Times 21st February:
NHS rips up Breast Cancer Leaflet and starts all over again.
Good news, but a wide range of experts and patient advocates need to be involved in producing the new information.
I don't think leaving it to a small group including the NHS and charities like Breakthrough Breast Cancer and Breast Cancer Care would be right. I don't think they can be trusted to do an impartial job. The NHS has invested huge amounts of money on breast screening and sets national targets for screening uptake. It isn't going to easily acknowledge and respond to the limitations of screening.
In my view, the charities have been complicit in denying women access to full information and I find that inexcusable.
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Check out Ben Goldacre's website and seach on Screen Test. There's a nice discussion about it.
Jane's right. It's the 21st Century. When are Charities and the NHS going to stop treating women like little girls?
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If you saw the Times yesterday (19th Feb), you'll be aware of the controversy as to whether women are being given enough information to make an informed decision about screening.
Breakthrough has posted a response to the criticism on its website and I have nominated the response as an example of Bad Science to Dr Ben Goldacre, who has a Guardian column and website called "Bad Science".
I've told Breakthrough that I don't think it's helpful to loosely compare breast screening with MMR vaccination. The danger is that it perpetuates the myth that, like a vaccination programme, breast screening is a prevention programme, when of course it is not that at all. It is an early detection programme.
Both Breakthrough and Breast Cancer Care are clearly concerned about the controversy causing a drop in uptake of screening appointments. I agree that is a possible consequence of women being given something they don't currently have - full, unbiased information about benefits and harms of screening, to enable them to make an informed decision as to whether to participate.
I wonder do Breakthrough and Breast Cancer Care have a problem with women being given all the facts and making informed decisions? I think both need to raise their game in future engagement with their patient supporters. The charities' policy of using young, bright, shiny staffers to tell women what's good for them is out of date and lacks credibility, especially now that more baby boomers are being called for screening. Many of that generation won't accept being told what to think because they have been educated to think for themselves. (Of course this also applies to women of all ages, not just baby boomers)
I think women have a right to full, unbiased information to help them make decisions about healthcare interventions. They are not getting that at the moment for Breast Screening.
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Let’s have a closer look at the statistics in NHSBSP61, published by NHS Cancer Screening Programmes and on its website.
It says the following:
1. The 2002/3 mastectomy rates for screening detected breast cancers was 27% for invasive cancer and 29% for DCIS (Ductal Carcinoma in Situ), a non-invasive breast cancer.
2. The Screening Programme has resulted in a large increase in the numbers of women diagnosed with DCIS.
3. In the UK, 69% of DCIS diagnosed is high grade which is assumed to be more likely to progress to invasive breast cancer than low grade. Currently all women diagnosed with DCIS are offered treatment, regardless of grade – mastectomy or lumpectomy and radiotherapy and possibly Tamoxifen.
4. The document discusses the question of overtreatment and diagnosis for DCIS, recognises it has a particular responsibility to encourage research into DCIS and notes that it would be “valuable” to be able to identify which cases of DCIS would not progress to invasive disease, but that’s not possible at the moment.
To put this into perspective, assuming a regional screening centre screens approximately 30,000 women per year (I’ve based this on a figure I’ve seen for 2005/6 for one UK centre), the rate of DCIS diagnoses per 1000 women screened is 1.44 (based on NHSBSP1 data for 2002/3). This means that approximately 47 women out of 30,000 screened would be diagnosed with DCIS. If 69% of them have high grade DCIS, 32 of them are high grade and 15 intermediate or low grade. They are all offered the same treatment which is based on current assumptions about the risk of DCIS progression.
Since increased rates of diagnosis of DCIS are a direct consequence of the Breast Screening Programme, you would expect it to be covered in the leaflet Breast Screening, The Facts, that’s issued to all women in England with their breast screening appointments (unless individual centres have their own leaflet) – especially as it’s designed to help women make a genuinely informed choice about breast screening. But DCIS is not mentioned at all. There is possibly a vague reference to it in a paragraph that says that if changes are found early, there’s a good chance of a successful recovery, but it says nothing about usual treatment for early changes.
I’ve lost count of the number of times I’ve seen statements made in the media that 5 year survival rates for breast cancer are now over 80%, whereas 30 years ago they were much lower (I think I’ve seen about 52% quoted). You don’t have to be a maths genius to realise that obviously breast cancer survival now is much better than it was 30 years ago because there wasn’t screening then and all women with screening detected cancers are being included in the survival statistics. (DCIS is excluded from the figures incidentally) As screening is very good at picking up early stage cancers, it would be astonishing if a significant majority of women weren’t surviving at least 5 years.
I think it would be more enlightening to compare recurrence, survival and mortality rates now and 30 years ago for women whose cancer is detected from symptoms, not screening. Then we could see the real effect of increased breast awareness campaigns and better treatments.
I think every woman has a right to have complete, unbiased information to help her to decide whether to participate in the Breast Screening Programme and to understand the possible consequences of a diagnosis of DCIS as well as invasive cancer, but I do not believe women are being given all the information they need. Admittedly, the NHS Cancer Screening website has an article about DCIS that is much more informative, but you won’t find it unless you go looking for it. Another factor to consider is that occasionally it is possible for invasive cancer to be present, but not visible with mammogram or ultrasound and it is only discovered following surgery for DCIS.
I don’t know whether access to all the facts would deter many women from breast screening or not. Breast screening units have targets for percentages of eligible women they screen and I believe funding is linked to achievement of the targets. Perhaps that partly explains why women don’t seem to get all the information they should.
Without this information, women don’t realise that a lot more research is required to really understand DCIS and that the treatments offered are based on the current assumptions about disease progression rather than evidence from clinical trials.
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Many of the questions regularly asked about mammography screening are discussed in NHSBSP61 - Screening for Breast Cancer in England Past and Future. Just enter NHSBSP61 in Google and you'll find it.
It covers costs, benefits v risks, overdiagnosis and treatment, interval cancers, DCIS and the Sloane Study, risk of radiation induced breast cancer, why it's not routinely performed for younger women (one reason given being increased susceptibility to harmful effect of radiation), the controversy between the IARC (International Agency for Research on Cancer) and the Nordic Cochrane Centre about mortality reduction.
It's not an easy read if you aren't very interested in science and statistics and like everything cut and dried. In my view it illustrates that mammography screening falls short of what we need from breast screening - which is accurate detection (which we've got - with some exceptions) and, just as importantly, much improved methods to predict which abnormalities can be safely left and which require intervention.
The sort of information contained in this document should be readily available to those who want it without them having to trawl through the internet to find it. Thank goodness for the internet. Without it we'd never get access to any of this.
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There's a very good book on Screening - called "Screening - Evidence and Practice" co-written by two British experts in Public Health and Screening Programmes. You can order it from Amazon.
It tells you the history of Screening (not just Breast Cancer Screening), what makes a good screening programme, benefits and disadvantages of screening and much more, including the fact that it was Harold Evans, the newspaper editor that pushed for a Cervical Screening Programme in the UK after seeing it in the US, the disastrous way the UK Cervical Screening Programme was implemented (without randomised controlled trials), and what had to happen to get a decent Programme set up.
The book is aimed at medical professionals, students and lay people, with clear, jargon-free discussion. If you want to understand the realities of screening rather than the hype, and don't mind the price – read it. You won't find any of this openly discussed by any British Cancer Charities.
I am open minded about Breast Screening. I believe that women must be given full information about the pros and cons to help them make an informed decision as to whether to participate. At the moment I don't believe they are given enough information and this appears to be the view of the Dept of Health because it commissioned a study which resulted in a paper (116 pages!) published in 2007 on improving quality of breast screening information provided to women, including an Appendix on DCIS. The paper is NHSBSP Publication No 64.
A key reason why US Breast Cancer Advocates are further ahead than us is simply that they are a more assertive and vocal nation. There are plenty of opportunities in the UK for patient advocates to make a difference for themselves and those that come after them, but we seem far more accepting of what we are told and we don’t challenge accepted wisdom and insist on seeing the quality of evidence in the way American advocates do.
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One of the reasons why UK Advocacy lags behind US Advocacy is that we don't have a UK Advocacy organisation where the strategy is led by people who have had breast cancer.
The National Breast Cancer Coalition in the US (NBCC) has paid staff, but their strategy is developed by women who've had breast cancer and that makes it a very different organisation to Breakthrough whose strategy is developed by paid employees.
There are some very fundamental differences between the two organisations. An example is the different views NBCC and Breakthrough hold in respect of Breast Screening Programmes - go to their websites (search on mammography on NBCC's and go to 25th Nov news on Breakthrough's) and check out their different comments on the recently publicised Norwegian study that proposes the theory that some breast cancers may regress without intervention. Both rightly say that the study is very preliminary, but NBCC's comments are thought provoking, Breakthrough's bland. Also have a look at NBCC’s evidence based harm/benefits analysis. There is nothing like this on the website of any UK Breast Cancer Charity. I can't think of any good reason why.
NBCC has done a lot of work to adopt an evidence-based position on Avastin (Bevacizumab) - see their website. I can't find any mention of Avastin on Breakthrough's - other than in an invitation to Tell your Story to the media on the basis that peoples' inspiring stories can help humanise abstract statistics about breast cancer and make a real impact.
Whether or not you agree with NBCC's position on Avastin, at least you get to read the background to their decision. Again - nothing like this analysis on the websites of UK Charities. I know which approach I believe can best make a real impact.
We once had a UK Breast Cancer Coalition led by people who'd had breast cancer and I wanted to join them in 2005, but I discovered that they'd merged with Breakthrough, so I joined them instead.
UK Breast Cancer Charities do a great deal of good work - Breakthrough's Service Pledge, sponsoring members to attend international conferences, Breast Cancer Care’s Peer Support ….and much more. But they have limitations for the reasons described by JaneRA and shown above.
NBCC's Project Lead has been mentioned in this thread as a Gold Standard of training for Patient Advocates and it is - some of the world's top scientists are lecturers. It would be interesting to know how many UK Project Lead Graduates are active members of the main UK Breast Cancer Charities. I think not as many as might be supposed.
Project Lead teaches advocates to understand breast cancer science and statistics, question and challenge conventional wisdom, campaign for quality research and evidence-based healthcare and have the confidence to debate issues and controversies in breast cancer on equal terms with researchers.
This seems to be an uncomfortable concept for UK Charities as evidenced by lack of willingness to openly discuss controversial subjects such as differing views on Breast Screening, the Avastin controversy and also the question of environmental factors and Breast Cancer – hence why Breast Cancer UK started their No More Breast Cancer campaign.
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Another twist to this. I am a trustee of a small charity that raises money for the local breast unit to help it buy advanced equipment to benefit its patients before the NHS will fund it.
A few years ago we helped to pay for a Digital Mammogram machine to support their One Stop and Follow up clinics. The local Private Hospital does not have Digital Mammography and hasn't set any timescales for getting it.
Does this mean that my charity has created a two tier system, not only for the NHS patients that aren't fortunate enough to live near enough to our our breast unit to access Digital Mammography, but also for local private patients who can't access it either because they have dared to trespass into the "dark side".
Will we and other charities who have saved the NHS money be offered our equipment back so that the NHS principle of equal access to care is maintained? Or to put it another way - if everyone can't have it, nobody is allowed to have it.
Doctors for Reform can also be found by searching on the internet.
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I agree, top ups need to be looked at in the wider context of how other European Countries make new treatments available to the people that need them, and not just for terminal conditions.
It seems to me that it suits the Government to try to whip up dissent by focusing on whether or not top ups are "unfair" because it detracts from hard questions that it needs to answer about negotiations between the Government and Pharmaceuticals on drug prices and inducements to keep the Pharmaceutical Companies investing in the UK rather than other European Countries. The Government talks about aiming for "World Class" cancer services for the UK, but Copayments seem to be used as a smokescreen to divert attention from how well the UK is really doing in comparison to the rest of Europe in respect of innovation in cancer treatment.
I hope Breast Cancer Care and other UK Cancer Charities do not get seduced into focusing solely on whether or not Copayments are fair when there are much more important questions to be answered.
Perhaps the question everyone should ask themselves is if you are ill and value a year of your life as worth more than Â£30,000 and the NHS doesn't, should the NHS be allowed to withdraw free access to your other NHS treatment that and your family have helped to pay for through taxes, simply because you choose to buy a drug that your doctor says will help you, but is unavailable through the NHS? The same applies if it is a member of your family that is ill.
The Patient's Association website invites people to complete a Copayments survey. I like it because it does not use the term "disadvantaged" and you can also comment at the same time on another controversial topic - Polyclinics.
When Breast Cancer Care's Submission goes to the DoH, whose views will it represent? Will it ultimately be the view of the majority of people who responded to the survey or will it be the views of Breast Cancer Care staff? This is an important question because the open letter indicates that Breast Cancer Care does not currently support Copayments.
Also many breast cancer patients choose not to be affiliated with charities, so it is important that their views are heard too.
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I find this question in the BCC survey interesting:
"In your opinion, if patients are allowed to top up, would this put patients who could not afford to do so at a disadvantage?"
It can be argued that patients who cannot afford to top up could be seen to be disadvantaged relative to people who can afford to. But allowing patients to top up would not lead to reduction in NHS treatment for those who cannot afford to top up. Therefore the use of the term "disadvantaged" could be construed as unnecessarily emotive.
I think care has to be taken to distinguish between those who would not be able to afford to top up and those who would choose not to. Truly well off people would not waste time haggling with the NHS. They would just go to Harley Street or abroad to get what they want.
Many people who are not particularly well off choose to pay for private health insurance or get it as part of their employment package. As we all know, they still pay in full for the NHS services they don't use through their taxes.
The NHS does not withdraw NHS services from privately insured patients, so why impose this for co-payments and argue that they go against the principles of free healthcare for all? These principles were breached long ago, and by the NHS itself when it messed up NHS dentistry and free eye tests and gave us the inequalities between England, Wales and Scotland in respect of prescription charges.
In my view, banning co-payments would not speed up delivery of Breast Cancer Care's vision that everyone with breast cancer gets the best treatment, information and support whenever they need it. Instead I think we would see "dumbing" down of innovation and progress in breast cancer treatment where everyone only got what the NHS could afford which is likely to be mediocre relative to treatment in other European countries.
Co-payments could set higher targets for standards of treatment and spur the NHS to devise some sensible ways of trying to make sure the best drugs are available to as many people as possible. Doctors and Scientists tell us that breast cancer is not one disease and that future improvements in treatments will rely on treatments targeted to individuals. These treatments are not going to be cheap.
I think the NHS should stop wallowing in its 60th anniversary and think about how it is going to best serve cancer patients in the 21st Century. Withdrawing NHS care from people who choose to top up does nothing to achieve this and seems rather spiteful.
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As people seem to be given different advice about Mirena by different doctors, it's worth checking the guidance provided by the Royal College of Obstetricians and Gynaecologists (RCOG)
They say that the The UK Medical Eligibility criteria for contraceptive use assesses the use of Mirena (aka LNG-IUS) in women with a past history of breast cancer and no evidence of current disease for the last 5 years as category 3. Which means that theoretical or proven risks usually outweigh the advantages of using the method.
They do not appear to provide any advice on use of Mirena in breast cancer patients primarily for heavy menstrual bleeding rather than contraception.
They note that it is protective against endometrial hyperplasia, especially for tamoxifen users. They confirm that it can be considered if non-hormonal contraception is unacceptable, and state that it may be considered on an individual basis and in consultation with the patients' breast surgeon.
Tamoxifen can be used as a fertility treatment which explains some doctors' concern about pregnancy after breast cancer diagnosis. Sometimes it can alleviate heavy menstrual bleeding so an option for anyone considering Mirena for heavy bleeding rather than contraception, and taking Tamoxifen, could be to just take Tamoxifen and see whether it reduces bleeding as well as protecting against breast cancer and only consider Mirena if Tamoxifen doesn't work on the bleeding.
In Hansard House of Commons written answers October 17th 2007, it is reported that Dawn Primarolo MP was questioned about Mirena. She advised that, as a precautionary measure, Mirena would be contraindicated in women with progesterone dependent cancers and said that product information for health professionals would be updated to reflect this advice.
The question I would ask to any doctor that recommends it for someone who's had breast cancer is that, since RCOG says that theoretical and proven risks of its use usually outweigh the advantages, what makes that patient an exception to the rule and what is the clinical evidence to support that opinion? It seems to me, following the Hansard report, that no doctor should advocate Mirena for any woman diagnosed with progesterone dependent breast cancer unless he or she can produce clear evidence to demonstrate why the contraindication can safely be ignored. A good doctor will not mind answering questions like this because it helps patients make informed decisions.
As to whether Mirena increases the risk of breast cancer in the general population, Cancer Research's website says that there is no evidence that Mirena causes hormone dependent cancers and cites a Finnish Study of 17,000 users to support this statement. It is possible to find more detail about this study by searching on the internet where you can find the study report and also a paper by BfArM, part of the German Ministry of Health. BfArM regards the study as flawed and also notes that it was funded by Schering who markets Mirena in Europe and that the study authors conclude that additional, larger studies with a different methodological approach are needed to either confirm or refute their findings.
Curiously Cancer Research UK mentions that the manufacturer of Mirena says that it should not be used after a diagnosis of cervical, uterine and liver cancer, but omits to mention that the manufacturer advises that it should not be used by those who have or have ever been diagnosed wih breast cancer.
At the start of Feb 08, I wrote to NICE (National Institute for Clinical Excellence) to ask them to select Mirena as a topic to produce guidance for use in people who had been diagnosed with breast cancer, on the basis that doctors seem to give conflicting advice to patients and that little seems to be known about the role played by progesterone in development of breast cancer. They are still considering whether to select it as a topic.
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I had Mirena for heavy periods and had it removed as a precaution after breast cancer diagnosis. I've had four years on another medication that seemed to sort out the heavy periods about 9 months after I started taking it - Tamoxifen.
Coincidence - who knows?
I developed a breast cyst within 3 months of having Mirena fitted and that's what got me referred to a breast clinic and led to cancer being found in the other breast. After mastectomy I developed more cysts in the remaining breast. It all quietened down after I had Mirena removed.
If I'd kept it, I would have felt like I was participating in an unregulated trial.
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In Feb I emailed this suggestion to NICE: That NICE provides guidance for the use of the levonorgestrel-releasing intrauterine system (LNG-IUS) device Mirena, having due regard to the uncertainties relating to breast cancer risk and use in women who have had breast cancer.
Anyone can suggest a topic to NICE. They evaluate suggestions to see whether they are appropriate for them to provide guidance. So I'll see what happens.
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I'm not aware of any trials that have found that Mirena prevents uterine cancer - a question for gynaecologists. The Eclipse Trial is currently looking at the clinical and cost effectiveness of Mirena ffor heavy menstrual bleeding compared with other treatments.
Recruitment started in 2004 with 5 year follow up. No mention of whether women who have had breast cancer are eligible for the trial or whether assessing breast cancer incidence in the study groups is going to be part of follow up.
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Forgot to say - just picking up on Angee's point. I think there is quite a lot of uncertainty about Mirena, but I'm not aware that there's any proof that it is implicated in new or recurring breast cancer so I hope you don't feel too bad about what you've read.
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Mirena seems to be trotted out regularly to deal with heavy bleeding and I wonder whether surgical alternatives - like endometrial ablation (for those that have had/don't want children) might actually be safer in relation to breast cancer risk - and less hassle.
Surgery to deal with gynae problems seems only to be used as a last resort now (perhaps due to cost), but I think modern techniques may make it much less unpleasant and debilitating than it used to be. GPs don't seem to want to discuss surgical options, they just seem to want to write out prescriptions for hormones or other medication.
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If you go onto the website of the Royal College of Obstetricians and Gynaecologists and search on Mirena, you can see what they say.
It is thought to be protective against endometrial problems caused by Tamoxifen, but they mention Canadian guidelines that talk about the unknown risk on recurrence in people who've had breast cancer, and the limited data available to suggest that it does not increase breast cancer risk in the general population.
The risk is "unknown" because no clinical trials have been done to specifically look at whether Mirena increases risk of recurrence in women who've had breast cancer.
Bottom line is that it's Cat 3 UK Medical Eligibility for use in women who've had breast cancer - where theorectical or proven risks usually outweigh the advantages of using the method.
I keep an open mind as to whether it is implicated in causing breast cancer. I was diagnosed with BC within four months of having one (which I then had removed), but mine was not an aggressive cancer so it may have existed for a long time before I used Mirena.
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If anyone wants to find the website link for themselves, they just need to enter the words Tubular Breast Cancer Swedish Study in a search engine and they'll find plenty of relevant info, including the link that was removed.
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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"
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How many of you were diagnosed with Tubular Breast Cancer? So called because of the shape of the cancer cells.
I doubt it's many as it's supposed to be only about 2% of cases. My reason for asking is that I was diagnosed with it and, having acquired some information about it, I have a theory as to why I developed it. So it would be interesting to see whether my theory applies to other people diagnosed with it or whether it's rubbish.
Every expert I've spoken to says Tubular Breast Cancer has an excellent prognosis. I want to look into whether it is actually an avoidable type of breast cancer.
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