It never fails to amaze me how current evidence on lifestyle, and cancer prevention and lifestyle, is so rarely talked about outside academic life. If family and friends know that I research cancer prevention strategies they assume this involves genetics, laboratory investigations or testing special dietary regimens.
If invited, I will talk about recent reviews on prevention of breast cancer and the importance of lifestyle, often to a sceptical audience who ask challenging questions and point out that they have never heard about lifestyle factors in a breast cancer context – the GP says nothing, the screening clinic provided no information and my friends ask if I might be confusing cancer and heart disease. At my life stage, we all know women who have had a diagnosis of cancer, we have shared the stories about diagnosis, treatments, hair loss, weight gain and we do our bit to fund raise for scientific endeavours.
Sadly, there is one area of breast cancer research that too often gets ignored – that is how to achieve the changes in lifestyle that could reduce around 30% of the disease. As a participant in a recent Breast Cancer Campaign workshop on risk determination and prevention of breast cancer, it is easy to see how the field has been dominated by risk prediction models, chemo prevention and biological targets.  However, the tide is starting to turn with recognition that breast cancer is an increasing public health problem.
Current estimates suggest that for each 5 BMI units, risk increases by 12%. However, the good news is that sustained weight reduction (of as little as 5% body weight) has shown to reduce risk, even in post-menopausal women. So time to stop accepting that weight gain in midlife is OK, and think carefully about how to avoid a bigger dress size. There is no special diet for breast cancer prevention other than the right caloric intake to avoid weight gain, and keeping to a plant based diet rich in wholegrain and fibre as recommended by the World Cancer Research Fund.
Being physically active is important, both as a way of losing weight, and for the independent beneficial effects on hormone levels – but it is not a magic bullet and forms one part of a lifestyle formulae for risk reduction. For women who drink alcohol, risk is increased by 7 to 10% for each one-unit increase in alcohol per day – a sobering tale that rarely gets told.
Later this year, women attending the West of Scotland breast screening clinic will be offered the SCPN Lifestyle magazine (based on our quarterly newsletter) on a trial basis. It is hoped that this initiative will complement work being undertaken by the NHS on prevention, and raise awareness about positive (and fun) ways to reduce breast cancer risk, and stack the odds against cancer occurrence. The ACTWell feasibility study  showed that women did not find lifestyle messages threatening, but offered a route to empowering action on a disease that women fear.
However, changing lifestyles is not easy when we live in an environment which promotes excess calories and alcoholic beverages, and where fund raising ventures regularly focus on cakes and cookies. It really is time to explore how we can support women to do the things that will reduce the incidence of breast cancer at a policy, practice and personal level.
Will any political party be brave enough to take this on?
Professor Annie S Anderson BSc PhD RD FRCP (Edin)
1 Risk determination and prevention of breast cancer. – PubMed – NCBI
2 Breast cancer risk reduction – is it feasible to initiate a randomised controlled trial of a lifestyle intervention programme (ActWell) within a na… – PubMed – NCBI