Raising Awareness That Breastfeeding Reduces The Risk of Breast Cancer
Hi! This is Christine. Welcome back to the Lactation Training Lab Podcast. I'm really excited to be back today to talk to you about what I have been learning about breast cancer and breastfeeding. The links are getting stronger - the links between how breastfeeding reduces breast cancer risk.
I think that one of the reasons I've always been, maybe not reluctant to share, but reluctant to talk about something I didn't know a whole lot about, would be a better description. I think I really just wanted to know the mechanisms by which it is believed that this works - that this risk reduction happens. I dove into some of the research that's out there, and I'll continue to do that as this month goes on. It's one of my commitments this month (this is October of 2021), and I'd like to be part of the conversations that I come across and that I seek out, where people are talking about breast cancer.
I think about this every year: I get frustrated that we don't hear so much about breastfeeding as a prevention strategy. I think that one of the reasons that happens, of course, is because most of the time when we're talking about breast cancer, the story is about people who already have it or people who survived it, or people who did not survive it. Talking about prevention turns into sort of an afterthought at the end of that story or article or piece that's being done in the media, and they tend to talk about the healthy nutrition and exercise keeping off excess weight - just being healthier, in general, as prevention strategies, and they skip over the breastfeeding part, even though it's listed there, everywhere that you look up breast cancer and prevention. Every major website that's about breast cancer contains this information. Every major medical website that you look up. Breastfeeding is there as a prevention strategy, but it's like they skip over it for the same reason they skip over it in other places, and we see the same thing when we hear talk about SIDS awareness. We see the same thing. We know that breastfeeding is preventive against SIDS, but we don't frequently hear that in media pieces that talk about SIDS and prevention. It's sort of the same thing, the same kind of train of thought.
I really wanted to get into how would this work: if this is true, how does it work because I hate getting in conversations about these things where I really don't know the answers. I don't want to just say something because it's something that we always say, that we always tell people I really want to know why.
I think that when you know why, it really makes a difference in people understanding and people finding your information credible, and we need to make this information more widely known, especially among people who still have the opportunity to breastfeed, to lactate, to feed their milk to babies, ahead of them. It's one thing to say it to a roomful of people who have already had children, or a roomful of people who are far beyond reproductive capacity, but to say it to adolescents, to say it to young adults, to really help younger people who have not been through reproduction yet, and who plan to - to understand that this is one of the reasons they might choose this - that it's not just something that is about the baby. They shouldn't be making choices that are only about the baby. They have this opportunity that can also have preventive health effects for them, not only breast cancer but other types of cancer including ovarian.
One of the reasons this matters so much in the work that we do is that we spend a lot of time reminding people, especially in our messages that we put out on social media and our marketing messages - we know that improving support and clinical assistance for breastfeeding mothers and parents protects them against breast cancer. We know this.
We've been hearing about these studies for a really long time and two of the older studies are frequently cited. You may not know the specifics on this so I just wanted to remind you: it was the 2002 paper in the Lancet, which looked at 47 studies, that's the one that told us that every 12 months of breastfeeding reduces the risk of breast cancer by 4.3%. You'll see that in a lot of places. You will see a lot of social media posts. You'll see that in articles that are written by experts in lactation; you won't always see it in other places. And then in 2013 there was a meta analysis of 32 studies which said that for people who had babies and breastfed, there was a 14% reduction in the risk of breast cancer versus those who had babies but did not breastfeed. It also said there was a 28% reduction if they breastfed for more than 12 months.
These are the studies that you're typically seeing cited, and there are no more recent meta-analyses that I could find in the research that exists on this link. Unfortunately, I wish there was something more recent than 2013. It's always frustrating when you want to see the latest information, and then you realize that no one has spent money to look at this in a while. Sometimes that's because they feel the connection is already strong.
But there's always an opportunity to learn more by studying something. What if that's an overestimation? What if it's an underestimation? We really need to know. This is really important and if you listen to any of the statistics that are being batted around right now about how many people are being diagnosed with breast cancer, it’s really important that we would know this. It's one of the only strategies that we have. There are not very many strategies for preventing breast cancer and this is one of them, so it would be really important for us to have this information.
There's a couple of things that come from sort of a negative setup that we could talk about when we discuss how breastfeeding reduces the risk of breast cancer. We could remind people that actually discouraging breastfeeding increases the lactating or birthing person's risk of breast cancer. When we tell people, oh, it's not that important or it doesn't matter. You know what, however you feed your baby, it doesn't really make any difference. It's all the same, or when we focus all of our attention on the effects on the baby, rather than bringing in the effects on the lactating person that is really, actually, it's not true, it's inaccurate, and it can increase their risk of breast cancer. So how is that ethical?
It's also unethical for us or for anyone to withhold information about maternal or parental breast cancer risk reductions afforded by lactation when we're discussing infant feeding choices. We can't leave that part out. We have to talk about all of the things, all of the health effects. And that's why we always say, people's feeding choices shouldn't be happening in a five-minute span while they're also in labor. We really want people to be spending a lot of time ahead of birth time really thinking about and considering what type of feeding they plan to do and getting the information that they need to make that choice.
I also wanted to point out that even in the studies that I was looking at, but especially in those two papers - the 2002 and the 2013 - specific information on the way that lactation was accomplished was not always available in the studies. So it's very likely that the population of people who indicated that they breastfed, they use the word breastfed. But that likely included people who exclusively breastfed or fed directly from their body. People who partially breastfed and partially formula fed, and also people who primarily or exclusively used a milk expression method like hand expression or used a breast pump. Now we can also say that if those were studies done in the US, at that time, it was more difficult and less accessible to acquire a high quality breast pump, the kind that we have now, which make it possible for people to exclusively pump or primarily pump for longer, but there were still many people, of course at that time, using breast pumps while they were away from their babies. So we definitely could be looking at a population of people who indicated that they breastfed and they meant any combination of those things.
Well, here's the good thing: if all of those people were in that population, that would mean that the effects are caused by lactation, not necessarily by feeding the baby from the body. That's an important thing for us to be thinking about and for us to be considering when we're talking about people making choices about how they are going to accomplish lactation. I think that's an important thing to think about and for us to point out, as we discuss this.
Getting into those mechanisms like I mentioned before, there are believed to be at least two mechanisms at work here. The primary one that many people easily understand and easily remember is that during the period of lactation the person's overall exposure to estrogen is reduced. Basically, breastfeeding or lactation reduces the lifetime exposure of the breast to estrogen, because it reduces exposure during that period of lactation, and that is linked to - that reduction of lifetime exposure to estrogen - is linked to lower risk of breast cancer. That's most likely one of the mechanisms that's at work here.
The second one is not as well studied or well understood, but there are some really specific things that have come out in more recent studies. Breastfeeding and lactation facilitate normal cell function and inflammation patterns during lactation. Breastfeeding alters the breast microbiome. It causes changes to cell structures and the way those cells are used. It allows for the growth of healthy breast cells, and possibly the shedding of unhealthy cells or abnormal cells, which might cause problems in the future.
There's a really great study that I found which looked at some rat studies (obviously, rats are not humans, so we can't extrapolate everything) but here's what they found: in some of those rat studies, they created a process by which they could observe what happened when those rats were breastfeeding for what they considered a normal amount of time versus abruptly weaning shortly after their pups were born. What they found in those rats was that abrupt weaning resulted in very specific changes to the breast microenvironment and the cells which are associated with increased risk of breast cancer. Then they found that for those rats which were facilitated to breastfeed for what they considered a normal course, and then gradually weaned, it resulted in gradual involution of the breasts, which is less inflammatory to the breast itself, and is associated with a reduced risk of breast cancer.
They did extrapolate that to talk about the difference between abrupt versus gradual weaning and they talked about this being used to say that gradual weaning after a period of breastfeeding longer than six months results in that gradual involution, which is less inflammatory and causes less of those very specific changes that are associated with the risk of breast cancer. I felt like this was a really important point to make: that gradual weaning results in acute remodelling of the mammary glands. Those are things that do not happen when babies are weaned suddenly or abruptly.
That's a really important thing for people to understand when they are giving advice or information to people during periods of using medications. We know that people get inaccurate information about whether they are able to breastfeed or use their milk during a time that they're using medication. We know that people are incorrectly told to wean because they have mastitis. We know that people are not facilitated to maintain milk production if they have mastitis in many situations, and that basically causes that abrupt weaning.
So anytime abrupt weaning is being recommended - hold off! Let's take a pause there and really think about what we're doing. We're going to see immediate acute effects right now on the person who's weaning, we're going to see immediate acute needs and effects on the baby who's being weaned, and then we're also going to be looking at long term effects inside the breast, that are not visible, not something we can feel, or that the person can feel, and they’re not predictable.
In those abrupt weaning situations, we really need to be taking a pause on those if abrupt weaning is really so different than gradual weaning. We know in lactation work that generally, when people do breastfeed for several months, whether partially or exclusively whether they're breastfeeding for six months. When they breastfeed that long they do tend to fade out, they sort of gradually wean whenever that is. Whether it's at nine months or 15 months or two years or three years, weaning tends to happen more gradually.
We might want to think about the way that we are supporting people who are finding their information in other sources where they're thinking that I've gone back to work, I can't breastfeed anymore, I have to “just” pump. Well, I never understand how that leap happens, but it does happen, and I think we need to make sure that we're really making that point and that things we think of as sort of obvious, like, you can still breastfeed, even if you're also pumping, you can still breastfeed if you go to work and your pump when you're at work, you can still breastfeed if you work for a few hours a day.
There's so many opportunities that we have to extend breastfeeding and the research that we have is not specific enough for us to really have to say, we really need to do it for this long, other than knowing that six months is important. And of course, taking into account that those decisions aren't made just based on this research. This is really a decision that's made with so many other factors in mind.
I think that it's important we're talking about these things because I'm not hearing this from any other angle of healthcare care. I'm not hearing this from anyone else who's talking about breast cancer. We're not hearing this and this, honestly, is a hopeful message. If we aim this message at the people who still have the opportunity to have lactation in front of them. It's a call to have better research about this specifically about the links between risk of breast cancer and lactation.
It's a call to have better and more research on how exclusive pumping happens and how it is best supported, and what types of variations in exclusive pumping result in normal outcomes and don't result in poor milk production. We are always trying to figure out the best way to do this. We need more research on that so that we can support people whose plan it is to continue pumping for a long time; a long time being whatever they say it is. We really just have to keep on talking about this, so that the people who can fund that research and the people who can perform that research, understand how much it matters to the work that we are doing clinically with clients and the information that we're able to give them.
We really have to think about this in terms of that global context - what was brought up in that Lancet article, which, in the conclusion, said that the lack of or short duration of breastfeeding in developed nations has led to an increased incidence of breast cancer. They actually implicated lower breastfeeding rates and shorter duration of breastfeeding with higher rates of breast cancer in developed nations.
We know that the protection against breast cancer which is afforded by breastfeeding is dose-dependent, so the longer the duration of breastfeeding, and the longer the cumulative amount of breastfeeding or lactation over the lifetime, the more protection that person has against breast cancer.
I just want to conclude with a few notes that are from the Academy of Breastfeeding Medicine, who wisely put out a protocol very recently about breastfeeding and breast cancer. It’s a great protocol for anybody who might have have clients who are facing a breast cancer diagnosis while they are in a lactation period. This is information that we need to have.
Firstly, and this is a really important message that we can spread this year during Breast Cancer Awareness Month, screening for breast cancer during breastfeeding or lactation is safe - all types of screening. It should be considered as part of the individual's risk factor analysis. Each case should be evaluated separately. Basically, in general, the guidelines for when someone should be screened for breast cancer, whatever age, whatever deciding factors they have discussed with their medical provider, whatever genetic risk factors they have, lactation is not a reason to delay screening. Screening should not be deferred because of lactation status. If someone is planning to wean within a few months, and they opt to screen after they have finished, they could choose that. But they don't have to. There's no reason that they would have to delay, so that would be a choice that they were making, and staying on a regular schedule of screening is always going to be more advantageous whenever somebody has risk factors or reasons to be screened.
Now, screening for breast cancer in a lactating person may require additional diagnostic imaging so they may have to go through more than a mammogram. They may have to also have an ultrasound. There may be additional testing that they need, due to what the ABM protocol calls the unique radiographic appearance of the lactating breast. That means that a person with experience needs to be looking at that so that they understand what they're seeing in a lactating breast. Screening for breast cancer during lactation is improved by milk removal just prior to imaging. So having the baby feed, having some milk expression go on so that the breasts are as empty as they possibly could be - feeling empty or not full -is really helpful to help remove what makes that unique radiographic image of the lactating breast. We want those glands to not be completely full.
They also recommend in their conclusion that women with a history of breast cancer who wish to breastfeed should be receiving anticipatory guidance as well as close postpartum management of lactation. That really puts the onus on us as lactation care providers to make sure that we are as educated as we can be about this issue. That should we have a client who has this need, we are prepared. We are ready to go. And we should remember that there's a protocol on this from the ABM in case that needs to be provided to her other medical providers. We really want to make sure that we're completely prepared for this situation should it happen, and that overall, we're understanding, and we're sharing the message that this is a major part of why we talk about breastfeeding as being something that's important.
Reducing the risk of breast cancer, of course, that's not a benefit of breastfeeding, there are no benefits. This is a health outcome. This is a physiologic health outcome. Breastfeeding is an important part of health through the reproductive phase of life.
There's a lot about this conversation that could be viewed as negative - I mean we're talking about breast cancer here - we could think about this as a really hopeless situation. We could think about this as a devastating thing for us to have to talk about, or we can look for those opportunities for hopeful education for people so that anyone who still has this opportunity in front of them understands this opportunity and knows that there is something that they can do.
At the same time, it gives us the opportunity for anybody who might feel upset or triggered, or sad or disappointed or angry or resentful or regretful about their own lactation experience - helping them to see how they were failed by the system of lactation support that we currently have, and helping them to see that we are working to make that better, that there are many of us already working in this field, and there are many people coming up behind us, to make sure that this ball does not get dropped. We know that without the proper environment of facilitating normal lactation for people, without the proper clinical assistance being accessible and available to absolutely everyone, without the proper information getting out there to people before they have babies, this is one of the unfortunate results of that. And this is just one thing; this is just one area of how health outcomes are changed when we don't properly support breastfeeding.
I hope this has been valuable for you. I know that just looking at the research one day for a couple of hours made a huge difference for me and understanding why I need to have this information basically tattooed in my brain, so that when somebody brings this up, when anyone is talking about breast cancer, I can participate. I've already added to many conversations on social media about this. When people are even just talking about breastfeeding, I'm adding some information about breast cancer now because I know it. When we know this and when we understand the why, then we ourselves can have that faith and confidence in the information that we share. We really do feel like we can share this information and have conversations and discuss it with people and always tie it back to that we know a lot of people are getting failed and that this is one of the big reasons why we're working on it.
There are so many reasons, and many of those reasons are adorable little human babies. But, you know, an equal number of those reasons are adult people, they're adolescent people with children. These are people whose health outcomes are being altered because they are not receiving or not living in the right environment to make breastfeeding possible for them. We really have this great opportunity and that's why I wanted to deliver this to you with hope. I hope you took it that way, and I hope that it's very valuable and helpful for you.
I also hope you have heard, somewhere along the way, in my emails or on my website or on social media that I've got a free training on optimizing early milk production. If you're interested in signing up for that training, you can watch this webinar at your convenience. If you visit my website at Christine staricka.com/fre, you can sign up and watch that webinar.
I pulled it - I extracted it - right out of The First 100 Hours Masterclass because I feel like it's a really important point to make. There's so much to know about early optimization of milk production. There are so many things in there that people just really need to know. And I think that it would help you wherever you practice lactation. I think it's helpful if you work in a hospital, if you're able to provide care to people in the very earliest days of lactation through your birth work through home visits.
I think it's a really valuable thing for you to watch and experience so that you have a better understanding of this concept of The First 100 Hours, how critical that timeframe is and what a difference it can really make in your practice, in your confidence, and in the results that your clients are seeing when you are able to explain this in a way that they can really get. Please visit my website https://www.Christine staricka.com/free, and you can sign up for that webinar, and of course there's other free things on that page as well. I look forward to seeing you there on the webinar and I'll see you next time. Thanks so much!