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Sunday, 26 May 2013

Compare and contrast

I have been ruminating over the Risk Factors for Breast Cancer over the past couple of days.  They are patently contradictory in some areas and, I fear, parent blaming in others.   I thought I would count the ways I could blame my parents for my breast cancer - not that I do, of course, because that is patently ridiculous.  I have highlighted these in blue.

  1. Not having enough children. Ideally we should have 6.5 children.
  2. Early menarche. If we could have just delayed this by 5 years, that would have reduced our risk. Apparently, we get our periods earlier because we are fed better as children.
  3. Having our children too late, although no ideal age specified
  4. Not breastfeeding for long enough 
  5. Later menopause 
  6. High insulin levels in post menopausal women not taking HRT.
  7. 66% increase risk in women taking HRT 
  8. Increase in risk of women taking oral contraceptives 
  9. Dense breasts (an inherited characteristic)
  10. Previous breast cancer 
  11. Previous breast disease
  12. Genetics and family history of related cancers
  13. Weight. Post menopausal, you need to be "lean" (BMI 21 - 25). Pre menopausal, it helps reduce risk if you are obese. 
  14. Not exercising enough (150 minutes of "moderate" exercise per week)
  15. Alcohol 
  16. Diet - all fats seemed to contribute. Soya seems to be good for you (or less risky than saturated fat?)
  17. Shift work
  18. Higher birth weight, longer labour, older mother oestrogen in the bloodstream 
  19. Height (17% risk for every extra 10cms over average.  I am close to 20cms over average)
  20. Chest X-rays between the age of 10-29
  21. Ionising radiation exposure 
  22. Smoking
  23. Hyperthroidism
  24. Anti-hypertensive medication

It seems to me that my parents shouldn't have been so tall, had me, the only girl, last, fed me so well, had children at all with their familial history of related cancers, fed me any fat and my mother certainly shouldn't have looked after herself so well when pregnant with me (12lbs at birth).

No one has suggested (and I venture to say, would suggest) that I should in any way hold my parents accountable for my disease.  Nor has it been suggested that I should "take the blame" in any way. What has happened is that a variety of factors, mostly beyond my control, have accumulated in a mess of biological and environmental factors to make me ill.  Who is to say that, had I been a lifelong teetotaller, that I wouldn't have breast cancer now?  Or if my mother had married someone shorter?  Or if I hadn't had pneumonia and had to have chest X-rays?  Or had had more children?  Or no children?

My life story is no one else's and my path into this disease is unique.  It is not the same as my friend, R, or my friend, D, both of whom are of a similar age and both of whom also have breast cancer.  I believe neither of them would blame their parents, their upbringing, their inherited breast density or not being obese.  My clinicians are interested in my history but very much as an aside.  I have filled in questionnaires and sent off blood samples.  However, this is very much secondary to my treatment.  Tackling the cancer with operations, chemotherapy and radiotherapy is the number one priority for my clinicians.  The "why" is just not that important and can wait.

Julie O Toole wrote a blog 2 years ago that still haunts me now.  In it, she describes listening with mounting horror, to clinicians discussing cases of anorexia nervosa and their treatment of them.  

Or take the story we heard of "an anorectic [sic] person" whose underlying problem was that she identified with her father's cachexia (wasting) as he was dying of cancer. She "recovered nicely," we were told, once this underlying "reason" for her illness had been uncovered in psychotherapy. Groundless claims such as "neglectful parents and bonding disturbances between mother and child," where you could "actually see why the patient became anorectic[sic]," were offered in place of clinical evidence. Lastly, we heard of a patient who was "exquisitely on death's doorstep," having gained no weight after four years of psychotherapy.

Imagine if I, or R, or D, had to find out what "caused" our breast cancer before we could receive treatment.  I doubt whether any of us would make 4 years of talking about it.  We would all certainly be "exquisitely on death's doorstep", being the age that we are, with no chance of recovery.

So what are the Risk Factors for Anorexia Nervosa? 

Risk factors
  1. female sex, 
  2. infant feeding problems, 
  3. maternal depression symptoms in early childhood; and 
  4. a history of under-eating during early childhood. 

Protective factors were 
  1. high self-esteem in late childhood and 
  2. higher maternal body mass index.
Prenatal events or gestational age, birth weight, separations from the mother, childhood emotions disorders, parenting style, and sleep problems, did not play any role in the later development of AN.  The authors note that the main limitation of their study is the self-report history of AN, and accept that under-reporting and over-reporting might result in some bias.

Prevalence, Heritability, and Prospective Risk Factors for Anorexia Nervosa Cynthia M. Bulik, PhD; Patrick F. Sullivan, MD, FRANZCP; Federica Tozzi, MD; Helena Furberg, PhD; Paul Lichtenstein, PhD; Nancy L. Pedersen, PhD

I have to admit to chuckling about higher maternal BMI.  This ties in with being obese before menopause as protective against breast cancer.  Anti-obesity idiots, please take note.

Is it time for the Eating Disorder clinicians to learn about treatment protocols from Cancer clinicians?  I certainly think so.

1 comment:

  1. Excellent analogy as usual and should be circulated post haste to all ED clinicians or ED psychotherapists who have not yet joined those in the evidence based treatment arena. I know, my daughter is well, thriving and living the teenage dream, dealing with exam stress because we approached this with FOOD IS MEDICINE - good thing I nor she, waited around to find out what parenting style we used to 'cause' her illness. Oncologists are wise souls and the ED field could learn much from their medical colleagues. Thank you Charlotte! Excellent blog :-) x