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We can beat breast cancer
by Sarah Barnett
So says breast surgeon Susan Love – and she doesn’t mean a little bit at a time, but altogether. Completely.
What exactly are the risk factors for breast cancer? Doesn’t matter, says Dr Susan Love. This iconoclastic US breast surgeon is founder of the Susan Love Research Foundation, whose aim is to eradicate breast cancer altogether. Her book, Dr Susan Love’s Breast Book, about to go into its fifth edition, has been called “the bible for women with breast cancer” by the New York Times.
Now, by phone from her California home before she speaks here at the Breast Cancer Network’s first national conference this weekend, she says, “I really get somewhat irritated with the whole concept of risk factors, because it makes it sound like, if you don’t have them, you’re home free, which is absolutely not right.”
Seventy to 80 percent of breast cancer patients she sees present with none of the known risk factors, she says, so “they really don’t mean very much”.
In fact, in New Zealand, according to the Breast Cancer Foundation, 90 percent of women diagnosed have no known risk factors – not counting the No 1 risk factor: being female. One percent of breast cancers occur in men.
The next risk factor is age, with the oft-repeated, scary and mostly misunderstood statistic that one in every 10 women will get the disease. That’s a lifetime risk, explains Sue Claridge of the Breast Cancer Network. So, “if you have a group of 80-year-olds, one in 10 of them will have had breast cancer. In a group of 40-year-olds, it’s more like one in 2000.”
Studies have drawn links between breast cancer and smoking, alcohol consumption and a lack of physical fitness; the jury is out on whether diet has any effect at all. The Associated Press reported this month that the massive US Women’s Health Initiative dietary study, in which nearly 40,000 women between the ages of 50 and 79 had their dietary fat intake monitored, has found negligible impact on breast cancer rates – although there are signs that lower fat intake helps avoid ovarian cancer.
The links between oestrogen and breast cancer are well-known – women having fewer children, later, and the corresponding overall lifetime oestrogen burden has led to increasing incidence.
Love doesn’t necessarily deny the validity of any of these correlations, but reiterates that they only account for a minority of the cancers she sees – although she understands the thirst for information.
“We so much want to have control, want to think, if I just do this, I won’t get it. We start giving them [the risk factors] more power than they deserve … That’s how we do breast cancer research – we keep looking at the same risk factors over and over again, because that’s what we know. If we stick with the same old stuff, we’re going to get the same old answers.”
But Love is no defeatist. Her foundation this month received a $US1.2 million grant from the cosmetic company Avon for, officially, “the Development of a Breast Fluid Test to Identify Women at Risk for Breast Cancer”, another step towards the end of breast cancer.
Love knows that people tend to be a little incredulous at her aims, but says there’s a problem with the current mindset: “Oh, we’re just going to make chemo a little better, or we’re just going to make the surgery a little better, as opposed to: how are we going to stop it altogether?”
Love is no stranger to sceptical reactions to her views. As a surgeon, she was an early proponent of lumpectomy and radiation instead of radical mastectomy. At the time, she was accused of putting women in danger for cosmetic reasons; now it’s routine.
She also rang early alarm bells over the dangers of almost universal Hormone Replacement Therapy for menopausal women and an increase in breast cancer as a result. As far back as 1998, she was openly critical of pharmaceutical companies marketing hormones to doctors and their patients. In an interview with Salon.com that year, she said that proponents of HRT “believe all the observational data that says taking hormones may prevent heart disease, yet they pooh-pooh the observational data that shows it may lead to breast cancer. You can’t have it both ways.”
In 2003, the UK’s “Million Women Study” revealed that post-menopausal women taking a combined form of HRT were twice as likely to develop breast cancer as women who had never taken the hormone preparation. Within a year of that bombshell, the incidence of breast cancer in the US dropped by over 15 percent, Love says, and six percent here.
“It doesn’t bother me at all that people think I’m crazy,” she says. “We keep having these great announcements – the chemo is slightly better, the surgery is slightly better, the radiation is slightly better. In the US, there was a big thing that breast cancer mortality is down two percent. And everybody was all excited. Two percent! We can do better than two percent.”
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