THE article by Sarah-Kate Templeton provides evidence that the incidence of breast cancer has increased in women under 40 by 57% over a 25-year period (News, last week). The annual rate of increase averages 2.2% between 1975 and 2001 and there is anecdotal evidence that it has risen between 2001 and 2005. Studies from America and Sweden reported annual increase rates of about 3%.

The higher increase in women over 50 is expected, as it coincides with the introduction of the national breast screening programme. However, there are no such programmes for women under 40. The increase is most likely due to factors related to our environment and modern lifestyle.

Breast cancer in younger women tends to be pathologically more aggressive and grows at a faster rate, tending to be more advanced at the time of diagnosis. Furthermore, it is more likely to be treated with radical treatments, such as mastectomy and chemotherapy.

The American Cancer Society and the National Cancer Institute recommend screening mammography in women aged 40-49 due to its proven ability to save lives.

Professor Kefah Mokbe
Consultant Breast Surgeon
at St George’s & The Princess
Grace Hospitals (London)

KYLIE’S LUCK: Templeton did not mention that breast cancer is still very uncommon in women under 40: it is 10 times more common in women in their forties and 20 times more common in their fifties. All that is required for rates to rise from 14 to 22 per 100,000 a year, over 25 years, is a 1.7% increase each year — hardly a “surge”.

While patterns in developed countries are broadly similar, I have no detailed information on breast cancer trends in Australian women under 40. Minogue has been very unlucky — but her misfortune should not cause undue alarm in other women of the same age.

Professor Michel Coleman
London School of Hygiene &
Tropical Medicine, London

AGE CONCERN: I am a breast cancer patient and chair of a cancer user group. While I agree with Minette Marrin (Comment, last week) about the excessive coverage of Minogue’s cancer, there is still a need to heighten awareness.

General practitioners are still telling patients that they are too young to have breast cancer. This seems unjust, especially when you have to get past the GP, who is the gatekeeper, to the secondary service.

Pat Roberts
Codsall, West Midlands

FEARFUL MESS: I’ve had cancer four times and it makes me realise I love life and that I’m not going to let the bastards grind me down. So I try, when I can, to convince people that there’s nothing to fear from cancer, as long as you don’t waste time because of the fear.

It only takes one headline about “the battle”, “brave Kylie” and “all her friends supporting her in this difficult time” to ruin all my work and send my friends back to the world of fear.

Keith Brook
via e-mail

PRIVATE GRIEF: Was it really necessary for the Australian prime minister to be interviewed, and his reaction (“shocked and saddened”) broadcast? Politicians should perhaps be made aware that women who are not celebrities, who cannot afford private treatment are having to wait months for diagnosis and surgery under state health systems.

The urge to raise awareness has increased womens’ fears instead of allaying them.

Debbie Bartlett
Cádiz, Spain

MALE PERSPECTIVE: My mother had two mastectomies around 10 years ago, so I’m not unsympathetic to Kylie, but I was flabbergasted when television cut through scheduled slots with the newsflash about her cancer. I became more amazed as the day progressed.

The amount of funding that goes into breast cancer research and awareness campaigns is huge — especially compared to testicular, prostrate or colonic cancers; all cancers which kill thousands of men a year.

Jack Snow
London N6

FAT NATION: The death rates from cancers, heart disease and chronic obstructive lung disease are all falling. Most people are not aware that the death rate from type II (non-insulin dependent) diabetes — for the most part, lifestyle related — is relentlessly rising.

In America it has reached epidemic proportions because of its direct relationship to excess visceral fat (obesity) and lack of exercise. The UK will follow within the next decade.

While there are 26 charities directly concerned with “finding a cure” for cancer, there is only one that funds type II diabetes, it is that “uncool”.

I wouldn’t wish breast cancer on anyone, but for myself I would prefer it, with the good chance of a cure, than the almost inevitable lingering death that would be my lot were I to contract diabetes instead.

Dr Henry Tegner
London SE22