Reader Mail,
Woman's Day.

Dear Woman's Day:

I recently read an article in your Sept 1, 1995, issue
informing your readers about the best ways to prevent breast cancer.
Although it mentioned some useful points, there was one glaring omission
from your list: breastfeeding.  There is now a solid body of evidence
showing a reduced risk of breast cancer among women who have breastfed
(Newcomb, PA, et al.  Lactation and a reduced risk of premenopausal
breast cancer.  New England Journal of Medicine. Vol 330, No.2, pp81-87,
Jan 13, 1994; Yoo,KY, et al.  Independent protective effect of lactation
against breast cancer: A case-control study in Japan.  American Journal
of Epidemiology, Vol 135, No.7, pp726-33, 1992; Byers T, et al.
Lactation and breast cancer: evidence for a negative association in
premenopausal women.  American Journal of Epidemiology Vol 121,pp664-74,
1985; Siskind V, et al.  Breast cancer and breastfeeding: results from
and Australian case-control study.  American Journal of Epidemiology, Vol
130, pp229-36, 1989; Layde PM, et al.  The independent associations of
parity, age at first full term pregnancy, and duration of breastfeeding
with the risk of breast cancer.  Journal of Clinical Epidemiology, Vol
42, pp963-73, 1989.)  The reductions in risk varied in these studies, and
some only showed a reduced risk for premenopausal breast cancer.
However, any way you look at it, there is a much more impressive body of
evidence for breastfeeding than there is for diet as a factor in reduced
risk.
Since there are so few factors which are within a woman's control (your
article points out family history, age at first pregnancy, among others
which are not easily altered), women need to be informed about the fact
that there is one decision they can make which could truly make a
difference in their risk.  Furthermore, since the total cumulative months
of breastfeeding appear to decrease the risk further, women need to be
informed that it may be best to plan on more than just a couple of weeks
of breastfeeding.
In the section about low fat diet, I found an interesting statement.
There was an allusion to the low rates of breast cancer in Japan,
followed by the assertion that scientists are furiously looking for the
connection between the low fat diet in Japan and the reduced risk of
breast cancer.  In light of the evidence about breastfeeding, perhaps the
scientists are just asking the wrong question.  The breastfeeding rate
in Japan in 1974 was 92% (the American breastfeeding rate at the same time
was 35%).
Despite overwhelming scientific evidence for the benefits of
breastfeeding not only to children, but to mothers and to society, the
prevailing message in this society is that breastfeeding is nice, but
probably not worth the perceived extra effort.  Such an attitude probably
at least partly accounts for the continued low rates of breastfeeding
(after a peak of 60% in 1984, American breastfeeding rates declined to
52% in 1991, rebounding slightly to 56% in 1993).  Perhaps if the media
did more reporting on the very important and significant differences
between breastfeeding and feeding of artificial breast milk substitutes,
more mothers would choose to breastfeed, resulting in improved health and
decreased health care costs for all Americans.

                                Sincerely,
                                Alicia Dermer, M.D.
                                69 County Road 516
                                Old Bridge, NJ 08857
                                (908)254-1515; Fax (908)651-0774
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