Was it my fault I got cancer Five years after her breast cancer, JENNI MURRAY can”t help wondering whether her weight was to blame
There”s no doubt that it”s one of the scariest moments of your life. You”ve had breast cancer and received the best radical treatment available: a mastectomy, chemotherapy, and a daily pill to control the oestrogen levels that can cause breast cancer in the first place.
And then, annually, a mammogram on the remaining breast and a consultation with your oncologist.
There”s that terrifying moment when he comes into the consulting room, having already seen the results of your mammogram, and your heart stops as you try to read his face. Does he look pleased or disappointed Will he deliver good news or bad
Survivor: Jenni with her mother on the Isle of Wight during school holidays
Last week, I went through this precise scenario. I thought I detected a remote hint of gloom in the oncologist”s eyes as he reviewed my scans. I expected him to say how sorry he was that I”d developed cancer in my other breast.
But no. He smiled and said those magic words: “Your mammogram is all clear.” He did a physical examination to confirm that there was nothing untoward and then we sat down at his desk for a chat about where we go from here, five years after my initial diagnosis.
The one thing he didn”t mention, until I raised it, was the issue of my weight — though it was surely the elephant in the room (no sniggering at the back, thank you).
All the more so, in light of the research published earlier this month by Cancer Research UK, linking excess weight to cancer. Their figures claimed that around a third of all cancers could be prevented by a change in lifestyle.
It”s an issue that has been particularly pertinent for me.
My oncologist had been so pleased when, a year ago, I embarked on the Dukan diet and lost a significant amount of weight — five stone in just under the year, during which I stuck pretty well to the strict regime. He and I had discussed how important it was for me to try to keep my BMI in the “normal” range.
Regular readers will know what ensued: I lost five stone, only to lapse on a recent holiday and put three back on. I was creeping back towards obesity. Not good news.
Radio 4 presenter, Jenni Murray who lost her hair after chemotherapy to treat her breast cancer
I felt the same sense of shame and disappointment that every failed dieter goes through, but in my case it was exacerbated by knowing that there”s a link between being overweight and cancers of the breast and lining of the womb.
Indeed, my main aim in dieting had been to be lighter, healthier and reduce any risk of another tumour.
According to the latest research, cigarettes, poor diet, alcohol and obesity are linked to 100,000 diagnoses of a range of cancers every year — with women at greater risk than men because of being overweight. But that”s a broad spectrum of risk factors.
What interested me most was how firm the new evidence is that so many women seem to be putting themselves at risk specifically because they are fat. So I decided to go straight to the horse”s mouth.
Professor Max Parkin, of Queen Mary College, London, was the epidemiologist commissioned by Cancer Research UK to investigate the influence of lifestyle on cancer.
He explained to me that his method was to review all the major observational studies carried out in recent years, including the famous Million Women Study, an NHS/Cancer Research UK collaboration looking at the causes of the disease in females over the age of 50.
He says that evidence of the danger of smoking is clear: 23 per cent of male cancers and just over 15 per cent of female cancers are related to the poisonous carcinogens in tobacco.
As for being overweight, Professor Parkin explains that it is more risky for women than for men when it comes to cancer, because “adipose tissue” (or fat) is a source of oestrogen, particularly so after the menopause.
When the ovaries pack up and the production of oestrogen falls, the hormone presents a real danger to the breast and endometrium (lining of the uterus), causing healthy cells to mutate and become cancerous.
Professor Parkin confirms that there was a notable rise in such cancers when HRT became popular with women struggling with the symptoms of the menopause.
Since 2001, however, fewer women have opted for HRT after the risks were publicised. Thus, since 2008, he says there has been an observable fall in the number of breast cancers believed to have hormone replacement as its cause.
Yet, overall, breast cancer diagnoses have continued to rise.
The reason Professor Parkin says 70 per cent of breast cancers in women who have been through the menopause can be attributed to the fact they are overweight or obese.
That”s a rise from 63 per cent at the turn of the century, and correlates with what”s known about the growing problem of obesity.
The BBC radio broadcaster and journalist with her son Charlie, now aged 18 (left), and (right) working as a presenter in the 1960s
Faced with this hard evidence, then, what do we do about it
Professor Parkin emphasises that it is far too simple to say “being fat causes cancer”.
In all the cancers he has examined, there can be a combination of factors — he points out that cancer is largely due to genes and chance; that the best way to avoid being the one in three predicted to get it is to have two parents who never had the disease; and never to smoke.
The professor even quotes a study of peasants in the Yemen who were exposed to none of the risks of the 21st century — drinking alcohol, smoking or fatty, sugary diets — but still developed cancer. This proved the ageing body is still the greatest risk factor.
So, no, you can”t guarantee that a change in lifestyle will protect you from cancer, he says. But you can lengthen the odds in your favour by making lifestyle changes, however tough they may be. And, believe me, they are tough.
No one knows better than I do how difficult it is to lose weight nor the opprobrium you face when — as happens to so many of us — you embark on a strict diet and make progress, only to fall off the wagon.
I have never endured such criticism as I did when recent photos of the expanding me were published after my investiture at Buckingham Palace. Being described on one website as Jabba the Hutt would be desperately hurtful to someone with a thinner skin than the one I”ve developed over the years.
The notion that being thin is somehow a woman”s moral duty goes back a long way.
Louise Foxcroft, in her new book Calories And Corsets, points to a history of using prayer to banish fat — from St Augustine of Hippo in the third century AD to Deborah Pierce in 1960, in her book I Prayed Myself Slim.
Dame Jenni Murray was made a Dame Commander by the Queen during an Investiture ceremony at Buckingham Palace earlier this month
Hermits, priests and philosophers across cultures have extolled abstention as a route to godliness. Saintly women were praised for starving themselves. Fat has long been deemed a manifestation of greed and indulgence: gluttony is one of the seven deadly sins.
The moral responsibility to be thinner is emphasised by further research published this month.
After Cancer Research UK”s figures came more from the healthcare analysts Laing and Buisson, who predicted a rise in the cost of cancer treatments from the current 9.4 billion to 15.3 billion by 2021 — the result of an ageing population and the expense of ever more sophisticated treatments. And so the pressure to take responsibility for our own health mounts.
But where does that leave those of us who may have a genetic disposition to being overweight As they aged, both of my grandmothers became as round as they were long.
I have known for a long time that by the time I showed symptoms of breast cancer at the age of 56, I had been far too fond of treating white wine as a non-alcoholic drink, had taken HRT to ward off the worst symptoms of the menopause, and had fallen prey to middle-aged spread.
After chemotherapy, I developed a problem in my hips that caused me agonising pain and necessitated a bi-lateral hip replacement. As a result, my ability to exercise was diminished. My weight kept going up. And up.
Honoured: Dame Jenni with (from the left) husband David and sons Charlie and Ed at Buckingham Palace
I still lead a sedentary lifestyle: travelling by car or train; sitting in front of a computer screen or in a radio studio; and I find walking long distances or climbing a flight of stairs difficult.
But slimming down to a normal weight is hard, and I despise people who make those of us who struggle to become healthier feel guilty about the cancer we had.
Nothing is worse than being told you have this wretched disease, and the last thing you or your desperately anxious family need to hear, as you suffer the terrible treatments, is that it was all your fault anyway.
But I do know that losing weight will reduce my chances of getting cancer in the other breast.
So I left the oncologist”s consulting room last week with the details of a regime called the Two-Day Diet, developed at the Genesis Breast Cancer Prevention Centre, which is in the South Manchester Hospital where I have my check-ups.
It recommends two days a week on a very low-calorie diet — just 650 a day — then a Mediterranean diet with no restrictions for the rest of the week.
My oncologist has been doing the diet himself and finds it reasonably easy to stick to. And in trials with patients, it”s been found to be successful, with an average weight loss of 1lb to 2lb a week — up to half a stone in the first month.
The literature promises that losing some of the excess weight can cut health risks by as much as 40 per cent. It sounds manageable, so we agreed I”ll give it a go and, maybe, by the time we have our next encounter in a year”s time, I”ll have lost six stone and be well within the normal BMI range at 11 stone. I”ll get cracking after Christmas!
At least I can afford to buy myself healthy food: fruit, vegetables, fish and olive oil. Not everyone can.
If we are ever to reduce this country”s pandemic of obesity and its consequences, we have to acknowledge that being overweight is often the result of poverty.
A burger and chips cost just a couple of pounds; carbohydrates are cheap and filling.
Good food should be affordable and available in the poorest areas. Schools all over the country should adopt Jamie Oliver”s healthy- eating plan, so we start off children with the right habits.
And we should put women”s sport and exercise on the same pedestal as men”s sport, so future generations of girls know it”s cool to keep fit.
For the rest of us, it”s a case of “do your best”. Make a New Year resolution to quit smoking, eat more fruit and veg, lose weight and drink less alcohol.
But, whatever you do, don”t feel immoral or guilty. Stress never did anyone any good.