Dr Britta Stordal from Breast Cancer UK highlights the important role that breastfeeding plays in breast cancer prevention and explains how CPs can play their part.
Breast Cancer UK’s mission is to prevent breast cancer through scientific research and by raising awareness about the risk factors. Currently, one woman in seven in the UK will develop breast cancer during her life (Cancer Research UK, 2023). The charity highlights the importance of focussing on preventive strategies in order to cut the number of people receiving a diagnosis – and the long-term impact this has.
CAN BREAST CANCER BE PREVENTED?
Researchers estimate that about 30% of breast cancer cases are preventable through making lifestyle changes (Masala et al, 2017; Turati et al, 2020).
Breast Cancer UK supports people to reduce their risk of breast cancer. From the foods people eat to the harmful chemicals people are exposed to; these can help determine whether a person is at a higher or lower risk of the disease. We provide information on these areas, how to be breast aware and how to check for early signs of breast cancer.
BREASTFEEDING REDUCES THE RISK
The UK has a relatively modest rate of breastfeeding, even though cutting a risk of developing breast cancer later on is one of the potential benefits. Just 72.7% of babies in England receive breastmilk as their first feed (NHS Digital, 2021) and breastfeeding rates drop quickly thereafter. Rates are much lower than in Australia and Sweden, for example, where from 92% to 98% of babies are breastfed – and for a longer duration (Victora et al, 2016). Breastfeeding rates are even lower in Scotland and Northern Ireland than in England. Younger mothers and those living in deprived areas are less likely to breastfeed (Oakley et al, 2013; Public Health Agency, 2018; Public Health Scotland, 2021).
The reason for low uptake in the UK is complex, but it has a lot to do with much lower breastfeeding rates a generation ago. In 1990 only 62% of babies were breastfed (McAndrew et al, 2010), so today’s grandmothers typically have less breastfeeding experience than their daughters. This is important as women are more likely to breastfeed if they were breastfed themselves as infants and if their friends were also breastfed (McAndrew et al, 2010).
So much of being pregnant and a parent is about trying to do the right things for the baby – for instance, breastfed babies have a lower risk of infectious diseases such as chest and ear infections, and diarrhoea (Hortaand Victora, 2013; Bowatte et al, 2015). But additionally, breastfeeding is an important opportunity for the mother to benefit.
One woman in seven in
the UK will develop breast
cancer in their lifetime
Mothers who breastfeed have a reduced risk of heart disease, diabetes, and breast and ovarian cancer (Jäger et al, 2014; Chowdhury et al,2015; Islami et al, 2015; Nguyen et al, 2019). The longer breastfeeding lasts, the greater the reduction in risk of disease. Indeed, the risk is reduced by 4.3% for every 12 months of breastfeeding (Collaborative Group on Hormonal Factors in Breast Cancer, 2002).The decreased risk of breast cancer is seen in high and low-income countries. It also doesn’t vary with age or ethnic group. In the UK, an estimated 2585 breast cancer cases each year (4.7%) are linked to women not breastfeeding (Brown et al, 2018).
We also know that breastfeeding reduces the risk of breast cancer in women with BRCA1 mutations (Friebel et al, 2014; Tosset al, 2017). BRCA1 mutations received more attention in recent years due to actress and filmmaker Angelina Jolie speaking publicly about her BRCA1 status and having mastectomies as a preventive strategy (Jolie, 2013). Women with family histories of breast cancer should, in particular, be supported to breastfeed.
About 55,500 women and
370 men are diagnosed
with breast cancer
every year in the UK
SUPPORTING WOMEN TO BREASTFEED
In the UK, first-time mothers may have little experience of witnessing breastfeeding and can need additional support in positioning and attachment of the baby (Brown, 2019). Support can be given professionally and through peer-support breastfeeding networks (Fox et al, 2015). Women who experienced breastfeeding problems but did not receive professional help are more likely to stop (McAndrew et al, 2010).
The 10 Steps to Healthy Breastfeeding (see Table 1) are the basis of WHO/UNICEF Baby-Friendly Hospital Initiative (WHO, 1998). In the UK, only 43% of maternity services and 67% of HV services had full Baby-Friendly accreditation, according toa UNICEF report (2022). However, 95% of maternity services and 91% of HV services were working towards Baby-Friendly accreditation, the report states (UNICEF,2022). A programme of mandatory Baby-Friendly Initiative training for HVs in Bristol led to an increase in breastfeeding rates at eight weeks afterbirth by 1.57 times (Ingram et al, 2011).
| RESOURCES |
| Breast Cancer UK offers videos, iGuides and a quiz to help take the right steps now to prevent breast cancer in the future |
| Find out more about reducing the risk of breast cancer |
| Look out for Breast Cancer Awareness Month |
| National Breastfeeding Helpline 0300 100 0212 |
A recent UK study showed that receiving emotional support from HVs is associated with continuing to breastfeed (Chambers et al, 2023). The authors called for HV caseloads to be reduced in order to boost breastfeeding rates. The informational support that HVs give is a critical factor (Chambers et al, 2023), and breastfeeding support services are not uniform. New mothers need to be signposted to the support available locally as well to the National Breastfeeding Helpline.
WHAT ELSE CAN YOU DO?
Everyone is born with some susceptibility to breast cancer – women more so than men. But the choices people make in their daily life can influence their level of risk. We encourage everyone to understand the risks they face and to attempt to make changes to decrease them (Masala et al, 2017; Turati et al, 2020). It’s never too soon or too late to start.
- Drink less alcohol: It’s best not to drink, but if you do, you should do so in moderation, without exceeding the UK government guidelines of 14 units of alcohol a week (Department of Health and Social Care, 2021).
- Get active: The WHO (2022) recommends at least 150 to 300 minutes of moderate or 75 to 150 minutes of vigorous exercise weekly.
- Maintain a healthy weight: This is a key part of reducing the risk of breast cancer. Gaining weight as an adult increases the breast cancer risk (Renehan et al, 2020).
- Eat more fruit and veg: Eating lots of green leafy vegetables and yellow/orange ones may reduce the risk of breast cancer (Farvid et al, 2019).
- Be aware of harmful chemicals: Chemicals in everyday products and the environment may increase breast cancer risks (Goodson et al, 2015).
We also support the NHS breast screening programme for early detection of breast cancer and encourage women to read about the programme.
Dr Britta Stordal is Breast Cancer UK’s vice chair and head of the science and public affairs committee. She is an associate professor in cancer research at Middlesex University London and recently reviewed the evidence on how breastfeeding can reduce breast cancer risk.
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Brown A. (2019) Why are breastfeeding rates in the UK so low? A Guide to Supporting Breastfeeding for the Medical Profession. Brown A, Jones W (Eds). Routledge: London.
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