Well, we won the Breast Cancer Now sponsored debate easily and the house supported the motion that “This house believes we should stop focussing on the CAUSES of breast cancer and get on with strategies to PREVENT the disease”.
It was indeed a pleasing win given we had a full house in a conference dominated by molecules, single nucleotide polymorphisms and chemotherapy. All important areas in the mega- challenge of cancer treatments, but let’s face it the challenge of prevention trumps it all and enjoys the least investment.
There is of course less profit to be made from public health prevention strategies involving lifestyle change– THE inconvenient grand challenge area that is conveniently side stepped.
But our debate was NOT about spending less on investigating treatment (which everyone wants to support) but spending less on investigating causes because (we argued) that the excellent work to date has already provided enough data to take action to prevent the disease. Future work on causes will be expensive refining – valuable, yes, but of less significance than research on developing preventative strategies. We cited the review paper by Howell et al. which reports that potentially 50% of breast cancers could be prevented in the subgroup of women at high and moderate risk by chemoprevention (e.g. tamoxifen) and that in all women lifestyle measures (weight control, exercise and moderating alcohol) could reduce cancer risk by 30%.
What was really interesting for me was not the science and our well-rehearsed arguments but the questions from the floor, scathing tweets, and quietly spoken comments at the end of the evening.
- Can we find drugs that emulate the protective factors of pregnancy and lactation?
- How can we help women to adhere to their chemoprevention regimes?
- What are the genetic risks of secondary cancer from chemoprevention?
These queries were ably addressed by fellow team member Professor Gareth Evans and opponents Professor Doug Easton and Professor Tim Key.
Then the audience waded in on their pet route to lifestyle change:
- tackle the food industry
- teach people to cook and develop cultural appreciation of food, education etc.
The twitosphere was more direct:
- not more education
- WCRF do this anyway
- teachable moments at screening clinics – let’s use them
- more support for women in sport
All of which feeds into my vision of the breast cancer charities really taking a lead on supporting and advocating lifestyle change, tackling an alcohol industry that actively promotes a carcinogen for women and being a force for changing the incidence of breast cancer in this country. In our ActWELL study many women participated in research because they had family and friends affected by breast cancer but most did not know about the links between obesity, activity, alcohol and breast cancer. There is much scope to do better than just provide a few facts in leaflets and draw on the strength of a potentially very powerful breast cancer lobby. Breast Cancer NOW have set out a challenge for really tackling this disease and, if they are serious they cannot achieve their aims without supporting research on effective lifestyle change.
Then there were the comments and queries from quieter members of the audience. Where was the patient voice – the women who had experienced the disease – have we listened to what they say? These quiet comments were about how patients with breast cancer feel very uncomfortable hearing about lifestyle, stigmatised by their weight and guilty that they might have been responsible for their cancer. Such comments were a reminder about how unfair my words might seem to patients and another blow to overweight women who try to cope with a society that already abhors obesity and yet promotes the supersize portion, leisurely lifestyles and drinking glamour.
Tobacco control measures have faced the stigma and guilt experienced by smokers who develop lung cancer. We need to find a way to talk about obesity that is supportive and allows engagement without anger and resentment. We can no longer afford obesity to be the elephant in the room. One of many areas we need to understand in a funded research programme about breast cancer prevention
Conflict of Interest: Professor Anderson is a policy advisor for Breast Cancer NOW Scotland
– Professor Annie S. Anderson