Thursday, January 15, 2009

Breast cancer

In quite a short period – certainly less than 20 years – the quoted lifetime risk of breast cancer for a woman in this country has risen from 1 in 13 to 1 in 9

This begins to look like an epidemic

I was struck by the number of family & friends of Cherie Blair who have died young from this disease & whom she mentions in her book, particularly since, when I thought about it I can really think only of friends of friends or family of friends who have been affected. The only member of my own family was a great aunt who was in her eighties and had been in generally poor health for years. (It is a completely different picture however if we consider gynaecological cancers)

There was an oft quoted mantra in the old Central Statistical Office: If a figure looks interesting it’s usually wrong. So my first question is: exactly how is the lifetime risk figure calculated, & would I agree with the method?

I hadn't looked at any of the figures since I made my own decision about screening, but a quick look at the basic source suggests no reason for fundamental doubts, though there is always room for discussion & interpretation

What strikes me about the graph for Age-standardised incidence however (Figure 5.5 page 40) is how the trend starts to move up on the introduction of the national screening programme in 1987 - & particularly alarmingly for in situ cancers

I will obviously need to do more work to find out how much might just be due to earlier diagnosis, whether proper account is taken of the perverse risk that with improved treatment a woman may develop breast cancer twice in her life, how much might be down to us all just living longer, and how much is a ‘real’ increase – something which I find truly alarming

It would be impertinent of me to claim friendship with Cathie Marsh though I did know her as a fellow professional. It therefore came as a shock when sometime in 1993 I was watching a tv programme about, I think, some anniversary of the Pill, when Cathie suddenly appeared on screen – some months after her death.

She was quite passionate about the notion that the combination of having taken the Pill and, later, fertility treatment, must have had something to do with her developing breast cancer at such an early age, and wanted to pass that message on. So today I am left wondering whether all the research has somehow failed to uncover some obvious link