DR ELLIE CANNON: The query girls will ask… Did HRT play a job in Davina McCall’s breast most cancers?
To hear that Davina McCall has been diagnosed with breast cancer, given she has recently battled a brain tumour, is dreadfully sad.
Her outlook is good: treatment for the disease, which affects 55,000 women a year in the UK, is now excellent and catching it early gives her the best possible chance of beating it fast.
But many women will understandably now be wondering whether 58-year-old Davina’s well-publicised and long-term use of hormone replacement therapy, or HRT, to treat her menopause symptoms could have played a role in the development of the disease.
First of all, HRT can be lifechanging for many women. And, of course, we can never definitively say what has caused someone’s cancer.
But it is true that there is a slightly increased risk of breast cancer among women who are taking HRT, in particular those who – like Davina – take combined oestrogen and progesterone in any form. (Women who take oestrogen-only HRT, or who use vaginal oestrogen, face no increase in risk.)
In the UK, about 2 per cent of all breast cancer cases, equivalent to around 1,000 new diagnoses a year, are thought to be linked to HRT. To put it in context, that’s still less than the risk of breast cancer from regularly drinking alcohol, or being obese.
Crucially, however, that risk depends how much HRT you take – and for how long.
The official advice from the British Menopause Society is that women should be on the lowest dose for the shortest time necessary – and to not exceed guidelines for the highest recommended dose.
Davina McCall, 58, posted to her Instagram story to encourage other women to check their breasts
The sign that Davina saw inside ITV headquarters toilets that encouraged women to ‘check their boobs’
As a GP, I’ve become increasingly concerned about the use of very high doses of HRT being advocated and prescribed by some private doctors.
The growth of the menopause industry, however well-intended, has misguided some women into believing HRT is harm-free.
It is still a drug, and it does carry risks. For most women these are hugely outweighed by the benefits.
But you can tip the balance if you take too much, for too long.
Breast cancer is one of the most common cancers in the world and affects more than two MILLION women a year
Breast cancer is one of the most common cancers in the world. Each year in the UK there are more than 55,000 new cases, and the disease claims the lives of 11,500 women. In the US, it strikes 266,000 each year and kills 40,000. But what causes it and how can it be treated?
What is breast cancer?
It comes from a cancerous cell which develops in the lining of a duct or lobule in one of the breasts.
When the breast cancer has spread into surrounding tissue it is called ‘invasive’. Some people are diagnosed with ‘carcinoma in situ’, where no cancer cells have grown beyond the duct or lobule.
Most cases develop in those over the age of 50 but younger women are sometimes affected. Breast cancer can develop in men, though this is rare.
Staging indicates how big the cancer is and whether it has spread. Stage 1 is the earliest stage and stage 4 means the cancer has spread to another part of the body.
The cancerous cells are graded from low, which means a slow growth, to high, which is fast-growing. High-grade cancers are more likely to come back after they have first been treated.
What causes breast cancer?
A cancerous tumour starts from one abnormal cell. The exact reason why a cell becomes cancerous is unclear. It is thought that something damages or alters certain genes in the cell. This makes the cell abnormal and multiply ‘out of control’.
Although breast cancer can develop for no apparent reason, there are some risk factors that can increase the chance, such as genetics.
What are the symptoms of breast cancer?
The usual first symptom is a painless lump in the breast, although most are not cancerous and are fluid filled cysts, which are benign.
The first place that breast cancer usually spreads to is the lymph nodes in the armpit. If this occurs you will develop a swelling or lump in an armpit.
How is breast cancer diagnosed?
- Initial assessment: A doctor examines the breasts and armpits. They may do tests such as a mammography, a special x-ray of the breast tissue which can indicate the possibility of tumours.
- Biopsy: A biopsy is when a small sample of tissue is removed from a part of the body. The sample is then examined under a microscope to look for abnormal cells. The sample can confirm or rule out cancer.
If you are confirmed to have breast cancer, further tests may be needed to assess if it has spread. For example, blood tests, an ultrasound scan of the liver or a chest X-ray.
How is breast cancer treated?
Treatment options which may be considered include surgery, chemotherapy, radiotherapy and hormone treatment. Often a combination of two or more of these treatments are used.
- Surgery: Breast-conserving surgery or the removal of the affected breast depending on the size of the tumour.
- Radiotherapy: A treatment which uses high energy beams of radiation focused on cancerous tissue. This kills cancer cells, or stops them from multiplying. It is mainly used in addition to surgery.
- Chemotherapy: A treatment of cancer by using anti-cancer drugs which kill cancer cells, or stop them from multiplying.
- Hormone treatments: Some types of breast cancer are affected by the ‘female’ hormone oestrogen, which can stimulate the cancer cells to divide and multiply. Treatments which reduce the level of these hormones, or prevent them from working, are commonly used in people with breast cancer.
How successful is treatment?
The outlook is best in those who are diagnosed when the cancer is still small, and has not spread. Surgical removal of a tumour in an early stage may then give a good chance of cure.
The routine mammography offered to women between the ages of 50 and 71 means more breast cancers are being diagnosed and treated at an early stage.
For more information visit breastcancernow.org or call its free helpline on 0808 800 6000
