TIME medicine

Hormone Treatments Raise Cancer Risk Even After They’re Stopped

30012561.tif

Estrogen and progestin therapy to treat menopause has led to controversial and confusing recommendations. But in the latest and longest term look at the data, experts say the risks of the hormones may last long after women stop taking them

Researchers admit that when it comes to hormone therapy — estrogen and progestin — to treat the symptoms of menopause for women, they don’t have a lot of consistent or convincing answers. They thought the medications could not only help menopause symptoms but also protect against heart disease, although some studies showed the added hormones could also raise risk of breast cancer. The resulting advice to women seeking answers about whether hormone therapy is for them has been anything but satisfying.

Now the scientists involved in the first large trial of hormone therapy, the Women’s Health Initiative (WHI), have continued to study those women who participated in the 1990s and found some surprising results. Reporting in the journal JAMA Oncology, they say that the risk of breast cancer for women taking the combination of estrogen and progestin remains the same seven to eight years after they stop the drugs than while they were taking them.

MORE: Hormone Replacement Therapy After Menopause: What Women Need to Know

The estrogen helps to maintain levels of that hormone as natural amounts start to drop during menopause, and the progestin protects the uterus from potential tumors arising from excess amounts of estrogen. They also found that for the quarter or so post-menopausal women who have had a hysterectomy, and can take estrogen alone, the hormone can lower their risk of breast cancer.

The WHI was created to study the health effects of hormone therapy on the millions of women taking them. Some small studies had suggested that the hormones could protect women from heart disease; women tend to have heart attacks about a decade or so later than men on average, and researchers believed some of that protection came from estrogen. But doctors were concerned about the known connection between estrogen and breast cancer, since during puberty estrogen contributes to breast tissue growth, and wanted to understand how the benefits for the heart matched up against the risks to the breast, so they enrolled more than 26,600 women aged 50 to 79 years in the WHI.

MORE: Estrogen After Menopause Lowers Breast Cancer Risk for Some Women

They intended to study them until 2005, but in 2002, they stopped the trial when it became clear that there was a group of women experiencing higher heart disease rates. It turned out that these were the women taking hormones, either the combination or estrogen alone.

MORE: The Truth About Hormones

The results completely changed menopause treatment, and led to a precipitous drop in the use of the medications; in the U.S., where about 40% of women turned to the hormones, only 15% did after most experts agreed that they should only be used in the short term, for about a year or so during and just after menopause. The assumption was that the benefits in lowering breast cancer risk would be similar — if women stopped taking the hormones, then their risk would decline.

That seemed to be true, at least for the first year or so after discontinuing the therapy. But in 2013, Dr. Rowan Chlebowski, an oncologist at Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, and one of the initial investigators on WHI, reported that the benefit didn’t hold for long. He found that if women who had previously been on estrogen and progestin therapy were studied for more than eight years, their risk of breast cancer started climbing back up, to levels that were on par with when they were taking the medications.

That finding, however, contradicted other results from studies. And to make matters more confusing, the women who had had a hysterectomy, and no longer had a uterus so could take estrogen alone, did not seem to experience the same increased risk of breast cancer. All of this data prompted Chlebowski to do a more detailed analysis of the WHI data on women who agreed to continue to participate years after they stopped taking the hormone therapy.

MORE: Making Sense of Hormone Therapy After Menopause

In the current study, it’s clear that the combination of estrogen and progestin increases breast cancer risk, he says. The drop in risk that occurs immediately after the therapy is stopped is likely due to the changing hormone environment. Any small or emerging tumors that were already present before hormone treatment started may eventually start growing again years later.

For women who have had a hysterectomy, taking estrogen alone does not increase breast cancer risk and may, according to the latest results, even provide some protection against the disease.

“It looks like hormones have longer term lingering effects,” says Chlebowski. “For estrogen and progestin together, we see an increase in risk even years after you stop. But for estrogen alone, it looks like the hormone may be more favorable in reducing breast cancer risk than we thought before. The estrogen alone findings are now quite compelling that we may had to call lit risk reduction.”

The results should stress the importance of defining what menopausal symptoms are, and how much they interfere with women’s daily lives. Most health groups now recommend short term hormone therapy, but it’s clear that the risks of breast cancer remain even after exposure. So doctors and patients need to weigh the relief of symptoms against the unhealthy legacy of taking these medications. “There is a little more risk than we thought with estrogen and progestin,” says Chlebowski. “But it’s always difficult to figure out how to categorize that risk. It’s different for each woman.”

TIME Infectious Disease

An Experimental Ebola Drug Shows More Promise

TKM Ebola, which at least a few US and European health care workers may have received to treat their Ebola infection, is upgraded and proves effective in animal studies

When the Ebola outbreak hit last spring, there were a handful of potential treatments at the experimental stage in labs around the world. Some of them—like the drug TKM Ebola—that had shown promise in primates were given to U.S. and European health care workers who had been infected. Assessing how effective these drugs were in humans, however, posed some unique challenges.

That’s because many of the patients who got experimental treatments were also given a number of other therapies—making it impossible to know what was responsible for their recovery. But in a new paper published Wednesday, several of the scientists responsible for developing TKM Ebola, led by Thomas Geisbert of the University of Texas Medical Branch, report that the drug worked on all the monkeys it used it on, even after the monkeys were given a lethal dose of Ebola.

The animals exposed to Ebola that didn’t get the drugs all died at day eight or nine.

The study used an updated version of the drug that is made up of snippets of the Ebola virus’ genome encapsulated in fatty particles. The fragments bind to their matching counterparts on the circulating virus and become a genetic monkey wrench that prevents Ebola from copying itself and infecting more cells.

MORE: WHO Outlines Timeline for Experimental Ebola Drugs

It turns out that the virus responsible for the current outbreak in west Africa differs from the 1976 strain at three points in the Ebola genome, so Geisbert and his team adjusted the drug accordingly. That’s one of advantages of the TKM Ebola approach, he says, compared to therapies such as vaccines or other drugs that rely on antibodies to the virus. These regimens are designed to attack the broadest range of virus strains possible, but in doing so, they may give up some of their virus-fighting potency. With gene sequencing technology becoming more refined and accessible, however, having drugs that are specifically targeted against a particular strain of a virus is actually a realistic goal. “It’s especially important when you look at how big this outbreak is, and it’s continuing for over a year,” says Geisbert of such matched therapies. “With this technology, we could theoretically turn around a new treatment in something like weeks. This outbreak taught us a lot about how to prepare for the future.”

MORE: The Ebola Fighters

These results will still have to be repeated in human patients, to ensure TKM Ebola is both safe and effective, but they strongly hint that the drug could be a critical part of future anti-Ebola strategies. The company that is developing TKM, Tekmira Pharmaceuticals, is now testing this latest form of the drug in Ebola patients in Sierra Leone, west Africa.

TIME Mental Health/Psychology

Is the Link Between Depression and Serotonin a Myth?

Depression
Getty Images

One in 10 Americans are on an antidepressant, and many are taking SSRIs. But a new report underlines the fact that despite what Big Pharma says, we don’t actually know how they work

Though antidepressants are a common treatment for depression, psychiatrists still don’t have a clear understanding of how exactly they work. A new paper suggests that some explanations persist thanks to clever marketing, despite a lack of scientific evidence.

On Tuesday, David Healy, a professor of psychiatry at Bangor University in Wales and author of Let Them Eat Prozac, published an opinion piece in the journal The BMJ writing that the link between serotonin and depression is a “myth” that continues to be perpetrated by the pharmaceutical industry. Specifically, Healy says the marketing of selective serotonin re-uptake inhibitors—better known as SSRIs—has been problematic.

“Drug companies marketed SSRIs for depression even though they were weaker than older tricyclic antidepressants, and sold the idea that depression was the deeper illness behind the superficial manifestations of anxiety,” he writes. “The approach was an astonishing success, central to which was the notion that SSRIs restored serotonin levels to normal, a notion that later transmuted into the idea that they remedied a chemical imbalance.”

While Healy has been described by some of his peers as an iconoclast, many members of the psychiatry community agree with him. “He’s preaching to the choir at this point,” says Dr. Victor I. Reus, a professor in the department of psychiatry at the University of California, San Francisco.

Reus adds that it’s not that SSRIs don’t work (though there are certainly some who do make that argument). Rather, it’s how they are marketed that is largely overblown. “My experience and belief is that they do work, but we don’t have a comprehensive and holistic understanding of why they work,” he says. “But I think [they] are in many cases remarkably successful even without understanding why they are so.”

MORE Do Depression Drugs Still Need Suicide Warnings?

The idea that SSRIs restore abnormal serotonin levels in the brain isn’t substantiated by research, so why does that line of thinking persist? According to Healy, the idea was adopted by physicians and patients as an easy way to communicate the confounding disorder and its treatment. That’s led to what he calls a costly distraction away from other depression drug research. Meanwhile, many other depression treatments have no effect on serotonin but can be effective against the condition, whereas some people who take SSRIs do not, in fact, get better.

“I think in essence the article raises a point that you have to think beyond SSRIs. They are not industry’s gift for the treatment of depression,” says Dr. Norman Sussman, a professor in the department of psychiatry at New York University Langone Medical Center. Some of the older drugs may actually work better with fewer qualit- of-life-impairing effects.”

Healy does not say that serotonin plays no role in the treatment of depression, writing that the compound is “not irrelevant,” but that the market boom of SSRIs raises questions about why physicians would put aside clinical trial evidence in place of “plausible but mythical” accounts of biology.

“My feeling is that these drugs maybe don’t work as well for depression as they do for other things like obsessiveness and anxiety,” says Sussman. “There are some people that do well on them but most of the evidence that’s come out recently is that they seem to work best in people that are the most depressed.”

Sussman says that SSRIs are often prescribed in primary care for people who have mild depression.

“You wonder what the real risk benefit ratio is in that population,” he says. “They’ve been oversold.”

Read next: Why Kids Who Believe in Something Are Happier and Healthier

Listen to the most important stories of the day.

TIME medicine

Vaccines Don’t Cause Autism, Even in Kids at Higher Risk

"We are able to look at the vaccines and show there is no association with autism"

In the latest study on the vaccines, researchers find even more evidence that childhood immunizations aren’t linked to autism.

In a study published in the Journal of the American Medical Association, a group led by Dr. Anjali Jain of the Lewin Group, a health care consulting organization, found that brothers and sisters of children with autism were not at any higher risk of developing the disorder if they were vaccinated compared with brothers and sisters of those without autism.

Numerous studies have found an increased risk of autism among those with older siblings with the condition, and some parents who believe that their older child’s autism is connected to vaccinations, specifically the MMR vaccine, have been reluctant to immunize their younger children. Indeed, Jain found that vaccination rates among siblings of autistic children were lower, at about 86% at 5 years, compared with 92% among those without autistic brothers or sisters.

But among the 95,000 children with older siblings included in the study, children who received the MMR and had autistic older siblings were no more likely to develop autism than children who were vaccinated and didn’t have any autistic older siblings. In fact, the relative risk of autism among those with older autistic brothers or sisters was lower if they were vaccinated compared with those who were not vaccinated.

“Our study confirmed that in kids with older siblings who we know are at increased risk of developing autism themselves, those kids are being vaccinated less,” says Jain. “But in the kids who did develop autism who were vaccinated, there was no increased risk from the vaccine compared to kids who did not get the vaccine.”

The results, she says, should put to rest any concerns that parents of autistic children might have that vaccinating their younger kids will somehow increase their risk of developing autism. The large size of the study, and the fact that vaccination and autism information wasn’t collected for purposes of a vaccines-and-autism study but as part of a larger health insurance database, also reinforce the strength of the findings. (The Lewin Group is an editorially independent part of Optum company, which collected the data.)

“We may not understand what is causing autism in these kids or families,” says Jain. “There could be a host of both genetic and environmental factors. But we are able to look at the vaccines themselves and show there is no association with autism.”

Read next: HPV Vaccine May Work for People Who Already Had the Virus

Listen to the most important stories of the day.

TIME medicine

This Is a Baby’s Brain on Pain

181571457
Getty Images

For the first time, scientists map newborn babies’ brains on pain, and the results are surprising

In a first, researchers at Oxford University have watched infants as young as a day old as their brains process a light prodding of their feet. The results confirm that yes, babies do indeed feel pain, and that they process it similarly to adults. Until as recently as the 1980s, researchers assumed newborns did not have fully developed pain receptors, and believed that any responses babies had to pokes or pricks were merely muscular reactions. But new research published Tuesday morning changes that.

Taking advantage of the fact that newborns less than a week old tend to sleep through anything, Rebeccah Slater, an associate professor of pediatric neuroimaging at Oxford, and her colleagues placed 10 infants who were 1-6 days old in an fMRI machine. The researchers, who reported their findings in eLife, observed which areas of the infants’ brains became more active, or consumed more oxygen, as the scientists lightly poked their feet. They did the same for adults and compared the brain images.

In adult brains, 20 regions were activated by the painful stimulus, and the newborns shared 18 of these. “The infant’s brain is much more developed than I was expecting,” says Slater. “I might have thought that some information might have gone to the sensory areas of the brain — telling the baby something was happening on the foot, for example — but I didn’t necessarily think it would go to areas more commonly involved in emotional processing such as the anterior cingular cortex, which is thought be involved in the unpleasantness associated with an experience.”

Even at birth, then, a baby’s brain possesses the foundation for quickly evaluating anything he or she experiences, including painful stimuli. “I hope this provides incentive to more researchers to find better ways of measuring pain in babies, and prioritize the importance of providing the best pain relief possible in children,” says Slater.

Slater found that newborn brains are still immature in some ways, however. Any stimulus, whether it’s a painful one or a sensory one such as a smell, tends to activate widespread regions of the brain. That signals that the baby’s brain is still trying to learn what’s what and distinguish different stimuli. The poking triggered even the newborns’ olfactory system, for example, even though the sensation had nothing to do with smell.

Second, babies tend to register all stimuli as having the same intensity. Even light pokes “feel” the same as harder ones, reflecting their still inexperienced system in distinguishing levels of activation.

But the fact that they are experiencing pain in almost the same ways as adults do is very revealing. Now that there’s evidence that the brains of babies do indeed process pain, that may change the way doctors treat newborns, especially those who are premature or need extra medical attention in the neonatal intensive care unit. In a recent study, scientists tallied an average of a dozen procedures including needle sticks that babies experienced every day; more than 60% of those infants did not receive any pain medication, either in the form of a topical numbing cream or other pain relief. Having these experiences may make these babies more sensitive to pain later in life, says Slater. A study of circumcised baby boys, for example, found that those who received pain relief felt less pain when getting vaccinations three months later than those who didn’t receive any pain medication.

“Now that we have seen for the first time what is happening in babies’ brains while they experience something mildly painful,” says Slater, “there should be a big drive to try to treat pain in these children, especially those having a high number of procedures performed in their early days.”

TIME medicine

Most Americans Think Medical Marijuana Shouldn’t Be Used By Kids, Poll Says

183842907
Getty Images

And 80% think adults shouldn't use medical marijuana in front of children

While most Americans think medical marijuana should be allowed for adults, a majority says the drug shouldn’t be used by or in the presence of children, a new poll shows.

The C.S. Mott Children’s Hospital National Poll on Children’s Health found that 63% of American adults think their state should allow the use of medical marijuana among adults. But only 36% think it should be allowed for children and teenagers under age 18. The poll also found that 80% think adults should not use medical marijuana in front of children. Ten percent know someone with a medical marijuana card or they have their own.

Close to half of the states currently allow the use of medical marijuana.

“Our findings suggest that not only is the public concerned about the use of medical marijuana among children, but that the majority of Americans worry that even exposure to it may be harmful to kids’ health,” Dr. Matthew M. Davis, director of the National Poll on Children’s Health and a professor at University of Michigan Medical School, said in a statement. “As is typical with anything involving health, the public’s standards are much higher when it comes to protecting children’s health.”

 

TIME medicine

Smokers Don’t Think a Few Cigarettes Will Harm Their Health

smoking
Getty Images

Nearly everyone knows that smoking is harmful for your health. But some refuse to admit that their habits may be killing them

Heart disease, lung cancer, throat cancer, diabetes—the list of bad things that smoking does to your health is long and growing longer. Thanks to public health warnings and education campaigns, most of us have heard that cigarettes can be dangerous to your wellbeing and can shorten your life.

But one group who should be getting that message loud and clear may be in a bit of denial. In a study of more than 1,600 French smokers and non-smokers, 34% said that lighting up 10 cigarettes a day would not put them at higher risk of lung cancer. And fewer than 40% knew that their risk of lung cancer wouldn’t disappear if even if they quit smoking. The results were presented at the European Lung Cancer Conference in Geneva, Switzerland.

“The fact that one third of subjects wrongly considered that a daily consumption of up to 10 cigarettes was not associated with any risk of lung cancer is particularly impressive and threatening,” writes study author Dr. Laurent Greillier from Aix Marseille University in response to questions about the findings.

The results were especially worrisome since the participants in the study were 40 years old to 75 years old and therefore spent most of their adult lives hearing strong public health warnings about the dangers of smoking. That means that while anti-smoking campaigns have been effective, they may not have educated people deeply enough about the dangers of tobacco. That’s especially true for people who engage in what they consider to be “safe” or “light” smoking, the study finds. “Our results suggest that public health policies must continue to focus on the tobacco pandemic, and notably initiate campaigns concerning the risk of any cigarette,” says Greillier.

TIME celebrities

Group of Doctors Tells Columbia University to Fire Dr. Oz

Ten doctors wrote a letter urging Columbia University to fire Dr. Mehmet Oz saying he "endangers" the public

A group of doctors has written a letter urging Columbia University to fire Dr. Mehmet Oz from its faculty.

“Dr. Oz has repeatedly shown disdain for science and for evidence-based medicine, as well as baseless and relentless opposition to the genetic engineering of food crops,” said the letter addressed to Columbia’s Dean of the Faculties of Health Sciences and Medicine, reports CBS. “Worst of all, he has manifested an egregious lack of integrity by promoting quack treatments and cures in the interest of personal financial gain.”

Oz is a cardiovascular and thoracic surgeon and vice-chair of the department of surgery at Columbia’s College of Physicians and Surgeons, but he’s also a television personality with The Dr. Oz Show. And according to medical experts, only 46% of the recommendations on his show were supported by evidence.

The letter, authored by a doctor at the Hoover Institution at Stanford University and co-signed by nine other doctors, ends, “Whatever the nature of his pathology, members of the public are being misled and endangered, which makes Dr. Oz’s presence on the faculty of a prestigious medical institution unacceptable.”

A university spokesman emailed the doctors in response, stating: “As I am sure you understand and appreciate, Columbia is committed to the principle of academic freedom and to upholding faculty members’ freedom of expression for statements they make in public discussion.”

Read next: Lawmakers Caution Dr. Oz on Weight-Loss Tips

Listen to the most important stories of the day.

TIME medicine

The Strange Way a Diabetes Drug May Help Skin Scars

128630038
BIOPHOTO ASSOCIATES—Getty Images/Photo Researchers RM

We all form scars, but most of us don’t want them. There may soon be a way to make them disappear

We all have them — scars that won’t let us forget the spill we took off a bike, the burn we got from a hot stove, or even the legacy of radiation therapy. Scarring is a good thing in some ways — it’s the body’s quick response to a deep injury, its way of protecting and sealing up the wound to keep infections and other noxious agents away.

Now scientists led by Dr. Michael Longaker, co-director of the Institute for Stem Cell Biology and Regenerative Medicine at Stanford University, report in the journal Science that they have teased apart the molecular steps behind scarring, and also discovered a way to inhibit them from forming.

While training to become a plastic surgeon, Longaker operated on fetuses still in the womb and became intrigued by the fact that they did not scar; any incisions surgeons made disappeared practically without a trace. Why, if babies did not change their genes from the womb to the time they are born, do infants form scars?

Working with mice, the team focused on two kinds of fibroblasts, which are cells responsible for maintaining the structural integrity of organs, tissues and more. One is primarily responsible for wound healing, and the formation of tumors like melanoma. “This type of fibroblast starts out as less than 1% of the developing skin, but by the time an animal is a month old, it’s 80% of the fibroblasts in skin on the back of the animals,” he says.

When he treated the cells with diphtheria toxin, which destroys the fibroblasts, the animals scarred less. It turns out that these fibroblasts carry a marker on their surface that helps scientists to pick them out. And even more fortuitous, there is a drug approved for treating type 2 diabetes that inhibits the work of this marker.

In the mice, the drug reduced scarring but did not compromise the integrity of the wounded skin at all, making it a promising potential treatment for scar in people. Each year in the US people get 80 million operations, the bulk of which require incisions that leave a mark, not to mention the millions more who get cuts or scrapes during accidents or who develop fibrous tissue after radiation to treat cancer. If the scar-inhibiting drug is used on those wounds before they begin to heal, says Longaker, it’s possible they won’t leave a scar.

Whether the same could be true of existing scars isn’t clear yet. But he says that doctors may be more eager to do revision surgery to minimize scars if such a compound exists. And, if the results are repeated and confirmed, doctors may be able to reduce scars not just for cosmetic purposes but for medical ones as well, such as in the heart after a heart attack, following spinal cord injury and in deep tissues treated with cancer-fighting radiation.

TIME health

How Doctors of the Past Blamed Women for Breast Cancer

Motherhood
Fine Art Photographic/Getty Images 'Motherhood' by Hector Caffieri, circa 1910

Breastfeeding, corsets and aging: the mysterious dangers of womanhood

History Today

 

 

 

This post is in partnership with History Today. The article below was originally published at HistoryToday.com.

‘I congratulate … [my fair countrywomen] on their present easy and elegant mode of dress’, wrote the surgeon James Nooth, in 1804, ‘free from the unnatural and dangerous pressure of stays.’ Nooth’s concern was not aesthetic. The danger he saw in restrictive bodices was cancer: ‘I have extirpated [removed] a great number of … tumours which originated from that absurdity.’

Breast cancer in the 19th century was a consistent, if mysterious, killer. It preoccupied many doctors, unable to state with any confidence the disease’s causes, characteristics or cures. While the orthodox medical profession in Britain were broadly agreed on cancer’s ultimate incurability, they were less uniform in their understanding of its origin. The disease was thought to develop from a range of harmful tendencies and events acting together. Both the essential biology of being female, as well as typically ‘feminine’ behaviors, were understood as causes of breast cancer.

Breastfeeding was a contentious topic at the end of the 18th century. An image of idealised motherhood emerged that infiltrated concepts of femininity: women were by nature loving, maternal and self-sacrificing. This ideology was expressed through changing social and political attitudes to breastfeeding and an outcry against wet-nursing across western Europe. In 1789 only 10 per cent of babies born in Paris were nursed by their own mothers; by 1801, this number had increased to half of all Parisian infants and two thirds of English babies.

Late 18th-century medical men were explicit about the associations between breastfeeding and breast cancer. In 1772, man-midwife William Rowley wrote: ‘When the vessels of the breasts are over-filled and the natural discharge through the nipple not encouraged … it lays the foundation of the cancer.’ Frances Burney – an aristocratic novelist who underwent a mastectomy in 1811 – attributed her disease to her inability to breastfeed properly: ‘They have made me wean my Child! … What that has cost me!’

Menstruation was seen as particularly hazardous. The surgeon Thomas Denman wrote: ‘Women who menstruate irregularly or with pain … are suspected to be more liable to Cancer than those who are regular, or who do not suffer at these times.’ However, their risk only increased after menopause. Denman considered ‘women about the time of the cessation of the menses’ most liable to cancer. Elderly women were blighted by a dual threat: their gender and their age. While surgeons insisted their theories were based on clinical observation, designating these various female-specific processes as causes of cancer supported their broader thoughts about female biology.

Eighteenth-century theory dictated that all diseases were explained by an imbalance in ‘humours’: black bile, yellow bile, blood and phlegm. Into the 19th century the insufficient drainage of various substances continued to be invoked as a cause of cancer; women’s ‘coldness and humidity’ made them particularly prone to disease. Menstruation was the primary mechanism by which the female body cleansed the system of black bile and its regularity was seen as central to a woman’s wellbeing. Certain situations in which the menses were disrupted or had been terminated were, therefore, especially dangerous: pregnancy, breastfeeding and menopause. Similarly, when the female body and its breasts were not used for their ‘correct’ purpose – childbearing and rearing – the risk of breast cancer increased.

The historian Marjo Kaartinen has noted that 18th-century theorists considered just ‘being female and having breasts’ a threat to a woman’s health. This way of thinking about female biology suggested that women were more likely to suffer from all cancers, not just cancer of the breast. Denman wrote: ‘It can hardly be doubted … that women are more liable to Cancer than men.’

This association between womanhood and disease and between breastfeeding, pregnancy, menopause and cancer is still part of our 21st-century understanding of breast cancer; that certain female-specific processes make you more or less likely to succumb to it. On its website, the breast cancer charity Breakthrough lists various ways you can reduce and increase your chances of disease. According to contemporary research, having children early and breastfeeding them reduces your risk. The later a woman begins her family the higher her risk is. The contraceptive pill, growing older and the menopause also increases your risk of breast cancer.

Drawing attention to such historical continuities questions the social and cultural environments that make certain medical assumptions possible. The causes of cancer suggested by Denman, Nooth and friends were informed by their understandings of female biology and female inferiority more generally. They were working within a school of thought that suggested any deviation from ‘appropriate’ womanhood could have hazardous consequences for a woman’s health. While the role of the historian might not be to deny the validity of 21st-century medical research, it is part of our remit to question cultural assumptions that continue to have some effect on both the conclusions of scientists and the way those conclusions are accepted by the broader public.

Agnes Arnold-Forster is a PhD candidate at King’s College London.

Your browser is out of date. Please update your browser at http://update.microsoft.com