THE BREAST CANCER COVER UP



THE BREAST CANCER COVER UP

Author: Eugene G Breen

Affiliation: Mater Misericordiae University Hospital, Dublin 7, Ireland.

Physician and Psychiatrist.

Dear Editor I submit the article The Breast cancer Cover Up for publication in the BMJ as a Personal View. I am the sole author and assign exclusive copyright to the BMJ and associated journals.

I have no vested interests. I have received no remuneration for this work.

THE BREAST CANCER COVER UP

Breast cancer is all over the place! The number of women in 2013 reported to have breast cancer was 1.6 million worldwide. This is up from .6 million in 1980 (1). In the UK according to the Cancer Research UK website there has been a 6% increase in breast cancer incidence in the past 10 years. The prevalence for women in UK getting breast cancer is now 1 in 10 women. What is worse is that the incidence in young women 25 – 49 years is very high at 25,500 cases in 2012 out of a total incidence of breast cancer that year of 50,000. That is 50%. The mortality in young women is also frightening at 39% of all female deaths being due to cancer. The equivalent figure for males is 18% of all deaths due to cancer. This is on a backdrop of 3740 total number of female cancer deaths in this age bracket that year compared to 2884 male cancer deaths.

The World Breast Cancer Report 2012 says there was a 3.1% annual increase in breast cancer worldwide over the past 30 years. More recent data published on the incidence of breast cancer in young women comes from USA (2). Again it is bad news and shows that there was a statistically significant increase in the incidence of breast cancer with secondary spread in USA between 1976 and 2009 for women age 25 to 39 years without a corresponding increase in older women. The figures nearly doubled from 1.53 to 2.9 per 100,000 population for these young women in this time frame. These data are taken from the SEER database. This age group has also the lowest 5 year survival for this type of aggressive cancer with 30% alive after 5 years.

The first undisputed fact is that breast cancer is becoming much more common and this is confirmed by all major cancer institutes and international databases and also by a major review in the Lancet 2011 entitled “ Breast cancer and cervical cancer in 187 countries between 1980 and 2010; a systematic analysis.” Why this is happening has not been satisfactorily answered. Why aggressive breast cancer in the young is at such a very high level and is actually increasing in incidence is a serious cause for concern. The WHO and similar data bases show three trends worldwide that are robust universal and consistent. They are that the incidence of breast cancer is inversely proportional to the rate of childbirth. The fewer the number of children per woman the more the incidence of breast cancer. The third variable is the use of female hormones as oral contraceptives (OCs) or hormone replacement therapy (HRT). The more they are used the more breast cancer and the lower the birth rate. All countries with these data show these trends.

Countries with low birth rates and high use of oral contraceptives have higher rates of breast cancer. It does make sense. The UK Cancer Research website quotes figures of 66% increase in breast cancer risk with HRT and “a quarter” -I presume that means 25%, with oral contraceptives.

The Million Women Study and studies from Canada and USA have confirmed these very high rates, and use of HRT has plummeted in those countries as a result (3).Why do healthy young women get cancer at all? Men of the same age get half as much cancer. Why do young women not only get breast cancer but aggressive poor prognosis breast cancer? Could it be because it is hormone sensitive and driven by exposure to OCs? The physiology is simple. There is an oestrogen sensitive tumour, as most of theses aggressive tumours are in younger women, and it is exposed to extra hormones, and the tumour becomes invasive. This makes sense. The worldwide fertility and breast cancer and OC-use tables all support it. It explains the increasing incidence of breast cancer in developing countries, because they are now using more OCs. It explains why it is young women that get cancer because they are the ones taking OCs. It explains why anti-oestrogens are the pharmacological treatment for breast cancer.

There is ample data in the literature to support this. A paper in USA in 2009 reported that the incidence of triple negative breast cancer, a very aggressive type of cancer, in women under 45 years, was 4.2 time higher in women who used OCs within the previous 1 to 5 years (4). Women who used the OCs before their 18th birthday were at 3.7 times the risk. More alarming is a paper published in Dec 2013 from India which reports a 9.5 fold increase in breast cancer in women who had a history of OC use (5).

Breast cancer should not be happening to young women at the rates it is. Cancer at these levels is not happening to men or to even to female mammals. The obvious cause needs to be honestly stated and eradicated (OCS, HRT). The cigarette wars were a similar cause and effect situation and it took 50 years to end that saga (6).

1. World Breast Cancer Report 2012. International Prevention Research Institute.

2. Johnson RH, Chien FL, Bleyer A. Incidence of breast cancer with distant involvement among women in The United States, 1976 to 2009. JAMA 2013;309(8):800-805.

3. De P, Neutel CI, Olivotto I, Morrison H. Breast cancer incidence and hormone replacement therapy in Canada. JNCI 2010;doi:10.1093/jnci/djq345.

4. Dolle DM, Daling JR, White E, Brinton LA, Doody DR, Porter PL, Malone KE. Risk factors for triple-negative breast cancer in women under age 45. Cancer Epidemiol Biomarkers Prev 2009;18(4):1157-1166.

5. Bhadoria AS, Kapil U, Sareen N, Singh P. Reproductive factors and breast cancer: A case control study in tertiary care hospital of North India. Indian J Cancer 2013;50(4):316-321.

6. Cummings A, Brown A, O’Connor R. The cigarette controversy. Cancer Epidemiol Biomarkers Prev 2007;16:1070-1079.

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