I’m not going to stick my neck out and say all Tubular Breast Cancer is definitely avoidable as I don’t know the circumstances of other people diagnosed with breast cancer. In my own case, I think it may have been avoidable. This is why:
I was diagnosed with it 4 years ago. My surgeon told me the bad news that it was breast cancer, but as it was tubular, it had a very good prognosis. I read stuff about it shortly afterwards on the internet and it’s mentioned in Susan Love’s Breast Book. It’s quite rare - only 1-2% of cases, though I think my surgeon said it was higher, about 9% in UK.
So that got me wondering how I got an uncommon breast cancer, having no family history etc. And I was intrigued by this statement from Susan Love’s book in relation to HRT.
“Studies show that women who take hormones get more breast cancer, but the mortality rate among these women is actually 10-15% lower than that of other women with breast cancer. The Iowa Women’s Health Study helped to explain this finding. It showed that the cancers of the women on oestrogen tended, not surprisingly to be more sensitive to oestrogen and to have a less aggressive pathology. The tumours were more likely to be colloid, tubular or medullary than standard infiltrating ductal”.
So that said to me that taking HRT could increase risk of tubular breast cancer. But I’ve never taken HRT.
Then a year ago at the San Antonio Breast Cancer Symposium there was the big announcement that breast cancer incidence had dropped in the US between 2002 and 2003 (by 7% I think) and the theory was because fewer women were taking HRT because of studies showing links to breast cancer. I attended the 2007 San Antonio Breast Cancer Symposium as a patient advocate rep for Breakthrough and HRT was discussed.
I saw a presentation that said HRT prescriptions in the US have dropped by 60%. It is combined oestrogen/progesterone HRT that is linked with higher risk of BC, (oestrogen only doesn’t appear to show the same link). The presenter said that women who develop BC following HRT have a higher rate of lobular and tubular BC than other people that develop BC but have never taken HRT.
In one of the evening sessions for patient advocates to ask questions of experts, a young woman asked why, if HRT has been conclusively linked to increased risk of BC, nothing seems to be happening to see if there are similar links with oral contraceptive use.
She did not get a satisfactory answer. They waffled on about oral contraceptives being a lot different now than they were in the 60s and 70s and seemed to imply that the levels of these hormones given to pre-menopausal women would have only a tiny risk.
I’ve done some research on the internet and there is information that demonstrates links between tubular BC and hormone therapy.
It says that tubular BC is associated with medium potency oestrogen/progesterone hormone therapy, plus tubular cancer is associated with recent alcohol consumption of >10g per day. That is not a lot of alcohol. 10ml alcohol (1 unit) = 8 g alcohol. In the UK we talk about safe alcohol consumption in glass measures. A 125ml glass of wine is 1.5 units of alcohol (assumed at 12% alcohol by volume). If my maths is right, that means that if you have one of these a day, you exceed the 10g alcohol per day as you are consuming 12g of alcohol.
So to conclude my theory. I have never taken HRT, but I did take Mercilon, an oral contraceptive containing oestrogen and progesterone in 2000 or therebouts for about a year to 18 months for gynae. problems. During 2001, I was doing a stressful job, involving a lot of travel and my alcohol consumption levels during that period were probably not very wise.
I was diagnosed with Tubular BC in December 2003 when I was 47. I do not know how the levels of hormones in Mercilon compare with those in the type of HRT that has been linked to BC, but I am going to find out and also check my medical records to see how long I took it for. The Swedish study looked at hormones being taken for >5 years. I did not take Mercilon that long, but I did take oral contraceptives for 9 years from age 19 to 28.
This is circumstantial evidence, but I think it is a strong explanation for how I got BC and, if I’m correct, I believe I could have avoided getting it by not taking oral contraceptives in my 40s and perhaps avoiding alcohol.
If Tubular cancer is 1-2% per year, that’s about 800 cases per year in the UK based on total incidence of 44,000. If it’s 9% it’s 4,000 cases per year. A researcher would probably regard these numbers as insignificant. But they aren’t if you happen to be included in them.
Whether or not oral contraceptives increase risk of tubular cancer, it has certainly been established that HRT does and Dr Susan Love’s words on this are very wise. She says that as Hormone Therapy tends to cause less aggressive cancers:
“this has been used to justify hormone therapy: if it only causes the “good” kind of cancer, who cares if they get it?” She says “I have a number of problems with that. Though the mortality is lower, it’s hardly non-existent: more women are still dying. Furthermore breast cancer is no fun, even if you survive it”