Recurrence 4: Fasting, aspirin, statins… is there anything that doesn’t reduce the risk of breast cancer coming back?

Every week it seems we’re being told that scientists have found yet something else that reduces the risk of breast cancer coming back or spreading. Prolonged nightly fasting, low-dose aspirin, cholesterol-lowering drugs, taking anti-oestrogen tablets for a decade instead of five years… you name it, it’s all meant to help improve the odds that women who’ve been treated successfully for primary breast cancer will live the rest of their lives breast-cancer free.

There’s been a lot in the past few months alone*. First it was reported that prolonged nightly fasting – of more than 13 hours, for god’s sake! – might reduce the risk. Then we were told low-dose aspirin might do the same (this isn’t new as such but there was new research). More recently there was huge media excitement over the possibility that cholesterol-lowering drugs or statins might prevent breast cancer that is fueled by oestrogen – by far the most common type of breast cancer – from returning. Then just a few weeks ago, reports seemed to bolster the argument that women with this type of cancer should take oestrogen-blocking aromatase inhibitors for ten years instead of the currently recommended five.

Read behind the headlines, though, and you invariably find things are never as straightforward as they seem. The research will be very early, or it’ll be based on limited data, or it’ll potentially apply just to some, not all, women, or there will be side effects that potentially outweigh any added benefit. You soon realise developments are nowhere near as earth-shattering as the headlines imply.

It’s easy to see why people want to believe we’ve solved the problem of breast cancer coming back and/or spreading. Primary breast cancer doesn’t kill but secondary/advanced/late-stage/Stage IV/metastatic breast cancer does. Once you’ve got it, median survival is just two to three years (Recurrence 1 & Recurrence 2). More than 11,500 women (and tens of men) die of breast cancer in the UK alone each year.

There’s no shortage of risk-reduction advice out there. Some of it is clearly rubbish, but I kind of understand why people choose to believe it. The novelist Helen Dunmore puts it much better than I ever could in her book The Siege. She writes: “The facts of life have been torn up and scattered, so you might as well believe in theory and rumour as anything else.”

You really do feel when you get a cancer diagnosis that the divine order of things as it were has somehow been disturbed. We complacently believe we’re all going to live til we’re 90 and we’re shocked, stunned, outraged, etc, etc, etc when we realise we might not get there. Dunmore’s novel is about the two-and-a-half- year siege of Leningrad during the Second World War in which hundreds of thousands of people starved to death. At some point during the blockade, people took to believing it was safer to walk on southern side of the street. It had to do with the fact the Germans were bombarding from the south of the city and so the northern pavements were seen as more dangerous. It probably didn’t make any difference which side you walked on. Like people who are desperate for a “cure” for their cancer or want to do everything they can to stop it coming back after being treated successfully first time round (Recurrence 3), it was case of any port in a storm.

Cancer Research UK points out that the fact there are problems with conventional medicine doesn’t automatically prove that alternative “cures” work. I like the metaphor they use: “Just because cars sometimes crash doesn’t mean that flying carpets are a viable transport option.” Sometimes, though, for the best of reasons, we really want to believe they are.

 

“Looking relaxed, happy and hairy”

I never thought I’d take being called hairy as a compliment, but when I posted a photo of myself on Facebook recently and a friend* commented that I was looking “relaxed, happy and hairy”, I had to smile. It’s nearly seven months since I finished the breast cancer chemotherapy treatment that rendered me bald (The great Sugar Loaf uncovering) and now I just look like another greying, short-haired, middle-aged woman.

I’ve already had one haircut and I’m close to needing another. The chemo has made my hair curly and everyone says it looks nice and thick. It really isn’t, though. In fact, the hormone therapy I’m taking causes your hair to thin, so that’s another delight to look forward to.

So am I more dark than grey or more grey than dark? I don’t care either way, but it seems the answer varies depending on who’s doing the looking. I come in after getting the haircut and younger son Finlay looks at me and says “It’s quite dark, isn’t it.” Five minutes later husband Andy appears and, subtle as ever, says “God, it’s really grey!” Go figure.

I still haven’t used a comb or brush. I towel it dry, add some ridiculously expensive “product” and off I go. I love not dying or colouring it.

The photo you see here is the one I posted on Facebook. It’s from two weeks ago, in Madrid, and I’m standing outside the flat I lived in when I first went to live there almost 33 years ago. I lived in Madrid for three years in all. I met Andy there. I still have good friends there. I love the place. Andy and I were there a couple of weeks ago for a bit of a treat (If planning a holiday is a clear sign of recovery…). In all the times I’ve been back since living there in the 1980s, I’ve never felt the urge to go and take a look at where I used to live. This time was different, I guess because so much has changed in the past year. The door to the block of flats was open. I could have gone in. I didn’t, of course. Because you can never go back, and that applies as much to early last summer, before breast cancer came on the scene, as it does to September 1983.

Back to the hair. The other day Finlay greeted with me with “Ooh, bed head!” rather than “Morning, mum”. We’re moving on.

*Thanks, Brenda!

Recurrence 3: Keeping my side of a really hard bargain

After you’ve had treatment for breast cancer, you’re told to do certain things to reduce the risk of it coming back. Don’t smoke, cut down on your alcohol consumption or stop drinking altogether, eat healthily, keep to a healthy weight, exercise and keep fit and, for many of us, keep taking the daily anti-oestrogen therapy (One down, just 3,652 to go).

This is all good advice. Really it’s no different from what we’re meant to do anyway (apart, of course, from the hormone therapy). I do have a problem with it, though. It risks making women feel guilty if they don’t manage to follow it – regardless of whether their cancer comes back or not.

I’ll do my best to keep my side of this hard bargain. No matter how well I manage, though, there’s no guarantee I’ll stay “cancer-free” (Recurrence 1 & Recurrence 2). As with getting breast cancer in the first place (How did I “get” breast cancer?), there are factors – some undoubtedly we’re not yet even aware of – over which we have little or no control.

So what am I doing to reduce my risk of recurrence? I don’t smoke, so that wasn’t a problem. I’ve always been active and done loads of sport but I’ve now started running regularly – not far, but at least I’m doing it. Also, I make a point of cycling to places where before I might have driven. So I’m probably fitter than I was before  I was diagnosed last July. I’ve also shed a good few kilos. I’ve gone from being a regular to an occasional drinker of alcohol… although I did make an exception for the few days I’ve just spent in Madrid (If planning a holiday is a clear sign of recovery…)! Finally, while I reckon I ate pretty healthily before, I have changed my diet quite substantially. I eat far less, for a start. I can’t bring myself to become a vegetarian but I have cut down on red meat and I’ve almost completely cut out processed meats – I very rarely now have things like bacon or chorizo, both of which I adore. I didn’t eat a lot of what I would term “rubbish” before, but I’ve cut out almost completely things like crisps and biscuits. We were on the coast in Norfolk for a few days over the Easter break and I didn’t even have an ice cream. Yes, I agree, where’s the fun in that?

I know these changes are all positive, but to be honest I’d feel better about them if they’d been driven by a genuine desire for change rather than by fear of recurrence.

A while back, I went to two pubs in one day – not my usual practice, I assure you. In one I had a coffee and in the other I had lime and soda. That would have been unthinkable before breast cancer. I’m sure it’ll wear off but I’m still at the stage where I have to force myself not to be paranoid or judgmental about the drinking and eating habits of friends, family members and even random members of the public. I look at folk knocking it back in the pub or tucking into some really unhealthy food and think “I know where you’re heading”. If I’m not careful, I’ll end up healthier and fitter than ever before but I’ll be bloody miserable and a real party pooper!