More frequent mammograms could half the risk of women presenting with advanced breast cancer, new study finds

As an oncologist specialising in breast cancer since the eighties, I have witnessed the transition in the type of disease women present with following the introduction of mammographic screening. This national programme was recommended to the NHS by The Forest report in 1988 and is estimated to save 1300 lives each year.

As screening became more established, across the UK, it became clear that a much greater proportion of women with early cancers were being picked up. This means they are more likely to have smaller, breast conserving operations, less likely to need chemotherapy or even hormone treatments. These tumours have a much better prognosis, but not everybody has agreed that breast screening is cost effective.

Reports started appearing in medical journals that sparked debate over whether the benefits of the breast cancer screening program were outweighed by the high costs and risks which include overdiagnosis and unnecessary radiation exposure. In fact a Cochrane review of all the available studies, published in 2015, even suggested that the screening program creates 30% greater overdiagnosis and overtreatment. Fortunately a more recent independent review for the NHS suggested that the program results in a 20% reduction death from breast cancer.

The reason why this figure is not even higher is because many women who present with larger, hence more advanced disease, are still cured. Advances in surgery, radiotherapy, chemotherapy and biological treatments such as herceptin are preventing relapse, later in life, for thousands of women each year. These treatments, however, can have devastating early side effects and long term consequences. So, picking up a cancer earlier, which avoids the need for these intense treatments, even if the cure rate is the same, is clearly an advantage. 

Currently,  all women aged from 50 up to their 71st birthday are invited for breast screening every three years, in the UK. However, a study published, last week, showed that screening once a year could further significantly reduce the number of women presenting with late stage disease.

The 15 year trial, led by Dr Margarita Zuley, from the University of Pittsburg involved 8,145 patients with breast cancer who had undergone pre-diagnosis screening mammography. The percentage of late-stage cancers diagnosed increased significantly with screening interval. In those who had two yearly mammograms 14% of cancers were regarded as advanced but this dropped to 9% in the women who had yearly mammograms. In those who had greater than two yearly, as in the UK, those whose who presented with advanced disease was nearly 20%. 

Breast cancer is a complex disease that accounts for 12,000 deaths in the UK. Further to this, breast cancer and this treatment has far-reaching impacts on patients’ families, friends, and livelihoods. In addition to attending for screening, look out for lumps in the breast, nipple retraction or discharge, dimpling in the skin or lumps under the arm and present to the GP.

If you have breast cancer in the family, you may be able to be referred for genetic testing and get more frequent screening. For the majority, despite this new data, I doubt if the NHS will adjust the programme any time soon. The trouble is that screening is expensive and the national programme is already near the threshold for cost effectiveness. This is an area, however, where artificial intelligence (AI) may have a role in reducing costs in the future. Studies are already showing improved efficiency in detection, so less mistakes. 

In the meantime, for those who can afford it, this new study suggests that halving the intervals by arranging a private mammogram every three years (alternating with the NHS test) could be a good idea. At around £250, many would regard this as money well spent.

In addition, apart from screening, there are other practical and otherwise healthy ways to reduce the risk from breast cancer. Avoid being overweight or obese which increases the risk of breast cancer. The combination of abdominal obesity raised sugar, fats, blood pressure and inflammation, a condition called metabolic syndrome, is particularly harmful.

Smoking is the main cause of lung cancer but also correlates with a higher risk of breast cancer particularly more aggressive types. Regular exercise for about 2.5 - 3 hours a week, and avoiding long periods of sitting, have also been linked to about a 30% lower breast cancer risk. Any exercise which increases heart and breathing rates is good but it's important to find an activity which is enjoyable, hence sustainable, including running, brisk walking and even cycling. 

Ensure adequate vitamin D levels as deficiency is linked to an increased risk of breast cancer. Sun bathing, without burning, is the best way to increase vitamin D levels. Otherwise, vitamin D supplementation, in the darker months would be sensible, especially if combined with a probiotic that enhances its effect.

Also try to get a good night's sleep. Chronic insomnia can lead to alteration in the circadian rhythm, fatigue, demotivation to exercise and undertake healthy living programmes all of which increases breast cancer risk. There are lots of dietary and lifestyle tips to improve sleep patterns and some over the counter supplements which can help.

Be careful with alcohol as, although a few glasses of red wine a week has been linked to a lower risk of prostate cancer, studies suggest that  any amount of alcohol increases the risk of breast cancer.

Eating more fruit, cruciferous vegetables, and spices increases the intake of healthy phytochemicals, which protect us from cancer by reducing excess inflammation and improving gut flora. There is some evidence that boosting the diet with phytochemical rich supplements may also have a role for reducing the risks of some cancers. 

Reducing meat and particularly processed meat intake such as grilled sausages, bacon, sliced ham and tinned meats will reduce the risk of many cancers including breast compared to low or no meat eaters. 

Avoid Ultra Processed Foods (UPFs) as they are high in salt, sugar, nitrates, trans fats, colours, flavourings, and industrial contaminants, whilst low in fibre, minerals, vitamins and phytochemicals. They can cause oxidative stress, inflammation, obesity and reduced immunity. People who eat a lot of these foods such as cakes, biscuits, pastries, veggie and meat burgers also tend to eat less healthy foods. They are more prone to infections and cancer but also other condition which indirectly increase the cancer risk such as obesity, diabetes and poor gut health.

We are surrounded by carcinogens - potentially toxic chemicals - which can increase the risk of cancer by promoting inflammation, blocking cellular repair and triggering oxidative stress which damages our DNA. These include smoked food, aromatic amines in chargrilled meats, and acrylamides in superheated sugary snacks and cereals. Some environmental chemicals such as pesticides, plastics, cosmetic, deodorants, household cleaning agents and air pollution can promote cancers of the breast via abnormal hormonal stimulation. Try to use glass or stainless steel containers instead of plastic, choose natural personal care products, and avoid using pesticides. It's hard to eliminate all carcinogens but a good idea to limit exposure to as few as possible.

Poor gut health has been linked with a higher risk of many cancers, fatigue, low mood and demotivation. Factors which affect gut health include lack of exercise, processed sugar, smoking, obesity and stress. Bacteria rich foods such as kefir and kimchi help and probiotic capsules, especially those combined with vitamin D  may have a role in boosting gut health especially in people with existing problems. 

Ditch the processed sugar, especially in drinks, as this increases the risks of many diseases including arthritis which impedes exercise, obesity which leads to breast cancer. Adding sugar to tea or coffee also negates their otherwise protective benefits. 

Eat more soy products such as soy milk, tofu and edamame has been linked to a reduced risk of breast cancer and relapse after treatment. Caution must be taken with concentrated soy extracts in supplement form as these could cause abnormal hormonal changes which could increase breast and prostate cancer progression. 

Omega fatty acids are essential for vital biological, immune and inflammatory pathways, yet western diets are noticeably deficient in them. Diets rich in omega fatty acids are associated with lower breast cancer risk and relapse. We certainly should be eating more oil rich foods such as nuts, flax, avocados, pumpkin and chia seeds, as well as seafood including algae, seaweed, mackerel, sardines and other oily fish at least three times a week. 

So, in conclusion, screening is one way we can reduce the impact of breast cancer but we can also do a lot to reduce the risks. Further information can be found in "How to Live" which provides more in-depth explanations of how and why lifestyle interacts with cancer, other disease and longevity.