Rubbing one's nipples and eating less margarine is the latest advice; 'Lifestyle theories say one thing: you've brought cancer on yourself'
Enough scaremongering and loony advice on 'controlling' breast cancer. Where's the serious research, asks Esther Oxford

Last week I had a breast-cancer scare. Lumps. A sore. The locum doctor who examined me said that she would laser away the sore and send it off for analysis. Meanwhile she would refer me to a breast specialist - I'd know the result in five weeks, she said.

When I left the surgery the noise in my ears was so overwhelming that the world became silent and slow around me. Two schoolgirls lolloped in slow motion down the street, large breasts heaving like a swelling, bursting wave. Cars passed, faces peering out like grotesque masks. The question pounded: would I be one of Britain's unlucky 25,000 women diagnosed with breast cancer this year? Would I be one of the 15,000 who die from it? And more pertinently: what could I have done to help myself?

Everything and nothing is the answer. Women who drink alcohol and women who are childless have a higher chance of getting breast cancer, say scientists. As do women who've had an abortion, are obese or have children late. And women who have a family history of breast cancer, are on HRT, have had a late menopause, been put on the Pill, or started their periods early.

Now, according to research outlined in Dressed to Kill, a "revolutionary" book just published in the States, there is a new X factor in the equation. The bra. Why? Because wearing a bra too many hours a day - and choosing the wrong kind of bra - can increase the risk of getting breast cancer, says Sydney Ross Singer, co-author of the book and director of the Institute for the Study of Culturogenic Disease in Hawaii.

The research took place over two and a half years and involved 4,730 women - half of whom had been diagnosed with breast cancer and half of whom had no known diagnosis of the disease. The researchers "discovered" that women who wear bras for more than half a day are at least 21 times more likely to develop cancer than those who wear their bra for less than 12 hours a day.

The book is based on a theory about the "build-up of toxins". Toxins, explain the researchers, are stored in the fatty parts of the body. They enter the body through pesticides in food and "cancer-causing substances in the air". The lymph system, which is part of the immune system, is supposed to cleanse the body of toxins. But if a woman wears a tight bra, she constricts the breast tissue, preventing the lymph system from cleansing toxins from the breast. Meanwhile the toxins beaver away inside her breasts "doing their best to transform normal cells into cancerous cells".

The researchers say they know "what women can do to reduce the odds of getting breast cancer". Wear your bra as little as possible. "Put it on as late as possible before leaving the house and remove it as soon as you return." Try to avoid under-wired bras or push-up bras, too: these "compress the breasts" and stop the lymph system from draining "cancer- causing toxins" from your breasts. And don't, whatever you do, wear your bra to bed: women who do are "125 times more likely" to get breast cancer than women who don't wear a bra at all.

Dressed to Kill will fuel women's copious fears of ill-health. It slots neatly into the hundreds of journals, books and pamphlets which tell women how to stop getting a lump, how to detect a lump, how to care for your lump. This book, like many others, puts the onus on women to change their lifestyle: stop wearing a bra and your chance of getting breast cancer will be reduced.

Lifestyle explanations for breast cancer were in their ascendancy in the mid-1970s. Diet and smoking were the key concerns then. During the 1980s female hormones took over as the main perpetrators of the breast- cancer crime. Best to breast-feed and get pregnant several times, doctors said.

Two years ago scientists switched their attention to the cancer gene. Women found to have the gene were told to take preventive measures. A good many "at risk" women dutifully requested a mastectomy. A handful of women identified as "high-risk" opted for a double mastectomy. That done, the fashion reverted to the lifestyle theories. Rubbing one's nipples and eating less margarine is the latest advice on how to avoid cancer.

"Patients find themselves bombarded with information," says Nikki Hill, spokeswoman for BACUP, a charity for patients with cancer. "Accurate information can help women get back in control ... but there is a lot of rubbish out there."

Ian Fentiman, consultant surgeon at the Clinical Oncology Unit at Guy's Hospital, says much of the so-called "advice" should be taken with a pinch of salt. "Some books contain an element of truth. But often they are written by crackpots," he says. Even data from surveyspublished in respected journals should not be taken as "proven".

The link between the contraceptive pill and breast cancer is one example of a popular theory that turned out wrong. For years a whispering campaign warned women not to take the Pill. Ten years on, the fears have proved unfounded. Dr Valerie Beral, head of the Imperial Cancer Research Fund's epidemiology unit in Oxford, recently told a conference on breast cancer that eight out of 10 women now in their late forties and six out 10 in their early fifties had taken the Pill. So far there has been no evidence of increased risk.

Other "scientific findings" have proved to be anything but scientific. Last year a tabloid newspaper carried an article which said that eating soya beans can reduce the risk of death from breast cancer. The research - from scientists at the Dunn Nutrition Centre in Cambridge - involved just six women in the preliminary trials.

In some cases figures have been sensationalised to give maximum impact to an article in a magazine or newspaper. A prime example is the "fact" which states that one in 10 women will get breast cancer. This is not true. A 25-year-old woman has a 1-in-19,608 chance of having breast cancer, according to another book, Preventing Breast Cancer: The Politics of An Epidemic, by Dr Cathy Read. The statistic goes up to 1 in 622 at age 35, 1 in 24 by age 60 and only reaches 1 in 10 at the age of 80.

The truth is that scientists know very little about cancer. Despite the billions of pounds that have been spent on "combating" breast cancer, there is, of course, no cure, and the available treatment (surgery, radiotherapy, hormone therapy and chemotherapy) is delivered unreliably (women at half of the 230 hospital units are getting sub-standard treatment from inexperienced surgeons, according to a government report published last month).

The death toll in Britain is a national scandal. The number of women dying of breast cancer is higher here than in any other industrialised country: Britain has 28.7 deaths per 100,000 population, compared with 22.4 per 100,000 in the States.

It is not surprising there is a climate of fear. So why are women and men exacerbating it? Why does a woman have to be a food-faddie, breast- feeding mother of three, who likes to whip her bra off the moment she comes home and stand there massaging her nipples, before she is seen as a woman in control of her own health?

In her book Dr Read argues that the lifestyle theories allow scientists to redistribute blame. "Simply translated, the lifestyle explanation says one thing - you have brought breast cancer on yourself because of something you have done." By putting the onus on women to protect themselves from breast cancer, doctors can shy away from the real issue: their own failure to save the lives of 15,000 breast-cancer patients each year.

Blaming patients for their "unhealthy" lifestyle makes them more malleable, says Dr Read. They are forced into a position where they have no option but to feel thankful. "Women are made to feel grateful: grateful that their cancers were picked up by screening, grateful for their treatment and lucky to still be alive," she says in her book. The doctor's job is thus made easier. "Certainly the easiest and probably the luckiest patients are those that say: 'Tell us what to do, doctor'," one gynaecologist is reported to have said.

But by overemphasising the impact of behaviour and lifestyle, women are being given a false impression of control. While this may give temporary relief to a government and medical establishment keen to distribute blame, the tactic has backfired. The more women are made to feel they should be controlling their lifestyle to cut the risks, the more likely they are to opt for "alternative" treatments, says Dr Read. They are also more likely to start yet another personal crusade to teach other women about so-called preventative measures.

All of which is probably true. But guess what. The blurb on Dr Read's book tells us: "Conventional medicine has failed to find a cure for breast cancer ... but it is not beyond our means to control it." Inside are chapters on diet (how to choose "protective" food), the environment (mostly anecdotal evidence about the damage caused by pesticides) and the Pill and HRT.

Yes, women should be empowered to fight against cancer. But surely what they must do is demand more research, better care, a truly scientific approach in all literature and a restriction on madcap theories. Perhaps someone should write a book about it.

Me? I passed the week in a trance then went back for a second opinion. "You're naturally lumpy," my GP said. And laughed.