The C-Word

Cancer. What is it? Why are we so scared of it? And what can we do about it?

Cancer is basically the mutation of cells. Cells that divide beyond the normal growth rate for their type and that invade and kill neighbouring cells are loosely defined as cancerous, sometimes they also travel around the body via blood or lymph.

We hear alarming figures thrown around such as 1 in 3 women will contract a female cancer in their lifetime and that almost all of us can say that they have been in some way affected by cancer, either themselves directly or a loved one. It's no wonder that we are so scared of this disease. But is this accurate?

According to Cancer Research UK, there are now over 2 million cancer survivors in the UK, approximately 3.3% of the population and around 10% of those over 65 are cancer survivors. The number of diagnoses per year keeps increasing, but the so does the survival rate. The most common cancer is breast cancer, with about 550,000 current survivors in the UK today. In 2008 the mortality rate was 0.176% of the UK population. That doesn't sound so scary.

Why might cells mutate? 90-95% of cancers are caused by environmental or lifestyle factors, only 5-10% are genetic. Tobacco is the big one, we all know that, smoking is the cause of nearly 30% of all cancer deaths, 83-90% of lung cancer deaths and is also linked to cancers of the oesophagus, larynx, pharynx, oral cavity, pancreas, bladder, nasal cavity and sinuses, stomach, liver, kidney, cervix and myeloid leukaemia.

Other environmental factors that can increase the risk of cancer are UV exposure, weight, diet and infection.

But the one I really want to talk about is hormones, particularly female hormones and the "female" cancers; breast, cervical, uterine and ovarian.

Certain lifestyle choices are known to impact on our chances of contracting a female cancer. The combination oral contraceptive pill slightly increases the risk of breast and cervical cancer whilst taking the pill, but once no longer taking it the risk decreases again. However, there is a significant reduction in the risk of ovarian cancer for women who take the pill for five years, lasting for more than 20 years. And when I say significant, I really mean it: 50%. There is also a 40-60% reduction in instances of endometrial cancer (uterine cancer) for women who take the pill.

Having 7 or more children and having a first child before the age of 17 are known to double the risk of cervical cancer

The oestrogen only Hormone Replacement Therapy (HRT) has been shown to increase the risk of breast, uterine and ovarian cancers.

And last but by no means least, women are at 4% less risk of breast cancer for each year that they breastfeed and women who do not breastfeed at all are twice as likely to contract endometrial cancer and two thirds more likely to get ovarian cancer.

While all these figures are interesting, what I am most interested in is why. What no one seems to be saying is that cancer is thought to occur in cells that are over-stimulated, that's why the pill is so protective, it prevents ovulation and therefore gives the ovaries and uterus a rest from menstruation. Just like pregnancy and breastfeeding does. The pill basically replicates the consequences of reproduction, but in a more thorough and predictable way. It is my belief that the cells in any given part of the body are programmed to behave a certain way, according to their function and if they are not given the opportunity to perform their function as they expect then they are more likely to mutate and turn cancerous.

The ovaries expect to ovulate regularly until conception and then take a break of an average of 22 months (9 of pregnancy and 13 of breastfeeding, this is the average return of menstruation for women who breastfeed their children on demand). The breasts prepare themselves during pregnancy for lactation, regardless of the mother's intentions, the breast tissue fundamentally alters. What happens then if the mother does not breastfeed? Likewise, the cervix prepares itself for birthing a baby during late pregnancy and labour. So what are the implications for those who do not labour or who have a surgical delivery? I didn't find any statistics on that, but I'd love to know if caesarian sections carry an increased risk of cervical cancer. It certainly wasn't a risk listed on my consent form. Does some research need to be done on this?

Could we go back to a time before cancer became the single biggest health scare simply by living as our bodies expect us to?

Informed Consent

Every day for the last two years I have encountered either directly or recounted through someone else, at least one woman who genuinely believes that because she is pregnant she has sacrificed her most fundamental human rights. The vast majority of women become submissive to the will of their care providers and the NHS does nothing to correct this misconception, in fact, it perpetuates it. Women are regularly told by their midwives and doctors that they are "not allowed x", or they "must have y". I myself, while in labour, was told by a midwife that I had to have an internal examination every 4 hours. No consent was sought, it was presented to me as non-negotiable and this happens routinely, probably with the most regularity in relation to induction.

Women are told that their baby is due on a specific date, the Estimated Due Date (EDD), with the emphasis on "due" rather than "estimated". Women fall for this almost every time, if they go just one day past their EDD then their baby is "late". Midwives seem to not point out the fact that babies can and do arrive whenever they are ready and that the World Health Organisation (WHO) defines normal pregnancy as lasting anywhere from 37 to 42 weeks. Once a woman passes 40 weeks, which about 50% of women do, they are told that they are now on a clock and must go into labour quickly otherwise they will "have to be induced".

The exact date at which hospitals routinely induce women with no clinical need, varies from one area to another, but what doesn't seem to vary is the lack of informed consent. Women and their families are not given the facts that enable them to make a decision for themselves, they are routinely led to believe that they have no decision to make, they will be induced, this is non-negotiable. They are not told the risks of the induction process, they are however given exaggerated and out of date "advice" about the risks of remaining pregnant for longer than 41 weeks.

If a woman's waters break she is put on a clock and if labour does not start spontaneously within 24 hours she is told that she must be induced. I've known women be told this and given no reason, at best they are told that it is because of the risk of infection. What they are not told is that the risk of infection only increases significantly after 96 hours and that it is a significantly higher risk in hospital than at home. Premature rupture of membranes (PROM) occurs in about 6-19% of pregnancies, 86% of women will go into spontaneous labour within 24 hours and 94% within 95 hours. Statistically, a baby born in hospital is 4 times more likely to acquire an infection than a baby born at home and around 9% of women birthing in hospital will acquire an infection, the highest risks being those who have a catheter and especially those undergoing a caesarian section, both of which are higher risks for those undergoing an induction.

It saddens me to hear women talking about their births as though they have no choices, no input to how and where it happens and what makes it worse is when people like myself try to inform them we are accused of being bullies! It is my sincere hope that the tide begins to turn soon and that women are given full, accurate information and are empowered to make their own choices for their births. It is one of Airedale Mums' primary goals, though it is not clear yet how we go about achieving it.