Breast cancer risk: what’s breastfeeding got to do with it?

Eliminating risk concept

Two articles on breast cancer risk were published this week and they provide a window on the politics of breastfeeding.

The first paper is Learning, Life, and Lactation: Knowledge of Breastfeeding’s Impact on Breast Cancer Risk Reduction and Its Influence on Breastfeeding Practices.

It received a fair amount of press, including articles like Study finds doctors aren’t telling moms about breastfeeding’s cancer protection:

Promoting breastfeeding as reducing breast cancer risk is yet another inappropriate attempt to pressure women.

When it comes to reducing women’s risk of breast cancer, epidemiological studies connect breastfeeding beyond the baby’s first year with a lower chance of developing triple-negative breast cancer.

That news isn’t getting out enough, according to a survey of 724 women from the Ohio State University Comprehensive Cancer Center. It found that although almost 60 percent of breastfeeding mothers knew their risk of cancer was reduced, only 16 percent said they got the news from health care providers.

The lead author, Bhuvana Ramaswamy, apparently a rabid lactivist, had this to say:

“There’s so much effective marketing by Nestle about infant formula,” she added. Hospitals still don’t always support early breastfeeding efforts, she said.

“Often mothers are told, ‘We can room the baby in the nursery, so you can get a good night’s sleep,’” she said. “They’re bottle-grooming the baby at the start.”

Bottle-grooming? Seriously? Are lactivists analogizing bottle feeding to sexual predation now?

What is the magnitude of this reduction in breast cancer risk? According to the widely cited study by Horta et al.:

The largest individual-level analysis on this topic included about 50000 patients with cancer from 47 studies,30 which is about half those included in our meta-analysis. Each 12-month increase in lifetime breastfeeding was associated with a reduction of 4·3% (95% CI 2·9–6·8) in the incidence of invasive breast cancer.

So Dr. Ramaswamy believes that it is imperative to make women aware of a 4.3% decreased risk of breast cancer because it is yet another factor that will convince women to breastfeed.

The second paper that was recently published is Breast Cancer Risk After Recent Childbirth: A Pooled Analysis of 15 Prospective Studies. The authors found:

Compared with nulliparous women, parous women had an HR for breast cancer that peaked about 5 years after birth (HR, 1.80 [95% CI, 1.63 to 1.99])…

Compared with nulliparous women, parous women have an increased risk for breast cancer for more than 20 years after childbirth. Health care providers should consider recent childbirth a risk factor for breast cancer in young women.

As a New York Times article explains:

…[I]n women between the ages of 41 and 50 who had given birth in the previous three to seven years, the study found that 2.2 percent developed breast cancer, while in those who had not had babies, the figure was 1.9 percent.

That’s an increased risk of 33%.

But don’t worry; that risk is still low.

[R]esearchers said that the findings should not influence women’s decisions about if or when to have children.

See the paradox?

Childbirth increases breast cancer risk by 33% in the short term, but that risk should not influence women’s decisions about if or when to have children.

Yet, breastfeeding decreases the risk of breast cancer by 4.3% and women should strongly consider that in making a decision about whether to breastfeed.

On the face of it, these opposing approaches make no sense. Even with a 33% increased short term risk of breast cancer, the actual number of breast cancer cases is so small that it should not be a factor for women in determining whether to have children. Obviously a 4.3% reduction in breast cancer risk as a result of breastfeeding is far smaller still. Therefore, it should not be a factor for women in determining whether or not to breastfeed.

In truth, a woman’s risk of breast cancer is complex and multifactorial and childbearing and breastfeeding are two relatively minor modifiers of risk. But in the world of breastfeeding promotion, any benefit no matter how small is exaggerated and celebrated as a reason to pressure women to breastfeed.

Taken together these studies illustrate how risk is emphasized or ignored based on researchers’ priorities, not based on reality. Promoting breastfeeding as reducing breast cancer risk is yet another inappropriate attempt to pressure women into breastfeeding. If anyone is engaged in grooming, it is lactation professionals who routinely mislead women about the benefits of breastfeeding, elide its risks and remain utterly dismissive of the harm that pressure to breastfeed causes both babies and mothers.

  • AnnaD2013

    Honestly, they could tell me that breastfeeding leads to everlasting life and given a do-over I would formula feed my daughter from the get-go instead of struggling so hard to breastfeed.

  • Young CC Prof

    As I’ve said before, teen birth is much more effective at reducing breast cancer risk than breastfeeding children later in the reproductive years (and this study just makes that even more clear.)

    But, instead of promoting teen pregnancy, the public health system devotes considerable effort to preventing it. Clearly, there are other considerations than cancer here.

  • HailieJade

    “There’s so much effective marketing by Nestle about infant formula,” – Where? Seriously, WHERE is all this “effective marketing by Nestle?! I’ve been on this earth 34 years and I can honestly say I’ve never seen a single ad for baby formula, ever. Not on TV, not on billboards, not in magazines. It literally does not exist in the world I inhabit.

    Breastfeeding promotion however is a whole other story- it’s everywhere I look. I can’t escape it even when I desperately want to!

    These people seriously live in some kind of alternate universe where no-one has ever heard of breastfeeding and Nestle is sending hit men to hold guns to new mothers’ heads telling them to feed their babies formula from a bottle and leave them in the nursery or die!

    • mabelcruet

      Me neither. And why pick on Nestle? There are other companies who make formula. We have adverts in the UK for follow-on milk, not that you’d know that’s what they are because 3/4 of the advert talks about how wonderful breast milk is. And maternity goodie bags that used to have samples that were given out to post-delivery mums have been stopped-I think all they get now are pamphlets and information sheets, no poisonous formula. I wonder if advertising standards in other countries are less restrictive, maybe the authors think Nestle produces all its allegedly brain washing marketing for developing countries?

      • demodocus

        Ours had a onsie, left over diapers from the pack they opened, nipple cream, breast pads, a sleep sack, and coupons for breast feeding aids. Which I never used.

        • HailieJade

          That is vomit-inducing.

          • demodocus

            To be fair, I’d expressed a preference for ebf. My eff’d daughter’s I’m fuzzier on, being in the nicu was a distraction, but the amount of boob stuff was smaller and the nicu nurses added a bunch of the 2 oz pre-mades.

          • HailieJade

            Ah ok, fair enough. Still, I can totally see those goodie-bags being handed out to women who haven’t expressed a preference either way, or even those who say they don’t want to breastfeed. Such is the world we live in and the state of mothers’ bodily autonomy within the medical community, apparently!

      • HailieJade

        The “Why Nestle?” bit I think I can answer- Nestle were the ones who got in big trouble 35-odd years ago for promoting formula to mothers in the 3rd world who.were mixing it with contaminated water and babies were dying as a result. In other words, these people think it’s still 1981…

    • Third World Countries in the 1970s. Somehow that’s supposed to still be an undue influence on mothers in fully developed nations in the 2010s.

  • mabelcruet

    Does anyone else think this statement is significantly biased?

    “In addition, almost 68 per cent of newborn deaths could be averted in 2030 with simple fixes such as exclusive breastfeeding; skin-to-skin contact between the mother or father and the baby; medicines and essential equipment; and access to clean, well-equipped health facilities staffed by skilled health workers.Other measures like resuscitating a baby who cannot breathe properly, giving the mother an injection to prevent bleeding, or delaying the cutting of the umbilical cord could also save millions”

    It’s from a joint report from WHO and UNICEF:

    https://medibulletin.com/every-year-30-mn-babies-need-special-care-to-survive/

    I’m quite sure that medicines, essential equipment and properly set up health facilities have a far, far greater impact on baby survival than exclusive breast feeding and skin to skin do, so why are those two put first in the list? I think its deliberately misleading and deceitful.

    • demodocus

      I agree. The first two parts are just another variation on homeopathy; no active ingredient but makes you feel like you’re doing something about helpful

    • FormerPhysicist

      One of these things is not like the other … sung as in Sesame Street. Well, two of these things.

    • rational thinker

      It is misleading, the only one of the two I see being useful is the skin to skin, but even that one only applies to a baby born in a mud hut in a village in Africa or somewhere else similar cause newborns often need help raising body temperature after birth. That’s the only reason I would think skin to skin is beneficial and only if you are not in hospital. If you are giving birth in the hospital in a first world country it doesn’t really apply. Personally I would prefer my newborn be placed under a heat lamp after birth than doing skin to skin with me, and both of mine were under one after birth. The whole helping bonding thing seems to me to be nothing more than romanticized poetic bullshit.

  • Cristina

    I transcribe for the BC Cancer Agency and the amount of women declining treatment to breastfeed current children or future children is increasing.

    • Madtowngirl

      That’s honestly horrible. I lost a friend this year to metastatic breast cancer. Early 40s, no children. And she hadn’t declined treatment. Your child needs you more than your breasts!!

      • momofone

        I had bilateral mastectomies almost 5 years ago for this very reason–my then-six-year-old son needed me to be around, not my breasts. It was a no-brainer. I still had people (think La Leche) “reassure” me that I could still breastfeed if I had another baby, maybe through my armpit. Uh, no. And they were floored to hear that if I were able to breastfeed, it would mean that my surgeon had done an incomplete job, not that I was blessed with the miracle of continued lactation. It was even more distressing to hear that I had breastfed for almost 2 years, because that could be interpreted to mean that it did not offer the magical protection they had been sold (assuming they were open to that interpretation, which many were not). Because clearly the important thing in the big picture was breastfeeding. /s

        Breastfeeding aside, many campaigns for breast cancer awareness have slogans along the line of “Save the tatas!” or some other dumbassery. What if we focus on saving the people, not the “tatas”? It’s incomprehensible with or without breastfeeding thrown in; how in the hell does breastfeeding take precedence over living?

        • rational thinker

          I absolutely hate that slogan, first cause its no laughing matter and second cause its a person, a life not just a pair of boobs.

        • Cristina

          I hate that slogan too. If the “tatas” are what are trying to kill me, cut them off! I also just hate the word tatas.

        • Melissa Wickersham

          La Leche League crackpots think that women could still breastfeed after losing their breasts to double mastectomies????
          What planet are they living on??? These idiots lack basic common sense.

    • RudyTooty

      🙁

      The cost-benefit ratio is out-of-whack, here.

      It really illustrates how breastmilk is promoted as having magical properties.

      Why else would someone choose breastfeeding in lieu of cancer treatment? They really, truly believe they are doing something vitally important and beneficial. Because they’ve been told the lie that not breastfeeding will cause their children lifetimes of irreparable harm.

    • rational thinker

      Im sorry but you have to be some kind of stupid to forgo cancer treatment just to breastfeed. What do they think the kid is gonna suck the cancer out? smh

  • swbarnes2

    Isn’t it possible/likely that this is correlation, not causation, and the causation is a woman’s hormone balance?

    • Merrie

      Could be that or any number of things. There are so many differences between groups of women who do and don’t breastfeed, as well as between groups of women who do and don’t bear children, that getting the causation right for any of these correlations is pretty tricky. For starters, you have to isolate those who don’t breastfeed or don’t bear children because they tried and physically couldn’t (and therefore perhaps some physiological factor at work that impacts other things and is different in those women who were able to do these things), versus those who didn’t do it because they didn’t want to or because of some other nonphysiological factor (and who might or might not have physically been able to had they tried and there’s no good way to know what might have happened). You need to have comparable groups for this kind of study and good luck figuring out how to create said comparable groups.

  • Madtowngirl

    Again, where is this “effective marketing” from formula companies? I have to seek out Similac/Enfamil coupons. I still have not seen a commercial on TV for infant formula. Toddler drinks, sure. And just how stupid do you think women are, Ramaswamy? “Well, breastfeeding is going so well, and I’m enjoying it, but I got a $5 coupon for formula, so I’m going to just formula feed instead.”

    Meanwhile, I get no less than 3 ads per day for crazy expensive breast pumps on Facebook alone.

    • space_upstairs

      The breast pump ads on Facebook probably are because you’re white, affluent, educated, living in or near a well-off zip code, have some crunchy friends, and/or who knows what other big data they have on you to try to guess your market niche. Perhaps down-market Facebook users do get formula ads, and perhaps they’re illegal or heavily restricted on TV like, say, tobacco ads. (I think I read somewhere once, maybe here, that formula ad restrictions are often almost as strict as those for tobacco due to the situational/outdated view of formula as a serious public health threat.) But still, it’s not like up-market choices either have nothing to do with social pressure or the social pressure to make those choices is somehow more justified.

    • rational thinker

      I haven’t even seen a formula commercial since I was pregnant with my son sixteen years ago.

    • Hannah83

      Ever since I got pregnant with my third, I get adds on facebook for pyjamas and weight loss pills. It’s sort of depressing as I’m highly educated Dr. Hannah without serious weight problems (babyfat is undeniable though).

  • rational thinker

    Seems like they will link anything to breastfeeding. I don’t know why lactivists care what women who they don’t even know do with their bodies.

    • fiftyfifty1

      Because it gives lactivists a way to judge and rank women. It’s like how some conservative Christians care whether other women use birth control.