A reason for the younger woman to keep eating toast

Day 69 

General status update

Fatigue/weakness: slowly improving

Hair: Mostly still attached, but thinning a little. Am starting to find its extreme shininess a little sinister, in the circumstances.

Nausea demon: Currently off-duty, and gone fell-walking. Lucky him.

Chemo Muse: Very unhappy with me for general debility, lack of application and for letting a virus take over my computer (as if I had any choice in the matter)

Despair Demon: Found a gaping hole in my psychic defences after two extraordinarily bad weeks, and has moved right back in. He keeps reminding me that we are only halfway through the chemo, and after the chemo has finished there will be several weeks of radiotherapy, which may inflict permanent damage on my already damaged right lung, not to mention burning of the skin, and more debilitating fatigue, and then there will be five years of the anti-oestrogen drug Tamoxifen, which has all sorts of unpleasant side effects. He has also been reminding me how nice the weather is in Goa at this time of year.

Chemo Brian: keeps offering me mind-altering pharmaceuticals from the sofa to cheer me up, and in truth being away with the fairies is looking a more and more attractive proposition every day.

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Anxiety level (1-10): Sharp anxiety has been replaced by dull despair.

State of mind: I did something really, really mean yesterday – as I walked down King St in Hammersmith to pick up my laptop from the computer repair shop, deeply anxious about whether or not all my data had been destroyed by the virus, I was accosted by a strapping young man with a charming smile and a cocky air, who was wearing a jacket which indicated he was fund-raising for the British Red Cross. These days it is almost impossible to walk down King St without being approached like this; charity fund raisers hang around there in packs, every day. This boy made the fatal error of greeting me by saying something about me needing to smile. I looked him in the eye and snarled ‘I’ve got cancer. I’m probably going to die soon. Why don’t you go and tell someone else to smile?’ So I think it’s fair to say my current state of mind is akin to that of a wounded 18 foot crocodile in a Seriously Bad Mood – approach at your extreme peril.

Before I got cancer, I looked at mortality from the point of view of a demographer: life expectancy at birth in the UK has almost doubled over the last 100 years, making us the luckiest people who have ever lived, in health terms. We all have to die of something, and now that we’ve stopped dying young from infectious diseases, of course more of us are going to die of cancer and heart disease and all the other degenerative diseases of later life. Death is not optional, however much we might like to pretend otherwise.

And if you get cancer relatively young – well, you’re just unlucky.

During one of my early meetings with Stan the Oncologist late last October, whilst I was still wrestling with the question of whether or not to have chemo - and I did have some real choice in the matter, for reasons which will be explained in due course – he said to me, in relation to my breast cancer, ‘I expect you’re thinking ‘Why me?’, aren’t you?’

I looked at him blankly ‘No, not at all. My husband died of leukaemia when he was 32. That was 20 years ago, and I’ve had a whole adult life since then. I’m lucky. He never even got to be middle-aged. Why not me?’

I was, however, somewhat surprised to develop breast cancer, as there is none in my family and all my immediate maternal forebears have lived into their late 80s or early 90s, fully compos mentis and with remarkably little in the way of physical debility; given that there is a strong genetic component in longevity I wasn’t at all worried about getting cancer, of any sort.

Immediately after my diagnosis, therefore, I started researching breast cancer, and what causes it, and was horrified to realise that I had, unknowingly, been in two high risk categories: I have not had any children and, despite being in my fifties, have not yet started the menopause. Both of these characteristics considerably increase your chance of getting breast cancer, because they both mean that in middle age you still have unusually high levels of the female hormone oestrogen, which is strongly linked to breast cancer. I used to be rather proud of the fact that my body was still manufacturing so much oestrogen – every woman dreads getting the menopause. I had absolutely no idea that the oestrogen I was so proud of was feeding the tumour that was developing in my right breast. They score tumours for hormone sensitivity, and mine scored 7/8: it just loved oestrogen.

The way this works in quantitative terms is that overall women who have had children have a 30% lower risk than nulliparous women and the risk of breast cancer is increased by 17% for every 5-year delay in menopause. So, other things being equal, my chances of getting breast cancer were at least 50 % higher than a woman of my age who had had children, and experienced the menopause. I was still unlucky, though, because the absolute risk of getting breast cancer at my age is about 1 in 25 – my added risk factors brought it down to maybe 1 in 15 (if my maths is wrong, then shoot me – at this stage I might be quite grateful).

If you’re interested in looking at the various risk factors for breast cancer, they’re listed and explained very clearly here on the Cancer Research UK website. It’s important to remember, though, that risk factors don’t translate directly into causes - for example, the single highest risk factor for developing breast cancer is age, but age in itself doesn’t cause the cancer.

Just as it’s pointless to wail ‘why me?’ about cancer, it’s also generally pointless to search for a single factor that has ‘caused’ your cancer, given the complex aetiology of the disease: relatively few cases have a direct genetic link – more than 85% of women with breast cancer have no family history of it, and more than 85% of women who have a close relative with breast cancer will never develop the disease.

Factors to do with your reproductive history are very important, as outlined above in my own case. Essentially, the more children you have, and the more you breastfeed, the less your risk of breast cancer. It’s well-known that women in developed countries have much higher rates of breast cancer than women in less developed countries, and this is often ascribed to diet, but in fact a large part of the variation (according to Cancer Research UK, anyway) is due to the fact that women in developed countries have far fewer children, and breastfeed for much shorter periods.

Other factors thought to be important are higher level of endogenous hormones, especially oestrogen and testosterone in post-menopausal women, and exogenous hormones, in the form of oral contraceptives and Hormone Replacement Therapy; the latter gives users a 66% increased risk of breast cancer whilst they’re actually taking it, although the risk increase is temporary – it’s certainly enough to give one pause for thought about using it, though,

I remembered reading that being overweight was an important risk factor for breast cancer, but the data here are quite strange: obesity does increase breast cancer risk moderately, but only if you’re post-menopausal; before the menopause, being overweight actually reduces breast cancer risk, and if you don’t believe me, look here . I include this unexpected fact to cheer up any woman reading this who’s overweight, pre-menopausal and feeling paranoid that every piece of toast she eats is contributing to her risk of breast cancer.

The academic research on diet and breast cancer in general is equivocal, although if you read the ‘grey’ literature you will find it passionately argued by proponents of various dietary regimes that particular foodstuffs e.g. dairy products, meat, white flour and sugar are heavily implicated in many cancers. For breast cancer, there is some hard evidence that saturated fat increases risk, as does high alcohol intake, and lack of exercise, but none of these factors can be pointed to as a single cause.

For me, anyway, it doesn’t really matter now why I got the disease; the real question is whether there is anything I can do, in terms of my lifestyle, to aid the surgery, chemo, radiotherapy and Tamoxifen in preventing the cancer from returning. With all those treatments, my probability of disease-free survival for 5 years is 90%, which sounds pretty good. Conversely, however, there is a 1 in 10 chance of it coming back within 5 years, and so far the statistics have been against me, given that there was only a 1 in 15 chance of me getting it in the first place. 

So, once I’d researched how breast cancer worked, and seen how the risk factors had stacked up against me before I got it, it seemed like a very sensible next step to see what, if anything, I could add to the doctors’ work in trying to reduce the risk of a re-occurrence, without going to the extremes of a completely vegan diet, or coffee enemas. Whilst there are no guarantees there is, it turns out, quite a lot you can do, which I will write about in another post, soon.