Fear of Breast Cancer: Are Women Overreacting?

Patient Expert

An article in today's Los Angeles Times by social psychologist Carol Tavris, and medical oncologist Avrum Bluming, claims that irresponsible reporting by the media foments an exaggerated fear of breast cancer in women. They say and they're right that heart disease kills 10 times as many American women every year as breast cancer. And yet, more women fear cancer than heart disease. Tavris and Bluming conclude that both the cancer research community and the media are playing unfairly on women's inherent dread of breast cancer to spread needless fear.

Tavris and Bluming use a series of studies detailing purported risk factors, some of which appear pretty far-fetched. For instance, one study notes that being a Finnish flight attendant increases breast cancer risk by 87%. Another says that a diagnostic chest X-ray increases a woman's breast cancer risk by 219%. Yet a third notes that gaining more than 33 pounds during pregnancy increases relative breast cancer risk by 61%.

Uh, really? Well, yes these are real studies by responsible doctors and researchers. But Tavris and Bluming argue that the key word here is "relative." For instance, the Women's Health Initiative report the study that started to blow hormone replacement therapy out of the water back in 2002-reported a 26% increase in relative risk of breast cancer for women who'd been taking HRT. Now, that doesn't mean 26 additional women out of every 100 will get breast cancer; that would be absolute risk. Relative risk, in this case, means that 6 out of 100 women taking HRT would be likely to get breast cancer, while that's true of 5 out of 100 in the general population: an increase of just a single woman.

Still" For those of us who've had breast cancer (and don't wish to relive the experience), ANY increase feels absolute. Women in the general population you know, the category we USED to fall into, B.C. (before cancer) can afford to be fearless. After all, statistically speaking, they're at little risk of cancer; as the Times article noted, they're 10 times more likely to die of heart disease.

And, let's face it; heart disease doesn't usually creep up on you. There are specific lifestyle issues that have been proven to increase the risk of heart disease by a huge amount: namely, smoking. And a high-fat diet leading to obesity. And genetic predisposition.

But breast cancer is a sneakier demon. It strikes women of all ages, women in the absolute pink of health. Women who appear to be at low risk. In fact, the majority of women who get breast cancer have no identified risk factors AT ALL. Is it any wonder women fear breast cancer? You always fear the unknown that mysterious bump in the night more than you do the danger that comes to meet you head-on, in broad daylight. And breast cancer is one of the most mysterious of potentially fatal diseases. It's no wonder we react Tavris and Bluming would say over-react to every new study detailing yet another possible risk factor.

My take on this? As survivors, we need to be vigilant. Not scared stiff; not frantic with fear. Just vigilant. And to me, that means sifting through all these studies, and deciding which ones feel "right" to our own situation. Do I have to worry about being a Finnish flight attendant? No. But should I avoid chest X-rays if I possibly can? I believe I should. As usual, you make your own decisions and run with them. And a couple of docs dismissing your fears as ungrounded can go take a hike: they're not the ones with cancer, are they?

Oh, and by the way, the Finnish flight attendant thing? It's not as outlandish as it sounds. Women who work the night shift and get a lot of exposure to artificial lights have been shown to be at increased risk for breast cancer. In addition, vitamin D from sunlight has been shown to help prevent breast cancer. Considering much of Finland's location above the Arctic Circle (read: very little sunlight, lots of artificial light), and the fact that flight attendants often work at night (under artificial light), it's not much of a jump to make the connection.