    Can you provide support for that assertion and also clarify to what extent it is known whether the over-diagnosis in non-DCIS cases has had an impact.

    Put another way what is the minimum amount of over-diagnosis artefact from the 65-69 group which would reduce the increased lifetime risk below the significance level, and can we sure that amount is not present?

    Thanks.

  • Dora
    9 February 2011

    It looks like screening increases breast cancer rates in most places.

    This is what the US National Cancer Institute (www.cancer.gov) says:

    Several observational population-based comparisons consider breast cancer incidence before and after adoption of screening.[22-26] If there were no overdiagnosis—and other aspects of screening were unchanged—there would be a rise in incidence followed by a decrease to below the prescreening level, and the cumulative incidence would be similar. Such results have not been observed. Breast cancer incidence rates increase at the initiation of screening without a compensatory drop in later years. For example, in Sweden, the age-specific incidence rates doubled between 1986 and 2002 for all age groups participating in screening.[22] Another study in 11 rural Swedish counties showed a persistent increase in breast cancer incidence following the advent of screening.[23] A population-based study from Norway and Sweden showed increases in invasive breast cancer incidence of 54% in Norway and 45% in Sweden in women aged 50 to 69 years, following the introduction of nationwide screening programs. No corresponding decline in incidence in women older than age 69 years was ever seen.[27] Similar findings suggestive of overdiagnosis have been reported from the United Kingdom [24] and the United States.[25,26]

    References

    22) Hemminki K, Rawal R, Bermejo JL: Mammographic screening is dramatically changing age-incidence data for breast cancer. J Clin Oncol 22 (22): 4652-3, 2004. [PUBMED Abstract]

    23)Jonsson H, Johansson R, Lenner P: Increased incidence of invasive breast cancer after the introduction of service screening with mammography in Sweden. Int J Cancer 117 (5): 842-7, 2005. [PUBMED Abstract]

    24)Johnson A, Shekhdar J: Breast cancer incidence: what do the figures mean? J Eval Clin Pract 11 (1): 27-31, 2005. [PUBMED Abstract]

    25)White E, Lee CY, Kristal AR: Evaluation of the increase in breast cancer incidence in relation to mammography use. J Natl Cancer Inst 82 (19): 1546-52, 1990. [PUBMED Abstract]

    26)Feuer EJ, Wun LM: How much of the recent rise in breast cancer incidence can be explained by increases in mammography utilization? A dynamic population model approach. Am J Epidemiol 136 (12): 1423-36, 1992. [PUBMED Abstract]

    27)Zahl PH, Strand BH, Maehlen J: Incidence of breast cancer in Norway and Sweden during introduction of nationwide screening: prospective cohort study. BMJ 328 (7445): 921-4, 2004. [PUBMED Abstract]

  • Irene North
    7 February 2011

    Thank you so much for your very measured information and advice.
    I have always attended for breast screening and was shocked to find a very large grade 3 aggressive tumour, only six weeks after a “clear” mammogram. This was in November 2008 but the care and treatment I have received in Lincoln have been second to none.

  • Henry Scowcroft
    7 February 2011

    Thanks everyone for your comments and questions – we’ve tried to clarify as much as we can below, and apologies for the length of this comment!

    Firstly, genetics. A number of you have mentioned that family history and genes are extremely important, and this is indeed the case. But the figures we discuss above relate to changes over the last ten years. As Underblog correctly points out, it’s extremely unlikely that the genetic make-up of the UK population would have altered enough over that period. So, while genes and family history are extremely important in setting an individual’s breast cancer risk, they’re probably not linked to the recent rise in rates we talk about above.

    Underblog, although it’s true our population is ageing, and that breast cancer is much more common among older people, our calculations have accounted for the effect of an ageing population, so that’s not an explanation for this rise.

    Jules610 raises an interesting point about ‘triple-negative’ breast cancers. These cancers account for about 12-17 per cent of all breast cancers, but only a few studies have compared risk factors for them with other types, and it’s hard to be sure which lifestyle changes affect the risk of triple-negative cancers. In fact, the picture’s rather murky and more research is needed to find out what’s going on: for example, while being overweight after the menopause increases the risk of other types of breast cancer, research suggests that being overweight before the menopause might slightly increase the risk of triple-negative breast cancer. We’re doing a bit of deeper digging into the stats and will get back to you in the next day or so about whether rates of this form of cancer have increased over the last ten years.

    On a similar note, several of you asked whether the increase in survival rates applies to women with more aggressive tumours – again, our stats team is looking into the data in this area and we’ll clarify this in the next few days.

    J Doherty asks about ‘overdiagnosis’ – i.e. people diagnosed with breast cancer through screening, but whose cancer would not have grown quickly enough to cause problems. The issue of overdiagnosis is the subject of much debate and is very hard to pin down. But overdiagnosis is most likely to happen with a type of condition called DCIS (ductal carcinoma in situ), which may or may not progress into invasive cancer. Our analysis excludes DCIS cases, so overdiagnosis is not likely to explain much of the rise in cases we’ve seen. There’s more info about breast screening here http://info.cancerresearchuk.org/spotcancerearly/screening/breastcancerscreening/.

    m adams asks about breast cancer rates in male alcoholics. There’s very little research looking into this so it’s difficult to say. There’s information about known risk factors for breast cancer in men on CancerHelp UK http://cancerhelp.cancerresearchuk.org/type/breast-cancer/about/types/breast-cancer-in-men

    Another common question you had was about smoking. This is an interesting one – many studies have looked at the links between smoking and breast cancer. It currently looks like there is a small effect, but – crucially – nowhere near as severe the effect that tobacco smoke has on other parts of the body. There’s an excellent article on the American Cancer Society’s blog discussing this which is worth reading if you’re interested.

    Several of you, including Jules, Harold Hobbs and Ann, are concerned about substances in our environment that are, or can act as, hormones, such as growth hormones or soya. As we say in the post, there’s not enough evidence that these are linked to breast cancer, nor that they’re to blame for the increase, and plenty of evidence pointing to other things. Interestingly, a recent paper looking at soy found that it had no effect in western populations and even decreased breast cancer rates in Asian populations. Here’s a link to the paper on PubMed and there’s more information on hormones and cancer risk on our website.

    M Wright, Isabel and self-confessed ‘Green troll’ Ben Samuel are concerned about radioactivity, particularly regarding the 1986 Chernobyl power station explosion. This is a complex question and our stats team are looking into it – we’ll get back to you some more info shortly.

    Gesa Behrens and Sheila Price ask why we discount the Pill as a significant cause, yet highlight hormone replacement therapy (HRT). Here’s why: HRT is generally taken to *replace* a woman’s oestrogen once she’s stopped producing it herself, and this usually happens at an older age, when breast cancer risk is higher. So women taking HRT are taking extra oestrogen and prolonging their exposure. Conversely, the contraceptive pill is taken by premenopausal women who have far lower risk of the disease. So although the pill does very slightly increase the risk of breast cancer, the overall contribution of pill-linked breast cancers to the increase we’ve seen is probably very small in numerical terms compared to the effect of HRT. There’s more info about the Pill and cancer here: http://info.cancerresearchuk.org/healthyliving/hormones/thepill/

    Amette Ley asks about a controversial topic – abortion. There has been lots of research about induced abortion and breast cancer. But the findings have been inconsistent and while some studies have found a link, many others have not. Recent studies that have found a link asked women with breast cancer whether they’d previously had an abortion, and all came from countries with strict laws about abortion. Scientists have expressed concern that in these countries, women may be less likely to admit that they had an abortion because of its controversial nature, but that breast cancer patients are actually more likely to do so because they may be trying to explain their disease (see e.g. http://www.ncbi.nlm.nih.gov/pubmed/8944006, http://www.ncbi.nlm.nih.gov/pubmed/15051280). This would exaggerate any links and make them look stronger than they actually were. Many studies which followed up healthy women over time, and one which used medical records to make sure the responses couldn’t be biased, found no link. (see, for example, http://www.ncbi.nlm.nih.gov/pubmed/17452545, http://www.ncbi.nlm.nih.gov/pubmed/18477486, and http://www.ncbi.nlm.nih.gov/pubmed/16646050).

    In 2003, the National Cancer Institute in the USA gathered a group of over 100 experts on pregnancy and breast cancer to review the existing scientific evidence. They also concluded that having an abortion does not increase a woman’s risk of breast cancer. And in 2004, a team of scientists analysed the results from all the 53 previous studies in this area. They too found no link.

    Helen: re. electricity pylons – you might find this page of our website of interest: http://info.cancerresearchuk.org/healthyliving/cancercontroversies/powerlines/

    And finally, even though the disease is far more common amongst older women, as Ingrid points out, it can occur at any age, to anyone. That’s why it’s important to be ‘breast aware’ and know what’s normal for you. That way you’ll be more likely to notice anything unusual that could be a sign of cancer. Screening can also help spot the disease at an early stage, and it’s intended for people without any symptoms, as it’s meant to spot the disease at a very early stage before any symptoms have developed (Rose Kenny).

    Thanks again for your questions, and we’ll get back to you on the other issues in due course,

    Henry

  • Richard Stanley
    7 February 2011

    There many things we do not know about in situ breast cancer (DCIS) which is being diagnosed frequently compared to 25 even 20 years ago. Do they always progress to invasive cancer, do some regress left on their own do some remain always as DCIS? How mant cases of DCIS have an invasive element missed by the pathologist. The same may be said of very small cancers =< 0.5cms, do they always grow or do some regress on their own? There is a fundamental flaw in breast screening in that half of all 1 mm, yes 1mm, tumours will have acquired a blood supply and can metastasise long before the screen detected lower limit of 0.5cms, it is only those 3% or so at the right hand end of the gaussian size/frequency distribution curve that have not acquired a blood supply that are potentially curable, this is a very small percentage and by far the geat majority of screen detected breast cancers will have already metastasised, hence the need for radiotherapy to the breast in lumpectomy, radiotherapy treatment of the axilla where there are positive node(s)and adjuvent chemotherapy
    Unfortunately we cannot do the necessary trials, that is treatment vs no treatment for DCIS and small tumours to find out whether these screen early cancers will progress to lethal cancer.
    Smoking can also have an effect, in fact it is probably a much bigger risk factor than alcohol

  • Rivka J
    7 February 2011

    Hi I was diagnosed with a stage 1 grade 3 breast cancer with no lymph node involvement in November 2009 and had a lumpectomy. I am 57 and a life long vegetarian who grows her own veg organically, is a non smoker and teetotal, exercises regularly (runs the race for life every year)is not overweight and fell into the very lowest breast cancer risk category. After due consultation with my breast surgeon and the consultant oncologist and doing a lot of research into adjuvant therapies I decided to opt only for minimal surgery and no chemo or radiation or drugs like arimidex. As a result I am as fit and healthy as I’ve always been. I know every case must be judged on it’s own merits but you do not have to have all the treatments if you don’t feel they are right for you. Yes I agonised over if I should have them or not and I just felt personally I couldn’t poison my body in that way. I also know it’s early days for me in the scheme of things but I have no sign of recurrence or spread to date. Too often treatments available may stop you dying from cancer in the interim but have horrendous side effects that too many women are not aware of since they are not told. I also hate the use of catergorisation into cancer victim and cancer survivor since I don’t see myself as either I’m just a woman who had an illness that was treated and now I get on with my life.
    Actually what we really need is a cure not treatments that may extend your life but at the cost of destroying your quality of life.
    So what we need is research into a vaccine against breast cancer to be paramount and for more treatments with fewer side effects to be put through the long drawn out process of ratification much faster.

  • Richard Stanley
    7 February 2011

    A significant part of my comment has been left out, in that 1 mm tumours can acquire a blood supply and can metastasise long before the screen detected lower limit of 0.5cms, it is only those 3% or so at the right hand end of the gaussian size/frequency etc

  • Richard Stanley
    7 February 2011

    There many things we do not know about in situ breast cancer, DCIS, which is being diagnosed frequently compared to 25 even 20 years ago. Do they always progress to invasive cancer, do some regress left on their own do some remain always as DCIS? The same may be said of very small cancers 0.5cms at the right hand end of the gaussian frequency distribution curve that have not acquired a blood supply that are curable.
    Unfortunately we cannot do the necessary trials, that is treatment vs no treatment for DCIS and small tumours to find out whether these screen early cancers will progress to lethal cancer

  • ben
    7 February 2011

    Is breast cancer exclusive to females? Or are males also susceptible to the disease?

    Also for all who have suffered or are suffering from the disease please stay strong

  • underblog
    7 February 2011

    Genes are a risk factor, but this article is about possible causes of the increase in breast cancer rates. Breast cancer genes have probably not become more common in the population over just 10 years, so they probably don’t explain the increase.

  • Clare Moynihan
    7 February 2011

    Thank you for this information – extremely clear and well put. I may have missed this but the genetic factor hasn’t been mentioned. I know that genes are relatively low on the breast cancer risk scale but nevertheless a family history is part of the picture and can be monitored. Is there a reason for not including genetic BRCA 1/2?

  • underblog
    7 February 2011

    It should be possible to work out what contribution demographic changes have made to the increase. Without this it’s impossible to tell if we should be concerned about other risk factors. Perhaps our aging population is responsible for the entire increase in breast cancer rates?

  • Elaine
    7 February 2011

    just a quick message to Irene North – I had grade 3 aggressive bc 4 in 2006, radiotherapy and chemo and am still fine and disease free as far as i know! have met many in the same position – survival rates are improving for all bc – know a lady who had a very similar diagnosis to my own who is still disease free after 15 years! think I have learned that although you can look at stats prognosis is a very individual thing with many factors involved and on the positive side new advances are being made almost daily. like many on here i had a very low risk rate – never smoked, healthy diet never been overweight do drink alcohol but in moderation, on the pill for abt 12 mnths in 70’s came off as it did not agree with me!! had 2 children (born when i was 28 and 32) both breast feed for abt 9 mnths (however i did have a daughter who died at 3mnths and a miscarriage at 20 wks so was interested in annettes contribution.)I do worry that putting too much emphasis on the idea that getting cancer can be self inflicted is a bit counterproductive for those who go on to develop it with low risk factors – i know we need to be made aware of the risks we are taking so that we can make informed choices but in my experience many with low risks do develop the disease and some of the choices we are being encouraged to make today in our lifestyles could be found to be detremental in the future. so whilst the current publication of the information about the risk factors is helpful as others have mentioned i am not sure there is as much publicity being given to the other less personally accountable risks such having taken the pill!

  • Ann
    6 February 2011

    I was wondering about the effects of soya as it is reputed to have oestrogen mimicking properties. Any thoughts?

  • dave warren
    6 February 2011

    please get up dates comming tome thanks

  • Isabel
    6 February 2011

    Everybody has the answers it seems! Though i do feel that perhaps we bloggers might be getting away from the scientific reasons for over fast cell renewal. Sexual activity outside the confines of marriage is hardly likely to be the real cause of breast cancer. The lung cancer and bowel cancer, and the myriad of other types of cancer people may scoff at us hormonal girls over this! However it has been known for many years that the cervix is vulnerable to cancer when it has been exposed to semen very often. But i am guilty of diversion. I have always understood that the pill reduces the risk of breast cancer because it mimics pregnancy and controls the over production of oestrogen.
    Sheila i love the fact that you are 80 and have such wonderful views, i wish my mum had embraced the modern world as you do. But i am worried that it was the enthusiastic scientists of previous generations that encouraged the pollution of our world, and continue to do and so this is the real cause. The children of Chernoble are our evidence. My own father’s blood cancer was due to radiation poisoning from his work at Aldermaston. My own breast cancer ( 6 years ago) has no known reason (apart from your theory that it might be due to multiple sexual partners!) and my sons thyroid cancer at the age of 12 was …why? Probably due to Chernoble cloud again!

  • Sheila Price
    6 February 2011

    I believe that the German medical student is on the right track. Sadly my husband is not alive to confirm what I have to say, but as a Vet. he always said that he knew if a dog owner had used the pill for their bitches, by the unhealthy look of the uterus when he operated on them. He would not allow me to use the pill as a young woman, we chose to be sensible and control ourselves. I have 3 wonderful children and so far had no side effects (I am now 80 years old).It is time a proper survey was carried out on all young women patients to see if they have been on the pill. And we should also stop mothers giving their young teenagers the morning after pill. Interference with the natural functions of the body can be dangerous. I never used any treatment when I had the menopause despite Tessa Jowel extolling the virtues of this treatment. We never had cases like this when I was a youngsterl There has to be a reason and it certainly is not alcohol. Self discipine in sexual activity outside marriage should be encouraged. This is meant to be an exptression of absolute love for one another within a lifelong partnership and offers the possibility of creating a new life. As my husband forecast it would, the adaptation of the pill originally desiged for canines, has caused a disaster amongst the current female population. But of course it earns huge profits for pharmaceutical firms !!!!

  • Gesa Behrens
    6 February 2011

    It has been proven that women taking estrogens for osteoporosis prophylaxes do have a much higher risk of getting breast cancer. How can it be, that younger women, taking exactly the same hormons (estrogen and gestagen) in form of the pill, do not have an increased risk?????? This is not plausible. Furthermore, the increase of breast cancer in the recent years fits well to the time, that the pill has been introduced in the 70s. As the pharma industry would have huge disadvantages of this risk being proven, of course there is no research about this. But clearly thinking, this has to be one of, if not THAT major risk for breast cancer. Regards from Gesa, medical student from Germany.

  • Wendy Green
    6 February 2011

    Like Irene, I had Grade 3 BC 3 years ago and would be interested to understand the survival rate for me – not the average across the board. Incidentally, I have never drunk much alcohol, never smoked, always been good weight (except since my illness) been fit and healthy but did have hrt for 5 years. No history of any cancers in family.

  • Ben Samuel
    6 February 2011

    Sorry to be a Green troll but, Cancer Research UK have not even mentioned radiation from nuclear fallout, waste etc.. Are we to believe that there is “not enough evidence”.

  • Helen
    5 February 2011

    I would be interested to know if there is any link between living under electricity pylons during childhood and breast cancer. I lived directly under pylons until age 20. I was diagnosed with an aggressive grade 3 tumour at age 40 and then another unrelated(in the other breast)two years later. My next door neighbour had breast cancer , as did another nearby neighbour,at the same age as me,- both sadly died.This seems a huge coinsidence to me!

  • J Doherty
    5 February 2011

    Thank you Margaret Chappell for your helpful response and the link to the useful BBC article.

    However, if “not all the “cancers” diagnosed through screening would ever have caused symptoms” then surely screening must cause an increase in breast cancer diagnoses.

    JD

  • kay Light
    5 February 2011

    I think it comes as no surprise, nearly everyone of my age seems to be on HRT. (59) Also with all the conflicting advice that constantly comes out about what to eat what not to eat and breastfeeding the nation is confused. Genetics surely play a major part, but manufacturers of HRT and other drugs must surely be another major factor in this rise.

  • Jules
    5 February 2011

    I have a personal theory about the sudden rise in breast cancer. Many years ago poultry farmers were known to inject the poultry with hormones. To do what? to make the breasts larger as that is the part that sells. I know several dear people that have died from breast cancer and in each case I either asked or knew that they ate a lot of chicken in their weekly diet as it is less fatty. These ladies were very fit, very diet conscious and ate mostly organic food, but did buy their chicken from supermarkets where the source was mass produced. It will be interesting to see if the levels of breast cancer come to a point of decreasing as the time lapse of hormone injections decreases. I do hope that some research is done on my theory! – I may be completely wrong but it does seem to fit. I am sure there are many other factors too but I wouldn’t be surprised if this theory is a valid one.

  • Nicola
    5 February 2011

    RE Breastfeeding reducing risk of breast cancer

    I read that breastfeeding reduces the risk of breast cancer because most women have few, if any, menstrual cylces (same applies for pregnancy) whilst (exclusively) breastfeeding.

    But what if a woman has regular periods (despite exclusively breastfeeding) from the day the babies were born. Will the, say, 6 years of breastfeeding have any risk reducing effect in this case?

    Would love to know you opinion on this!

  • Amette Ley
    5 February 2011

    You haven’t mentioned the link shown in several studies between the non-spontaneous abortion of a first child, resulting in high oestrogen levels without a pregnancy to support. [This is not usually linked to spontaneous abortion (miscarriage) as the hormone level would have gradually decreased beforehand.]

  • Ingrid
    4 February 2011

    I have a healthy diet, regular exercise, drink very rarely and have no family history of breast cancer, however, at the age of 23 I got diagnosed with breast cancer. It might be rare in my case, however, there are no statistic to support the under 29 year old woman that get diagnosed with breast cancer.
    I found my lump in August 2010, after seeing consultation from three different GPs I was then referred for tests on the lump. In December 2010 I got diagnosed with breast cancer and can now finally get the right treatment.
    With the time it took for me to be diagnosed, I now have to go through a longer more rigorous treatment. If I had been older I feel that it would have been dealt with quickly and more seriously.

    I just want to make women aware of the fact that being young, healthy and fit does not mean that you are exempt from this awful disease.

  • susie.
    4 February 2011

    I would just like to reassure some of the women that have contributed, that there are other women on study progammes into the courses of breast cancer.One study is about weight,alcohol,genes,lifestyle.Hopefully some results made be out in the spring. There is also the million women study which was mention in an email, This is still ongoing. I was also her2pos’ and have given regular blood samples to continue with the research. They are always looking for people to join study progammes when funds allow. The more that join in the better the research.

  • Isabel
    4 February 2011

    Yes, radioactivity is of HUGE interest to me. My son was diagnosed with thyroid cancer in 2001. He was 12. He is now 22 and thriving. But, the BC i had 3 years later could be due to the massive stress, IF stress were a risk factor, which it isnt…. apparently….We dont live near any known radioactive hot spots here in Dorset. Apart from the EDF plant across the sea in Normandy.

  • M Wright
    4 February 2011

    Have any studies been conducted on the possibilty that when the UK was covered in radioactive fallout following Chernobel that all cancers have been on the rise?

  • Isabel
    4 February 2011

    I had BC (grade 2 DCIS that had spread a bit and 1 affected lymph node) in 2004, I was 44. I had double mastectomy(from choice) and chemo. BUT i had none of the risk factors: I had 3 babies before the age of 33, and breast fed them all, i hardly drank a drop of alcohol then, and none now. I love healthy food, but was always between 8 1/2 and 9 1/2 stone prior to diagnosis. I have never ever smoked any type of ‘tobacco’. But would have been a passive smoker as a child. Your article doesn’t mention smoking at all. Why is this? Are we really 100% sure that nicotine/cannabis and other narcotics have no part to play in causing healthy breast cells to turn cancerous?
    I would love to know!!!!

  • Rose Kenny
    4 February 2011

    Could anyone tell me if at 51 you should have a breat screening, if you do not have any symptons

  • Irene North
    4 February 2011

    I had a grade 3 aggressive breast cancer two years ago. Is the increased survival rate applicable to the more severe tumours that required chemotherapy?

  • Kevan Gelling
    4 February 2011

    they found no link between vitamin D and breast cancer

    Both meta-analyses found that, in the case-control studies, higher vitamin D levels reduced breast cancer incidence (by 17% and 41% respectively). There were unable to say that the results were conclusive, but they found a link. The 2nd meta-analysis concluded that “further studies are needed”.

    A randomised control trial in 2007 found that vitamin D supplementation reduced breast cancer by 37%.

    A new 10 year study (E3N cohort – PMID 21127286) suggested that “vitamin D exposure from both sun and diet is required to prevent [breast cancer]”. Another (PMID 21160130) concluded “vitamin D had a protective effect against breast cancer in premenopausal women of normal weight in subtropical Taiwan”

    Breast cancer is more common at higher latitudes, women with breast cancer have lower levels of vitamin D, in the lab vitamin D has been shown to inhibit breast cancer cells, etc.

    The evidence may be uncertain, but there definitely is a link.

  • Cherub
    4 February 2011

    For years I’ve been reading about the link between alcohol and breast cancer, but what I’d really like to see is some decent research into what causes the over expression of growth hormone leading to a diagnosis of Her2 positive cancer. I was diagnosed with this 4 years ago and feel a lot more research is needed.

  • Harold Hobbs
    4 February 2011

    Breast cancer is increasing because all cancers are increasing. The reason for this is our increasingly toxic chemical filled environment.

  • m adams
    4 February 2011

    What is the rate of breast cancer among alcoholics? Do male alcoholics get breast cancer?

  • Margaret Chappell
    4 February 2011

    @ J Doherty. Cancer Research UK hase not included breast screening itself as a cause of the increase in diagnoses of breast cancer. Note that I used the word diagnoses – not all the “cancers” diagnosed through screening would ever have caused symptoms during life (due to low risk of growth and spread and death from other causes before significant tumour growth). There are also difficulties in the way statistical findings are presented. See this interesting article on the BBC News Magazine.

    http://news.bbc.co.uk/1/hi/magazine/7910011.stm

    Sorry link not worked and you will have to cut and paste the address.

    Diagnosis of tumours without serious malignant potential could also have contributed to the apparent increase in survival, as women are included who would not have died even if left untreated. The increase in survivial is undoubtedly related to better treatment but this unfortunately has side-effects which are sometimes dangerous as well as unpleasant. All to be considered in the complicated business of figuring out quite how helpful screening is.

  • Lisa
    4 February 2011

    I think more women should hear the message that breastfeeding for the recommended period of time can reduce breast cancer risks. Many women are simply unaware. Also – it seems to have been found that their daughter’s risk (of breast cancer) is reduced!

    Made my day this morning to hear Dr Kat Arney including lengthy breastfeeding in a discussion of how a few simple steps can markedly reduce the risk of breast cancer… and then to hear it all over again a few minutes later on the news on R4 Today.

    Thankyou!

  • J Doherty
    4 February 2011

    Dear Editor,

    Re Screening.

    Excluding DCIS, what is the estimated contribution of screening overdiagnosis to the increase in the 65-69 group?

    Thanks,

    JD

  • Jules610
    4 February 2011

    Could you please let me know how these findings relate to breast cancer patients or future patients that are “triple negative”? There seem to be little (published) reports in the UK about this section of suffers who, I believe, are a not insignifacant section of those diagnosed. Although obesity and alcohol are not good things, I feel that people should be aware of other factors.