tag:theconversation.com,2011:/id/topics/breast-cancer-999/articlesBreast cancer – The Conversation2024-03-19T14:07:42Ztag:theconversation.com,2011:article/2258602024-03-19T14:07:42Z2024-03-19T14:07:42ZWhat breast cancer risk assessments can tell you<figure><img src="https://images.theconversation.com/files/582489/original/file-20240318-22-a2250w.jpg?ixlib=rb-1.1.0&rect=0%2C5%2C3589%2C2495&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">After her doctor calculated her breast cancer risk, Munn went on to have further tests which ultimately revealed her cancer.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/olivia-munn-23rd-annual-critics-choice-1020846856">Tinseltown/ Shutterstock</a></span></figcaption></figure><p>Actress Olivia Munn recently shared on social media that she had undergone a double mastectomy after being diagnosed with <a href="https://www.bbc.co.uk/news/entertainment-arts-68554938">luminal B breast cancer</a>. In <a href="https://www.instagram.com/p/C4dXfrULDdJ/?img_index=1">an Instagram post</a>, Munn explained how she had been diagnosed with the fast-growing cancer.</p>
<p>The actress had initially undergone genetic testing in an effort to be proactive about her health. Munn tested negative for mutations of the BRCA gene, which is associated with a <a href="https://www.nature.com/articles/nrc2054">much higher risk of breast cancer</a>. Still, Munn’s doctor decided to calculate her “Breast Cancer Risk Assessment Score” by looking at other factors known to increase risk of the disease. </p>
<p>The test revealed Munn had a 37% risk of developing breast cancer in her lifetime. Munn subsequently decided to undergo further testing, which revealed she had cancer. Many people reading this story may be wondering whether they should also have a breast cancer risk assessment done – and what this would entail.</p>
<p>In general, a breast cancer risk assessment involves evaluating various factors that can contribute to a person’s likelihood of developing breast cancer. Some factors that would be taken into consideration include: </p>
<h2>1. Age</h2>
<p>Age is a major risk factor for breast cancer. The older you are, the more likely you are to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4491690">develop breast cancer</a>.</p>
<p>About 80% of breast cancer cases occur in woman over 50, who have been through the menopause. This is one reason why all women aged 50-71 should be <a href="https://www.nhs.uk/conditions/breast-screening-mammogram/">screened for breast cancer</a> every three years. </p>
<h2>2. Family history</h2>
<p>Having a mother, sister or daughter (referred to as a “first-degree relative”) diagnosed with breast cancer approximately <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8428369/">doubles the risk of breast cancer</a>. This risk is even higher the more close relatives you know who have had breast cancer, or if a relative developed breast cancer under the age of 50. </p>
<p>While family history of breast cancer on your mother’s side is associated with greater risk, history of breast cancer on the father’s side shouldn’t be <a href="https://pubmed.ncbi.nlm.nih.gov/12697961/">dismissed</a> either. </p>
<h2>3. Genetic mutations</h2>
<p>Mutations in genes such as <a href="https://www.nature.com/articles/nrc2054">BRCA1 and BRCA2</a> are associated with a higher risk of breast cancer and ovarian cancer, with these cancers occurring at younger ages.</p>
<p>About <a href="https://pubmed.ncbi.nlm.nih.gov/33301022/">10-13% of women will develop breast cancer</a> at some point in their lives and most of these cases do not have predisposing mutations, <a href="https://pubmed.ncbi.nlm.nih.gov/32710860/">such as changes in BRCA1 or BRCA2 genes</a>. By contrast, most women who inherit a harmful BRCA1 or BRCA2 gene variant <a href="https://pubmed.ncbi.nlm.nih.gov/30572612/">will develop breast cancer</a> by 70-80 years of age if they aren’t followed up and treated properly, for example with bilateral (meaning both sides) mastectomies.</p>
<p>But these may not be the only genetic mutations which increase breast cancer risk. In Munn’s case, although she didn’t have a BRCA mutation, she may have had other genes which we’re now understanding have a role – such as the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8152746/">ATM gene</a> or the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7066089/">CHEK2 gene</a>. </p>
<p>Importantly, genetic tests are now much quicker and easier to access than they used to be – and <a href="https://www.nice.org.uk/guidance/cg164">can often be accessed</a> on the NHS. </p>
<h2>4. Medical history</h2>
<p>Previous breast biopsies and benign breast conditions (such as fibroadenomas or pre-cancerous lesions in the breast tissue) would all be taken into account as they can be associated with an increase breast cancer risk. </p>
<figure class="align-center ">
<img alt="An older woman and her female doctor both look down at a clipboard the doctor is holding." src="https://images.theconversation.com/files/582493/original/file-20240318-30-uxd635.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/582493/original/file-20240318-30-uxd635.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/582493/original/file-20240318-30-uxd635.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/582493/original/file-20240318-30-uxd635.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/582493/original/file-20240318-30-uxd635.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/582493/original/file-20240318-30-uxd635.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/582493/original/file-20240318-30-uxd635.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Your doctor would also take her medical history into account when assessing risk.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/female-doctor-sits-her-desk-chats-1679462023">Lordn/ Shutterstock</a></span>
</figcaption>
</figure>
<p>A doctor would also look at a person’s hormonal and reproductive health, looking specifically at when they had their <a href="https://pubmed.ncbi.nlm.nih.gov/23084519/">first period</a>, when they had their <a href="https://linkinghub.elsevier.com/retrieve/pii/S030146810960579X">first full-term pregnancy</a> and if they were <a href="https://pubmed.ncbi.nlm.nih.gov/19450345/">pre or post-menopausal</a>.</p>
<p>Research <a href="https://www.nature.com/articles/s41467-023-40608-z">published by my team</a> explored the mechanisms by which delaying a first pregnancy to the late-30s increases the <a href="https://www.telegraph.co.uk/news/2023/09/06/breast-cancer-risk-pregnancy-older-mothers-age-mutation/">risk of breast cancer</a>. We discovered that changes that occur in the breast’s tissues during pregnancy can ultimately trigger more mutations to occur in the breast’s tissue over time.</p>
<h2>5. Breast density</h2>
<p>Having very dense breasts is a risk factor for breast cancer and is associated with a <a href="https://pubmed.ncbi.nlm.nih.gov/36183671/">doubling of risk</a>.</p>
<p>A person is considered to have <a href="https://www.cancer.gov/types/breast/breast-changes/dense-breasts">dense breasts</a> if they have high amounts of glandular tissue and connective tissue and low amounts of fatty breast tissue. <a href="https://www.cdc.gov/cancer/breast/basic_info/dense-breasts.htm#:%7E:text=Women%20with%20dense%20breasts%20have%20a%20higher%20chance%20of%20getting,%2Ddense%20(fatty)%20breasts.">Breast density</a> can only be seen on mammograms. </p>
<h2>6. Lifestyle</h2>
<p>Factors such as whether a person <a href="https://pubmed.ncbi.nlm.nih.gov/25307527/">smokes</a>, what their <a href="https://pubmed.ncbi.nlm.nih.gov/31277273/">diet is</a>, how <a href="https://pubmed.ncbi.nlm.nih.gov/17130685/">physically active</a> they are, if they’re <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6437123/">obese</a> and if they take <a href="https://pubmed.ncbi.nlm.nih.gov/12927427/">hormone replacement therapy</a>, may all linked with greater risk of breast cancer. Your doctor will take all of these into account when assessing your risk.</p>
<p><a href="https://www.nature.com/articles/s41416-021-01492-w">Alcohol consumption</a> is a particularly important factor, as excess alcohol use is associated with greater risk. Even moderate alcohol consumption can <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3832299/">increase the risk by 30-50%</a>.</p>
<h2>7. Radiation exposure</h2>
<p>Having previously <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1895063">undergone radiation therapy</a> for lymphoma, especially during childhood and adolescence, may increase the risk of breast cancer – though this is rare.</p>
<p>It’s important to note that this is only referring to radiation treatment. Routine X-rays should not increase your breast cancer risk.</p>
<h2>Caveats and limitations</h2>
<p>This isn’t an exhaustive list and other factors can be important. For example, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1895063/">diabetic women</a> are up to 20% more likely to develop postmenopausal breast cancer than older, non-diabetic women – but this may be related to obesity.</p>
<p>Calculating breast cancer risk typically involves integrating these factors into risk assessment models – sometimes called risk calculators. These models use statistical algorithms to estimate a person’s likelihood of developing breast cancer over a period of time by giving the average risk of breast cancer for a group of women with similar risk factors.</p>
<p>For example, say it gives a woman a five-year risk of 1%. This means the tool estimates 1% of women who have similar risk factors will develop breast cancer over the next five years. However, it can’t predict which of these women will get breast cancer. </p>
<p>While these risk assessment tools can provide valuable information, they are not perfect predictors. Personalised medical advice should always be sought from healthcare professionals, and you should have more than one discussion before undergoing any preventative treatment.</p><img src="https://counter.theconversation.com/content/225860/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Justin Stebbing does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Olivia Munn recently shared on Instagram that she’d had a double mastectomy after being diagnosed with luminal B breast cancer.Justin Stebbing, Professor of Biomedical Sciences, Anglia Ruskin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2229442024-03-14T12:43:02Z2024-03-14T12:43:02ZProteins in milk and blood could one day let doctors detect breast cancer earlier – and save lives<figure><img src="https://images.theconversation.com/files/581419/original/file-20240312-28-8qcsls.jpg?ixlib=rb-1.1.0&rect=18%2C91%2C5398%2C3982&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">What if a simple blood test could diagnose otherwise undetected breast cancer?</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/vascular-testing-in-research-laboratories-royalty-free-image/1443155227">Srinophan69/Moment via Getty Images</a></span></figcaption></figure><p>Doctors may someday be able to use bodily fluids to noninvasively detect breast cancer in patients earlier than is possible now.</p>
<p>Breast cancer is the <a href="https://doi.org/10.3322/caac.21763">most commonly diagnosed cancer among women</a> in the U.S. and is currently one of the leading <a href="https://www.cancer.org/cancer/risk-prevention/understanding-cancer-risk/cancer-facts/cancer-facts-for-women.html">causes of cancer deaths</a>. Earlier diagnosis and treatment <a href="https://doi.org/10.1002/cncr.32887">lead to better prognoses</a> for breast cancer patients. But mammograms have proved to be <a href="https://www.cancer.org/cancer/types/breast-cancer/screening-tests-and-early-detection/mammograms/limitations-of-mammograms.html">less effective for those under age 40</a>, as their breast tissue is denser and screening and biopsies can be unpleasant to endure.</p>
<p><iframe id="Nf0up" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/Nf0up/2/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<p>In breast milk and blood serum, researchers, including <a href="https://people.clarkson.edu/%7Ecdarie/">those in my lab group</a>, have identified proteins that are involved in tumor development. Eventually, biochemists like my colleagues <a href="https://scholar.google.com/citations?user=GH2M7ZEAAAAJ&hl=en">and I</a> hope we can use these cancer-related proteins to create a <a href="https://doi.org/10.3390/proteomes10040036">biomarker panel</a> that physicians can use to detect breast cancer earlier, therefore aiding in diagnosis and treatment.</p>
<h2>Proteins as biomarkers for what’s happening</h2>
<p>Researchers can analyze the proteins present in a variety of tissues, from biopsies of tumors to biological fluids including blood, saliva, urine, tears or breast milk. This technique is an example of studying a sample’s proteome – all the proteins in a particular cell, organism or species. The field is called <a href="https://doi.org/10.4331/wjbc.v12.i5.57">proteomics</a>. </p>
<p><a href="https://doi.org/10.1016/S1672-0229(07)60018-7">Proteomics can be a powerful tool</a> when researchers compare the proteomes of individuals from different groups, such as in blood from healthy people versus those with breast cancer. This kind of case-control comparison can identify a single protein or a group of proteins and their variants that are specific to one condition.</p>
<p>That’s what my colleagues and I are looking for: proteins that are present only in the samples from people who have breast cancer. Scientists call them <a href="https://www.britannica.com/science/biomarker">biomarkers</a> because they signal that a patient has a particular condition. Once our candidates are verified by large-scale clinical trials that include many patients, we hope that particular proteins can then be used to assess someone’s future risk of developing the disease.</p>
<p>Doctors can currently use <a href="https://doi.org/10.5493/wjem.v2.i5.86">biomarkers for breast cancer</a> to gauge a patient’s response to treatment. For instance, the molecules cancer antigen 15-3 (CA 15-3) and carcinoemybronic antigen (CEA) are elevated in breast cancer patients, so monitoring their levels can let physicians know whether treatment is working. </p>
<p>Inherited variants of the BRCA1/2 genes can increase the likelihood of developing cancer; they can act as biomarkers in screening for cancer risk. </p>
<p>None of these biomarkers aid in diagnosis of breast cancer, though.</p>
<p>Researchers prefer proteins as cancer biomarkers over the genetic materials DNA and RNA because proteins provide a snapshot of what is happening in a patient’s body at the time a sample is collected. DNA and RNA can tell you whether a certain gene is turned on or off, but not the active form of the protein it codes for or the relative abundance of <a href="https://doi.org/10.1016/j.heliyon.2023.e13323">proteins</a>. Protein analysis can also reveal changes the protein has undergone and <a href="https://doi.org/10.1016/S1672-0229(07)60018-7">protein-protein interactions</a> that can alter the way a protein functions.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/581402/original/file-20240312-18-og1u88.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="diagram showing nursing mother and breast milk bag, and a blood draw and test tube" src="https://images.theconversation.com/files/581402/original/file-20240312-18-og1u88.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/581402/original/file-20240312-18-og1u88.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=368&fit=crop&dpr=1 600w, https://images.theconversation.com/files/581402/original/file-20240312-18-og1u88.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=368&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/581402/original/file-20240312-18-og1u88.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=368&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/581402/original/file-20240312-18-og1u88.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=463&fit=crop&dpr=1 754w, https://images.theconversation.com/files/581402/original/file-20240312-18-og1u88.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=463&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/581402/original/file-20240312-18-og1u88.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=463&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Looking for biomarker proteins in breast milk or blood serum could detect the presence or absence of cancer.</span>
<span class="attribution"><span class="source">Danielle Whitham</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<h2>Benefits of milk and serum biomarkers</h2>
<p>Breast milk and blood serum are two bodily fluids that can be collected noninvasively and that give information about what is happening in the body when collected.</p>
<p><a href="https://doi.org/10.1002/elps.201700123">Breast milk contains</a> secreted proteins, immune cells and sloughed cells of the milk ducts. During lactation, the breast is actively working to create milk to feed an infant. Any abnormalities in the breast milk reflect the current situation in the body. Some proteins in breast milk also circulate throughout the body and can be found in blood serum as well.</p>
<p>Serum is the <a href="https://www.cancer.gov/publications/dictionaries/cancer-terms/def/serum">liquid part of the blood</a> after red blood cells have been removed. It contains all the same proteins found in the blood, minus the clotting factors, therefore allowing circulating protein levels to be monitored. Narrowing in on a serum-based biomarker would mean it could be used to screen every woman, not just one who is currently lactating.</p>
<p><a href="https://doi.org/10.3390/proteomes10040036">The proteins we’ve found</a> <a href="https://doi.org/10.3390/proteomes10040036">in breast milk and identified as being</a> <a href="https://doi.org/10.1002/elps.202300040">out of whack in breast cancer</a> are involved in the cancer cells’ ability to divide, multiply and spread throughout the body. They all promote disease progression.</p>
<p>My colleagues and I currently consider these breast milk proteins to be <a href="https://doi.org/10.1080/14789450.2024.2320158">a draft biomarker for breast cancer</a>. Our group is currently working on using blood serum to identify proteins that could be involved with breast cancer. Moving from breast milk to blood serum would allow people of any age and reproductive status to be screened for the disease, rather than just those who are lactating.</p><img src="https://counter.theconversation.com/content/222944/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The Biochemistry and Proteomics Laboratories at Clarkson University receives funding from National Cancer Institute of the National Institutes of Health under Award Number R15CA260126.</span></em></p>Identifying proteins that are only present in bodily fluids when a patient has breast cancer could provide a way to screen healthy people for the disease.Danielle Whitham, Ph.D. Candidate in Chemistry and Biochemistry, Clarkson UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2202822024-02-15T00:00:55Z2024-02-15T00:00:55ZFeminist narratives are being hijacked to market medical tests not backed by evidence<figure><img src="https://images.theconversation.com/files/575240/original/file-20240213-27-twey75.jpg?ixlib=rb-1.1.0&rect=252%2C97%2C6218%2C4210&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/woman-sitting-on-floor-and-leaning-on-couch-using-laptop-Nv-vx3kUR2A">Thought Catalog/Unsplash</a></span></figcaption></figure><p>Corporations have used feminist language to promote their products for decades. In the 1980s, companies co-opted messaging about female autonomy to encourage women’s consumption of unhealthy commodities, <a href="https://www.mdpi.com/1660-4601/17/21/7902">such as tobacco and alcohol</a>. </p>
<p>Today, feminist narratives around empowerment and women’s rights are being co-opted to market interventions that are not backed by evidence across many areas of women’s health. This includes by commercial companies, industry, mass media and well-intentioned advocacy groups. </p>
<p>Some of these health technologies, tests and treatments are useful in certain situations and can be very beneficial to some women. </p>
<p>However, promoting them to a large group of asymptomatic healthy women that are unlikely to benefit, or without being transparent about the limitations, runs the risk of causing more harm than good. This includes inappropriate medicalisation, overdiagnosis and overtreatment. </p>
<p>In our analysis published today in the <a href="https://www.bmj.com/content/384/bmj-2023-076710">BMJ</a>, we examine this phenomenon in two current examples: the anti-mullerian hormone (AMH) test and breast density notification.</p>
<h2>The AMH test</h2>
<p>The AMH test is a blood test associated with the number of eggs in a woman’s ovaries and is sometimes referred to as the “egg timer” test. </p>
<p>Although often used in fertility treatment, the AMH test cannot reliably predict the <a href="https://jamanetwork.com/journals/jama/fullarticle/2656811">likelihood of pregnancy</a>, timing to pregnancy or <a href="https://academic.oup.com/humupd/article/29/3/327/6990969">specific age of menopause</a>. The American College of Obstetricians and Gynaecologists therefore <a href="https://pubmed.ncbi.nlm.nih.gov/30913192/">strongly discourages testing</a> for women not seeking fertility treatment. </p>
<figure class="align-center ">
<img alt="Woman sits in a medical waiting room" src="https://images.theconversation.com/files/575242/original/file-20240213-24-tbgpbk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/575242/original/file-20240213-24-tbgpbk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/575242/original/file-20240213-24-tbgpbk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/575242/original/file-20240213-24-tbgpbk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/575242/original/file-20240213-24-tbgpbk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/575242/original/file-20240213-24-tbgpbk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/575242/original/file-20240213-24-tbgpbk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The AMH test can’t predict your chance of getting pregnant.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/a-woman-sitting-on-a-bench-in-a-waiting-area-UssKpGyrBzw">Anastasia Vityukova/Unsplash</a></span>
</figcaption>
</figure>
<p>Despite this, several <a href="https://bmjopen.bmj.com/content/11/7/e046927.info">fertility clinics</a> and <a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2808552">online companies</a> market the AMH test to women not even trying to get pregnant. Some use feminist rhetoric promising empowerment, selling the test as a way to gain personalised insights into your fertility. For example, “<a href="https://www.ondemand.labcorp.com/lab-tests/womens-fertility-test">you deserve</a> to know your reproductive potential”, “<a href="https://kinfertility.com.au/fertility-test">be proactive</a> about your fertility” and “<a href="https://monashivf.com/services/early-intervention/amh-blood-test/">knowing your numbers</a> will empower you to make the best decisions when family planning”. </p>
<p>The use of feminist marketing makes these companies appear socially progressive and champions of female health. But they are selling a test that has no proven benefit outside of IVF and cannot inform women about their current or future fertility. </p>
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Read more:
<a href="https://theconversation.com/dont-believe-the-hype-egg-timer-tests-cant-reliably-predict-your-chance-of-conceiving-or-menopause-timing-207008">Don't believe the hype. 'Egg timer' tests can't reliably predict your chance of conceiving or menopause timing</a>
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<p>Our <a href="https://academic.oup.com/humrep/article/38/8/1571/7193900?login=false">recent study</a> found around 30% of women having an AMH test in Australia may be having it for these reasons.</p>
<p>Misleading women to believe that the test can reliably predict fertility can create a false sense of security about delaying pregnancy. It can also create unnecessary anxiety, pressure to freeze eggs, conceive earlier than desired, or start fertility treatment when it may not be needed.</p>
<p>While some companies mention the test’s limitations if you read on, they are glossed over and contradicted by the calls to be proactive and messages of empowerment. </p>
<h2>Breast density notification</h2>
<p>Breast density is one of several independent risk factors for breast cancer. It’s also harder to see cancer on a mammogram image of breasts with high amounts of dense tissue than breasts with a greater proportion of fatty tissue. </p>
<p>While estimates vary, approximately 25–50% of women in the breast screening population <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4200066/">have dense breasts</a>.</p>
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<img alt="Young woman has mammogram" src="https://images.theconversation.com/files/575244/original/file-20240213-22-kbvlxa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/575244/original/file-20240213-22-kbvlxa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/575244/original/file-20240213-22-kbvlxa.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/575244/original/file-20240213-22-kbvlxa.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/575244/original/file-20240213-22-kbvlxa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/575244/original/file-20240213-22-kbvlxa.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/575244/original/file-20240213-22-kbvlxa.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Dense breasts can make it harder to detect cancer.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-woman-taking-mammogram-xray-test-75178006">Tyler Olsen/Shutterstock</a></span>
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<p>Stemming from valid concerns about the increased risk of cancer, advocacy efforts have used feminist language around women’s right to know <a href="https://insightplus.mja.com.au/2022/34/breast-density-we-can-handle-the-truth/#:%7E:text=%E2%80%9CWomen%20can%20handle%20the%20truth,need%20to%20know%20that%20truth.">such as</a> “women need to know the truth” and “women can handle the truth” to argue for widespread breast density notification. </p>
<p>However, this simplistic messaging overlooks that this is a complex issue and that <a href="https://ebm.bmj.com/content/26/6/309">more data is still needed</a> on whether the benefits of notifying and providing additional screening or tests to women with dense breasts outweigh the harms. </p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/what-causes-breast-cancer-in-women-what-we-know-dont-know-and-suspect-86314">What causes breast cancer in women? What we know, don't know and suspect</a>
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<p>Additional tests (ultrasound or MRI) are now being recommended for women with dense breasts as they have the ability to detect more cancer. Yet, there is no or little mention of the <a href="https://www.nejm.org/doi/full/10.1056/NEJMe1912943">lack of robust evidence</a> showing that it prevents breast cancer deaths. These extra tests also have out-of-pocket costs and high rates of false-positive results. </p>
<p>Large international advocacy groups are also sponsored by companies that will <a href="https://www.volparahealth.com/news/volpara-announces-expanded-sponsorship-of-densebreast-info-org-at-sbi-2023/">financially benefit from women being notified</a>.</p>
<p>While stronger patient autonomy is vital, campaigning for breast density notification without stating the limitations or unclear evidence of benefit may go against the empowerment being sought. </p>
<h2>Ensuring feminism isn’t hijacked</h2>
<p>Increased awareness and advocacy in women’s health are key to overcoming sex inequalities in health care. </p>
<p>But we need to ensure the goals of feminist health advocacy aren’t undermined through commercially driven use of feminist language pushing care that isn’t based on evidence. This includes more transparency about the risks and uncertainties of health technologies, tests and treatments and greater scrutiny of conflicts of interests. </p>
<p>Health professionals and governments must also ensure that easily understood, balanced information based on high quality scientific evidence is available. This will enable women to make more informed decisions about their health.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/young-women-wont-be-told-how-to-behave-but-is-girlboss-just-deportment-by-another-name-132351">Young women won't be told how to behave, but is #girlboss just deportment by another name?</a>
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<img src="https://counter.theconversation.com/content/220282/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Brooke Nickel receives fellowship funding from the National Health and Medical Research Council (NHMRC). She is on the Scientific Committee of the Preventing Overdiagnosis Conference.</span></em></p><p class="fine-print"><em><span>Tessa Copp receives fellowship funding from the National Health and Medical Research Council (NHMRC). She is also on the Scientific Committee of the Preventing Overdiagnosis Conference. </span></em></p>Corporate medicine is hijacking feminist narratives around empowerment and women’s rights to market technologies, tests and treatments that aren’t backed by evidence.Brooke Nickel, NHMRC Emerging Leader Research Fellow, University of SydneyTessa Copp, NHMRC Emerging Leader Research Fellow, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2145432024-02-08T13:38:26Z2024-02-08T13:38:26ZBreastfeeding benefits mothers as much as babies, but public health messaging often only tells half of the story<figure><img src="https://images.theconversation.com/files/558172/original/file-20231107-19-cjfj8i.jpg?ixlib=rb-1.1.0&rect=23%2C23%2C7961%2C5303&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Breastfeeding lowers the risk of diabetes as well as breast and ovarian cancers for mothers.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/smiling-mom-holding-her-baby-boy-in-her-arms-while-royalty-free-image/1370476365?phrase=black+mothers+breastfeeding&adppopup=true">Goodboy Picture Company/E+ via Getty Images</a></span></figcaption></figure><p>Four babies are born <a href="https://www.theworldcounts.com/populations/world/births">every second in the world</a>, and there are only two options for their first food at birth: human milk or formula. </p>
<p>Global and U.S. health authorities agree, however, that human milk provides the optimal nutrition for infants. The World Health Organization and the American Academy of Pediatrics <a href="https://www.who.int/health-topics/breastfeeding#tab=tab_2">recommend exclusive breastfeeding</a> for the <a href="https://doi.org/10.1542/peds.2022-057988">first six months of an infant’s life</a>. Following the introduction of solid foods, these organizations recommend continued breastfeeding up to two years and beyond. </p>
<p>Human milk can be given to infants directly through breastfeeding or by pumping or expressing human milk into a cup or bottle. The health benefits of breastfeeding and human milk for infants stem from its composition, which includes <a href="https://www.aap.org/en/patient-care/newborn-and-infant-nutrition/newborn-and-infant-breastfeeding/">vitamins, minerals and antibodies</a> that can prompt its composition to change over time to meet the growing infant’s needs. The dynamic nature of human milk leads to commonly known benefits, such as <a href="https://doi.org/10.1111/apa.13151">lower risks of ear</a> and <a href="https://doi.org/10.1111/apt.14291">gastrointestinal infections among infants</a> who are breastfed. </p>
<p>However, there are other benefits for infants that many people aren’t aware of, as well as for the breastfeeding mother and society.</p>
<p>We are women’s health scholars with combined professional expertise in <a href="https://sc.edu/study/colleges_schools/nursing/faculty-staff/riversj.php">maternal obstetrics nursing</a> and <a href="https://sc.edu/study/colleges_schools/nursing/faculty-staff/feldert.php">public health</a>. Together, we co-founded <a href="https://www.instagram.com/mochamamasmilk/">Mocha Mamas Milk</a>, a research and support initiative focused on improving <a href="https://doi.org/10.1177/01939459211045431">breastfeeding among Black families in South Carolina</a>, a <a href="https://www.cdc.gov/mmwr/volumes/66/wr/mm6627a3.htm">state where just 55.1% of Black infants are breastfed</a>, compared with 75.2% of white infants. </p>
<p>Human milk is personalized medicine that can benefit both the mother and infant. We are personally and professionally passionate about this because many people are not aware that some of these benefits can save lives and reduce persistent health disparities.</p>
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<figcaption><span class="caption">Breast milk provides benefits to the infant that no other food source can.</span></figcaption>
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<h2>Lesser-known benefits of breastfeeding for infants</h2>
<p>One significant benefit of breastfeeding not widely known by the public is its ability to lower the risk of <a href="https://www.childrenshospital.org/conditions/sudden-infant-death-syndrome-sids#">sudden infant death syndrome</a>, or SIDS. SIDS, sometimes referred to as “crib death,” is the unexplained death of a baby, usually under 1 year of age. </p>
<p>Some risk factors include stomach- or side-lying sleep, low birth weight, sleeping on a soft surface or overheating. A large analysis of studies found that infants who received any human milk for at least two months had nearly a <a href="https://doi.org/10.1542/peds.2017-1324">50% lower risk of SIDS</a>. </p>
<p>This reduction is notable for two reasons. First, the reduction in risk occurs about 60 days following birth, which is several months before the six-month exclusive breastfeeding guideline is met. Second, the protection from SIDS was the same for infants who were exclusively breastfed compared to infants who may have received formula in addition to any breastfeeding. </p>
<p>In addition, breastfeeding can <a href="https://doi.org/10.1016%2Fj.pcl.2012.09.008">significantly protect premature infants</a> – those <a href="https://www.who.int/news-room/fact-sheets/detail/preterm-birth">born before 37 weeks of pregnancy</a> – from developing a condition called <a href="https://www.ncbi.nlm.nih.gov/books/NBK513357/#">necrotizing enterocolitis</a>, an inflammation of the intestines that <a href="https://doi.org/10.3390/nu12051322">can be fatal</a>. While this condition is rare in full-term infants, it <a href="https://doi.org/10.1097%2FNNR.0000000000000483">occurs in 5% to 15% of preterm infants</a>.</p>
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<h2>Benefits for mom, too</h2>
<p>Breastfeeding also provides important benefits for the mother, such as reducing <a href="https://doi.org/10.1001/jama.294.20.2601">risks of diabetes</a> and <a href="https://doi.org/10.1016/s0140-6736(02)09454-0">breast</a> and <a href="https://doi.org/10.1001/jamaoncol.2020.0421">ovarian cancers</a>. Breastfeeding for any length of time compared to never is associated with a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4855244">10% decrease in hormone receptor-negative breast cancers</a>, which are more common in younger women. These cancers cannot be treated with hormonal therapy and <a href="https://www.cancer.org/cancer/types/breast-cancer/understanding-a-breast-cancer-diagnosis/breast-cancer-hormone-receptor-status.html">often grow faster</a> than the more commonly diagnosed hormone receptor-positive breast cancers. </p>
<p>The reduction in risk from breastfeeding is even greater for Black women, who are more likely to be diagnosed with these hormone receptor-negative breast cancers and <a href="https://doi.org/10.1158/1055-9965.EPI-20-1784">have worse prognoses and fewer treatment options</a>. Any way of reducing the risk for Black women is critically important because, compared to white women, Black women are 40% more likely to die from breast cancer, <a href="https://www.cancer.org/research/acs-research-news/breast-cancer-death-rates-are-highest-for-black-women-again.html">yet 4% less likely to be diagnosed </a> with the disease.</p>
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<figcaption><span class="caption">Tisha Felder explains the vision behind Mocha Mamas Milk to help improve the way that Black mothers think about breastfeeding. Figures presented in the 2021 film were from the National Immunization Survey, 2011–2015.</span></figcaption>
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<p>There is also growing research suggesting the positive impact of breastfeeding on a mother’s mental health. One possible reason for this is that <a href="https://www.yourhormones.info/hormones/oxytocin/">oxytocin</a> – often <a href="https://www.health.harvard.edu/mind-and-mood/oxytocin-the-love-hormone">called the “love hormone” because of its association with bonding</a> – plays a <a href="https://doi.org/10.1016%2Fj.ijnss.2019.09.009">role in the maternal-infant bonding process</a>. </p>
<p>After delivery, the release of oxytocin causes human milk to flow – a process called the <a href="https://www.ncbi.nlm.nih.gov/books/NBK148970/#">letdown reflex</a> – and initiate breastfeeding. This release of milk can satisfy the new baby and leave the mom with “warm and fuzzy” feelings toward her baby. Research also suggests that breastfeeding can <a href="https://doi.org/10.1017/s0033291713001530">reduce the risk of depression </a>. A 2021 study also found that the longer a woman breastfed, <a href="https://doi.org/10.1111/phn.12969">the lower her risk for postpartum depression</a>. </p>
<h2>Closing racial gaps</h2>
<p>Despite the benefits of breastfeeding to both infants and mothers, few U.S. families are able to sustain breastfeeding over time. The Centers for Disease Control and Prevention 2022 Breastfeeding Report Card – the latest data that is currently available – shows that more than 80% of infants start out receiving human milk, yet just over a quarter of them <a href="https://www.cdc.gov/breastfeeding/pdf/2022-Breastfeeding-Report-Card-H.pdf">are exclusively breastfed through six months</a>.</p>
<p>Black infant-mother pairs not only have the lowest breastfeeding rates in South Carolina, but they also have the lowest rates nationally, compared to other U.S. racial and ethnic groups. More recent data from the National Vital Statistics System of U.S. infants born in 2020 and 2021, shows that <a href="https://www.cdc.gov/pcd/issues/2023/23_0199.htm">only 74.5% of Black infants were breastfed</a>, compared with non-Hispanic Asian infants (90.1%), non-Hispanic white infants (84.0%) and Hispanic infants (86.8%), based on analysis of birth records collected by the CDC. </p>
<p>Black infants are also more likely <a href="https://www.ncbi.nlm.nih.gov/books/NBK513376/">to die from SIDS</a> and to be born prematurely. So <a href="https://www.contemporarypediatrics.com/view/breastfeeding-least-2-months-provides-sids-protection">increasing breastfeeding among Black families</a> could lead to saving significantly more Black infant lives. </p>
<p>The Southeast U.S. is where the <a href="https://www.cdc.gov/mmwr/volumes/70/wr/mm7021a1.htm?s_cid=mm7021a1_w">widest racial gaps in breastfeeding exist</a>. In addition, infants living in Southern states are <a href="https://doi.org/10.1038%2Fs41372-022-01535-x">less likely to achieve national goals for breastfeeding</a> at 6 or 12 months old compared to infants living in other regions of the country.</p>
<h2>Removing barriers to breastfeeding</h2>
<p>Reducing barriers is critical to closing racial and geographic gaps in breastfeeding and allowing U.S. mothers and their infants the opportunity to benefit from the life-saving qualities of human milk. Studies show that addressing work-related barriers by making investments in paid family leave, for example, could <a href="https://doi.org/10.1016/j.ehb.2023.101308">increase exclusive breastfeeding rates by 15%</a>. </p>
<p>The U.S. is one of the only countries in the world that <a href="https://www.worldpolicycenter.org/policies/is-paid-leave-available-for-both-parents-of-infants">does not provide national paid family leave</a>. </p>
<p>Workplaces that support breastfeeding breaks and provide safe and clean spaces for expressing and storing human milk are also <a href="https://www.unicef.org/sites/default/files/2019-07/UNICEF-policy-brief-family-friendly-policies-2019.pdf">important in promoting breastfeeding</a>. Given that U.S. women’s labor force participation rates are <a href="https://www.bls.gov/opub/ted/2023/labor-force-participation-rate-for-people-ages-25-to-54-in-may-2023-highest-since-january-2007.htm">at a record high</a>, the importance of reducing barriers in the workplace cannot be overstated.</p>
<p>The U.S. Agency for International Development estimates that every U.S. dollar invested in breastfeeding <a href="https://www.usaid.gov/global-health/resources/fact-sheets/breastfeeding#">yields $35 in economic returns</a>.</p>
<p>Societal investments in breastfeeding-friendly workplace policies will not only yield cost savings and extend breastfeeding rates, but they will shift the burden of breastfeeding from simply being an individual choice to being a public health priority.</p><img src="https://counter.theconversation.com/content/214543/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Tisha Felder receives funding from the Patient Centered Research Outcomes Institute (PCORI) and National Institutes of Health (NIH).</span></em></p><p class="fine-print"><em><span>Joynelle Jackson receives funding from Patient Centered Research Outcomes Institute (PCORI). </span></em></p>Some states, especially in the Southeastern US, have large disparities in breastfeeding among racial groups, making clear the need to lower barriers for breastfeeding in the workplace and elsewhere.Tisha Felder, Associate Professor of Behavioral Sciences, University of South CarolinaJoynelle Jackson, Associate Professor of Nursing, University of South CarolinaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2172182023-11-08T17:36:49Z2023-11-08T17:36:49ZBreast cancer prevention drug approved for post-menopausal women in the UK – here’s how it works<figure><img src="https://images.theconversation.com/files/558434/original/file-20231108-21-8cqks7.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5577%2C3706&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Anastrozole may stop breast cancer before it starts.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/just-awaken-senior-lady-holding-morning-1950650434">fizkes/ Shutterstock</a></span></figcaption></figure><p>A drug that can <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6961114/">halve the risk</a> of developing breast cancer in post-menopausal women has been approved for use in the UK. This drug, called anastrozole, could benefit an estimated 289,000 women in the UK who are at <a href="https://www.nice.org.uk/guidance/cg164/ifp/chapter/how-breast-cancer-risk-is-described">increased risk of breast cancer</a>. </p>
<p>Anastrozole was already approved for use in the UK as a breast cancer treatment. It belongs to a group of drugs called <a href="https://www.ncbi.nlm.nih.gov/books/NBK557856/">aromatase inhibitors</a> that were first developed to treat breast cancer in women who had undergone menopause.</p>
<p>The key to anaztrozole’s success both in treating and preventing breast cancer, is due to its effects on the body’s oestrogen levels.</p>
<p><a href="https://www.cancerresearchuk.org/about-cancer/breast-cancer/getting-diagnosed/tests-breast-cancer-cells">Up to 80%</a> of all breast cancers produce a protein called the oestrogen receptor, which binds to the hormone oestrogen. When it binds, this protein tells breast cancer cells to divide. This overrides the normal controls that prevent cells from dividing too much – causing a tumour to grow. The more oestrogen circulating around the body, the more likely it is that tumour growth will be stimulated.</p>
<p>But anastrozole reduces oestrogen levels, preventing breast cancer cells from dividing. It does this by targeting a specific enzyme in the body.</p>
<p>Before the menopause, most of the body’s oestrogen is produced in the ovaries. But after the menopause, oestrogen is instead produced by an enzyme called <a href="https://academic.oup.com/edrv/article/30/4/343/2355213">aromatase</a>. This oestrogen is typically made in our fat tissue. Aromatase produces oestrogen by converting other hormones – such as testosterone and androstenedione.</p>
<p>Anastrozole and similar drugs – such as letrozole and exemestane – stop aromatase from working and drastically reduce the amount of oestrogen in the body. This means that in post-menopausal breast cancer patients, the drug is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5564654/">very effective</a> at stopping cancers which produce the oestrogen receptor from recurring after surgery or chemotherapy.</p>
<figure class="align-center ">
<img alt="A nurse looks at a breast cancer scan on a computer screen." src="https://images.theconversation.com/files/558436/original/file-20231108-19-ipcdma.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/558436/original/file-20231108-19-ipcdma.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=386&fit=crop&dpr=1 600w, https://images.theconversation.com/files/558436/original/file-20231108-19-ipcdma.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=386&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/558436/original/file-20231108-19-ipcdma.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=386&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/558436/original/file-20231108-19-ipcdma.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=486&fit=crop&dpr=1 754w, https://images.theconversation.com/files/558436/original/file-20231108-19-ipcdma.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=486&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/558436/original/file-20231108-19-ipcdma.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=486&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">The majority of breast cancers produce a protein which bind to the hormone oestrogen.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/hospital-patient-undergoes-screening-procedure-mammogram-1951533499">ORION PRODUCTION/ Shutterstock</a></span>
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<p>The reason anastrozole also works to prevent breast cancer is because often the earliest stages of normal breast tissue becoming cancerous depend on oestrogen. Indeed, many of the <a href="https://breastcancernow.org/about-breast-cancer/awareness/breast-cancer-causes">known risk factors</a> for developing breast cancer – such as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3488186/">late menopause</a> and <a href="https://www.cancer.gov/about-cancer/causes-prevention/risk/obesity/obesity-fact-sheet">obesity</a> – are associated with increased oestrogen levels. But using anastrozole to reduce oestrogen levels can stop breast cancer before it even starts in at-risk post-menopausal women.</p>
<h2>Preventative drug</h2>
<p>Thanks to the new licence, post-menopausal women in the UK who are at moderate to high risk of developing breast cancer will now be offered the chance to take anastrozole to protect themselves. Women who have a <a href="https://www.nice.org.uk/guidance/cg164/ifp/chapter/First-steps-finding-out-about-your-family-history">family history of the disease</a> should talk to their doctor about their risk and whether they could benefit from taking anastrozole.</p>
<p>It’s worth noting, however, that the drastic reductions in oestrogen levels caused by an aromatase inhibitor such as anastrozole are not without their drawbacks. Not only may it <a href="https://www.breastcancer.org/treatment-side-effects/menopause/types/hormonal-therapy">worsen menopause symptoms</a>, it may also cause other <a href="https://www.frontiersin.org/articles/10.3389/fendo.2021.713700/full">side-effects</a> – such as a decrease in bone density and increased risk of fractures. These side-effects <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2104162">can become more serious</a> the longer the drug is taken. This is why it’s currently recommended that anastrozole is only taken for prevention for five years.</p>
<p>Women who are at increased risk of breast cancer and are considering using anastrozole need to be supported in making an informed decision that’s right for them. Women with osteoporosis or serious kidney or liver disease are <a href="https://www.nhs.uk/medicines/anastrozole/">particularly advised</a> to discuss this decision with their doctor first.</p>
<p>In the UK, there are <a href="https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/breast-cancer">almost 56,000 new diagnoses of breast cancer</a> annually. The NHS estimates that if just 25% of eligible patients opt to take anastrozole, then <a href="https://www.england.nhs.uk/2023/11/tens-of-thousands-of-women-set-to-benefit-from-repurposed-nhs-drug-to-prevent-breast-cancer">2,000 breast cancer cases</a> could be prevented each year in the UK. </p>
<p>Breast cancer is the <a href="https://www.who.int/news-room/fact-sheets/detail/breast-cancer">most common cancer in the world</a>. An estimated 2.3 million people – mainly women – will develop the disease each year. Preventing even a fraction of these cancers has the potential to save many lives and reduce suffering. Although anastrozole is prescribed off-label to prevent breast cancer in <a href="https://www.cancer.org/cancer/types/breast-cancer/risk-and-prevention/aromatase-inhibitors-for-lowering-breast-cancer-risk.html">other countries</a>, the UK is the first to license it for this specific use. Given the burden of breast cancer, it’s hoped that other countries will follow suit.</p><img src="https://counter.theconversation.com/content/217218/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sarah Allinson does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Anastrozole was already approved for use in the UK to treat breast cancer.Sarah Allinson, Professor, Department of Biomedical and Life Sciences, Lancaster UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2154582023-10-17T19:08:15Z2023-10-17T19:08:15Z‘I’m not going to be cured’. How breast cancer awareness and support sidelines people with metastatic disease<figure><img src="https://images.theconversation.com/files/553954/original/file-20231016-27-pmm9h6.jpg?ixlib=rb-1.1.0&rect=41%2C0%2C4550%2C3056&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/sad-adult-woman-look-window-distance-2193124113">Shutterstock</a></span></figcaption></figure><p>There have been incredible <a href="https://www.cancer.gov/types/breast/research">advances</a> in breast cancer diagnosis and treatment in recent years. And stories about celebrities who have “beaten” breast cancer continue to be a source of inspiration for many people. </p>
<p>However, this emphasis on fighting, beating and surviving cancer shuts out the voices of those who will not survive. That is, the many people diagnosed with incurable, life-limiting metastatic breast cancer, <a href="https://www.aihw.gov.au/reports/cancer/cancer-data-in-australia">which kills nine Australians every day</a> or nearly <a href="https://www.aihw.gov.au/reports/cancer/cancer-data-in-australia">3,300 people</a> a year. Yet an <a href="https://www.bcna.org.au/latest-news/bcna-news/making-metastatic-breast-cancer-count/">estimated 10,000</a> Australians are living with the diagnosis.</p>
<p>Being diagnosed with metastatic breast cancer, as one of the authors has been, means ongoing treatment to live as long, and as well, as possible. It also means an ongoing need for emotional and practical support. </p>
<p>However, society, health-care professionals, cancer advocacy organisations, even a patient’s closest family and friends, can struggle to understand what it is like to live with an incurable and life-limiting cancer and how best to provide support. </p>
<h2>Why is there so little awareness?</h2>
<p><a href="https://www.breastcancer.org/types/metastatic">Metastatic breast cancer</a>, also called stage four breast cancer, is the most serious form of breast cancer. Unlike early breast cancer that is contained within the breast or nearby lymph nodes, metastatic breast cancer has spread to other parts of the body, most often the bones, lungs, liver, or brain. </p>
<p>There is no cure for metastatic breast cancer despite decades of advocacy, funding and research. Treatment continues for as long as it helps to control the cancer and is tolerated by the patient. Median survival is <a href="https://onlinelibrary.wiley.com/doi/10.5694/mja2.51687">two to three years</a>, although newer, novel treatments mean some patients are living much longer. </p>
<p>As a society, we can be uncomfortable <a href="https://theconversation.com/before-you-go-are-you-in-denial-about-death-34056">talking about and facing death</a>. When it comes to cancer, we usually prefer focusing on good news stories. These narratives are often perceived to be better for fundraising and are reassuring for people newly diagnosed. But they fail to <a href="https://onlinelibrary.wiley.com/doi/10.1111/1467-9566.13704">represent</a> the diversity and reality of cancer experiences.</p>
<p>Despite considerable research into people with non-metastatic breast cancer, <a href="https://www.bcna.org.au/latest-news/bcna-news/making-metastatic-breast-cancer-count/">relatively little</a> is known about Australians with metastatic breast cancer.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-dirty-disease-both-smokers-and-non-smokers-get-lung-cancer-they-face-stigma-on-top-of-illness-206595">'The dirty disease' – both smokers and non-smokers get lung cancer. They face stigma on top of illness</a>
</strong>
</em>
</p>
<hr>
<h2>Feeling silenced and unsupported</h2>
<p>Through our <a href="https://onlinelibrary.wiley.com/doi/10.1111/1467-9566.13704">research</a> we wanted to better understand people’s experiences of metastatic breast cancer. We interviewed 38 participants from around Australia with diverse experiences of metastatic breast cancer. Participants were recruited through breast cancer and community organisations. </p>
<p>We found messages and public campaigns about cancer survivorship, which emphasise hope and positivity, drowned out the voices of those with metastatic breast cancer. The focus on “success stories” about surviving breast cancer made some people feel like it was their responsibility to “beat” cancer. If they didn’t, it was their own fault. As one interviewee told us:</p>
<blockquote>
<p>I react quite badly to all the, ‘we’ve had breast cancer and we beat it and we’ve survived. Aren’t we fantastic.’ There’s almost a feeling if you haven’t beaten your breast cancer you haven’t tried hard enough. </p>
</blockquote>
<p>Silence around metastatic breast cancer was common in research participants’ experiences. It prevented many from connecting with others and to the support they needed. It even affected relationships with those closest to them leaving them feeling misunderstood: </p>
<blockquote>
<p>They don’t realise I’ve got to be on treatment forever. I’m not going to be cured. I think society thinks everything can be fixed; metastatic breast cancer actually can’t be fixed.</p>
</blockquote>
<p>Sharing deep fears and worries about their life expectancy can leave people with metastatic breast cancer feeling drained rather than supported. Many participants reported having to support and shield family, friends, acquaintances and work colleagues from the reality of their terminal diagnosis. </p>
<blockquote>
<p>You hide how you feel because you don’t want to be avoided […] You put on that big, happy face. But like an onion if you peeled the layers away, you’d find out what’s going on.</p>
</blockquote>
<p>While many participants wanted to join a community of people with metastatic breast cancer, they struggled to know how to find one. Those who did, emphasised how invaluable it had been: </p>
<blockquote>
<p>Being able to identify with and know that these people really get me is a huge relief and it reduces the isolation. </p>
</blockquote>
<p>These findings echo <a href="https://www.bcna.org.au/media/alcjjmm2/bcna_member-survey-report_2017.pdf">previous research</a> demonstrating people with metastatic breast cancer have higher support needs than those with non-metastatic breast cancer. And these needs are <a href="https://www.bcna.org.au/media/alcjjmm2/bcna_member-survey-report_2017.pdf">less likely to be met</a> by <a href="https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-022-08269-8">health care, support services</a>, family or friends. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/553915/original/file-20231016-22-62ee2w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Two women join hands in supportive gesture." src="https://images.theconversation.com/files/553915/original/file-20231016-22-62ee2w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/553915/original/file-20231016-22-62ee2w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/553915/original/file-20231016-22-62ee2w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/553915/original/file-20231016-22-62ee2w.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/553915/original/file-20231016-22-62ee2w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/553915/original/file-20231016-22-62ee2w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/553915/original/file-20231016-22-62ee2w.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">People with metastatic breast cancer must be represented in advocacy and support efforts.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/close-african-american-psychotherapist-holding-clipboard-1805672500">Shutterstock</a></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/poor-middle-aged-australians-are-more-likely-to-die-from-cancer-and-the-gap-is-widening-210878">Poor, middle-aged Australians are more likely to die from cancer – and the gap is widening</a>
</strong>
</em>
</p>
<hr>
<h2>A new path</h2>
<p>Being diagnosed with metastatic breast cancer can be terrifying, lonely and create significant support needs. It is essential people with metastatic breast cancer have their <a href="https://ascopubs.org/doi/10.1200/OP.20.00183">voices listened to</a> and their needs met.</p>
<p>Next steps should include: </p>
<ul>
<li><p><a href="https://bcna-dxp.azureedge.net/media/d32bhdzf/bcna_making-metastatic-breast-cancer-count_2022.pdf">improving data collection by cancer registries</a> so we know exactly how many people in Australia have metastatic breast cancer</p></li>
<li><p>increasing representation of people with metastatic breast cancer in advocacy, support organisations and research</p></li>
<li><p>nationwide access to peer-to-peer programs and professionally led metastatic breast cancer support groups.</p></li>
</ul>
<p>We must ensure people with metastatic breast cancer are the ones to speak to their experience and needs. As a colleague with metastatic breast cancer said: </p>
<blockquote>
<p>I read an article written by an early-stage breast cancer ‘survivor’. It felt like someone describing winter when they had only ever experienced autumn.</p>
</blockquote>
<p>If you or someone you know has metastatic breast cancer, these organisations may be able to support you or connect you with others with the same diagnosis:</p>
<ul>
<li><p><a href="https://www.bcna.org.au">Breast Cancer Network Australia</a> for information and support</p></li>
<li><p><a href="https://www.mcgrathfoundation.com.au/">McGrath Foundation</a> for information about access to metastatic breast care nurses.</p></li>
</ul>
<hr>
<p><em>The authors would like to thank the members of Breast Cancer Network Australia’s Metastatic Breast Cancer Lived Experience Reference Group for their review of this article.</em></p><img src="https://counter.theconversation.com/content/215458/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sophie Lewis receives funding from the Australian Research Council and the National Health and Medical Research Council. </span></em></p><p class="fine-print"><em><span>Andrea Smith receives funding from a Daffodil Centre Research Fellowship, The Professor Martin Tattersall ECR Oncology Award and the University of Sydney Bright Ideas Award. She works on a voluntary basis with several national and international breast cancer advocacy organisations including Breast Cancer Network Australia (BCNA) and the ABC Global Alliance.</span></em></p><p class="fine-print"><em><span>Katherine Kenny receives funding from the Australian Research Council. </span></em></p>Being diagnosed with metastatic breast cancer means ongoing treatment to live as long, and as well, as possible. It also creates considerable need for emotional and practical support.Sophie Lewis, Senior Lecturer, University of Sydney, University of SydneyAndrea Smith, Research fellow, University of SydneyKatherine Kenny, ARC DECRA Senior Research Fellow, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2136862023-09-20T15:34:22Z2023-09-20T15:34:22ZBreast cancer: new study reveals real risk of the disease if you have genetic mutation<figure><img src="https://images.theconversation.com/files/549088/original/file-20230919-27-avuv5u.jpg?ixlib=rb-1.1.0&rect=0%2C16%2C5463%2C3620&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">There are numerous consumer tests available that look for BRCA gene mutations.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/preparation-blood-test-pretty-young-woman-2147296239">Photoroyalty/ Shutterstock</a></span></figcaption></figure><p>In 2013, actress Angelina Jolie wrote an op-ed where she revealed she’d undergone a double mastectomy. Although Jolie didn’t have breast cancer, a genetic test had revealed she carried a <a href="https://www.nytimes.com/2013/05/14/opinion/my-medical-choice.html">genetic mutation</a> that her doctors said put her at an 87% risk of developing breast cancer in her lifetime. Jolie also had a family history of breast cancer, losing her mother, grandmother and aunt to the disease.</p>
<p>Jolie has a genetic mutation to one of her BRCA genes – specifically the BRCA1 gene. We all have BRCA genes, which function as tumour suppressors. These genes are essential for healthy cell survival and cancer prevention. They act to repair our DNA and fix errors that occur due to ageing or environmental exposures (such as tobacco or radiation). </p>
<p>When there’s a defect in these genes, they don’t function as they should. This leaves people at higher risk of <a href="https://bmccancer.biomedcentral.com/articles/10.1186/s12885-023-10956-6">developing breast cancer</a>. According to previous research, mutations in the BRCA1 gene carry an estimated 65-80% lifetime risk of developing breast cancer, while mutations in the BRCA2 gene carry a 45-85% risk of breast cancer.</p>
<p>What followed the publication of Jolie’s testimonial has been dubbed “<a href="https://www.nature.com/articles/s41598-021-82654-x">The Jolie Effect</a>” – a sharp rise in the number of women worldwide undergoing genetic testing and having preventative mastectomies to reduce their risk of breast cancer if they are found to have the BRCA genetic mutation. This increased access to testing has resulted in greater detection of BRCA mutations and has undoubtedly led to life-saving preventative care for many. </p>
<p>But a <a href="https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(23)00336-X/fulltext#:%7E:text=Penetrance%20to%20age%2060%20was,%2C%20CI%2013.8%E2%80%9323.0">recent study</a> from researchers at the University of Exeter has questioned how useful these tests may be after showing that breast cancer risk from BRCA mutations may not always be as high as once thought.</p>
<h2>BRCA gene</h2>
<p>To conduct their study, investigators looked at a total of 454,712 participants aged 40-69 from the <a href="https://www.ukbiobank.ac.uk/">UK Biobank study</a> (a large-scale health study containing genetic and medical information from half a million UK residents). They identified participants with a BRCA gene mutation, then used the database to ask if they had a family history of breast cancer. </p>
<p>Then, using cancer registry data collected as part of the UK Biobank study, the researchers calculated a person’s risk of developing breast cancer if they had a BRCA gene mutation – both with and without a known family history of breast cancer. </p>
<figure class="align-center ">
<img alt="Angelina Jolie poses on the red carpet." src="https://images.theconversation.com/files/549089/original/file-20230919-17-1oobbp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/549089/original/file-20230919-17-1oobbp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=482&fit=crop&dpr=1 600w, https://images.theconversation.com/files/549089/original/file-20230919-17-1oobbp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=482&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/549089/original/file-20230919-17-1oobbp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=482&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/549089/original/file-20230919-17-1oobbp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=606&fit=crop&dpr=1 754w, https://images.theconversation.com/files/549089/original/file-20230919-17-1oobbp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=606&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/549089/original/file-20230919-17-1oobbp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=606&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Angelina Jolie has a BRCA1 gene mutation.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/angelina-jolie-23rd-annual-critics-choice-1045534666">Tinseltown/ Shutterstock</a></span>
</figcaption>
</figure>
<p>The investigators found that while all participants with BRCA gene mutations carried a greater risk of developing breast cancer compared to the general population, this risk was 1.5-1.9 times higher for those with a family history of the disease. </p>
<p>The study also found that risk of breast cancer from the BRCA gene was not as high as previously thought in people without a family history of the disease. Women who only carried the BRCA1 gene variant had a 23% greater risk of developing breast cancer by age 60, while those with the BRCA2 variant had an approximately 18% risk of developing breast cancer before 60. But in women who’d had a close relative develop breast cancer, the BRCA1 variant carried a 45% greater risk of developing the disease before age 60. The BRCA2 variant carried a 24% greater risk.</p>
<p>While this is a significant study with a large number of participants, the relative risk values were generated for cancer diagnosis before the age of 60. Usually, lifetime risk is calculated up to the age of 75. This means we are limited with regard to understanding risk in older people who have these gene mutations.</p>
<h2>Genetic testing</h2>
<p>Being able to access genetic testing is important as it allows each person to better understand their health and make decisions about treatments that will most benefit them. But the choice to undergo risk reduction surgery as a result of genetic testing is not an easy one to make. This study highlights the importance of speaking with your doctor when interpreting the results of these tests before making any decisions.</p>
<p>This study has shown just how important it is to take family history into account when deciding whether or not to have preventative surgery. People with a BRCA1 or BRCA2 gene mutation who have had a close family member develop breast cancer (such as a parent or sibling) may see the greatest benefit from having preventative surgery. Those who do not have a family history of breast cancer may want to talk to their doctor and discuss their risk of developing breast cancer, alongside strategies for monitoring their health into the future.</p><img src="https://counter.theconversation.com/content/213686/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Family history may be the most important thing to take into account when it comes to breast cancer risk.Aisling Hegarty, PhD Researcher, Endocrine Oncology Research Group, RCSI University of Medicine and Health SciencesLeonie Young, Professor, Department of Surgery, RCSI University of Medicine and Health SciencesLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2128342023-09-07T16:55:30Z2023-09-07T16:55:30ZCancer is rising in under-50s – but the causes are a mystery<figure><img src="https://images.theconversation.com/files/546918/original/file-20230907-7251-svut2z.jpg?ixlib=rb-1.1.0&rect=0%2C7%2C5176%2C3437&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Breast cancer was the most common early-onset cancer in 2019.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/nurse-preparing-patient-mammogram-xray-machine-1866109360">Juice Flair/ Shutterstock</a></span></figcaption></figure><p>Cancer is often thought of as a disease that mostly affects older people. But worrying new research shows that cancer in younger adults is a growing problem. The study found there’s been a nearly 80% increase in the number of under-50s being <a href="https://bmjoncology.bmj.com/content/2/1/e000049">diagnosed with cancer</a> globally in the last three decades.</p>
<p>Also of concern are the types of cancers being seen in younger adults – with this latest study and previous research showing that cancers thought of as typical of older age groups are now increasingly being diagnosed in younger people. These include <a href="https://pubmed.ncbi.nlm.nih.gov/31105047/">bowel cancer</a>, <a href="https://pubmed.ncbi.nlm.nih.gov/31331685/">stomach cancer</a>, <a href="https://pubmed.ncbi.nlm.nih.gov/32144720/">breast cancer</a>, <a href="https://pubmed.ncbi.nlm.nih.gov/30733056/">uterine cancer</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/35053447/">pancreatic cancer</a>. </p>
<p>This is worrying because some of these cancers – particularly <a href="https://www.cancerresearchuk.org/about-cancer/pancreatic-cancer/survival">pancreatic</a> and <a href="https://www.cancer.org/cancer/types/stomach-cancer/detection-diagnosis-staging/survival-rates.html">stomach</a> cancer – have low survival rates, due to the fact they’re often diagnosed at a late stage. Research has also shown that bowel cancer tends to be <a href="https://pubmed.ncbi.nlm.nih.gov/29564176/">diagnosed at a more advanced stage</a> in young people compared with older adults.</p>
<p>While it’s clear from this latest study that cancer is becoming more common in those under 50, experts still aren’t entirely sure what’s causing this rise.</p>
<h2>Early-onset cancer</h2>
<p>The study investigated cancer cases in people under the age of 50 (termed “early-onset cancer”) from 204 countries and regions. The data analysed was collected between 1990 and 2019. The researchers were interested in knowing not only the incidence of early-onset cancer, but what types of cancer had the highest burden in under-50s.</p>
<p>They found that in 2019, there were 3.26 million cases of early-onset cancer diagnosed worldwide – a 79% increase since 1990. The authors also predicted that by 2030, the number of under-50s diagnosed with cancer would increase by a further 31%.</p>
<p>Breast cancer was the most common early-onset cancer in 2019, but incidences of prostate and throat cancers increased at the fastest rate since 1990. Liver cancer decreased the fastest over the same time period. </p>
<p>The number of deaths due to early-onset cancers also increased from 1990 to 2019 – although less quickly than the rate of diagnosis, with 1.06 million deaths worldwide in 2019, an increase of 28%. The cancers with the highest number of deaths in 2019 were breast, lung, bowel and stomach cancers. The age group at greatest risk of early-onset cancer were those in their 40s. </p>
<figure class="align-center ">
<img alt="A doctor explains an x-ray to a male cancer patient." src="https://images.theconversation.com/files/546916/original/file-20230907-27-xn2ow9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/546916/original/file-20230907-27-xn2ow9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=316&fit=crop&dpr=1 600w, https://images.theconversation.com/files/546916/original/file-20230907-27-xn2ow9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=316&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/546916/original/file-20230907-27-xn2ow9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=316&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/546916/original/file-20230907-27-xn2ow9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=398&fit=crop&dpr=1 754w, https://images.theconversation.com/files/546916/original/file-20230907-27-xn2ow9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=398&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/546916/original/file-20230907-27-xn2ow9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=398&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">People in their 40s were at greatest risk of early-onset cancer.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/mature-oncologist-explaining-condition-incurable-brain-1911734488">Frame Stock Footage/ Shutterstock</a></span>
</figcaption>
</figure>
<p>In 2019, early-onset breast cancer had the highest burden for women, while early-onset lung cancer the highest burden for men. Women were disproportionately affected in terms of death and poor health from early-onset cancer in low- and middle-income countries.</p>
<p>The study also shows that while the highest number of early-onset cancer cases were in developed countries such as western Europe, North America and Australasia, many cases were also seen in low- and middle-income countries. Death rates were also higher in low- and middle-income countries.</p>
<p>The main limitation of this paper is the variability of the data collected by different countries, making it difficult to measure its completeness. Nonetheless, it is still useful in getting a picture of global health. </p>
<h2>Unknown causes</h2>
<p>There’s no single explanation for why cancers are rising in under-50s. </p>
<p>Some cancers in younger people happen as a result of a genetic condition – but these only <a href="https://aacrjournals.org/cancerres/article/80/16_Supplement/1122/641186">account for a small number of cases</a> (around 20%). </p>
<p>Lifestyle factors such as the foods we eat, whether we drink alcohol or smoke, and being overweight are all linked to an <a href="https://www.cancer.gov/about-cancer/causes-prevention/risk">increased risk</a> of many types of cancer. Research indicates that these factors may be contributing to a rise in <a href="https://pubmed.ncbi.nlm.nih.gov/33524598/">early-onset colorectal cancer</a>, for example. Whether this is true for other types of early-onset cancer remains unknown. </p>
<p>Some people affected by early-onset cancers may live healthy lifestyles. This suggests there are probably other reasons for the increase that have not yet been discovered. </p>
<p>It’s clear from this research that the landscape of cancer is changing. While the incidence of early-onset cancers is increasing, cancer in this age group is still much less common than for those over-50. Early-onset cancers account for only around a tenth of <a href="https://www.cancerresearchuk.org/health-professional/cancer-statistics/incidence/age">new cases in the UK</a>. But though the numbers are still relatively low, this doesn’t mean the trend we’re seeing isn’t of concern. </p>
<p>It will be crucial now to ensure there’s greater awareness of early-onset cancers. Most younger people, and even healthcare professionals, don’t necessarily put cancer at the top of the list when symptoms develop. It’s important for people to see their GP if they notice any new symptoms, as detecting cancer at an early stage leads to a better prognosis.</p>
<p>Urgent research into early-onset cancer is also needed at a national and international level. The underlying causes are probably different depending on a person’s sex, ethnicity and where they live. </p>
<p>On a personal level, there are many things you can do to reduce your risk of developing cancer. <a href="https://www.cancerresearchuk.org/about-cancer/causes-of-cancer/can-cancer-be-prevented">Following a healthy lifestyle</a> remains important. This includes eating a healthy diet, stopping smoking, exercising regularly, reducing your alcohol intake, being safe in the sun and maintaining a healthy weight. If something doesn’t feel right with your body or you experience any new symptoms, it’s important to see a doctor as soon as you can.</p><img src="https://counter.theconversation.com/content/212834/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ashleigh Hamilton works for Bristol-Myers Squibb (independent speaker - payment for lectures, presentations, educational events). She previously received funding for research from the HSC R&D Division of the Public Health Agency in Northern Ireland (EAT/5494/18).</span></em></p>Since 1990, there’s been a nearly 80% increase in the number of under-50s being diagnosed with cancer globally.Ashleigh Hamilton, Academic Clinical Lecturer, Centre for Public Health, Queen's University BelfastLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2108002023-08-01T23:47:58Z2023-08-01T23:47:58ZAI can help detect breast cancer. But we don’t yet know if it can improve survival rates<figure><img src="https://images.theconversation.com/files/540591/original/file-20230801-37936-vo7733.jpg?ixlib=rb-1.1.0&rect=22%2C99%2C5089%2C2774&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/hospital-radiology-room-beautiful-multiethnic-woman-1942278181">Shutterstock</a></span></figcaption></figure><p>Around <a href="https://nbcf.org.au/about-breast-cancer/breast-cancer-stats/#:%7E:text=Breast%20cancer%20is%20the%20most,breast%20cancer%20in%20their%20lifetime.">one in seven Australian women</a> will be diagnosed with breast cancer in their life, with 20,000 new breast cancers diagnosed each year. </p>
<p><a href="https://www.cancer.org.au/mammogram">Mammograms</a> are a key detection tool for early-stage breast cancer and involve placing the breast tissue between two plates and then doing an x-ray. </p>
<p>Scans from mammograms are usually analysed by two doctors. But a Swedish study, published today in the <a href="https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(23)00298-X/fulltext">Lancet</a>, found using artificial intelligence (AI) to help analyse the scans detected 20% more cancers and reduced the workload by 44%.</p>
<p>However there is a risk it could detect small cancers in women that would never cause harm, resulting in unnecessary treatment. </p>
<h2>How are breast cancers currently detected?</h2>
<p>Breast screening using mammography was introduced in Australia <a href="https://www.health.gov.au/our-work/breastscreen-australia-program">more than 30 years ago</a> to detect cancers earlier, allowing more effective and often less invasive treatments. Free mammograms <a href="https://www.health.gov.au/our-work/breastscreen-australia-program/having-a-breast-screen/who-should-have-a-breast-screen">are available</a> to women over the age of 40 and are recommended for all women aged 50-74. </p>
<p>Currently, a mammogram is studied (or “read”) by two doctors (called radiologists) who decide whether the mammogram looks normal or not. If any abnormality is seen, the woman is referred for further tests to a <a href="https://www.health.gov.au/our-work/breastscreen-australia-program/having-a-breast-screen/book-your-free-breastscreen-mammogram-appointment#state-and-territory-contacts">BreastScreen assessment clinic</a>. These tests may include more mammograms, ultrasounds, needle biopsies and sometimes surgery.</p>
<p>Most of those referred are cleared of cancer, but around one in ten are <a href="https://www.aihw.gov.au/reports/cancer-screening/breastscreen-australia-monitoring-report-2022/summary">eventually diagnosed with a breast cancer</a>. </p>
<p>This reading and assessment requires a lot of expertise and time, and is performed by an ageing and diminishing workforce who are retiring and leaving the profession. Coupled with a <a href="https://treasury.gov.au/sites/default/files/2021-06/p2021_182464.pdf">growing population</a> eligible for screening, this adds up to a perfect test bed for an AI solution.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/biopsies-confirm-a-breast-cancer-diagnosis-after-an-abnormal-mammogram-but-structural-racism-may-lead-to-lengthy-delays-185824">Biopsies confirm a breast cancer diagnosis after an abnormal mammogram – but structural racism may lead to lengthy delays</a>
</strong>
</em>
</p>
<hr>
<h2>What did the researchers test?</h2>
<p>The Swedish study followed 80,000 women aged 40–80 attending a screening program in one area of Sweden. </p>
<p>The researchers set out to test whether AI could better direct a radiologist’s attention to a suspicious, but often very subtle, abnormal area on a mammogram, using a commercially available AI-supported mammogram reading system.</p>
<p>They also looked at whether using AI could replace one of the two radiologists who normally read the mammogram. This would make the process more efficient.</p>
<p>The study was randomised so half of the women received normal screening protocols and the other half the AI-assisted protocol. </p>
<figure class="align-center ">
<img alt="African-Australian woman has a mammogram" src="https://images.theconversation.com/files/540594/original/file-20230801-16682-nsicg8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/540594/original/file-20230801-16682-nsicg8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=480&fit=crop&dpr=1 600w, https://images.theconversation.com/files/540594/original/file-20230801-16682-nsicg8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=480&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/540594/original/file-20230801-16682-nsicg8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=480&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/540594/original/file-20230801-16682-nsicg8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=603&fit=crop&dpr=1 754w, https://images.theconversation.com/files/540594/original/file-20230801-16682-nsicg8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=603&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/540594/original/file-20230801-16682-nsicg8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=603&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Mammograms aim to detect breast cancers early.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/SMxzEaidR20">National Cancer Institute</a></span>
</figcaption>
</figure>
<h2>So what did they find?</h2>
<p>The early findings are very encouraging. In those in whom AI was used, if the AI suggested a suspicious area, the mammogram was still read by two radiologists. But if the AI did not see a suspicious area then only one “live” radiologist read the mammogram. </p>
<p>This saved nearly six months of radiologists’ time. There were 36,886 fewer screenings read by radiologists in the AI supported group (46,345 vs 83,231), resulting in a 44% reduction in the radiologists’ screening workload. </p>
<p>Using the AI software to direct the radiologist attention to abnormal areas also seemed to improve the accuracy of their reading. The AI-assisted reading meant slightly more women were referred for further assessment (2.2% versus 2%) and of those assessed from the AI group, more cancers were seen. </p>
<p>In total, 244 women (28%) from the AI-supported group were found to have cancer, compared to 203 women (25%) in the standard double reading without AI. </p>
<p>Overall, the AI program picked up one extra cancer for each 1,000 women screened (six per 1,000 vs five per 1,000).</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/cervical-breast-heart-bowel-heres-what-women-should-be-getting-screened-regularly-148575">Cervical, breast, heart, bowel: here’s what women should be getting screened regularly</a>
</strong>
</em>
</p>
<hr>
<h2>Risk of overdiagnosis</h2>
<p>But just detecting more cancers is not necessarily a good thing if the cancers found are tiny, non-aggressive tumours that may never grow to harm the woman. </p>
<p>Of course what we really want to know is can any new test improve survival from cancer – and make the burden of treatment easier. </p>
<p>“Interval cancers” are faster-growing aggressive cancers that turn up between mammograms. Studies often use the detection of interval cancers as a surrogate for improving cancer survival. But it’s unclear if AI can detect more of these interval cancers. </p>
<p>Until we understand more about these extra cancers the AI detects, these remain open questions.</p>
<p>So, despite the positive signals from this study, we are still <a href="https://www.breastscreen.org.au/news/using-ai-to-improve-breast-screening/">not ready to use it</a> in our screening programs without more mature data form this and other work, including data that currently is being collected in Australia.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/29-000-cancers-overdiagnosed-in-australia-in-a-single-year-127791">29,000 cancers overdiagnosed in Australia in a single year</a>
</strong>
</em>
</p>
<hr>
<p><em>Correction: this article originally said 20,000 new breast cancers were diagnosed in Australia each week, rather than each year.</em></p><img src="https://counter.theconversation.com/content/210800/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Christobel Saunders does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Mammograms are usually analysed by two doctors. But a new study found using one doctor with AI assistance detected 20% more cancers and reduced the workload by 44%.Christobel Saunders, James Stewart Chair Of Surgery, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2057002023-05-29T13:10:10Z2023-05-29T13:10:10ZDrink up, it’s closing time: South African study calculates that limiting opening hours will save lives<figure><img src="https://images.theconversation.com/files/527034/original/file-20230518-17-8xdcj5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Cristi Lucaci/Shutterstock</span></span></figcaption></figure><p>South Africans are among the heaviest drinkers in the world. The country has the highest per capita rate of <a href="https://www.who.int/publications/i/item/9789241565639">alcohol consumption</a> in Africa. Excessive drinking is especially widespread in the Western Cape. Research <a href="https://dgmt.co.za/wp-content/uploads/2023/02/Minumum-Unit-Pricing-Phase-1.1-Modelling-Impact-of-MUP-15112021-FINAL-1.pdf">estimates</a> that per capita alcohol consumption in the province is between 30% and 40% higher than the national consumption. </p>
<p>Alcohol use contributes to <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-019-7771-4">over 200</a> different diseases, injuries and conditions. It is also a risk factor for gender-based violence and <a href="https://www.westerncape.gov.za/assets/departments/health/mortality_profile_2016.pdf">violent crime</a>. </p>
<p>In a bid to reduce alcohol-related harms in the province, the Western Cape government has <a href="https://www.westerncape.gov.za/text/2017/September/white_paper_alcohol-related_harms_reduction.pdf">proposed</a> a policy to restrict trading hours for onsite alcohol consumption. International <a href="https://pubmed.ncbi.nlm.nih.gov/28647704/">research</a> shows that reducing trading hours is an effective way to curb alcohol consumption and its associated harms. This type of policy is also supported by the <a href="https://apps.who.int/iris/bitstream/handle/10665/259232/WHO-NMH-NVI-17.9-eng.pdf">World Health Organization</a>. </p>
<p>My colleagues and I at the University of Cape Town recently conducted a modelling <a href="https://dgmt.co.za/wp-content/uploads/2023/03/Trading-Hours-Phase-2-Modelling-Trading-Times-Final-Report-vf.pdf">study</a>. We wanted to determine the health and economic impacts of restricting the hours of onsite alcohol consumption. </p>
<p>We considered three latest closing-time scenarios: midnight, 1am and 2am. Data for the model baseline was drawn from national surveys on alcohol consumption, the national treasury’s annual budget reviews and publications from Statistics South Africa and the South African Medical Research Council. </p>
<p>We estimated the impact of each of the proposed closing times on the number of cases and deaths associated with certain health conditions. The study also assessed the policy’s impact on alcohol expenditure, excise tax, value added tax and retail revenue. Finally we estimated the impact on the cost of combating alcohol-related crime in the Western Cape.</p>
<p>Our <a href="https://dgmt.co.za/wp-content/uploads/2023/03/Trading-Hours-Phase-2-Modelling-Trading-Times-Final-Report-vf.pdf">results</a> make it clear that limiting the hours for onsite consumption of alcohol will save lives. It will also prevent alcohol-related diseases and injuries, and reduce hospital and crime prevention costs.</p>
<p>On the other hand, national tax revenue and revenue to the alcohol industry will decrease. </p>
<h2>The findings</h2>
<p>We looked at how the policy might affect public health costs of six alcohol-related conditions. We also factored in the hospital costs of treating these conditions. The conditions we looked at were: road injury; intentional injury; liver cirrhosis; HIV; TB; and breast cancer. </p>
<p>Model estimates suggest that all closing-time scenarios correspond to decreases in six areas. These are: </p>
<ul>
<li><p>alcohol consumption</p></li>
<li><p>number of deaths due to the six alcohol-related conditions</p></li>
<li><p>number of cases of these six conditions</p></li>
<li><p>hospital costs of these conditions</p></li>
<li><p>cost of combating alcohol-related crime</p></li>
<li><p>revenue from alcohol sales and alcohol taxation.</p></li>
</ul>
<p>We estimated how much lower the number of cases of the six conditions would be over the next 20 years. The cases averted were:</p>
<ul>
<li><p>163,800 to 453,000 under the midnight closing-time scenario </p></li>
<li><p>88,700 to 220,300 (1am scenario) </p></li>
<li><p>12,600 to 28,300 (2am scenario). </p></li>
</ul>
<p>Correspondingly, the total hospital cost saving over the next 20 years is between: </p>
<ul>
<li><p>R326.8 million and R890.2 million (midnight scenario)</p></li>
<li><p>R130.5 million and R381.2 million (1am)</p></li>
<li><p>and between R18.7 million and R46.0 million (2am). </p></li>
</ul>
<p>(At the time of publication the <a href="https://www.xe.com/currencyconverter/convert/?Amount=1&From=USD&To=ZAR">exchange rate</a> was R19.42 to the US$) </p>
<p>In the year following the policy’s introduction, tax revenue (excise and value added tax) on alcohol sales is expected to decrease by between R100 million and R333 million under a midnight closing-time scenario. Under the 1am scenario it would fall by between R54 million and R179 million. And in the 2am scenario tax revenue would fall by between R9 million and R27 million. </p>
<p>Retail revenue would decrease by between R328 million and R1,093 million (midnight closing time), between R176 million and R587 million (1am) and between R27 million and R89 million (2am).</p>
<h2>What this all means</h2>
<p>The Western Cape government has expressed a clear commitment to protecting health in the Alcohol Harms Reduction <a href="https://www.westerncape.gov.za/text/2017/September/white_paper_alcohol-related_harms_reduction.pdf">White Paper</a>. Introducing uniform trading-time restrictions for onsite retailers of alcohol is a good first step. </p>
<p>A midnight closing time restriction is the most pro-health policy option.
A 2am closing time is the most pro-industry. But the <a href="https://dgmt.co.za/wp-content/uploads/2023/03/Trading-Hours-Phase-2-Modelling-Trading-Times-Final-Report-vf.pdf">research</a> does suggest that, from a public health standpoint, the 2am closing time still represents a modest improvement on the status quo.</p>
<p>Applying <a href="https://apps.who.int/iris/bitstream/handle/10665/259232/WHO-NMH-NVI-17.9-eng.pdf">evidence-based policies</a> to reduce alcohol consumption is necessary to reduce alcohol-related harms and deaths. The possibility of limited economic costs should not be a deterrent to this policy objective.</p>
<p>The alcohol industry may also point to the direct, indirect and induced job losses resulting from this policy. Concerns about employment losses are genuine and valid. But employment losses are only one side of the issue and should be considered with caution. One needs to consider the overall effects of the policy on employment. Jobs will be created in sectors attracting new demand as people spend some of their money on goods and services other than alcohol. It is nearly impossible to predict the number of jobs that will be created directly because of the policy, or because of the lives saved and lengthened.</p>
<h2>What more needs to be done</h2>
<p>Whatever closing time the government chooses, this policy won’t solve every problem. It will need to be enacted alongside other policy interventions geared towards reducing alcohol consumption and its associated harms. </p>
<p>These policies <a href="https://apps.who.int/iris/bitstream/handle/10665/259232/WHO-NMH-NVI-17.9-eng.pdf">include</a> banning alcohol advertising; adopting a minimum alcohol unit price; reducing the legal limits for drinking and driving; and making it easier for people to get counselling and medically assisted treatment if they struggle with alcohol dependence.</p>
<p>A comprehensive policy framework that targets alcohol consumption at an individual and societal level will be required to combat alcohol-related illness and death, and the adverse health, economic and social consequences.</p><img src="https://counter.theconversation.com/content/205700/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>This modelling study on which this article is based was commissioned and funded by the DG Murray Trust, an organisation which Sam has collaborated with as a consultant. Sam Filby works for the Research Unit on the Economics of Excisable Products based at the University of Cape Town. Her research conducted at the University of Cape Town is funded by the African Capacity Building Foundation through the Bill & Melinda Gates Foundation, Tax Justice Network Africa (also through the Bill & Melinda Gates Foundation), the CDC Foundation, and Cancer Research UK. Sam is also CIO of byegwaai, an app-based smoking cessation program. </span></em></p>Alcohol use contributes to over 200 different diseases, injuries, and conditions. It is also a risk factor for gender-based violence and violent crime.Sam Filby, Research Officer, Research Unit on the Economics of Excisable Products, University of Cape TownLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2019512023-04-07T12:16:57Z2023-04-07T12:16:57ZThe FDA’s rule change requiring providers to inform women about breast density could lead to a flurry of questions<figure><img src="https://images.theconversation.com/files/519672/original/file-20230405-1759-sbi3a7.jpg?ixlib=rb-1.1.0&rect=107%2C71%2C7832%2C5225&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Breast density is one of the factors that can influence whether people should pursue supplemental screening. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/female-doctor-talking-to-her-patient-and-adjusting-royalty-free-image/1221770065?phrase=mammogram&adppopup=true">andresr/E+ via Getty Images</a></span></figcaption></figure><p><em>The U.S. Food and Drug Administration <a href="https://public-inspection.federalregister.gov/2023-04550.pdf">finalized a regulation</a> in early March 2023 that updates mammography reporting requirements. The new regulation goes into effect on Sept. 10, 2024, and will require that all women receive information about breast density following a mammogram. It will also require they be told in their mammogram report that dense breast tissue can mask cancer and make cancer more difficult to detect.</em></p>
<p><em>The Conversation asked <a href="https://www.rad.pitt.edu/profile-detail.html?profileID=311">Dr. Wendie A. Berg</a>, professor of radiology at the University of Pittsburgh School of Medicine, to explain how the rule change could affect screening recommendations as well as the way people interpret their results.</em></p>
<h2>What is breast density and why does it matter?</h2>
<p>All breasts are made up of a mix of fat, milk glands and ducts. The glands are supported by fibrous tissue and ligaments, collectively called “fibroglandular tissue.” The more fibroglandular tissue a woman has, the “denser” her breast tissue. </p>
<p>When a woman has a mammogram, the radiologist reviewing it will describe her breast density using one of four categories: A) fatty, B) scattered tissue, C) heterogeneously dense or D) extremely dense. Categories C and D are considered “dense” whereas categories A and B are “not dense.” </p>
<p>Dense breasts are <a href="https://doi.org/10.1093/jnci/dju255">normal and common</a>. Over 50% of women have dense breasts before menopause, as do about 40% of women in their 50s and 30% of women in their 60s. Breasts can become less dense after menopause, but a woman with extremely dense breasts will likely continue to have dense breasts all her life.</p>
<p>Breast density matters for two reasons. Most importantly, dense breast tissue can hide cancer on a mammogram. About 40% of breast cancers will go unseen on mammography in the densest breasts, labeled “extremely dense breasts,” and about <a href="https://doi.org/10.7326/m14-1465">25% will go undetected in heterogeneously dense breasts</a>. </p>
<p>Secondly, dense tissue also increases the risk of developing breast cancer, with about <a href="https://doi.org/10.1158/1055-9965.epi-06-0034">fourfold the risk of breast cancer in extremely dense breasts</a> compared with fatty breasts, and about <a href="https://doi.org/10.1016/j.breast.2022.09.007">twofold the risk compared to breasts with scattered tissue</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/519670/original/file-20230405-24-mpiqoo.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Mammography comparison of cancer easily seen in a a fatty ('not dense') breast on the left and hard to see in a 'dense' breast on the right." src="https://images.theconversation.com/files/519670/original/file-20230405-24-mpiqoo.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/519670/original/file-20230405-24-mpiqoo.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=429&fit=crop&dpr=1 600w, https://images.theconversation.com/files/519670/original/file-20230405-24-mpiqoo.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=429&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/519670/original/file-20230405-24-mpiqoo.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=429&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/519670/original/file-20230405-24-mpiqoo.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=539&fit=crop&dpr=1 754w, https://images.theconversation.com/files/519670/original/file-20230405-24-mpiqoo.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=539&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/519670/original/file-20230405-24-mpiqoo.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=539&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Dense breasts not only make cancer harder to spot, they also increase the risk of developing cancer.</span>
<span class="attribution"><span class="source">DenseBreast-info.org and Dr. Wendie Berg</span></span>
</figcaption>
</figure>
<h2>What does the FDA ruling entail?</h2>
<p>Until now, <a href="https://densebreast-info.org/legislative-information/state-legislation-map/">38 states plus Washington, D.C.</a>, have had varying laws about what to tell women about breast density. This has resulted in inconsistent levels of information being provided to U.S. women depending on where they live. </p>
<p>Beginning in September 2024, the <a href="https://public-inspection.federalregister.gov/2023-04550.pdf">FDA’s final rule</a> creates a uniform national standard requiring that all women be informed in the mammogram results letter that their breasts are either “dense” or “not dense.” They will be told that dense tissue can hide cancer on a mammogram and that it also raises the risk of developing breast cancer.</p>
<p>The new regulations require that the specific density category be included in all mammography reports that go to the referring health care provider. Some states require the specific density category also be included in the patient results letter, and this information can be included, but must be separate from the language required by the FDA. The FDA notification cannot be altered in any way.</p>
<p>The FDA requirement also includes this sentence in the letter to women with “dense” breasts: “In some people with dense tissue, other imaging tests in addition to a mammogram may help find cancers.” Such “supplemental screening” deserves discussion.</p>
<h2>How might this affect how patients respond to mammogram results?</h2>
<p>Without some guidance on what to do about it, there is the potential for this information to cause some confusion and worry. </p>
<p>3D mammograms, also known as tomosynthesis, are becoming standard and are slightly <a href="https://doi.org/10.1148/radiol.221571">better at detecting cancer, with fewer callbacks</a> for extra testing for findings that turn out not to be cancer. Women with dense breasts should make sure to have routine screening with a 3D mammogram.</p>
<p>Deciding whether to pursue supplemental screening beyond an annual mammogram starting at age 40 depends on several considerations. These include breast density and other risk factors, potential benefits, downsides – such as additional testing for findings that turn out not to be cancer – insurance coverage and costs. </p>
<p>By age 30, <a href="https://doi.org/10.1016/j.jacr.2017.11.034">all women should discuss their risk factors</a> with their health care provider and consider genetic testing, if appropriate. This is because women considered to be “high risk” should start screening earlier and have MRI screening in addition to mammography, regardless of breast density. </p>
<p><img src="https://cdn.theconversation.com/static_files/files/2615/BIRADS_Cancer_%281%29.gif?1680793880">
</p><figure><figcaption><span class="caption">Breast density is described as one of four categories in the mammogram report. The denser the breast, the harder the cancer is to see on a mammogram.</span></figcaption></figure><p></p>
<p>Here is a list of some of the factors that would make a woman “high risk,” and good candidates for yearly screening with MRI up to ages 70 to 75, depending on overall health.</p>
<ul>
<li><p>Women with disease-causing genetic variants, such as BRCA1 or BRCA2, or who have a mother, sister or daughter with a disease-causing variant, should start having yearly <a href="https://doi.org/10.3322/canjclin.57.2.75">screening with MRI by age 25-30</a>, and add mammography screening once they turn 30. </p></li>
<li><p>Women who received radiation therapy to the chest for prior cancer – usually Hodgkin lymphoma – before age 30 should start MRI screening eight years after treatment – but not before age 25 – and add mammography by the time they’re 30. </p></li>
<li><p>Women with an estimated lifetime risk of breast cancer of at least 20% should have annual MRIs, in addition to mammography. The most accurate estimates are from the <a href="https://ibis.ikonopedia.com/">Tyrer-Cuzick or IBIS model</a> and include weight, height, breast density, family history, biopsy history and other risk factors. AI-based processing of mammograms alone may be even <a href="https://doi.org/10.1200/jco.21.01337">more accurate than risk models</a> at predicting who will develop breast cancer in the next one to five years.</p></li>
<li><p>Annual MRI screenings are also recommended for women <a href="https://doi.org/10.1016/j.jacr.2017.11.034">diagnosed with breast cancer prior to age 50 or women with dense breasts</a>.</p></li>
<li><p>The European Society of Breast Imaging recommends that <a href="https://doi.org/10.1007/s00330-022-08617-6">women with extremely dense breasts</a> add MRI screening every 2 to 4 years from age 50 to 70 (with mammograms every 2 years).</p></li>
</ul>
<p>Women with dense breasts, especially if they also have other risk factors such as family history of breast cancer or prior atypical biopsy, should consider adding screening MRI to their annual mammogram. But MRI requires lying in the tunnel of the magnet, which can be <a href="https://doi.org/10.1148/radiol.2541090953">difficult for women with claustrophobia</a>. It also requires intravenous contrast injection. Cancers become more visible with contrast because they have more and leakier blood vessels than normal tissue. </p>
<p>For women who cannot tolerate or access MRI, adding ultrasound to mammography can be considered, but <a href="https://densebreast-info.org/screening-technologies/cancer-detection-by-screening-method/">MRI finds more cancers than ultrasound</a>. <a href="https://doi.org/10.1016/j.ejrad.2022.110513">Contrast-enhanced mammography</a> is being evaluated as an alternative to MRI.</p>
<h2>Will insurance cover additional screening tests?</h2>
<p>Currently 15 states plus D.C. have <a href="https://densebreast-info.org/legislative-information/state-legislation-map/">laws requiring insurance coverage</a> for supplemental breast cancer screening, but only New York, Connecticut and Illinois require such coverage without copays. </p>
<p>A federal insurance bill, the <a href="https://densebreast-info.org/legislative-information/find-it-early-act/#">Find It Early Act</a>, is being reintroduced by two U.S. representatives. This measure would ensure all health insurance plans cover screening and diagnostic breast imaging with no out-of-pocket costs. </p>
<p>This would include supplemental screening for women with dense breasts or at a higher risk for breast cancer, in accordance with National Comprehensive Cancer Network guidelines and the <a href="https://doi.org/10.1016/j.jacr.2021.09.002">American College of Radiology’s Appropriateness Criteria</a>.</p><img src="https://counter.theconversation.com/content/201951/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Wendie A. Berg receives funding from the Breast Cancer Research Foundation and Pennsylvania Breast Cancer Coalition. She is voluntary Chief Scientific Advisor to <a href="http://www.DenseBreast-info.org">www.DenseBreast-info.org</a>. </span></em></p>Dense breast tissue is common and normal, but it can make cancer more difficult to detect. FDA requirements going into effect in September 2024 will dictate that patients be better informed about it.Wendie A. Berg, Professor of Radiology, School of Medicine, University of PittsburghLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2020872023-03-21T18:02:21Z2023-03-21T18:02:21ZBreast cancer: progestogen-only and combined birth control both increase risk – here’s what you need to know<figure><img src="https://images.theconversation.com/files/516644/original/file-20230321-1390-p2mixq.jpg?ixlib=rb-1.1.0&rect=0%2C7%2C4947%2C3280&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The progestogen-only pill is more commonly known as the 'mini pill'.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/black-african-american-woman-holding-contraceptive-135468863">Samuel Borges Photography/ Shutterstock</a></span></figcaption></figure><p>Breast cancer is one of the <a href="https://www.cancerresearchuk.org/health-professional/cancer-statistics/worldwide-cancer#heading-Zero">most common types of cancer</a> worldwide, with around <a href="https://www.who.int/news-room/fact-sheets/detail/breast-cancer">2.3 million women</a> diagnosed with the disease every year. In the UK alone, it is estimated that <a href="https://cks.nice.org.uk/topics/breast-cancer-managing-fh/background-information/prevalence/">one in seven women</a> will develop breast cancer at some point in their lifetime. </p>
<p>The biggest determinants for developing breast cancer are age and being female. But other lifestyle factors, such as weight, how much you drink, whether or not you exercise, and hormone levels, can also play a smaller part in elevating your risk.</p>
<p>It has also been known for many years now that women who are using or have recently used the combined oral contraceptive pill for more than five years <a href="https://www.cancer.gov/about-cancer/causes-prevention/risk/hormones/oral-contraceptives-fact-sheet#:%7E:text=Ovarian%20cancer%3A%20Women%20who%20have,contraceptives%20(16%E2%80%9318).">have a 25% greater risk</a> of developing breast cancer compared to their risk if they hadn’t taken the pill. But despite this small increase in risk, only about <a href="https://www.royalmarsden.nhs.uk/information-gps/gp-resources/breast-cancer/breast-cancer-incidence-and-risk-factors">1% of all breast cancers</a> in the UK are linked to the use of oral contraception.</p>
<p>Until now, it was thought that only the combined hormonal pill carried a greater risk of breast cancer. But a <a href="https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1004188">recent study</a> suggests that the progestogen-only pill (also known as the mini pill) and other forms of hormonal contraception also carry the same increase in breast cancer risk as the combined pill.</p>
<p>The authors of the study looked at data from the GP records of more than 27,000 women in the UK, and combined this with data from 12 other published studies that had looked at the effect of different types of hormonal contraceptives (including the progesterone-only pill, hormonal IUDs, the implant and the injection) on breast cancer risk. </p>
<p>With this data, they were able to estimate whether women who had been diagnosed with breast cancer under the age of 50 were more likely to have used various forms of hormonal contraceptives, compared to women of the same age who had not been diagnosed with breast cancer. The study took into account other factors that may affect risk of breast cancer, such as body weight, alcohol intake and whether they had children. </p>
<p>The study found women who used progestogen-only hormonal contraceptives had between a 20-30% greater risk of developing breast cancer compared to women not using these methods. This increased risk disappeared ten years after stopping the method. </p>
<h2>Making individual choices</h2>
<p>To better put the study’s findings into perspective, it might help to look at the extra number of people who may develop breast cancer due to having used hormonal contraceptives, compared to the number of women who will develop breast cancer without having used birth control. </p>
<figure class="align-center ">
<img alt="A woman undergoes a breast examination using a machine operated by a male doctor." src="https://images.theconversation.com/files/516647/original/file-20230321-22-7uvc0u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/516647/original/file-20230321-22-7uvc0u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=407&fit=crop&dpr=1 600w, https://images.theconversation.com/files/516647/original/file-20230321-22-7uvc0u.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=407&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/516647/original/file-20230321-22-7uvc0u.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=407&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/516647/original/file-20230321-22-7uvc0u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=512&fit=crop&dpr=1 754w, https://images.theconversation.com/files/516647/original/file-20230321-22-7uvc0u.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=512&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/516647/original/file-20230321-22-7uvc0u.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=512&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Many factors may increase your risk of breast cancer.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/male-doctor-checking-mammography-machine-scan-206670595">GagliardiPhotography/ Shutterstock</a></span>
</figcaption>
</figure>
<p>So for example, the <a href="https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1004188">researchers in this study estimate</a> that in a group of 100,000 women aged 35-39, about 2,000 women will develop breast cancer over a 15-year period due to a range of factors unrelated to the use of hormonal contraception. But given that the study found birth control carries between a 20-30% greater risk of developing breast cancer, they estimate that an additional 265 women will therefore develop breast cancer over a 15-year period as a direct results of taking oral birth control. </p>
<p>If we were to look at women aged 50-54, we know from other research that about <a href="https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/breast-cancer/incidence-invasive#heading-One">280 women per 100,000</a> are diagnosed with breast cancer each year. If birth control increases breast cancer risk by 20-30%, it would mean an additional 70 women per 100,000 would develop breast cancer each year. </p>
<p>This is one of the reasons women are not advised to take the combined pill <a href="https://www.fsrh.org/standards-and-guidance/documents/combined-hormonal-contraception/">over the age of 50</a>. The results of this latest study mean women may also want to consider the slightly increased risks of breast cancer with progestogen-only contraceptives over the age of 50. However, <a href="https://www.bhf.org.uk/informationsupport/support/practical-support/contraception">progestogen-only methods remain safer</a> in terms of cardiovascular risks – such as stroke and heart attacks – in this age group.</p>
<p>Obviously, breast cancer is a serious disease and a leading cause of death in <a href="https://www.gov.uk/government/publications/health-profile-for-england/chapter-2-major-causes-of-death-and-how-they-have-changed">younger women</a>, so anything which increases a person’s risk of breast cancer has to be considered carefully.</p>
<p>But one of the difficulties of deciding on whether a contraceptive method presents an acceptable risk is that many other common lifestyle behaviours <a href="https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/breast-cancer%23heading-Four">also increase cancer risk</a>. For example, it’s estimated that while 1% of breast cancers in the UK are caused by hormonal contraceptives, 5% are caused by not breastfeeding, 8% by being overweight and 8% by drinking alcohol.</p>
<p>This is further complicated by the fact that hormonal contraceptives can have some benefits. For example, the contraceptive injection can help ease symptoms in women who have <a href="https://endometriosisnews.com/depo-provera/">endometriosis</a>, while the intrauterine device is very effective in treating <a href="https://uk.mycontraception.com/contraception-methods/all-methods/ius">very heavy periods</a>. </p>
<p>The combined oral pill <a href="https://www.cancer.gov/about-cancer/causes-prevention/risk/hormones/oral-contraceptives-fact-sheet#:%7E:text=Ovarian%20cancer%3A%20Women%20who%20have,contraceptives%20(16%E2%80%9318).">reduces the risk</a> of endometrial cancer by about 50% and ovarian cancer by about 40%. It’s also beneficial in helping with <a href="https://www.gennev.com/education/birth-control-pills-for-perimenopause">hot flushes and other pre-menopausal symptoms</a>. Not to mention that contraception allows a woman to control her reproductive cycle and avoid unwanted pregnancy. </p>
<p>The decision about which contraceptive method to use is an extremely personal choice. The findings of this study provide important clarity on breast cancer risk, allowing women to make a more informed decision when it comes to using contraception.</p><img src="https://counter.theconversation.com/content/202087/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Susan Walker has previously received funding from Bayer PLC, and previously advised Natural Cycles.</span></em></p>It was previously thought that only combined hormonal contraceptives carried an elevated breast cancer risk.Susan Walker, Reader in Contraception, Reproductive and Sexual Health, Anglia Ruskin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1989152023-02-08T12:46:08Z2023-02-08T12:46:08ZArtemis is a new body suit for period pain – here’s why it’s named after a Greek goddess<p>A new body suit to <a href="https://www.bbc.co.uk/news/business-64397795">control period pain</a> is in the pipeline – and it’s called Artemis. Named after the Greek goddess of chastity, hunting, childbirth and the moon, it works by combining a <a href="https://www.nhs.uk/conditions/transcutaneous-electrical-nerve-stimulation-tens/">tens machine</a> (which provides pain relief through the use of a mild electrical current) and heat panels. </p>
<p>If it proves effective, it could be a huge benefit to women who suffer particularly with period pain – which is now acknowledged to sometimes be <a href="https://qz.com/611774/period-pain-can-be-as-bad-as-a-heart-attack-so-why-arent-we-researching-how-to-treat-it">as painful as a heart attack</a>. </p>
<p>There’s a long history in our society of period pain being played down, or just considered <a href="https://www.tandfonline.com/doi/pdf/10.1080/09612020000200260">“normal”</a> – with so much of history written by men who wouldn’t have understood – alongside the use of euphemisms to avoid even discussing it. But there’s also plenty of evidence on the historical record showing how coping with severe menstrual pain has always been a struggle for some women. </p>
<p>In her 2015 <a href="https://www.google.co.uk/books/edition/Maids_Wives_Widows/SXg7CQAAQBAJ?hl=en&gbpv=1&dq=Between+the+kidneys+and+the+womb+the+consent+is+evident+in+the+torments+and+pains+in+the+loins+which+women+and+maids&pg=PT84&printsec=frontcover">book</a> Maids, Wives, Widows: Exploring Early Modern Woman’s Lives 1540-1714, historian Sara Read notes a passage in a medical text from the 1600s – the first anatomy text to be written in English – that compares having a period to childbirth. </p>
<p>In <a href="https://shakespeare.lib.uiowa.edu/item/mikrokosmographia-or-a-description-of-the-body-of-man/">Microcosmographia. A Description of the Body of Man</a> London physician Helkiah Crooke physician, discusses “the courses” – a term for menstruation. He writes:</p>
<blockquote>
<p>Between the kidneys and the womb, the consent is evident in the torments and pains in the loins which women and maids have in or about the time of their courses. In so much as some have told me they had at least bear a child as endure that pain; and myself have seen some to my thinking by their deportment; in as great extremity in the one as in the other.</p>
</blockquote>
<h2>Artemis the great</h2>
<p>The connection between the pain of having a baby and having a period is very appropriate to a product named after Artemis, the ancient Greek goddess associated with both. Artemis was the goddess that was turned to during times of transition, such as menstruation, development, and marriage.</p>
<p>A virgin goddess – one of three, the others being Athena and Hestia – she was involved as girls reached womanhood, with <a href="https://www.theoi.com/Cult/ArtemisCult.html">dedications made to her</a>. <a href="https://diotima-doctafemina.org/translations/anthologies/womens-life-in-greece-and-rome-selections/ix-medicine-and-anatomy/349-hysteria-in-virgins/">These included</a> your childhood toys and, before your sexual initiation, your belt. Indeed, women would dedicate their finest clothing to Artemis when their menstrual periods began.</p>
<p><div data-react-class="InstagramEmbed" data-react-props="{"url":"https://www.instagram.com/p/CktYLkdII0r/?utm_source=ig_web_copy_link","accessToken":"127105130696839|b4b75090c9688d81dfd245afe6052f20"}"></div></p>
<p>Young Athenian girls who had not yet been through puberty were sent to an early sacred site, the sanctuary of Artemis at Brauron (about 30 miles from Athens), to <a href="https://womeninantiquity.wordpress.com/2017/03/20/the-cult-of-artemis-at-brauron/">serve at the shrine of the goddess</a>. Records show gifts given in thanks, possibly for surviving childbirth, another transition in women’s lives involving blood.</p>
<h2>Goddesses sell products</h2>
<p>From the mid-20th century onwards, it has been popular to name women’s products after famous women and goddesses from the ancient Mediterranean. For example, the name of a company developing a modern treatment for breast cancer, Atossa, dates back to around 520BC.</p>
<p>It was the name of a Persian queen, who – according to the historian Herodotus – was troubled by a lump in her breast, which was treated by the Greek doctor Democedes. In his famous <a href="http://www.perseus.tufts.edu/hopper/text?doc=Perseus%3Atext%3A1999.01.0126%3Abook%3D3%3Achapter%3D133">Histories</a> – an account of the period up to the Persian Wars – Herodotus writes that: </p>
<blockquote>
<p>A short time after this, something else occurred; there was a swelling on the breast of Atossa, the daughter of Cyrus and wife of Darius, which broke and spread further. As long as it was small, she hid it out of shame and told no one; but when it got bad, she sent for Democedes and showed it to him. He said he would cure her, but made her swear that she would repay him by granting whatever he asked of her, and said that he would ask nothing shameful.</p>
</blockquote>
<p><a href="https://www.youtube.com/watch?v=RJWd8fiLEyQ">Some scholars</a> have read this as the first recorded instance of breast cancer, but this isn’t clear from this brief description. Nor is the nature of Democedes’ treatment. But we do know that Atossa was cured. </p>
<p>Australian company <a href="https://atossatherapeutics.com/">Atossa Therapeutics</a> is running trials of hormone therapy in patients with invasive breast cancer who are about to have a mastectomy or lumpectomy. As of January 2023, the results were looking encouraging and trials have moved to the next stage. </p>
<h2>The power of the classics</h2>
<p>An early version of the contraceptive pill, marketed as Enovid, used the mythical Ethiopian princess <a href="https://muvs.org/en/contraception/c-media/enovid-badge-id2333/">Andromeda</a> in its advertising. The story runs that after her parents went too far in boasting about her exceptional beauty, the angry gods had Andromeda tied to a rock at the mercy of a sea monster, but <a href="https://artuk.org/discover/stories/andromeda-forgotten-woman-of-greek-mythology">she was saved by the hero Perseus</a>, who then took her as his queen.</p>
<p>For the manufacturers of Enovid, using their drug meant that every woman could “free herself from the chains” of worrying about unwanted pregnancy.</p>
<p>So the solution to women’s health problems is often presented in terms of ancient Greek female figures. Using these names may support the idea of continuity across history in how women have experienced their bodies, playing down how changes in society have affected them. </p>
<p>It also shows the lasting power of the classics, even at a time when few people learn about ancient Mediterranean cultures. And at the same time, it promotes a story in which “now” we can cure anything – even conditions that have been part of women’s lives for millennia.</p><img src="https://counter.theconversation.com/content/198915/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Helen King does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>There’s a long history in our society of period pain being played down, or just considered “normal”. But there’s plenty of evidence in the historical records that women have always experienced it.Helen King, Professor Emerita, Classical Studies, The Open UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1931122022-12-12T14:05:58Z2022-12-12T14:05:58ZBreast cancer patients in South Africa may find it hard to stick to treatment: here’s what they told us<figure><img src="https://images.theconversation.com/files/497958/original/file-20221129-18-90j6ha.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Adherence to treatment plans, particularly chemotherapy is complex. </span> <span class="attribution"><span class="source">Yaw Niel/Shutterstock</span></span></figcaption></figure><p>Worldwide, breast cancer is the most commonly diagnosed cancer. It’s also the leading cause of cancer-related death among women. The incidence of breast cancer is expected to rise, with the majority of breast cancer cases occurring among women in low- and middle-income countries such as South Africa, where adherence to treatment remains a challenge. For example, outcomes are dependent upon patients following the recommended chemotherapy protocols and getting the recommended drugs at the right time. </p>
<p>There were <a href="https://www.nicd.ac.za/wp-content/uploads/2021/12/NCR_Path_2019_Full_Report_8dec2021.pdf">10,174</a> new known breast cancer diagnoses in South Africa in 2019. These accounted for 23% of all the new cancer cases in women in South Africa. It is likely that the burden of disease is even higher, though, as not everyone has access to diagnostic facilities. Some people don’t know they have breast cancer because it hasn’t been diagnosed. </p>
<p>As a breast surgeon and scholar I have worked in the field for decades. Together with Dr Bronwyne Coetzee and Professor Ashraf Kagee from the Department of Psychology at Stellenbosch University, I supervised Brigitta Kepkey (a masters student), who conducted a study of the factors that challenge adherence to breast cancer treatment among South African women.</p>
<p>After conversations with patients attending the Breast and Endocrine Unit at Tygerberg Hospital in Cape Town, she <a href="https://scholar.sun.ac.za/bitstream/handle/10019.1/124696/kepkey_barriers_2022.pdf?sequence=1">documented</a> some of the barriers that affect their ability to adhere to breast cancer management. The perspectives of patients, family members and oncology healthcare workers involved with chemotherapy treatment and administration were sought.</p>
<p>Adherence to treatment plans, particularly chemotherapy, is complex. Our research found that there were personal, environmental and structural factors that influenced a patient’s ability to be adherent. These included access to transport, socioeconomic level and social support.</p>
<h2>Treatment</h2>
<p>In low- and middle-income countries such as South Africa, more patients present with advanced cancer. For example, in the US, approximately <a href="https://seer.cancer.gov/statfacts/html/breast.html">64% of women have early-stage cancer</a> at the time of diagnosis. In comparison, more than <a href="https://pubmed.ncbi.nlm.nih.gov/25295329/">60% of patients</a> seen in the public healthcare system in South Africa have locally advanced (inoperable) breast cancer at the time of diagnosis. They therefore receive relatively aggressive form of treatment: usually chemotherapy. The aim is to downsize their cancer, so they become operable. </p>
<p>Timely diagnosis in South Africa is dependent on <a href="https://pubmed.ncbi.nlm.nih.gov/25295329/">many factors</a>, including where a person lives. </p>
<p>Data from another study in Soweto in Johannesburg <a href="https://pubmed.ncbi.nlm.nih.gov/25295329/">showed</a> that the stage of cancer at the time of diagnosis depended on the distance from the healthcare facility. Patients who lived more than 20km away from the breast clinic were more likely to have locally advanced disease than those who lived nearby: 62% versus 50%. </p>
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<p>Distance, socioeconomic status and transport affect not only diagnosis but adherence to treatment. </p>
<h2>Barriers to sticking with therapy</h2>
<p>To define some of the barriers faced by women, Kepkey interviewed two small groups of women: those who had remained adherent and those who were non-adherent to chemotherapy treatment. </p>
<p>Some patients struggled with side effects such as hair loss, fatigue, weight loss and change in body image. These concerns were more prevalent among younger patients, who were also concerned about the impact of chemotherapy on their fertility and ability to have a family later on in life. </p>
<p>But these concerns were not raised more commonly by those who weren’t sticking to their treatment regimens. This may be because women who were nonadherent were generally older. </p>
<p>Patients may miss out on treatment due to family responsibility, if they are the breadwinners and cannot afford to miss a day of work or cannot find a child-minder. </p>
<p>According to <a href="https://www.statssa.gov.za/?p=14388">StatsSA</a>, 42% of South African households are headed by females. Children are more likely to live with their mothers in both rural (38%) and urban (49%) areas. </p>
<p>The extra pressure put on an individual with breast cancer was illustrated by a healthcare worker: </p>
<blockquote>
<p>“They (patients) would rather go to work than come for treatment cause they still need to feed their family.” </p>
</blockquote>
<p>A patient also said: </p>
<blockquote>
<p>“When I’m not feeling well (as a result of treatment), I must get up (and) struggle to go to walk around and look for money.” </p>
</blockquote>
<p>The importance of health education was highlighted by healthcare workers as many patients have preconceived ideas as a result of social knowledge and second-hand accounts. Some patients assumed that chemotherapy affected everyone in the same way and therefore the negative side effects of chemotherapy such as hair loss, treatment side effects and infertility were deterrents to adherence as patients thought they would experience these side effects to the same or a worse extent.</p>
<p>Patients who lack social support are also more likely to be non-adherent to treatment as the cancer journey is difficult to go through alone. </p>
<h2>Why this matters</h2>
<p>In order to help patients adhere to their treatment protocols, more time needs to be spent unpacking the challenges that patients experience. One of the practical outcomes from the study was that the oncology healthcare workers realised the importance of using simplified explanations of treatment, and answered patients’ questions. We recommend that healthcare workers be sensitive to the influences on a patient’s decision-making and treatment outcomes. If possible, patients should receive psychological support throughout their cancer journey. Addressing the barriers to care is essential as failure to do so may compromise patient health. </p>
<p>The barriers identified are not unique to our clinic. It takes time to address the practicalities needed to provide adequate care, but doing it will increase patient compliance, make the cancer journey less daunting and therefore improve cancer outcomes.</p><img src="https://counter.theconversation.com/content/193112/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Brigitta Kepkey received funding from Stellenbosch University's Wilcocks bursary and Postgraduate Support bursary and Yad-Marpe Physiotherapists' Education Fund during her Masters Degree. </span></em></p><p class="fine-print"><em><span>Jenny Edge does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>There are personal, environmental and structural factors that influence a patient’s ability to adhere to treatment.Jenny Edge, Specialist Consultant / Head: Breast and Endocrine Surgery Unit, Stellenbosch UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1932312022-12-07T14:38:18Z2022-12-07T14:38:18ZBreast cancer patients in South Africa are battling to maintain treatment because of high transport costs<figure><img src="https://images.theconversation.com/files/496473/original/file-20221121-14-ej3hku.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Transport is the most common reason a patient doesn't follow their treatment regimen.</span> <span class="attribution"><span class="source">Hoberman Collection/Universal Images Group via Getty Images</span></span></figcaption></figure><p>South Africa has a two-tiered health system. Public health services – which are largely provided free of charge – are run and funded by the state. Private healthcare is owned and run by the private sector. Patients have to pay themselves or via medical insurance to access private care. </p>
<p>The majority of South Africa’s population – 80% – relies on the public health sector. This includes patients receiving care for breast cancer. </p>
<p>All breast cancer patients experience challenges during their treatment journey. However, the specifics vary considerably depending on treatment, socioeconomic circumstances and where the individual lives. </p>
<p>In the private sector, breast cancer treatment is widely available – at a cost. In contrast, few public health facilities have the specialists and resources to treat breast cancer. </p>
<p>Services such as chemotherapy are only available in tertiary hospitals which are located in the country’s urban centres. Although there is minimal cost to the individual for the treatment, access to the central hospitals can be a barrier to care. </p>
<p>I’ve been working at the Breast Clinic at Tygerberg Hospital in Cape Town, South Africa for five years. A major problem patients have repeatedly highlighted is transport to and from the facility. It is a great expense (as a share of the monthly family income). And, depending on where they live, it can be difficult to get to the hospital; it may involve multiple journeys. Transport is the most common reason a patient doesn’t follow their treatment regimen.</p>
<p>The outcome from breast cancer should not depend on where a person resides, but it is an important factor in determining outcome. </p>
<h2>Public transport in South Africa</h2>
<p>Access to private vehicles is a problem among the patients at Tygerberg. Most of them rely on public transport. </p>
<p>In South Africa, three kinds of public transport are available: trains, buses, and minibus taxis. For some patients, there’s another option in the form of the <a href="https://www.westerncape.gov.za/service/medical-emergency-transport-and-rescue-metro">HealthNet transport service</a>. This is a limited service provided to the major hospitals in the Western Cape province. It does not run every day and has to be booked in advance. Many of our patients can’t use it as a result.</p>
<p>Although the service is free of charge, the HealthNet buses are not always available on the day of a medical consultation or treatment, and patients must therefore make alternative arrangements. </p>
<p>Minibus taxis are the most common and most expensive mode of public transport. About <a href="https://www.statssa.gov.za/publications/P0320/P03202020.pdf#page=114">two thirds</a> of households use them. Due to <a href="https://www.statssa.gov.za/publications/P0320/P03202020.pdf">crumbling infrastructure</a>, there has been a sharp decline in the use of cheaper modes of transport such as buses and trains between 2013 and 2020.</p>
<p>Unfortunately, there are no statistics on travel expenditure for the patient population. However it has <a href="https://www.news24.com/Fin24/poor-cape-town-households-spend-43-of-income-on-transport-mayco-member-20190821">previously been reported</a> that low-income households spend one-third of their income on transport. This figure could be higher for patients as travel for hospital appointments for diagnosis and treatment involves multiple visits. </p>
<p>Usually, a patient diagnosed with cancer may require four hospital appointments for investigations. If they require systemic treatment, such as chemotherapy, this entails eight hospital appointments as patients are usually given eight cycles of treatment. The average patient would therefore need to make 12 visits to the hospital to receive the necessary care. </p>
<p>As one of the oncology nurses <a href="https://scholar.sun.ac.za/handle/10019.1/124696">commented</a>: </p>
<blockquote>
<p>Most of the people who are sick (and) who need our help here (Tygerberg Hospital) live nearby. Even though they live nearby, it’s not within walking distance. </p>
</blockquote>
<h2>A possible solution</h2>
<p>Given the increasing problem of transport identified, the <a href="https://www.pinkladycraftsforcancer.co.za/the-fund">Tygerberg breast unit transport fund</a> (in its present form) was founded as a collaboration with Dr Justus Appfelstaedt in 2010, with funding from <a href="https://www.pinkladycraftsforcancer.co.za/">Pink Lady Apples</a>. Pink Lady Apples is a local apple producer which runs an annual fund raising campaign, Crafts for Cancer.</p>
<p>Initially, the fund was a cash-based system which had the advantage of immediate reimbursement. But this resulted in problems with equity, management, and processing of the funds. It now utilises a “move money” bank account and reimburses patients for their travel costs to hospital appointments.</p>
<p>Remuneration is based on the standard taxi fare per individual from their postal code to Tygerberg Hospital. </p>
<p>In the first nine months of 2022, over 100 patients had their transport costs reimbursed. About 20% of payments were not collected, however, and further follow-up is needed to understand why.</p>
<p>This project has assisted many patients with their travel expenses. </p>
<p>We believe it could work for patients in other districts as well, if the necessary funds were available. Within the unit, the transport fund has been extended through the creation of the <a href="https://www.facebook.com/people/Breaking-Barriers-in-Health-Care/100085238297451/">Breaking Barriers NPO</a>, which assists other patients in the Breast and Endocrine Unit with their travel costs and access to social support.</p><img src="https://counter.theconversation.com/content/193231/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Services such as chemotherapy are only available in tertiary hospitals located in the country’s urban centres. Transport to these hospitals can be a barrier to care.Jenny Edge, Specialist Consultant / Head: Breast and Endocrine Surgery Unit, Stellenbosch UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1921792022-10-27T23:51:32Z2022-10-27T23:51:32Z‘I take it with a pinch of salt’: why women question health warnings linking alcohol with breast cancer<figure><img src="https://images.theconversation.com/files/492025/original/file-20221027-13-3n7rkv.jpg?ixlib=rb-1.1.0&rect=0%2C28%2C6349%2C4191&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Up to <a href="https://adf.org.au/insights/alcohol-breast-cancer/#:%7E:text=There's%20a%20direct%20link%20between%20drinking%20alcohol%20and%20breast%20cancer.&text=In%20Australia%2C%20up%20to%201,cancers%20is%20related%20to%20drinking.&text=But%2C%20many%20people%20just%20don,cancer%20risk%20associated%20with%20drinking.">one in ten</a> cases of breast cancer in Australia is linked to drinking alcohol. Midlife women are already at increased risk for breast cancer because of their age, and <a href="https://www.aihw.gov.au/getmedia/77dbea6e-f071-495c-b71e-3a632237269d/aihw-phe-270.pdf.aspx?inline=true">tend to drink more than younger women</a>. That means this group is at even more risk for breast cancer. </p>
<p>Health authorities have mostly so far dealt with this by telling women not to drink. But does this approach – which positions drinking as an individual’s “problem” based on their own “bad” choices – actually work?</p>
<p>In fact, our recent <a href="https://pubmed.ncbi.nlm.nih.gov/36095014/">study</a> found women aren’t necessarily aware of the link between alcohol and breast cancer. And even when they are, they aren’t always able to “choose” to quit.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/488928/original/file-20221010-57785-g8xev5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A woman looks at her wine glass." src="https://images.theconversation.com/files/488928/original/file-20221010-57785-g8xev5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/488928/original/file-20221010-57785-g8xev5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=456&fit=crop&dpr=1 600w, https://images.theconversation.com/files/488928/original/file-20221010-57785-g8xev5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=456&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/488928/original/file-20221010-57785-g8xev5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=456&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/488928/original/file-20221010-57785-g8xev5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=573&fit=crop&dpr=1 754w, https://images.theconversation.com/files/488928/original/file-20221010-57785-g8xev5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=573&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/488928/original/file-20221010-57785-g8xev5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=573&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Women face mixed messages about alcohol and cancer risk.</span>
<span class="attribution"><a class="source" href="https://pixabay.com/photos/adult-people-portrait-woman-3183055/">Image by Thomas Rüdesheim from Pixabay</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<h2>What women told us</h2>
<p>We wanted to better understand where women sought health information, how they accessed information specific to breast cancer risk as it relates to alcohol, and how they determined whether (or not) such information was trustworthy.</p>
<p>We interviewed 50 “midlife” women (aged 45-64) living in South Australia from different social classes. </p>
<p>Previous <a href="https://theconversation.com/oh-well-wine-oclock-what-midlife-women-told-us-about-drinking-and-why-its-so-hard-to-stop-188882">research</a> has shown alcohol consumption performs a range of important functions for women, such as coping, socialising, networking and managing difficulties. Women often feel they cannot necessarily “choose” not to drink in these circumstances.</p>
<p>Women also face mixed messages about alcohol and cancer risk. Some alcohol brands <a href="https://pubmed.ncbi.nlm.nih.gov/26350708/">display pink ribbons</a> in an effort to “raise awareness” about breast cancer. And more broadly, media reports have come and gone over the years about the purported risks or benefits of alcohol for various illnesses.</p>
<p>Many women in our study did not know that alcohol causes breast cancer. But upon hearing about it, they mostly wanted to know more.</p>
<p>One woman told us:</p>
<blockquote>
<p>I didn’t realise there was a link and I went on and interrogated it after that, because I do enjoy a glass of wine. And I wondered, what am I knowingly getting into here […] and to understand how alcohol affects your body, in terms of it increases the estrogen levels, and so that has a link to breast cancer.</p>
</blockquote>
<p>Others thought if knowledge became more common, breast cancer risk messages might more likely be accepted (or, at least, be less likely to be rejected). One woman told us:</p>
<blockquote>
<p>I think sometimes the more information comes out, or the more it’s repeated, the more it becomes common knowledge for people rather than easily dismissed.</p>
</blockquote>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/488926/original/file-20221010-58516-y23r1g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A woman drinks champagne." src="https://images.theconversation.com/files/488926/original/file-20221010-58516-y23r1g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/488926/original/file-20221010-58516-y23r1g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/488926/original/file-20221010-58516-y23r1g.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/488926/original/file-20221010-58516-y23r1g.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/488926/original/file-20221010-58516-y23r1g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/488926/original/file-20221010-58516-y23r1g.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/488926/original/file-20221010-58516-y23r1g.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Many women in our study did not know that alcohol causes breast cancer.</span>
<span class="attribution"><a class="source" href="https://pixabay.com/photos/woman-drink-glass-wine-alcohol-5943480/">Image by Bastian Riccardi from Pixabay</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/oh-well-wine-oclock-what-midlife-women-told-us-about-drinking-and-why-its-so-hard-to-stop-188882">'Oh well, wine o’clock': what midlife women told us about drinking – and why it's so hard to stop</a>
</strong>
</em>
</p>
<hr>
<h2>Questioning the message and the messenger</h2>
<p>But, even if women are aware, the message that alcohol causes breast cancer can be difficult and confusing to hear. In response, trust in the message can waver. As one woman said:</p>
<blockquote>
<p>I do question quite a lot because I do think the media play it up […] I take it with a pinch of salt.</p>
</blockquote>
<p>Messages that seem exaggerated were also off-putting. As one woman put it:</p>
<blockquote>
<p>First of all, you just look at the tone of the way they wrote about things, you’d probably, if you thought it’d been sensationalised, or if they were axe-grinding.</p>
</blockquote>
<p>Indeed, encountering conflicting information in daily life made some public health messages feel less believable to some women we spoke to. Some women instead preferred to rely on “gut feeling” to judge information.</p>
<p>Considering who and what to trust in terms of information about alcohol and breast cancer was key for women. Some want these complexities to be recognised and messages to be delivered in “even-handed” ways. As one woman told us:</p>
<blockquote>
<p>You just listen to it, see if they’re going to be harping on a certain theme, maybe without having any basis for saying so, if they’re trying to push a certain point of view without having any basis or back-up for that. Rather than someone being even-minded about, you know, even-handed about things.</p>
</blockquote>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/488925/original/file-20221010-58076-3ly4qx.jpg?ixlib=rb-1.1.0&rect=0%2C11%2C1894%2C1256&q=45&auto=format&w=1000&fit=clip"><img alt="A woman drinks beer outdoors." src="https://images.theconversation.com/files/488925/original/file-20221010-58076-3ly4qx.jpg?ixlib=rb-1.1.0&rect=0%2C11%2C1894%2C1256&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/488925/original/file-20221010-58076-3ly4qx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/488925/original/file-20221010-58076-3ly4qx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/488925/original/file-20221010-58076-3ly4qx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/488925/original/file-20221010-58076-3ly4qx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/488925/original/file-20221010-58076-3ly4qx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/488925/original/file-20221010-58076-3ly4qx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Health messaging for women around alcohol breast cancer risk must acknowledge the social and commercial factors that encourage alcohol consumption.</span>
<span class="attribution"><a class="source" href="https://pixabay.com/photos/beer-drink-alcohol-woman-girl-bar-4620372/">Image by Engin Akyurt from Pixabay</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<h2>Sceptical of experts</h2>
<p>Some women, especially those living with disadvantage, were more likely to be sceptical of information and information sources, even if it is based on research from experts. </p>
<p>They described needing time to consider messages and judge them as trustworthy, with some feeling research evidence can be skewed to serve different interests. As one put it:</p>
<blockquote>
<p>Well, I know there’s been various research done but I have to admit I tend to be rather sceptical about certain research […] things can be found that really say “Oh, yes, this is what [has been found] and then someone will come along and [say] "No, it’s not like that at all”.</p>
</blockquote>
<p>We found women want to trust clear, consistent and non-judgemental messaging, otherwise distrust in the message and messenger might become the default position. </p>
<p>Health messaging for women around alcohol breast cancer risk must acknowledge the social and commercial factors that encourage alcohol consumption.</p>
<p>Too often, public health messaging asks women to take on the responsibility of reducing their alcohol consumption – without enough recognition that the same women are targeted by alcohol advertising and many <a href="https://theconversation.com/oh-well-wine-oclock-what-midlife-women-told-us-about-drinking-and-why-its-so-hard-to-stop-188882">see alcohol</a> as a reliable “friend” in the absence of other social support.</p>
<p>If we don’t acknowledge that, we risk perpetuating the same stigma and blame that drives women to drink in the first place.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/did-you-look-forward-to-last-nights-bottle-of-wine-a-bit-too-much-ladies-youre-not-alone-109078">Did you look forward to last night's bottle of wine a bit too much? Ladies, you're not alone</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/192179/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Belinda Lunnay receives funding from the Australian Research Council.</span></em></p><p class="fine-print"><em><span>Samantha Meyer receives funding from the Australian Research Council. </span></em></p><p class="fine-print"><em><span>Paul Ward does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Our study found women aren’t necessarily aware of the link between alcohol and breast cancer. And even when they are, they aren’t always able to ‘choose’ to quit.Belinda Lunnay, Post-doctoral researcher in Public Health , Torrens University AustraliaPaul Ward, Professor of Public Health, Torrens University AustraliaSamantha Meyer, Associate Professor in Public Health, University of WaterlooLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1923512022-10-20T07:17:48Z2022-10-20T07:17:48ZBreast cancer: five tips from an expert on catching it early and keeping safe<figure><img src="https://images.theconversation.com/files/489332/original/file-20221012-3949-p1oqgi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Kwame Amo/Shutterstock</span></span></figcaption></figure><p>Breast cancer is the <a href="https://www.who.int/initiatives/global-breast-cancer-initiative/breast-cancer-inequities">most common</a> cancer in the world. Every year it claims more than <a href="https://www.who.int/news-room/fact-sheets/detail/cancer">650,000</a> lives.</p>
<p>Breast cancer affects more women in high-income countries like the US and the UK. But people in low- and middle-income countries, such as Nigeria, are most vulnerable. This is mainly because people in these countries seek medical help at a late stage when the <a href="https://pubmed.ncbi.nlm.nih.gov/33506499/">disease is advanced</a>. When breast cancer is at an advanced stage, it is harder to treat and people are more likely to die. </p>
<p>Nigeria, for example, has <a href="https://ascopubs.org/doi/full/10.1200/GO.20.00541">one of the highest</a> breast cancer <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8626596/">fatality rates</a>. The country has seen a <a href="https://academic.oup.com/bjs/article/86/5/665/6269416">significant increase</a> in the number of breast cancer cases over the past four decades. It’s currently the most <a href="https://www.sciencedirect.com/science/article/abs/pii/S1877782112000604?via%3Dihub">commonly diagnosed cancer</a> and one of the leading causes of cancer deaths in the country.</p>
<p>The deficiencies in the Nigerian healthcare system – which requires that most patients pay out-of-pocket for their own healthcare – further contributes to the poor outcomes. Some patients who get diagnosed with breast cancer are either unable to access quality healthcare or suffer catastrophic healthcare expenditure when they do so. Worryingly, most of those affected are in their forties or sometimes younger. White patients tend to be older – often in their sixties.</p>
<p>Breast cancer is curable, provided it is detected early and treated promptly. There are steps that one can take to minimise the risk and increase the possibility of survival.</p>
<p>I’m a breast cancer expert, working in south-west Nigeria. My work in breast cancer focuses on promoting early detection, creating clinical pathways for prompt evaluation and treatment, and improving treatment outcomes. Based on my experience, I outline here five things one can do to detect breast cancer early and reduce the risk of death. </p>
<h2>Recognise breast cancer symptoms and signs</h2>
<p>The first important thing is to be familiar with the symptoms and signs of breast cancer. This will enable you to act promptly. Here are some of the symptoms and signs to watch for:</p>
<ul>
<li><p>Lump in the breast – not all breast lumps are cancerous but when you feel one seek medical help</p></li>
<li><p>Change in the size or shape of the breast </p></li>
<li><p>Dimpling or thickening of a part of the breast </p></li>
<li><p>Nipple changes such as retraction of the nipple inwards, deformity of the nipple or an ulcer on the nipple</p></li>
<li><p>Nipple discharge, particularly if bloody</p></li>
<li><p>Changes in the skin of the breast such as redness </p></li>
<li><p>Swelling in the armpit.</p></li>
</ul>
<h2>Seek help early</h2>
<p>If you notice any abnormality in your breast, have your breasts examined by a specialist as soon as possible. </p>
<p>There are three ways in which an abnormality in your breast is evaluated: a clinical examination, breast imaging (ultrasound or mammography) and, if necessary, laboratory testing (histopathology). </p>
<p>Until you have been evaluated by a trained medical professional, never make assumptions about what you feel in your breast.</p>
<h2>Take advantage of breast cancer screening</h2>
<p>Breast cancer screening refers to tests and examinations performed on women who have no symptoms, in order to detect breast cancer very early. All women are generally encouraged to participate in screening, but it is imperative for those who are at high risk, such as those who have a family history of breast cancer. Screening can be done in a variety of ways:</p>
<ul>
<li><p>Mammography: This is most appropriate if you are 40 years or older. It can be done yearly, or once every two years. It’s a specialised x-ray that examines the breasts for the presence of early signs of breast cancer which are sometimes not evident to the naked eye. It’s the <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(03)13143-1/fulltext">standard way</a> of screening for breast cancer globally. </p></li>
<li><p>Clinical breast examination: This refers to an examination by a trained health professional – like a doctor or nurse. Although not as sensitive in detecting breast cancer as mammography, it’s an option in situations where mammography isn’t accessible. It’s also recommended for women younger than 40 who may not qualify for mammography.</p></li>
<li><p>Self breast examination: This refers to the methodical examination of the breasts by a woman herself, looking out for the signs and symptoms I mentioned above. All women right from their twenties are encouraged to do this on a monthly basis. The aim of this is for women to be familiar with their breasts so as to easily recognise any changes that occur. </p></li>
</ul>
<h2>Living healthy</h2>
<p>Healthy living can potentially reduce your risk of developing breast cancer. Certain activities have been <a href="https://www.cdc.gov/cancer/breast/basic_info/prevention.htm">found</a> to contribute to the prevention of breast cancer. This is referred to as primary prevention.</p>
<p>These activities promote health and wellness. They include regular exercise, avoidance of a sedentary lifestyle, and weight reduction. These examples of lifestyle modifications have been <a href="https://ascopubs.org/doi/abs/10.14694/EdBook_AM.2015.35.e66">proven to reduce</a> your chances of developing breast cancer.</p>
<p>There are activities that are also known to raise your risk of developing breast cancer. They include smoking, excessive alcohol, and excessive eating of fatty foods.</p>
<h2>Beware of misinformation</h2>
<p>Watch out for information circulated on social media. While some information flying around the social space is true, there are several myths and falsehoods about breast cancer. </p>
<p>Many of these are perpetuated by people who have no training in the treatment of the disease. For instance, I’ve heard of rumours that breast cancer can develop because women have kept money in their bras, or because a breastfeeding baby bit the mother’s breast. These rumours are untrue. It is also often said that a woman will die if she undergoes treatment or surgical operation for breast cancer. This is untrue too. Some also claim that supplements can cure breast cancer. To date, there is no evidence in science to support this claim.</p>
<p>Myths like these are unfounded. People lose their lives because of poor counsel from people who are not trained cancer experts. </p>
<p>We can beat breast cancer by living a healthy life, knowing the facts and taking the right decisions.</p><img src="https://counter.theconversation.com/content/192351/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Olalekan Olasehinde does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Breast cancer is curable, provided it is detected early and treated promptly.Olalekan Olasehinde, Lecturer and Consultant Surgeon, Department of Surgery, Obafemi Awolowo UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1909702022-10-19T19:05:36Z2022-10-19T19:05:36ZAfter breast cancer: 5 changes you can make to stay healthy<figure><img src="https://images.theconversation.com/files/487718/original/file-20221003-14-426efs.jpg?ixlib=rb-1.1.0&rect=50%2C30%2C6659%2C4436&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://images.pexels.com/photos/8172908/pexels-photo-8172908.jpeg?auto=compress&cs=tinysrgb&w=1260&h=750&dpr=2">Pexels</a></span></figcaption></figure><p>Every year, more than <a href="https://www.canceraustralia.gov.au/cancer-types/breast-cancer/statistics">20,000 Australians</a> – mostly women – are diagnosed with breast cancer. If you’re one of them or know someone who is, the great news is that <a href="https://www.canceraustralia.gov.au/cancer-types/breast-cancer/statistics">92 out of every 100</a> women will survive for five years or more after their diagnosis.</p>
<p>But women are often surprised by the life-altering side effects from their cancer treatment that can continue for years after, such as pain and fatigue. And many live with the dread of their cancer returning, even after they pass the celebrated five-year survival mark.</p>
<p>So, what can you do to improve your chances of living a longer, healthier life after a breast cancer diagnosis? </p>
<h2>1. Stay physically active</h2>
<p>Move more and sit less. Ideally, this includes gradually progressing towards and then maintaining about 150 minutes (two and a half hours) of planned, regular <a href="https://www.cosa.org.au/media/332488/cosa-position-statement-v4-web-final.pdf">exercise a week</a>. This involves a mix of aerobic exercise (such as walking) and resistance exercises (that target specific muscle groups), done at a moderate or high enough intensity to make you huff and puff a bit. </p>
<p>Observational studies show associations between exercise and living longer and <a href="https://pubmed.ncbi.nlm.nih.gov/32337494/">prevention of cancer recurrence</a>. And there’s some <a href="https://www.jsams.org/article/S1440-2440(18)31270-2/fulltext#secsect0075">preliminary evidence</a> from clinical trials to support this too. </p>
<p>Women with breast cancer who exercise and are more active, have better quality of life, strength and fitness, and fewer and less severe side effects during <a href="https://pubmed.ncbi.nlm.nih.gov/32337494/">active treatment</a>.</p>
<h2>2. Eat a high quality diet</h2>
<p>Women with better diets – that include a high intake of vegetables, fruit, legumes, nuts, whole grains and fish – <a href="https://www.mdpi.com/2072-6643/14/2/348">have been shown</a> to live longer after a breast cancer diagnosis than those who have a diet high in refined or processed foods and red meat. </p>
<p>This is due mainly to the benefit of a good diet on reducing the risks of other health conditions, such as heart disease, rather than having a direct effect on the risk of dying from breast cancer. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/487940/original/file-20221004-24-ci00sy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="health salad bowl" src="https://images.theconversation.com/files/487940/original/file-20221004-24-ci00sy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/487940/original/file-20221004-24-ci00sy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/487940/original/file-20221004-24-ci00sy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/487940/original/file-20221004-24-ci00sy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/487940/original/file-20221004-24-ci00sy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/487940/original/file-20221004-24-ci00sy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/487940/original/file-20221004-24-ci00sy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Women with higher dietary quality lived longer after breast cancer diagnosis.</span>
<span class="attribution"><a class="source" href="https://images.unsplash.com/photo-1512621776951-a57141f2eefd?ixlib=rb-1.2.1&ixid=MnwxMjA3fDB8MHxwaG90by1wYWdlfHx8fGVufDB8fHx8&auto=format&fit=crop&w=1740&q=80">Unsplash</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Many women, particularly older women or those with early stage breast cancer, are actually at higher risk of dying from <a href="https://www.ahajournals.org/doi/10.1161/CIR.0000000000000556">heart disease</a> than their breast cancer. A high quality diet can help maintain a <a href="https://theconversation.com/health-check-six-tips-for-losing-weight-without-fad-diets-52496">healthy body weight</a> and <a href="https://www.ahajournals.org/doi/10.1161/CIR.0000000000001031">heart health</a>.</p>
<p>There has been <a href="https://www.breastcancer.org/research-news/intermittent-fasting-may-help-cancer-treatments-work-better">growing interest</a> in specific diets (such as <a href="https://www.curetoday.com/view/early-evidence-shows-fasting-keto-diet-may-make-chemo-and-some-other-cancrer-treatments-more-effective-and-easier-to-tolerate">ketogenic</a> or low-carbohydrate diets) and fasting during cancer treatment. But the most recent guidelines state <a href="https://ascopubs.org/doi/full/10.1200/JCO.22.00687">there’s no evidence yet</a> to say these are of significant benefit. </p>
<p>More research is being done following findings from a <a href="https://www.nature.com/articles/s41467-020-16138-3">2020 study</a>, which suggested a “fasting mimicking diet” (low calorie, low protein) on the days prior to and of chemotherapy, produced a better response to treatment. However, compliance with the diet was difficult – only one in five women in the study were able to stick to the fasting diet for all their chemotherapy treatments.</p>
<h2>3. Maintain a healthy weight</h2>
<p>Excess body weight has also been <a href="https://www.wcrf.org/diet-activity-and-cancer/cancer-prevention-recommendations/after-a-cancer-diagnosis-follow-our-recommendations-if-you-can/">linked to poorer survival</a> after breast cancer diagnosis. But so far there haven’t been <a href="https://ascopubs.org/doi/full/10.1200/JCO.2016.69.4026">any clinical trials</a> to show the opposite: that weight loss following a breast cancer diagnosis can improve survival. Trials are <a href="https://onlinelibrary.wiley.com/doi/10.1002/oby.23287">underway</a> to answer this question.</p>
<p><a href="https://acsjournals.onlinelibrary.wiley.com/doi/10.1002/cncr.34343">Weight gain is common</a> following breast cancer treatment. The causes for this are complex and carrying extra weight can make some of the side effects of treatment worse. <a href="https://www.mdpi.com/2072-6643/13/11/4091">Our recent study</a> of women following breast cancer treatment, found that when they are supported to lose a modest amount of weight (5% of their body weight), they improved their physical quality of life and reduced their pain levels. They also reduced their risk of heart disease and diabetes. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1576014115440558081"}"></div></p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/cancer-in-the-under-50s-is-rising-globally-why-190302">Cancer in the under 50s is rising, globally – why?</a>
</strong>
</em>
</p>
<hr>
<p>Besides these well-established tips, a small body of research suggests two more behaviours, related to our <a href="https://theconversation.com/your-body-has-an-internal-clock-that-dictates-when-you-eat-sleep-and-might-have-a-heart-attack-all-based-on-time-of-day-178601">body clock</a>, can impact health after a breast cancer diagnosis.</p>
<h2>4. Get good sleep</h2>
<p>Disrupted sleep – common among women with breast cancer – can remain for years after your treatment has ended. </p>
<p>Women with breast cancer who <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5418457/#bib35">regularly struggle</a> to fall or stay asleep at night – compared those who rarely or never – are at greater risk of dying from any cause. </p>
<p>And it’s not just about how <em>well</em>, but also how <em>long</em> you sleep. <a href="https://pubmed.ncbi.nlm.nih.gov/28190251/">Sleeping longer</a> than nine hours per night – compared to seven to eight hours – is associated with a 48% increased risk of breast cancer returning. But, studies are yet to tease apart the possible reasons for this. Is increased risk of cancer recurrence a result of sleeping longer or is sleeping longer a consequence of progressing or recurrent disease?</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/487941/original/file-20221004-22-ansjxv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="woman lies awake in bed" src="https://images.theconversation.com/files/487941/original/file-20221004-22-ansjxv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/487941/original/file-20221004-22-ansjxv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/487941/original/file-20221004-22-ansjxv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/487941/original/file-20221004-22-ansjxv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/487941/original/file-20221004-22-ansjxv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/487941/original/file-20221004-22-ansjxv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/487941/original/file-20221004-22-ansjxv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Sleep can be challenging when you’re dealing with health worries.</span>
<span class="attribution"><a class="source" href="https://images.unsplash.com/photo-1495546200065-d92a90266a1e?ixlib=rb-1.2.1&ixid=MnwxMjA3fDB8MHxwaG90by1wYWdlfHx8fGVufDB8fHx8&auto=format&fit=crop&w=1470&q=80">Unsplash</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<h2>5. Be mindful of when you eat</h2>
<p>Preliminary research suggests when you eat matters. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4982776/">Delaying the time</a> between the last meal of the day (dinner or supper) and first meal of the next (breakfast) may help reduce the chances of breast cancer returning.</p>
<p>When women reported fasting overnight for fewer than 13 hours – compared to 13 or more hours – after a breast cancer diagnosis, it was linked to a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4982776/">36% increased</a> risk of breast cancer coming back. But the study’s authors note randomised trials are needed to test whether increasing the amount of time fasting at night can reduce the risk of disease.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/olivia-newton-john-gave-a-voice-to-those-with-cancer-and-shifted-the-focus-to-the-life-of-survivors-188444">Olivia Newton-John gave a voice to those with cancer and shifted the focus to the life of survivors</a>
</strong>
</em>
</p>
<hr>
<h2>Small steps to big changes</h2>
<p>The World Cancer Research Fund has developed <a href="https://www.wcrf.org/diet-activity-and-cancer/cancer-prevention-recommendations/">a list of recommendations</a> to reduce cancer risk and reduce the risk of cancer coming back. But <a href="https://www.jandonline.org/article/S2212-2672(22)00076-4/fulltext">our research</a> has found most women aren’t meeting these recommendations after their breast cancer diagnosis. Changing habits after breast cancer <a href="https://www.jandonline.org/article/S2212-2672(20)31340-X/fulltext">can also be harder</a>, mainly due to fatigue and stress.</p>
<p>Starting exercise after treatment can be intimidating and even frightening. It’s a good idea to start small, for example: aim to increase exercise by 10 to 15 minutes each week. Having an exercise buddy really helps and there are lots of <a href="https://www.bcna.org.au/services-and-support-groups/services/31217">exercise programs</a> for people who’ve had breast cancer. </p>
<p><a href="http://exerciseismedicine.com.au/wp-content/uploads/2020/04/EIM-FactSheet_Breast-Cancer_Public-2020.pdf">Common questions</a> about exercising after a breast cancer diagnosis include how to avoid the swelling and discomfort of <a href="https://www.bcna.org.au/health-wellbeing/physical-wellbeing/lymphoedema/?gclid=CjwKCAjw7eSZBhB8EiwA60kCW4nqYq_XXsvaC29ijwWQRMGpvL563VMuExeCjZ39l-KAyQ-BukbSLBoCIZYQAvD_BwE">lymphoedema</a>, which develops in about 20% of breast cancer
survivors who have had lymph nodes removed. People also worry about exercise and wig discomfort or irritation from radiation. Specific <a href="http://exerciseismedicine.com.au/wp-content/uploads/2020/04/EIM-FactSheet_Breast-Cancer_Public-2020.pdf">advice</a> is available. </p>
<p>Similar to exercise goals, rather than striving for a perfect diet, you can aim to <a href="https://theconversation.com/4-plant-based-foods-to-eat-every-week-and-why-science-suggests-theyre-good-for-you-157235">eat more vegetables each week</a>.</p>
<p>Sleep can be challenging if you’ve been worrying about a cancer diagnosis or treatment but <a href="https://www.bcna.org.au/media/3757/bcna-fact-sheet-sleepless-nights-jan-2017.pdf">tips</a> for getting the recommended seven to nine hours sleep each night include exercising earlier in the day, avoiding snacks before bed and good sleep hygiene.</p><img src="https://counter.theconversation.com/content/190970/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Marina Reeves receives funding from Medical Research Future Fund and World Cancer Research Fund. Marina Reeves has previously received funding from the National Health and Medical Research Council and National Breast Cancer Foundation. </span></em></p><p class="fine-print"><em><span>Caroline Terranova previously received funding from the University of Queensland Research Scholarships. </span></em></p><p class="fine-print"><em><span>Kelly D'cunha receives funding from an Australian Government Research Training Program (RTP) Scholarship.</span></em></p><p class="fine-print"><em><span>Sandra Hayes receives funding from Cancer Council Queensland, Medical Research Future Fund, and Cancer Australia. </span></em></p>Our research shows most women aren’t meeting lifestyle recommendations that can help prevent cancer recurrence.Marina Reeves, Professor, The University of QueenslandCaroline Olivia Terranova, Research Trial Coordinator, The University of QueenslandKelly D'cunha, PhD Candidate, The University of QueenslandSandra Hayes, Professor, Griffith UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1919782022-10-18T20:19:22Z2022-10-18T20:19:22ZFinding community online after finding a lump: Social media and younger adults with cancer<figure><img src="https://images.theconversation.com/files/490300/original/file-20221018-20-gqdw2o.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C4357%2C2736&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Research suggests that supports are more likely to be provided to meet the needs of the majority of people with cancer who are older, rather than to younger people with cancer.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>October marks Breast Cancer Awareness Month. The Canadian Cancer Society estimates that <a href="https://cancer.ca/en/cancer-information/cancer-types/breast/statistics">one in eight women will contract breast cancer in their lifetime</a>, making it the most common cancer among Canadian women. </p>
<p>It is also the most commonly diagnosed cancer in women under 40 years old. <a href="https://breastcancernow.org/about-us/media/statements/younger-women-increasingly-diagnosed-breast-cancer">Incidence of breast cancer continues to increase among these younger women</a>, though <a href="https://doi.org/10.3390/ijerph17134884">scientists do not yet understand why</a>. </p>
<p>Young women (and men) with breast cancer face unique challenges, such as <a href="https://www.youngadultcancer.ca/yacprime/">disruptions to career or family plans, greater likelihood of more aggressive cancers and a lifetime of fears of recurrence</a>. Further, many targeted supports (like support groups and resources) are not always available or accessible for younger people. Research suggests that <a href="https://doi.org/10.3389/fonc.2013.00075">supports are more likely to be provided to meet the needs of the majority of people with cancer who are older</a>. </p>
<p>This was made worse during the COVID-19 pandemic. During this time, access to health-care services of all kinds changed, as did cancer care and support. As a result of pandemic restrictions, many face-to face appointments and support groups offered through local and regional organizations were paused or at best moved online. </p>
<p>These changes to cancer care and support made sense in the context of a virus that poses a major threat to immunocompromised people with cancer. But this move also left many <a href="https://doi.org/10.1111%2Fecc.13385">feeling even more isolated, at a time when their diagnosis already brought feelings of loneliness</a>. This in turn has <a href="https://doi.org/10.1080/07347332.2020.1853653">led to depression for some people navigating cancer</a>.</p>
<h2>Cancer in younger patients</h2>
<p>The authors of this article are both women under age 45 who have experienced a cancer diagnosis. Now we study cancer, <a href="https://healthresearchbc.ca/award_researcher/cheryl-heykoop/">its unique impacts on young people</a> and the ways young people can be better supported during and beyond treatment. </p>
<figure class="align-center ">
<img alt="Two women in chairs beside medical equipment. One is middle-aged and one is young." src="https://images.theconversation.com/files/489738/original/file-20221014-17-l36wyf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/489738/original/file-20221014-17-l36wyf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/489738/original/file-20221014-17-l36wyf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/489738/original/file-20221014-17-l36wyf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/489738/original/file-20221014-17-l36wyf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/489738/original/file-20221014-17-l36wyf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/489738/original/file-20221014-17-l36wyf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Young patients often feel out of place navigating cancer care, where they are often a generation younger than the others they see around them at appointments or support programs.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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<p>In both our research work and our personal experiences, we’ve recognized the tremendous potential for digital communication technologies like social media and instant messaging to connect younger cancer patients to one another, and provide information, emotional support and, crucially, hope during difficult times. </p>
<p>Research with young adults with cancer <a href="https://doi.org/10.2196/28234">highlights the benefits of social media</a> to <a href="https://doi.org/10.3390/curroncol29020099">offer support specific to adolescents and young adults</a>. And through talking with younger adults and organizations that serve them (such as <a href="https://www.youngadultcancer.ca">Young Adult Cancer Canada</a>), researchers are learning that digital communication tools have been essential for their emotional and mental support needs, particularly during the pandemic. </p>
<p>Younger adults have shared that the communities they find on social media sites like Instagram or TikTok can help them to feel less alone. They often feel out of place navigating cancer care, where they are often a generation younger than the others they see around them at appointments or support programs. </p>
<p>Digital technologies can offer a community of people at the same life stages. When younger people with cancer find community online they also find others who have the same concerns about having children, interrupting their careers, or managing young families during the course of their illness. </p>
<h2>Digital communities</h2>
<p>Digital technologies make these kinds of communities possible because they allow people to connect across geographical boundaries. There might be only one other person your age with cancer in your city or town, and you might never run into them if your treatment appointments don’t line up. But online you can connect with others from around the world, meaning that even people with rare cancers can find one another.</p>
<p>However, not all online tools are created equal. In a soon to be published study, which was recently presented at the 2022 <a href="https://socialmediaandsociety.org/page/2/">Social Media and Society annual conference</a>, Hodson, one of the authors of this article, learned that Facebook and Twitter are viewed as more negative than Instagram or TikTok, which offer more hopeful and positive depictions of cancer. And different platforms also attract different users. Facebook tends to attract gen X users, whereas Instagram and TikTok skew to gen Y and Z — data that needs to be taken into account when providing digital support to people with cancer, and particularly younger people. </p>
<p>Of course, social media also presents challenges for people experiencing a cancer diagnosis. <a href="https://www.proquest.com/openview/e18614b5f377026155470a24c3c76772/1?pq-origsite=gscholar&cbl=18750&diss=y">Alarmingly, they are a growing source of misinformation</a>. And if misinformation leads to people with cancer rejecting conventional treatments, <a href="https://doi.org/10.1093/jnci/djx145">it can result in deadly outcomes</a>. </p>
<figure class="align-center ">
<img alt="A young man wearing glasses and a hospital gown lying with his head on a blue pillow holding a smartphone with an IV line in his hand." src="https://images.theconversation.com/files/490486/original/file-20221018-12-ka32bv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/490486/original/file-20221018-12-ka32bv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/490486/original/file-20221018-12-ka32bv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/490486/original/file-20221018-12-ka32bv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/490486/original/file-20221018-12-ka32bv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/490486/original/file-20221018-12-ka32bv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/490486/original/file-20221018-12-ka32bv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Digital technologies make it possible for young cancer patients to connect with each other.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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</figure>
<p>In Hodson’s study, participants also indicated that they sometimes experienced harassment or trolling when discussing their disease on online platforms. This results in a less safe space for people with cancer when they are at their most vulnerable, and can prevent some people with cancer from benefiting from these valuable connection tools. </p>
<p>Digital communication technologies are an invaluable resource for young people who experience a cancer diagnosis and are living with cancer, but right now most of these groups are created on the fly, are independent and are not moderated. This means that not everyone who needs them has access to them, and when people do use social media to connect with others, they’re exposed to such problems as misinformation and online bullying. </p>
<p>We recommend that health-care institutions and policy-makers alike consider ways to build out communities on popular social media platforms for younger people with cancer to ensure everyone can connect. We encourage social media platforms to create moderation policies and procedures that allow young people experiencing cancer to connect safely. </p>
<p>This October, we call on social media companies to think beyond pink, and provide spaces for all young people with cancer to connect with each other in safe, inclusive and supportive ways.</p><img src="https://counter.theconversation.com/content/191978/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jaigris Hodson receives funding from the Social Sciences and Humanities Research Council of Canada.</span></em></p><p class="fine-print"><em><span>Cheryl Heykoop receives funding from Michael Smith Health Research BC, Vancouver Foundation, and the Canadian Institutes for Health Research. She was diagnosed with cancer as a young adult and volunteers with BC Cancer, Young Adult Cancer Canada, and Callanish Society.</span></em></p>Younger cancer patients have unique challenges, and resources often target older patients. Social media brings younger cancer patients together to share information, emotional support and hope.Jaigris Hodson, Associate Professor of Interdisciplinary Studies, Royal Roads UniversityCheryl Heykoop, Associate Professor, School of Leadership, Royal Roads UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1908772022-10-05T12:19:56Z2022-10-05T12:19:56ZBreast cancer awareness campaigns too often overlook those with metastatic breast cancer – here’s how they can do better<figure><img src="https://images.theconversation.com/files/487963/original/file-20221004-26-x590oy.jpg?ixlib=rb-1.1.0&rect=64%2C32%2C4217%2C2811&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Many stage 4 breast cancer patients say that they don't relate with the pink ribbon.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/pink-breast-cancer-awareness-ribbon-with-copy-space-royalty-free-image/183579195?adppopup=true">AnthiaCumming/E+ via Getty Images</a></span></figcaption></figure><p>Is there anyone who isn’t aware of breast cancer? </p>
<p>Since 1985, cancer-related nonprofits, along with pharmaceutical firms and other businesses, have sponsored an international campaign to <a href="https://web.archive.org/web/20110716123431/http://www.nbcam.org/about_faq.cfm">observe October as “Breast Cancer Awareness Month</a>.” During these weeks, the public is bombarded with awareness and education messaging featuring the campaign’s symbol, a pink ribbon. </p>
<p>A wave of pink products typically appears, too, including clothing – think about <a href="https://greatnonprofits.org/org/save-the-ta-tas-foundation">the “Save the Ta-Tas” shirts</a> – as well as events like marches and walkathons. This onslaught has led some to term the <a href="https://www.fredhutch.org/en/news/center-news/2014/10/Pinktober-breast-cancer-awareness-month-patients.html">campaign “Pinktober</a>.” </p>
<p>These efforts often focus on encouraging women to get screened with mammograms to increase the possibility that the cancer will be detected early. Breast cancer patients are celebrated for “beating” cancer, “winning” the battle, having survived and being cured. But these messages overlook the experiences of millions of breast cancer patients. </p>
<p>I am a <a href="https://www.bsu.edu/academics/collegesanddepartments/sociology/about/faculty-staff/krausrachel">sociology professor</a> who specializes in studying gender as well as how having a serious illness affects identity. These themes also hit close to home for me: In 2009, I was diagnosed with metastatic breast cancer – also referred to as stage 4 on a scale from 0 to 4 – which means a cancer that has spread beyond the breasts to other parts of the body. Since that time, I have participated in face-to-face and online support groups, joined retreats and met myriad health professionals who specialize in oncology while also continuing my research. </p>
<p>In 2019, I began a nationwide study to examine the experiences of women with stage 4 breast cancer. The first of my papers on religion’s role in coping with metastatic breast cancer <a href="https://onlinelibrary.wiley.com/doi/epdf/10.1111/jssr.12771">was recently published</a> in the Journal for the Scientific Study of Religion. I am now working on research that examines metastatic breast cancer and a range of spiritual experiences. </p>
<p>The seriousness of metastatic breast cancer, which is the only breast cancer that kills, is rarely discussed. This leaves people with this diagnosis feeling ignored and angry – and largely invisible to most of the organizations focused on breast cancer. </p>
<h2>A need for inclusion</h2>
<p>Breast cancer is <a href="https://www.cancer.org/cancer/breast-cancer/about/how-common-is-breast-cancer.html#">the second most common cancer in women</a> in the U.S. after skin cancer. <a href="https://www.cancer.org/cancer/breast-cancer/about/how-common-is-breast-cancer.html#">One in 8 American women</a> will be diagnosed with breast cancer at some point in her life. </p>
<p>Although <a href="https://doi.org/10.1007%2F978-3-030-20301-6_3">women of color</a> are less likely to get breast cancer, they are more likely to die from it. <a href="https://www.cancer.gov/types/breast/patient/male-breast-treatment-pdq">Male breast cancer</a> makes up less than 1% of all cases of breast cancer. </p>
<p>Nearly <a href="https://www.breastcancer.org/symptoms/types/recur_metast">30% of people with early stages breast cancer</a> will see their cancer metastasize to stage 4, which kills <a href="https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/breast-cancer-facts-and-figures/breast-cancer-facts-and-figures-2017-2018.pdf">about 44,000 American women and men</a> each year. </p>
<figure class="align-center ">
<img alt="Georgia Bulldogs football team displays the slogan 'Save The Ta-Tas!' on their backs." src="https://images.theconversation.com/files/426994/original/file-20211018-13-bn7bpw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/426994/original/file-20211018-13-bn7bpw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=319&fit=crop&dpr=1 600w, https://images.theconversation.com/files/426994/original/file-20211018-13-bn7bpw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=319&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/426994/original/file-20211018-13-bn7bpw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=319&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/426994/original/file-20211018-13-bn7bpw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=401&fit=crop&dpr=1 754w, https://images.theconversation.com/files/426994/original/file-20211018-13-bn7bpw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=401&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/426994/original/file-20211018-13-bn7bpw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=401&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Breast Cancer Awareness Month events, like this display by Georgia Bulldogs football fans, often aim to encourage women to get mammograms, which can detect the disease in its early stages.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/georgia-bulldogs-fans-supper-breast-cancer-awareness-month-news-photo/184230633?adppopup=true">Kevin C. Cox/Getty Images Sport via Getty Images North America</a></span>
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<p>To find participants with stage 4 breast cancer for my survey, in 2019 I sent out requests through online support groups, cancer organizations and societies, and word of mouth. Ultimately 310 women completed a questionnaire about their experiences with metastatic breast cancer, such as perceived support, feelings about breast cancer organizations and the pink ribbon, and ways of coping. </p>
<p>I selected 33 of those women to participate in in-depth interviews to provide additional information about some of their survey answers.</p>
<h2>Recognizing people with metastatic disease</h2>
<p>I’m a member of several metastatic breast cancer social media groups. For the purpose of this article, I asked people in these groups to share their thoughts about Breast Cancer Awareness Month and specifically the term “survivor.” Most people who responded aren’t overly excited about October: They don’t find terms like survivor and related language relevant. Nor do they feel the pink ribbon represents them. </p>
<p>Of the women who took my original survey, the majority – at least 70% – felt that pink-ribbon events tend to minimize the seriousness of metastatic breast cancer and tend to ignore stage 4 altogether. They also believe that pink-ribbon campaigns focus too much on breasts and selling products and services, <a href="https://www.bcaction.org/pink-ribbon-marketing-culture/what-is-pinkwashing">a practice known as “pinkwashing</a>.” </p>
<p>As one respondent in a social media group wrote, “I don’t like the term survivor. That and October are aimed at early stage cancer, not at supporting people who have Stage 4 cancer. We won’t survive. We aren’t going to be cured. Early detection didn’t save many of us. Removing boobs didn’t save us. All the pinkwashing does nothing to help us.” </p>
<p>Asking women to rate their preferences on a scale of 1 to 4, from “not at all” to “a great deal,” I found that far more metastatic people prefer “patient” and “a person who has cancer” over the term “survivor.”</p>
<p>On average, many participants also say there isn’t much recognition that those with metastatic disease have a different treatment plan. Often, stage 1 to 3 patients can look forward to a treatment end date after they finish radiation, surgery – mastectomy or lumpectomy – and what are called systemic therapies, such as chemotherapy. The vast majority of metastatic patients will be in treatment for the rest of their lives. </p>
<p>For stage 4 breast cancer, <a href="https://www.cochrane.org/CD011276/BREASTCA_breast-surgery-metastatic-breast-cancer">there is some debate</a> as to whether lumpectomy or mastectomy are effective options. The effectiveness of radiation treatment <a href="https://moffitt.org/cancers/metastatic-breast-cancer/radiation/#">is also debatable</a>. So metastatic patients more typically receive chemotherapy and – more recently – immunotherapy, with no surgery.</p>
<p>I also learned that many stage 4 breast cancer patients find it necessary to manage the diagnosis in ways that don’t apply to those with earlier stages. Metastatic patients must go into treatment simultaneously hoping the drugs will calm the cancer and confronting potential end-of-life issues. They may worry about leaving their families. Some may set milestones, such as seeing their children or grandchildren graduate from school or get married. </p>
<p>They may also be contending with issues like how many possible treatment options are left, or maximizing both quantity and quality of life amid a range of side effects. </p>
<h2>Overturning worn-out narratives</h2>
<p>I surveyed participants about the degree to which they feel excluded from breast cancer organizations, and why. They firmly indicated feeling a recognition gap among breast cancer organizations and awareness campaigns. So many seem to emphasize early detection and survivorship, and leave out the concerns and needs of metastatic patients.</p>
<p>One respondent talked about the “early detection mantra.” Another referred to the “ringing of the bell,” a common celebratory ritual when one is done with chemotherapy or radiation. I’ve been known to use the phrase “that damn bell” to express frustration that I will always be on treatment and won’t get to ring that bell. </p>
<p>People echoed these same sentiments when I posed my question in social media groups. One woman wrote, “I am not going to ever be a survivor. Feels like we are the under belly. … No ‘you got this.’ … There is no stage 4 fanfare.” </p>
<p>Many women with stage 4 breast cancer also feel like little is being done to showcase the less optimistic and more frightening aspects of metastatic disease. </p>
<p>Several organizations are starting to fill these gaps. Some are devoting themselves to funding research for breast cancer, while others are now paying more attention to stage 4 patients – or at least moving in that direction. <a href="https://www.metavivor.org/">Metavivor is one organization</a> focused exclusively on serving the metastatic breast cancer community. The Susan G. Komen organization has also begun offering resources and <a href="https://www.komen.org/breast-cancer/metastatic/">information about metastatic breast cancer</a>. </p>
<p>I see hopeful signs that some of these efforts are making a difference. Just the other day, I stopped by my cancer center’s gift shop to buy some mastectomy bras and saw that they were handing out pink-ribbon bracelets. So I asked the woman running the shop if they could get bracelets representing metastatic breast cancer. I was encouraged that – without hesitation – she said it shouldn’t be a problem. </p>
<p><em>This is an updated version of an article <a href="https://theconversation.com/breast-cancer-awareness-campaigns-can-do-a-better-job-supporting-women-whove-received-a-stage-4-diagnosis-instead-of-focusing-only-on-early-detection-and-beating-cancer-168628">originally published on Oct. 29, 2021</a>.</em></p><img src="https://counter.theconversation.com/content/190877/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rachel Kraus receives funding from the Society for the Scientific Study of Religion and the Louisville Institute. </span></em></p>October is awash in seas of pink T-shirts, balloons and ribbons in honor of Breast Cancer Awareness Month. But this messaging fails to recognize people who are not cured of the disease.Rachel Kraus, Professor of Sociology, Ball State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1864502022-07-21T17:56:39Z2022-07-21T17:56:39ZGetting hammered by cancer: ‘Thor: Love and Thunder’ re-examines the hero’s journey<figure><img src="https://images.theconversation.com/files/475399/original/file-20220721-22-swp7hy.jpg?ixlib=rb-1.1.0&rect=27%2C4%2C2992%2C1521&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Meaning is found in love and risk, not in superpowers.</span> <span class="attribution"><span class="source">(Marvel Studios)</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/getting-hammered-by-cancer---thor--love-and-thunder--re-examines-the-hero-s-journey" width="100%" height="400"></iframe>
<p><em>This story contains spoilers about ‘Thor: Love and Thunder.’</em></p>
<p>In the new movie <em>Thor: Love and Thunder</em>, based on recent comic books about the superhero, cancer complicates what it means to be Thor.</p>
<p>The superhero Thor <a href="https://marvel.fandom.com/wiki/Journey_into_Mystery_Vol_1_83">first appeared in 1962</a>, quickly joining the super-team The Avengers. Thor was the epitome of the male superhero: morally upstanding and astonishingly physically powerful.</p>
<p>But recent comic book stories have seen different characters — the original, a male Thor Odinson and, lately, a female Mighty Thor, also known as Jane Foster — team up to command the power of Thor.</p>
<p><em>Thor: Love and Thunder</em>, the newly released film by director <a href="https://www.nytimes.com/2022/06/29/movies/taika-waititi-thor-love-and-thunder.html">Taika Waititi,</a> adapts some of these stories. Thor Odinson (Chris Hemsworth) is surprised when, after an eight-year separation, his ex-girlfriend Foster (Natalie Portman) transforms into The Mighty Thor. </p>
<p>Foster as The Mighty Thor has cancer in both the movie and in recent comics. </p>
<p>The character raises questions about the impact cancer has on ideas of worthiness, responsibility and power — and what it means to be a superhero. These are themes we examine in our forthcoming book, <em>The Cancer Plot: Terminal Immortality in Marvel’s Moral Universe</em>. </p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/Go8nTmfrQd8?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">‘Thor: Love and Thunder’ official trailer.</span></figcaption>
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<h2>Bewildered, angry fans</h2>
<p>In both the recent comic books and film, Foster controls the enchanted hammer <a href="https://marvel.fandom.com/wiki/Mjolnir">Mjolnir</a>, the weapon that grants superheroic powers to the person who can to lift it. </p>
<p>Some comic book <a href="https://www.cbr.com/fans-calm-down-jane-foster-mighty-thor/">readers reacted</a> negatively to Foster’s time as The Mighty Thor, arguing that Marvel was stripping away or confusing the history of a male Thor superhero in order to introduce gender diversity in its characters.</p>
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Read more:
<a href="https://theconversation.com/why-ms-marvel-matters-so-much-to-muslim-south-asian-fans-184613">Why Ms. Marvel matters so much to Muslim, South Asian fans</a>
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<p>Some movie viewers have expressed similar disappointment about seeing a <a href="https://www.insider.com/fans-react-to-natalie-portman-playing-female-thor-2019-7">female Thor</a>.</p>
<p>The film’s focus, however, is not on the gender of Thor, but on Odinson’s moral journey. Foster’s spreading cancer is the catalyst for Thor Odinson’s moral growth.</p>
<h2>Facing enemies</h2>
<p>In both comic books and the Thor film franchise, which began with the 2011 movie <em>Thor</em>, Thor Odinson is a deity: <a href="https://www.worldhistory.org/Thor/">the Norse God of Thunder</a>. A moral exemplar, Odinson could only lift the enchanted hammer <a href="https://marvel.fandom.com/wiki/Mjolnir">Mjolnir</a> if he was worthy. </p>
<p>In both earlier comic books and films, Foster’s typical role was as a minor character. Writers used her as the love interest in danger, giving the male hero someone to rescue.</p>
<p>That is, until she became The Mighty Thor herself. </p>
<p>In <em>Love and Thunder</em>, Foster takes on new enemies: cancer and the <a href="https://marvelcinematicuniverse.fandom.com/wiki/Gorr_the_God_Butcher">cosmic villain Gorr</a> (Christian Bale). While Foster and Odinson vanquish Gorr, they are not able to defeat her cancer.</p>
<p>By taking on Gorr, and risking death from cancer, Foster shows Odinson that a meaningful life is one of emotional and physical risk that may result in loss.</p>
<figure class="align-center ">
<img alt="Black and white image of a vampirish-looking pale villain's grimacing face." src="https://images.theconversation.com/files/475404/original/file-20220721-9523-13bqsb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/475404/original/file-20220721-9523-13bqsb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=251&fit=crop&dpr=1 600w, https://images.theconversation.com/files/475404/original/file-20220721-9523-13bqsb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=251&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/475404/original/file-20220721-9523-13bqsb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=251&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/475404/original/file-20220721-9523-13bqsb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=316&fit=crop&dpr=1 754w, https://images.theconversation.com/files/475404/original/file-20220721-9523-13bqsb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=316&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/475404/original/file-20220721-9523-13bqsb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=316&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">The cosmic villain Gorr (Christian Bale) is one of the enemies The Mighty Thor faces.</span>
<span class="attribution"><span class="source">(Marvel Studios)</span></span>
</figcaption>
</figure>
<h2>Complicating the superhero</h2>
<p>Foster transforms when she holds Mjolnir in both the comic book and movie.</p>
<p>Emaciated from chemotherapy, Foster becomes muscled (and blonde) as The Mighty Thor. The film and comic books link these different bodies through the ethical decisions she must make.</p>
<p>The movie runs up against idealizing narratives of cancer. Cultural critic Barbara Ehrenreich has criticized depictions of cancer as “<a href="https://www.theguardian.com/lifeandstyle/2010/jan/02/cancer-positive-thinking-barbara-ehrenreich">the source of [one’s] happiness</a>.”</p>
<p>Such narratives <a href="https://www.washingtonpost.com/lifestyle/style/detailing-the-problems-of-breast-cancer-culture/2012/02/09/gIQA3DiT2Q_story.html">minimize the painful process of cancer care to promote</a> a lifestyle brand.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/cancer-and-loneliness-how-inclusion-could-save-lives-140516">Cancer and loneliness: How inclusion could save lives</a>
</strong>
</em>
</p>
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<p>The film mostly avoids this. Cancer becomes the occasion for determining what’s important in life through struggle on behalf of others while facing death.</p>
<p>Foster’s continual decision-making — to have chemotherapy or engage in battle — vividly characterizes the struggle of cancer patients highlighted <a href="https://www.bcaction.org/from-the-executive-director-pink-ribbon-culture-gaslighting-and-the-breast-cancer-epidemic/">in critical</a> works <a href="https://www.npr.org/templates/story/story.php?storyId=6303890">and memoirs</a>. </p>
<p>Thus, The Mighty Thor’s cosmic work cannot be separated from her mortal life as a cancer patient.</p>
<h2>The cost of superheroism</h2>
<figure class="align-right ">
<img alt="A smiling man seen against a Marvel backdrop." src="https://images.theconversation.com/files/475412/original/file-20220721-10055-c3xwd7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/475412/original/file-20220721-10055-c3xwd7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=693&fit=crop&dpr=1 600w, https://images.theconversation.com/files/475412/original/file-20220721-10055-c3xwd7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=693&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/475412/original/file-20220721-10055-c3xwd7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=693&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/475412/original/file-20220721-10055-c3xwd7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=870&fit=crop&dpr=1 754w, https://images.theconversation.com/files/475412/original/file-20220721-10055-c3xwd7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=870&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/475412/original/file-20220721-10055-c3xwd7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=870&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Chris Hemsworth in role as Thor Odinson does not have to consider the same complicated ethical decisions as his girlfriend, Jane Foster.</span>
<span class="attribution"><span class="source">(AP Photo/Mark Baker)</span></span>
</figcaption>
</figure>
<p>The same superheroic action has different effects on Odinson and Foster.</p>
<p>For Odinson, the cost of battle does not jeopardize his superhero identity or practice. He can <a href="https://marvelcinematicuniverse.fandom.com/wiki/Thor%27s_Prosthetic_Eye">lose a body</a> <a href="https://screenrant.com/thor-metal-arm-origin-marvel-comics/">part, or</a> use a cane when in <a href="https://marvel.fandom.com/wiki/Donald_Blake_(Earth-616)">a temporary human form</a>, but neither puts him at risk of dying. </p>
<p>The costs for Foster, however, are much higher. Foster’s superhuman power, ironically, prevents her cancer treatments from working. Being The Mighty Thor risks killing her. </p>
<p>She must consider death and disease when choosing to battle. Cancer forces The Mighty Thor to make complicated ethical decisions that Odinson doesn’t have to consider.</p>
<h2>Renewed life</h2>
<p>In both the comic books and the film, cancer kills Foster.</p>
<p>In <a href="https://www.marvel.com/articles/comics/the-full-reading-order-of-jason-aaron-s-thor">the years-long comic book story</a>, <a href="https://marvel.fandom.com/wiki/Mighty_Thor_Vol_2_706">Foster dies</a> after throwing Mjolnir into the sun. </p>
<p>Odinson rewards Foster with renewed life and the consolation prize of new <a href="https://marvel.fandom.com/wiki/Valkyrie:_Jane_Foster_Vol_1">superhero identity</a> as a Valkyrie, an elite warrior of Asgard.</p>
<figure class="align-center ">
<img alt="Two women in fancy dresses seen against a blue backdrop smiling at each other." src="https://images.theconversation.com/files/475410/original/file-20220721-22-gu6xud.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/475410/original/file-20220721-22-gu6xud.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/475410/original/file-20220721-22-gu6xud.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/475410/original/file-20220721-22-gu6xud.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/475410/original/file-20220721-22-gu6xud.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/475410/original/file-20220721-22-gu6xud.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/475410/original/file-20220721-22-gu6xud.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Foster (Natalie Portman) finds new life as a Valkyrie in New Asgard, ruled by King Valkyrie (Tessa Thompson).</span>
<span class="attribution"><span class="source">(AP Photo/Scott Garfitt)</span></span>
</figcaption>
</figure>
<h2>Love and loss</h2>
<p>In <em>Thor: Love and Thunder</em>, Foster’s cancer journey enables Odinson learn a lesson on meaning and risk. While she is in hospital, Odinson begs her to give up Mjolnir so that he won’t lose her. </p>
<p>Despite the likelihood of her death, Foster chooses to live, and die, on her own terms. She joins Odinson in the final battle against Gorr, dying as a result of the wounds she sustains and her cancer. </p>
<p>Early in the movie, fellow superhero Star-Lord (Chris Pratt) talks to Odinson about the loss of own his love. He advises: “<a href="https://gamerant.com/best-quotes-from-thor-love-and-thunder/">I hope one day you can feel this shitty</a>,” a variation on the adage that it is better to have loved and lost than never to have loved at all. </p>
<h2>How meaning is found</h2>
<p>By choosing to make hard moral decisions and take risks, even that of losing him, Foster gives Odinson things to feel shitty about. In this state, Odinson now empathizes with Gorr to the point of taking on the care of his enemy’s orphaned daughter.</p>
<p>Though Foster dies, she is rewarded as The Mighty Thor with entry into <a href="https://www.britannica.com/topic/Valhalla-Norse-mythology">Valhalla</a>. However, she enters the place of the gods in her mortal form. Her heroism is not tied to her powers but to her moral decision-making and risk-taking.</p>
<p><em>Thor: Love and Thunder</em> offers a new way to read Foster’s cancer. It shows how meaning is found in love and risk, not in superpowers.</p><img src="https://counter.theconversation.com/content/186450/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>In the latest ‘Thor’ movie, the character Jane Foster raises questions about the impact of cancer on ideas of worthiness, responsibility and power — and what it means to be a superhero.Reginald Wiebe, Associate professor, Department of Language and Literature, Concordia University of EdmontonDorothy Jean Woodman, Associate Lecturer, Department of English and Film Studies, University of AlbertaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1858242022-07-08T12:17:05Z2022-07-08T12:17:05ZBiopsies confirm a breast cancer diagnosis after an abnormal mammogram – but structural racism may lead to lengthy delays<figure><img src="https://images.theconversation.com/files/472092/original/file-20220701-16-qwlz5x.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2122%2C1410&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Black patients are more likely than other racial and ethnic groups to have a biopsy delay of 90 days or more after an abnormal mammogram.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/nurse-with-patient-signing-consent-for-mammogram-royalty-free-image/141089953">Yellow Dog Productions/The Image Bank via Getty Images</a></span></figcaption></figure><p>While mammograms are often the first step to detecting breast cancer, patients need additional tests after an abnormal screening result. Further imaging can determine if a finding is truly suspicious for cancer, and sometimes a biopsy is required to confirm a diagnosis. But biopsy delays reduce the benefit of early detection, putting patients at a higher risk of treatment failure and lowering their chances for survival.</p>
<p><a href="https://www.cancer.org/cancer/breast-cancer/screening-tests-and-early-detection/breast-biopsy.html">Breast biopsies</a> involve removing a small piece of tissue from a suspicious area and examining the sample under a microscope. Once doctors are able to confirm the presence of tumor cells and what type they are, they are then able to devise a treatment plan.</p>
<p>Much <a href="https://doi.org/10.1038/s41416-020-01038-6">prior research</a> has looked at disparities in breast cancer care, including potential factors underlying <a href="https://doi.org/10.1001/archinte.166.20.2244">diagnostic and treatment delays</a>. On average, <a href="http://doi.org/10.1001/jamasurg.2017.0005">Black patients</a> are more often diagnosed with late-stage breast cancer, have higher mortality rates and are less likely to receive guideline-recommended treatment compared with white patients. <a href="http://doi.org/10.1001/jama.2014.17322">Hispanic and South Asian patients</a> are also more often diagnosed with late-stage breast cancer compared with non-Hispanic white patients.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/472557/original/file-20220705-24-c1s9pw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Diagram of ultrasound-guided breast biopsy" src="https://images.theconversation.com/files/472557/original/file-20220705-24-c1s9pw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/472557/original/file-20220705-24-c1s9pw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=424&fit=crop&dpr=1 600w, https://images.theconversation.com/files/472557/original/file-20220705-24-c1s9pw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=424&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/472557/original/file-20220705-24-c1s9pw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=424&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/472557/original/file-20220705-24-c1s9pw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=533&fit=crop&dpr=1 754w, https://images.theconversation.com/files/472557/original/file-20220705-24-c1s9pw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=533&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/472557/original/file-20220705-24-c1s9pw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=533&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">One breast biopsy method involves using ultrasound to guide a needle to a suspected cancer mass in order to take a sample for further analysis.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/illustration/biopsy-the-breast-cancer-cell-royalty-free-illustration/1003502426">Tsezer/iStock via Getty Images Plus</a></span>
</figcaption>
</figure>
<p>But previous studies have not looked at how multiple factors, including at the neighborhood and institutional level, can affect breast cancer care across diverse groups in different geographic locations. And not many studies have evaluated the disparities that may occur within the time-sensitive period between routine screening and an official diagnosis.</p>
<p>As radiologists who study <a href="https://rad.washington.edu/radiology-personnel/mblawson/">health disparities</a> and <a href="https://scholar.google.com/citations?user=wADZtfAAAAAJ&hl=en">population health</a>, we wanted to fill in this research gap. Our <a href="https://doi.org/10.1001/jamaoncol.2022.1990">recently published study</a> found that patients from racial and ethnic minority groups are more likely to have significant delays in getting a diagnosis-confirming breast biopsy after a mammogram compared with white patients.</p>
<h2>Racial and ethnic differences in biopsy delays</h2>
<p>We wanted to investigate potential reasons why some patients experienced a delay between when they received an abnormal mammogram result and when they underwent a diagnostic biopsy. So we used data from the <a href="https://www.bcsc-research.org/">Breast Cancer Surveillance Consortium</a>, a network of imaging registries researching ways to improve breast cancer detection. We collected the demographic information of 45,186 patients in six states across the U.S. and analyzed their risk of not receiving a biopsy within 30, 60 or 90 days after getting an abnormal mammogram.</p>
<p>We found that all racial and ethnic minority groups experienced a higher risk of having a biopsy delay of over 30 days compared with white patients. Asian patients had the highest increased risk; they were 66% more likely to get a biopsy more than 30 days after their mammograms. When we looked at biopsy delays of 90 days or more, however, we found that only Black patients had a significantly increased risk – they were almost 30% more likely to experience extended delays compared with white patients.</p>
<p><iframe id="8wLwZ" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/8wLwZ/3/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<h2>Factors behind biopsy disparities</h2>
<p>To figure out the potential reasons for these differences, we statistically accounted for other factors that may contribute to racial and ethnic differences in biopsy delays. These included individual-level factors, such as age and family history of breast cancer; neighborhood-level factors, such as area median income and education; and screening facility factors, such as academic affiliation and availability of on-site biopsy services.</p>
<p>We found that which screening facility a patient went to had the biggest effect on biopsy delays. This suggests that there are health care setting differences that could be contributing to longer wait times for nonwhite patients. These health care setting differences could include a number of factors, including whether there is a robust <a href="https://www.cancer.org/latest-news/patient-navigators-can-help-when-live-disrupts-cancer-care.html">patient navigation system</a> to provide guidance throughout the care process or the availability of same-day biopsies.</p>
<p>Our analysis suggests that nonwhite patients were still at higher risk of breast biopsy delays, even when we compared white and nonwhite patients with similar individual, neighborhood and screening facility characteristics.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/_rdOjtVi56w?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Structural racism plays a significant role in long-standing public health disparities in the U.S.</span></figcaption>
</figure>
<p>This persistent difference in risks suggests that unmeasured factors such as <a href="http://dx.doi.org/10.1377/hlthaff.2021.01466">structural racism</a>, or ongoing policies and practices that lead to inequitable resource distribution for racial and ethnic minority communities, could also account for these differences. This could include health care coverage inequities with higher out-of-pocket costs, or policies that restrict access to higher quality care. </p>
<p>Structural racism may also have contributed to the facility-level disparities we saw. For example, facilities where more white people went to may have had additional resources allocated to patient navigators and same-day services that would have facilitated more timely biopsies.</p>
<h2>Reducing the diagnostic gap</h2>
<p>Long diagnostic delays after an abnormal screening mammogram can <a href="https://doi.org/10.1158/1055-9965.EPI-17-0378">reduce the benefit</a> of early cancer detection. Consequently, racial and ethnic differences in timely biopsy scheduling may exacerbate existing disparities in breast cancer diagnosis, treatment and survival – especially for Black patients.</p>
<p>While we were unable to identify more specific drivers behind these differences, we found that screening facilities do contribute to differences in biopsy delays among racial and ethnic groups. Our future work will focus on identifying facility-specific factors that may affect timely diagnosis after abnormal screening results. Our goal is to eventually be able to target these factors with interventions that reduce racial and ethnic disparities in breast cancer outcomes.</p><img src="https://counter.theconversation.com/content/185824/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Marissa Lawson receives funding from grant number T32CA09168 from the National Institutes of Health. </span></em></p><p class="fine-print"><em><span>Christoph Lee does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Early detection of breast cancer is critical to improving chances of survival. But racial and ethnic minority patients systematically have delayed diagnoses that reduce the benefits of screening.Marissa Lawson, Medical Fellow in Radiology, School of Medicine, University of WashingtonChristoph Lee, Professor of Radiology, School of Medicine, University of WashingtonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1846302022-06-17T12:35:38Z2022-06-17T12:35:38ZDecades of research document the detrimental health effects of BPA – an expert on environmental pollution and maternal health explains what it all means<figure><img src="https://images.theconversation.com/files/468379/original/file-20220613-26-mheqwr.jpg?ixlib=rb-1.1.0&rect=0%2C7%2C5112%2C3395&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The chemical BPA has been shown to leach from food packaging products into our bodies.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/african-woman-drinking-water-royalty-free-image/90306673?adppopup=true">Jacobs Stock Photography Ltd/DigitalVision via Getty Images</a></span></figcaption></figure><p>Whether or not you’ve heard of <a href="https://www.niehs.nih.gov/health/topics/agents/sya-bpa/index.cfm">the chemical bisphenol A, better known as BPA</a>, <a href="https://doi.org/10.1016/j.numecd.2020.01.005">studies show that</a> it’s <a href="https://www.epa.gov/americaschildrenenvironment/biomonitoring-bisphenol-bpa">almost certainly in your body</a>. BPA is used in the manufacturing of products like plastic water bottles, baby bottles, toys and food packaging, including in the lining of cans. </p>
<p>BPA is one <a href="https://www.epa.gov/americaschildrenenvironment/ace-environments-and-contaminants">of many</a> <a href="https://doi.org/10.1016/j.ijgo.2015.09.002">harmful chemicals</a>
<a href="https://doi.org/10.1289/ehp358">in everyday products</a> and <a href="https://www.nrdc.org/sites/default/files/bpa.pdf">a poster child for chemicals in plastics</a>. It is probably best known for its presence in baby bottles due to campaigns by organizations such as <a href="https://saferchemicals.org/2011/03/22/message-in-bpa-baby-bottles-dont-mess-with-moms/">Safer Chemicals, Healthy Families</a> and Breast Cancer Prevention Partners.</p>
<p>An extensive body of research has linked BPA to <a href="https://doi.org/10.1530/REP-17-0734">reproductive health problems</a>, including <a href="https://doi.org/10.1289/EHP3802">endometriosis</a>, <a href="https://doi.org/10.1186/s12958-019-0558-8">infertility</a>, <a href="https://doi.org/10.3390/ijerph18020716">diabetes</a>, <a href="https://doi.org/10.1016/j.jaci.2012.12.1573">asthma</a>, <a href="https://doi.org/10.1177/1559325820916949">obesity</a> <a href="https://neurosciencenews.com/bpa-fetal-development-19902/">and harming</a> <a href="https://doi.org/10.1016/j.envint.2017.12.028">fetal neurodevelopment</a>. </p>
<p>After years of pressure from environmental and public health advocates, the U.S. Food and Drug Administration agreed in June 2022 to <a href="https://www.eenews.net/articles/fda-agrees-to-reassess-bpa-risks/">reevaluate the health risks</a> of BPA. This is significant because a vast body of research <a href="https://doi.org/10.1002/ijgo.14126">has documented that</a> <a href="https://doi.org/10.1016/j.envres.2016.06.008">BPA is leaching from products and packaging</a> into our food and drink and ultimately our bodies.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/SRDUQWJgnn0?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">The game of “chemical Whack-A-Mole” – and how it affects the products you buy.</span></figcaption>
</figure>
<h2>What is BPA?</h2>
<p>BPA is not only used in plastics and food and drink containers but also in pizza boxes, shopping receipts, liners of aluminum cans and much more. Scientists <a href="https://doi.org/10.1371/journal.pone.0120330">have found that BPA</a> <a href="https://doi.org/10.1016/j.jsbmb.2011.05.002">is an endocrine disruptor</a>, which means <a href="https://doi.org/10.1210/endocr/bqaa171">it disrupts hormonal systems</a> that support the body’s functioning and health. </p>
<p>Hormonal disruption is a particular problem during pregnancy and fetal development, when even minor changes can alter the trajectory of developmental processes, including <a href="https://efsa.onlinelibrary.wiley.com/doi/epdf/10.2903/j.efsa.2015.3978">brain and metabolic development</a>. </p>
<p>Over the last two decades, public awareness about the risks led many companies to remove BPA from their products. As a result, studies have shown that BPA levels in people’s bodies <a href="https://doi.org/10.1016/j.envres.2019.05.046">appear to be declining</a> in the U.S. However, a nationwide research team that I helped lead <a href="https://echochildren.org/">as part of a national NIH consortium</a> showed in a <a href="https://doi.org/10.1021/acs.est.1c08942">recent study of pregnant women</a> that the decline in BPA could in part be explained by the fact that BPA replacement chemicals have been on the rise over the last 12 years. And other studies have found that many BPA substitutes are <a href="https://www.science.org/content/article/bpa-substitutes-may-be-just-bad-popular-consumer-plastic">typically just as harmful</a> as the original.</p>
<p>As an environmental health scientist and <a href="https://profiles.ucsf.edu/tracey.woodruff">professor and director</a> of the University of California, San Francisco <a href="https://prhe.ucsf.edu/">Program on Reproductive Health and the Environment</a> who specializes in how toxic chemicals affect pregnancy and child development, I am part of a <a href="https://oehha.ca.gov/proposition-65/developmental-and-reproductive-toxicant-identification-committee-darticmembers">scientific panel</a> that decides if chemicals are reproductive or developmental toxicants for the State of California. In 2015, this committee declared <a href="https://oehha.ca.gov/proposition-65/chemicals/bisphenol-bpa#">BPA a reproductive toxicant</a> because it has been shown to be <a href="https://doi.org/10.1210/en.2016-1887">toxic to ovaries</a>.</p>
<h2>BPA and the FDA</h2>
<p><a href="https://www.fda.gov/food/food-additives-petitions/bisphenol-bpa">BPA was first approved for use</a> in food packaging by the FDA in the 1960s. In 2008, the agency released a draft report concluding that “BPA remains safe in food contact materials.” This assessment was <a href="https://www.latimes.com/archives/la-xpm-2010-jan-16-la-na-fda-bpa16-2010jan16-story.html">met with pushback</a> from many health advocates and environmental health organizations. The FDA claimed BPA to be “safe in food contact materials” as recently as 2018. </p>
<p>Meanwhile, since 2011, Canada and Europe have taken steps to <a href="https://www.chemistryviews.org/details/news/11169386/EU_Wide_Bisphenol_A_Ban_Expected/">ban or limit BPA in children’s products</a>. In 2021, the European Union <a href="https://grist.org/regulation/europe-proposes-dramatic-new-regulation-for-bpa/">proposed “dramatic” decreases</a> <a href="https://www.efsa.europa.eu/en/news/bisphenol-efsa-draft-opinion-proposes-lowering-tolerable-daily-intake">in BPA exposure limits</a> due to a growing body of evidence linking BPA to health harms.</p>
<p>One of the major challenges to limiting harmful chemicals is that regulatory agencies like the FDA try to figure out the levels of exposure that they consider harmful. In the U.S., both the FDA and the Environmental Protection Agency have a long history of underestimating exposures – in some cases because they do not adequately capture “real-world exposures,” or because they fail to fully consider how even small exposures can affect vulnerable populations such as pregnant women and children.</p>
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<figcaption><span class="caption">Surprising research findings on the safety of ‘BPA-free’ products.</span></figcaption>
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<h2>Latest research</h2>
<p>A large body of research has explored BPA’s <a href="https://doi.org/10.1289/ehp.1307728">effects on reproductive health</a>. These studies have also revealed that many <a href="https://doi.org/10.4093/dmj.2019.0027">BPA substitutes are potentially even worse</a> than BPA and have looked at how these <a href="https://doi.org/10.1080/10408444.2019.1621263">chemicals act in combination</a> with other chemical exposures that can also come from a variety of sources. </p>
<p>And while much attention has been paid to BPA’s effects on pregnancy and child development, there is also significant research on its effects on male reproductive health. It has been linked to <a href="https://www.scientificamerican.com/article/bpa-exposure-linked-to-prostate-cancer/#">prostate cancer</a> and <a href="https://doi.org/10.1016/j.envint.2022.107322">drops in sperm count</a>. </p>
<p>In a study our research team conducted that <a href="https://doi.org/10.1186/s12940-016-0131-2">measured BPA in pregnant women</a>, we asked study participants if they knew about BPA or tried to avoid BPA. Many of our study participants said they knew about it or tried to avoid it, but we found their actions appeared to have no effect on exposure levels. We believe this is, in part, because of BPA’s presence in so many products, some of them known and some unknown that are difficult to control.</p>
<h2>What you can do</h2>
<p>One of the most common questions our staff and clinicians that work with patients are asked is <a href="https://prheucsf.blog/?s=BPA">how to avoid harmful chemicals</a> like BPA and BPA substitutes. A good rule of thumb is to avoid drinking and eating from plastics, microwaving food in plastic and using plastic take-out containers – admittedly easier said than done. Even some paper take-out containers can be lined with BPA or BPA substitutes. </p>
<p>Our <a href="https://doi.org/10.1002/ijgo.14126">recent review of the research</a> found that avoiding plastic containers and packaging, fast and processed foods and canned food and beverages, and instead using alternatives like glass containers and consuming fresh food, can reduce exposures to BPA and other endocrine-disrupting chemicals.</p>
<p>Research has shown that when <a href="https://doi.org/10.1080/15287390903212329">heat comes into contact with plastic</a> – whether water bottles, Tupperware, take-out containers <a href="https://doi.org/10.4315/0362-028x-66.8.1444">or cans</a> – BPA and other chemicals are more likely to leach into the food inside. One should also avoid putting hot food into a food processor or putting plastic containers into the dishwasher. Heat breaks down the plastic, and while the product might appear fine, the chemicals are more likely to migrate into the food or drink – and ultimately, into you.</p>
<p>We also know that when acidic foods like tomatoes are packaged in cans, <a href="https://doi.org/10.1016/j.envres.2016.06.008">they have higher levels of BPA</a> in them. And the amount of time food is stored in plastic or BPA-lined cans can also be a factor in how much the chemicals migrate into the food.</p>
<p>No matter how much people do as individuals, policy change is essential to reducing harmful chemical exposures. A large part of our work at UCSF’s <a href="https://prhe.ucsf.edu/">Program on Reproductive Health and the Environment</a> is to hold regulatory agencies accountable for assessing chemical risks and protecting public health. What we have learned is that it is essential for agencies like the EPA and FDA to use the most up-to-date science and scientific methods to determine risk.</p><img src="https://counter.theconversation.com/content/184630/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Tracey Woodruff received funding for BPA research from NIEHS. She receives and has received funding for research on chemical exposures from NIH/NIEHS, USEPA and California EPA.</span></em></p>Due to increasing concerns over the health hazards posed by BPA, the Food and Drug Administration plans to reevaluate the safety of the controversial chemical for use in everyday products.Tracey Woodruff, Professor of Environmental Health, University of California, San FranciscoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1783812022-05-30T12:27:57Z2022-05-30T12:27:57ZRace, gender and the ways these identities intersect matter in cancer outcomes<figure><img src="https://images.theconversation.com/files/463462/original/file-20220516-11-3il8v8.jpg?ixlib=rb-1.1.0&rect=43%2C51%2C5708%2C3742&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Cancer care research usually focuses on just one of a patient's social identities.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/patients-in-infusion-room-royalty-free-image/522902646">Isaac Lane Koval/Corbis/VCG via Getty Images</a></span></figcaption></figure><p><em>The <a href="https://theconversation.com/us/topics/research-brief-83231">Research Brief</a> is a short take about interesting academic work.</em> </p>
<h2>The big idea</h2>
<p>Belonging to one or more groups with long-standing social and economic disadvantages increases the risk of cancer diagnoses and death, according to <a href="https://doi.org/10.1002/pon.5890">our review of 28 cancer studies</a> published between 2012 and 2021. </p>
<p>People who were both nonwhite and LGBTQ <a href="https://doi.org/10.1002/pon.5890">received fewer cancer</a> prevention services and had fewer cancer screenings, we found, for example. </p>
<p>We started by searching for studies of groups with poor cancer outcomes. Then we narrowed our focus to cancer studies that specified the race, sexual orientation, gender identity, socioeconomic status, disability status or rural residency of study participants. We found just 28 that provided such information. We classified those studies according to the aspect of cancer care they covered. Some studies, for example, were about <a href="https://doi.org/10.1016/j.socscimed.2014.06.039">cancer screening and prevention</a>, while others <a href="https://doi.org/10.1245/s10434-020-09267-y">focused on treatment</a>. </p>
<p>Most of the studies focused on what people did to prevent cancer or to check for it. Examples include getting mammograms or a human papilloma virus vaccine. And we found some studies that were about specific kinds of cancer, like cervical or breast.</p>
<p>We found that sexual orientation and race influenced whether women chose to get screened for cancer or to take preventive treatments. Nonwhite women of low socioeconomic status also had lower cancer survival rates. We saw that these patients experienced fears of discrimination, a general discomfort with health care providers and more distrust of the health care system. </p>
<h2>Why it matters</h2>
<p>Despite advances in detection and treatment, <a href="https://www.cdc.gov/cancer/dcpc/research/update-on-cancer-deaths/index.htm">cancer remains the second-leading cause of death in the United States</a>. And in communities with long-standing social and economic disadvantages, the risk of cancer diagnoses and death is higher than in the general population.</p>
<p>For example, Black women are <a href="https://doi.org/10.1136/bmj.a586">more likely than white women</a> to die of breast cancer. New diagnoses of prostate cancer occur more frequently <a href="https://www.cancer.gov/about-cancer/understanding/disparities">in rural Appalachia</a>, compared with urban areas in the same region. And bisexual women are 70% more likely to get a cancer diagnosis, <a href="https://www.cancer.gov/about-cancer/understanding/disparities">compared with heterosexual women</a>.</p>
<p>Cancer care research usually overlooks the multiple identities of individual patients. But most people have more than one social identity, and those identities are hard to separate from one another. For example, a gay Black man is not gay one day and Black the next; he’s both, all the time. And he has different experiences of discrimination and disadvantage compared with a straight Black man. </p>
<p><a href="https://theconversation.com/intersectionality-how-gender-interacts-with-other-social-identities-to-shape-bias-53724">Intersectionality describes</a> the recognition and consideration of a person’s multiple, intersecting social identities. Taking these multiple identities into consideration could help improve cancer prevention and survival among those who belong to one or more historically disadvantaged groups. </p>
<h2>What still isn’t known</h2>
<p>We did not look at lifestyle behaviors, such as smoking, that could increase the risk of getting cancer and contribute to poorer cancer treatment outcomes. However, cancer <a href="https://www.cancer.gov/about-cancer/understanding/disparities">disparities based on lifestyle behaviors</a> are well documented, and it would be valuable to look at how complex identities and lifestyle affect those outcomes.</p>
<p>As researchers we wanted to focus on identifying studies in the literature that focused on the interconnected, multiple ways patients self-identify and how this related to their health care. Unfortunately, only a small amount of data was available, and our current report suffered from these limitations.</p>
<h2>What’s next</h2>
<p>Our paper describes ways for scientists to take patients’ multiple identities into account when doing cancer research. This model includes recommendations for setting up studies, conducting the research itself and documenting the findings. Considering more complex patient identities could make future studies more consistent and understandable. It will help fill some large gaps we’re seeing in how researchers study cancer.</p><img src="https://counter.theconversation.com/content/178381/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Belonging to one or more groups with long-standing social and economic disadvantages increases the risk of cancer diagnoses and death.Timothy Pawlik, Professor of Surgery, The Ohio State UniversityElizabeth Palmer, Research Scientist, The Ohio State UniversitySamilia Obeng-Gyasi, Assistant Professor of Surgical Oncology, The Ohio State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1777872022-02-24T15:24:09Z2022-02-24T15:24:09ZVegetarian, pescatarian or low meat diets may reduce cancer risk – new research<figure><img src="https://images.theconversation.com/files/448337/original/file-20220224-33175-nyx8j2.jpg?ixlib=rb-1.1.0&rect=51%2C0%2C5760%2C3837&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Vegetarians had a 14% lower risk of developing all types of cancer compared to people who regularly eat meat.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/family-lunch-party-home-vegetarian-meal-1662594976">Dejan Dundjerski/ Shutterstock</a></span></figcaption></figure><p>A growing number of people are choosing to eat less meat. There are many reasons people may choose to make this shift, but health is often cited as a popular motive.</p>
<p>A large body of research has shown that plant-based diets can have many health benefits – including lowering the risk of chronic diseases, such as <a href="https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002039">type 2 diabetes</a> and <a href="https://www.sciencedirect.com/science/article/pii/S0735109717375216?via%3Dihub">heart disease</a>. Two large studies – <a href="http://www.epic-oxford.org/">EPIC-Oxford</a> and the <a href="https://adventisthealthstudy.org/studies/AHS-2">Adventist Health Study-2</a> – have also suggested vegetarian or pescatarian diets (where the only meat a person eats is fish or seafood) may be linked to a slightly lower overall cancer risk. </p>
<p>Limited research has shown whether these diets could lower risk of developing specific types of cancer. This is what our <a href="https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-022-02256-w">recent study</a> aimed to uncover. We found that eating less meat lower a person’s risk of developing cancer – even the most common types of cancer.</p>
<p>We conducted a large-scale analysis of diet and cancer risk using data from the <a href="https://www.ukbiobank.ac.uk/">UK Biobank</a> study (a database of detailed genetic and health information from nearly 500,000 British people). When participants were recruited between 2006 and 2010, they completed questionnaires about their diet – including how often they ate foods such as meat and fish. We then tracked participants for 11 years using their medical records to understand how their health had changed during this time.</p>
<p>Participants were then categorised into four groups depending on their diet. Around 53% were regular meat-eaters (meaning they ate meat more than five times a week). A further 44% of participants were low meat-eaters (eating meat five or less times a week). Just over 2% were pescatarians, while just under 2% of participants were classified as vegetarians. We included vegans with the vegetarian group as there weren’t enough to study them separately.</p>
<p>Our analyses were also adjusted to ensure other factors that might increase risk of cancer – such as age, sex, smoking, alcohol consumption and sociodemographic status – were taken into account.</p>
<p>Compared with regular meat-eaters, we found the risk of developing any type of cancer was 2% lower for low meat-eaters, 10% lower in pescatarians and 14% lower in vegetarians.</p>
<h2>Specific cancer risk</h2>
<p>We also wanted to know how diet affected risk of developing the three most common types of cancer seen in the UK. </p>
<p>We found that low meat-eaters had a 9% lower risk of colorectal cancer compared with regular meat-eaters. <a href="https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(15)00444-1/fulltext">Previous research</a> has also shown that a higher intake of processed meat in particular is associated with higher colorectal cancer risk. We also found that vegetarians and pescatarians had a lower risk of colorectal cancer, however this was not statistically significant. </p>
<p>We also found that women who ate a vegetarian diet had an 18% lower risk of postmenopausal breast cancer in comparison to regular meat-eaters. However, this association was largely due to the lower average body weight seen in vegetarian women. Previous studies have shown that being overweight or obese after menopause increases <a href="https://www.wcrf.org/dietandcancer/breast-cancer/">risk of breast cancer</a>. No significant associations were observed between postmenopausal breast cancer risk among pescatarians and low meat-eaters.</p>
<figure class="align-center ">
<img alt="A woman holds a bowl of vegetarian foods." src="https://images.theconversation.com/files/448338/original/file-20220224-5831-pbrr7g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/448338/original/file-20220224-5831-pbrr7g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=360&fit=crop&dpr=1 600w, https://images.theconversation.com/files/448338/original/file-20220224-5831-pbrr7g.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=360&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/448338/original/file-20220224-5831-pbrr7g.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=360&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/448338/original/file-20220224-5831-pbrr7g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=452&fit=crop&dpr=1 754w, https://images.theconversation.com/files/448338/original/file-20220224-5831-pbrr7g.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=452&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/448338/original/file-20220224-5831-pbrr7g.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=452&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Vegetarian diets were linked with lower breast cancer risk in women.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/healthy-vegetarian-dinner-woman-jeans-warm-1317602774">Foxys Forest Manufacture/ Shutterstock</a></span>
</figcaption>
</figure>
<p>Pescatarians and vegetarians also had a lower risk of prostate cancer (20% and 31% less respectively) in comparison to regular meat-eaters. But it’s not clear whether this is because of diet, or if it’s due to other factors – such as whether or not a person sought cancer screening. </p>
<p>As this was an observational study (meaning we only observed changes to a participant’s health without asking them to make changes to their diet), this means we can’t know for sure if the links we’ve seen are directly caused by diet, or if they’re due to other factors. Although we adjusted the results carefully to take into account other important causes of cancer, such as smoking and alcohol consumption, it’s still possible other factors may still have influenced the results we observed. </p>
<p>Another limitation of our study is that most of the participants <strong>(around 94%)</strong> were white. This means we don’t know whether the same link will be seen in other ethnic groups. It will also be important for future studies to look at a more diverse population, as well as larger numbers of vegetarians, pescatarians and vegans to explore whether this link between lower cancer risk and these types of diets is as strong as we observed. </p>
<p>It’s important to note that simply eliminating meat doesn’t necessarily make your diet healthier. For example, some people who follow a vegetarian or pescatarian diet may still eat low amounts of fruits and vegetables and high amounts of refined and processed foods, which might lead to poor health.</p>
<p>Most evidence showing an association between lower cancer risk and vegetarian or pescatarian diets also seems to suggest that greater consumption of vegetables, fruits and whole grains may explain this lower risk. These groups also don’t consume red and processed meat, which is linked with <a href="https://www.wcrf.org/dietandcancer/meat-fish-and-dairy/">higher colorectal cancer risk</a>. But more evidence will be needed to fully explore the reasons for the results we observed.</p>
<p>The links between red and processed meat and cancer risk are well known – which is why it’s <a href="https://www.wcrf.org/diet-and-cancer/cancer-prevention-recommendations/">widely recommended</a> people aim to limit the amount of these foods they consume as part of their diet. It’s also recommended that people consume a diet rich in whole grains, vegetables, fruits and beans as well as maintain a healthy body weight in order to reduce their risk of cancer.</p><img src="https://counter.theconversation.com/content/177787/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Cody Watling receives funding from Nuffield Department of Population Health Doctoral Scholarship.
The authors would like to thank Dr. Caroline Wood for her writing assistance, language editing, and proofreading of this article.</span></em></p><p class="fine-print"><em><span>Aurora Perez-Cornago receives funding from Cancer Research UK and the World Cancer Research Fund. </span></em></p><p class="fine-print"><em><span>Tim Key receives funding from Cancer Research UK, Wellcome
</span></em></p>Eating less meat was also linked with a lower risk of colorectal, breast, and prostate cancer.Cody Watling, PhD Researcher, Cancer Epidemiology Unit, University of OxfordAurora Perez-Cornago, Senior Nutritional Epidemiologist, University of OxfordTim Key, Professor of Epidemiology, University of OxfordLicensed as Creative Commons – attribution, no derivatives.