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Breast cancer is diagnosed in 33,000 women in the UK each year; of these, an unusually high proportion had an abortion before eventually starting a family. Such women are up to four times more likely to develop breast cancer.

A report by the Royal Statistical Society shows that a termination of pregnancy interrupts the cellular changes that occur in the breast during pregnancy. Once the woman has had children, the effect is less because the cellular changes have been completed.

Breast cancer becomes more common with advancing years — 75 per cent of these cases occur in post-menopausal women, which emphasises the importance of continuing with routine mamm-ography after the age of 65, and the need to remain vigilant by checking the breasts regularly. The outlook for women who develop breast cancer and who have had their breasts screened frequently by mammography is exceptionally good.

The NHS now provides this service for older women, though they may have to apply for it.

The introduction of tamoxifen in the treatment of breast cancer in those women who are oestrogen-receptor positive, and whose tumours are therefore influenced by hormone levels, has revolutionised the treatment of breast cancer. Four out of ten such cancers are receptor positive before the menopause, six out of ten after.

Recently drugs have been introduced that may be suitable for treating patients who have become tamoxifen-resistant — this is called second-line treatment. These drugs, known as the aromatase inhibitors, are anastrozole (Arimidex), vorozole (Rivizor) and letrozole (Femara); each has been shown to be superior to those formerly used in second-line treatment.

These drugs challenge some assumptions made about the treatment of breast cancer when the earlier drugs were the only ones available.

In so far as Arimidex, Rivizor and Femara are concerned, there seems to be little to choose between them as a second-line treatments. There are minor advantages and disadvantages to each, but a report in the Annals of Oncology suggests that the differences were such that it may be that they were no more than a reflection on the way in which the trials were designed, or of the patients who were recruited for the trials.

Femara has been granted a licence for first-line treatment and pre-operative use in post-menopausal women to shrink their breast tumours before surgery. Its use increases the likelihood of patients being assessed as suitable to undergo breast-conserving surgery as opposed to a mastectomy. Femara is also useful as an initial form of treatment in advanced breast cancer and has been shown to be superior to tamoxifen in such cases.



Member Organisation, World Council for Life and Family

NGO in Special Consultative Status with ECOSOC of the UN