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.