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Stressed about breasts

When one in five women say they would have their breasts removed to prevent the risk of cancer, has ‘awareness’ gone too far?

Dr Liz Frayn

Topics Politics

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Research released this week by Cancer Research UK shows that 60 per cent of women in the UK, more than in other countries, are concerned about the possibility of contracting breast cancer (1). Perhaps most startling was the finding that among the 1,565 women questioned in Australia, Belgium, Brazil, Germany, Italy and the UK, one in five women said they would consider having a double mastectomy (breast removal) to prevent breast cancer if they were at high risk.

Cancer Research UK is using these findings to publicise its trial of anastrazole, a drug currently used to prevent recurrence in women with breast cancer, which may also help reduce the risk of developing breast cancer in the first place. Apparently 50 per cent of women questioned said they would be happy to take part in such a trial. But why are many of them so scared of breast cancer that they feel having a mastectomy just in case could be a preferable option?

Over recent decades, breast cancer has become an increasingly high-profile disease, starting with celebrities such as Shirley Temple Black in the 1970s, one of the first women to talk openly about her diagnosis, to today’s celebrities such as Kylie Minogue, the details of whose operation made front-page news.

This new openness is in many ways healthy and sensible. But there is another side to it. When cases such as that of Kylie, an unusually young sufferer of breast cancer, receive so much publicity, the effect is a disproportionate public anxiety. One BBC news report following her diagnosis featured interviews on the street with concerned young women. ‘So, do you examine your own breasts regularly?’ they were asked, with a microphone shoved in their face. Rather than slapping the reporter for his impertinence, most of these young women confessed their guilt at not regularly examining their own breasts for signs of cancer.

This line of questioning highlights another of the problems of increased breast cancer awareness. Women inevitably feel under pressure to do something, anything, to allay their anxieties. Cancer Research UK points out that its survey findings ‘highlight the need for preventive measures that women can take to reduce their risk and reassure themselves’. Unfortunately, at the moment, there is not much any of us can do to influence whether or not we will develop breast cancer, and what happens when we do. Breast self-examination has been conclusively proven to be pretty much ineffective in detecting breast cancers, and in some studies has been shown to be harmful (2).

In this context it is understandable that many women feel that bilateral mastectomy might be the safest option. But that doesn’t mean that it actually is. In reality, the few women who do have bilateral mastectomies to avoid the risk of cancer are those with the very rare genetic make-up that means they have close to 100 per cent risk of contracting the disease at some stage. For them it may well be a sensible option, to get the treatment out of the way and continue with life. For the rest of us, this outlook seems unnecessarily bleak.

The irony is that mortality rates from breast cancer in all age groups have been gradually falling over the past 15 years, due mainly to improving treatments, and also improved detection methods. And the diagnosis of breast cancer in young women is still rare: over 80 per cent of cases are in post-menopausal women. Sadly, the results of Cancer Research UK’s survey seem to show that the increased awareness of breast cancer promoted by cancer charities does not translate automatically into public optimism about the outcome.

Dr Liz Frayn is a surgical trainee in southwest England.

Read on:

Worrying women, by Liz Frayn

What mammography misses, by Michael Baum

(1) Current news, on the Cancer Research UK website

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Topics Politics

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