Even Christmas can’t drive breast cancer out of the headlines. Desmond Morris, the biologist and author on human behaviour, has written about the importance of breasts in Madonna and Child paintings, and how the Virgin Mary is usually depicted cradling Christ against her left breast, as in the picture by the early Flemish artist Robert Campin. Had it not been for Mary’s healthy and efficient breasts, Jesus might not have thrived after an impoverished entry into that grubby stable. Thus Christianity might never have become an established religion.

Breasts are not only the essence of femininity that has inspired artists from prehistoric times to Rubens, Fragonard and Picasso, they have also been thought by women to epitomise sexual potential. Even if breasts didn’t have such an important physiological and psychological role, talk of breast cancer would still provoke strong emotions.

Fortunately, this Christmas, most of the news is good. This is just as well, as breast cancer affects more than 44,000 women in Britain each year and accounts for more than 30 per cent of all cancers affecting women.

One boost to sufferers was provided by the artist Sam Taylor-Wood, who last week released nude self-portraits after breast cancer treatment. These made the point that its treatment doesn’t eradicate beauty. Not all women will feel inclined to make a similar gesture but older women are more likely to draw comfort and benefit from the news last week of a trial of hormonal treatment.

Four out of five women who receive a diagnosis of breast cancer are postmenopausal. This trial compared Arimidex anastrozole, one of the aromatase inhibitor drugs, with tamoxifen, the drug used for hormonal treatment of those women who had a hormone-receptor positive form of breast cancer. The study, published on the internet by Lancet Oncology,was one of the largest and longest to compare the early use of Arimidex with tamoxifen.

Arimidex and two other aromatase inhibitors, Aromasin exemestane and Femara letrozole, were introduced in the mid1990s. It was quickly predicted that they would replace tamoxifen, but there remained doubts about the best stage of treatment at which to start them.

The trial has provided important statistics that confirm the difference in efficacy when Arimidex, rather than tamoxifen, was prescribed from the start. The outcomes clearly indicate that using Arimidex can improve the chances for a woman trying to rid herself of breast cancer.

In an eight-year follow-up, women who had been prescribed Arimidex had recurrence reduced by 24 per cent; for those women who did have a recurrence, the rate at which remained clear increased by 15 per cent; the spread to distant sites, so that the cancer recurred elsewhere, was reduced by 16 per cent and the reduction of the spread into the previously unaffected breast was reduced by 40 per cent.

Using Arimidex (or probably one of the other aromatase inhibitors though these were not part of this trial), would mean that fewer patients would be told that their cancer had returned. Earlier trials have already shown that when Femara, another aromatase inhibitor, was prescribed after surgery, it reduced recurrence by 28 per cent in high-risk women with early invasive breast cancer. That trial didn’t investigate first-line treatment in early noninvasive cancer.

Femara is also licensed for use before surgery in invasive cases. Similarly, trials have shown that switching from tamoxifen to Aromasin, the third aromatase inhibitor, after two or three years of hormonal therapy with tamoxifen, cuts the chances of the cancer returning by 50 per cent. The rationale for using switch treatment, changing from tamoxifen to an aromatase inhibitor, was that it reduced side-effects and was more cost-effective. This may now have to be be reconsidered.

This is only one of the many advances in treatment. If we could take advantage of them, improve our screening with the latest equipment and extend the service to the overseventies, have a shorter gap between appointments and include selective screening for some younger women, more than 95 per cent of women with breast cancer would be able to look forward to a full lifetime of Christmases.

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