Thursday, 24 March 2016

Would Women Be 50% Better Off Not Getting Their Health Facts From Jamie Oliver?


Celebrity chef turned healthy eating campaigner, Jamie Oliver, has been telling us all about the wonders of breastfeeding - Queue backlash and counter backlash but has he got a point and do his stats stack up?



I wasn't going to, I really wasn't, but then, yeah, stuff it, it's my blog and I'll weigh in if I want to...

Last week Jamie Oliver was probably riding pretty high, his crusade against sugar had seen the surprise announcement of a new tax on sugary drinks included in the UK budget. He's already brought about changes in school meals so the natural question was - what's next? 

Next apparently (although he's since back peddled a bit) is Breastfeeding:


Miles of online column inches and many a social media rant have been written in response to this so I'm not going to write any more about why breastfeeding isn't easy for an awful lot of women (it's really not). I'm also not going to explain why a man shouldn't be talking about something he has never done himself. People can have an informed opinion on plenty of things they've never personally experienced, so I don't think men should be barred from all discussions on breastfeeding. But what I do take issue with is when anyone, man or woman starts making personal opinion sound like fact. Especially if they are talking from a position of perceived authority.

The thing that really grabbed me in Oliver's comments was the bit about a 50% reduction in breast cancer if you breastfeed for at least six months. I was certainly aware that breastfeeding reduces the chances of a mother getting breast cancer, but I had thought that you had to breastfeed for at least two years and that the reduction in breast cancer was, even then, more modest.

So I decided to take a look at this figure, after all Oliver has far more access to knowledgeable advisers than me, so I could just be out of date. Or have we never heard about the 50% figure because it's rubbish?

 Having asked around it seems that the 50% may have come from this study from 2001. It looked at 404 women breastfeeding in China and did indeed show a 50% reduction in the incidence of breast cancer for some of them. But only if they fed each of their children for at least two years. The study also looked at how long the women involved breast fed in total. That data showed that the protection from breast cancer only kicked in after at least 73 months of breastfeeding. That's a full six years of your life breastfeeding to see the 50% cut.
That though is just one study and it's always risky to rely too much on the information from a single group of scientists working with a small group of people in a specific location. It's far more reliable to look at the overall trends seen in lots of different studies. Well, you can bet there are plenty of studies on this subject but finding and analysing them all requires both a lot of time and some pretty top end stats skills. I, like most Mums, posses neither of these things but thankfully there are other people who do. 

The Lancet published a series of articles and papers about Breastfeeding recently. One of the things it looked at was a meta analysis of breastfeeding / breast cancer studies. From this it concluded that yes, there does seem to be a strong link between breastfeeding and reductions in breast cancer. But, the stats are very different from Jamie's. The Lancet reported a reduction in invasive breast cancer of 4.3% for every 12 months a women breastfed. Clearly a far lower figure,  but they still estimated that if almost every baby in the world was breastfed, there would be 20,000 fewer women dying of cancer each year (not all of these are breast cancer btw, breastfeeding also seems to reduce ovarian cancer).

But even with the Lancet's more reliable data, we're talking about global averages. For individual mums it's not simply a matter of x months breast feeding = y% reduction in breast cancer. There are cultural and ethnic factors and some women's genetics will over rule everything else. Then there is smoking, alcohol and obesity. Whether or not breast feeding totally stops a woman's menstrual cycle may also be significant and breast cancer isn't a single disease. There are a variety of types with different responses to different hormones. Breast feeding may not be protective against them all. 

So breastfeeding for a bit longer probably will help some women avoid breast cancer but it offers no guarantees. It can be a consideration in the decision to breastfeed or formula feed, but so should a whole lot of other things and, just in case I actually need to say this - that decision should always be made by the person with the breasts, not their partner, friends, midwife, doctor or favourite TV chef.



To be fair to Oliver, I think he was caught unprepared. He quite rightly talks about the need to support women to breastfeed and that is a huge issue. As so many of us know, you get bombarded with pressure to breastfeed as soon as you enter the world of pregnancy and birth, but once the baby is out that rarely turns into good help. Let's support women who want to breastfeed, let's stop making them hide in the toilets to feed their babies and let's make sure they don't have to battle through poor, inconsistent or non existent advice. But let's also make sure we have accurate information.

Jamie Oliver has established a reputation as a healthy eating campaigner, as someone who knows the facts and can call on experts to help him out. To mangle an over used quote, with great respectability comes great responsibility. It would have been far better if he had stopped at saying breast feeding seemed to reduce breast cancer and he was still searching for more facts on the issue. Instead he seemed to grasp at a half remembered statistic which a lot of people will understandably believe, based on their opinion of him, to be true.

Sometimes taking the lead in informing people means not just sharing what we do know, but also being honest and explaining what we don't. Now when do you ever hear that? - Never?

SBx
PS. As ever I am by no means an expert on this subject and I've not done a comprehensive literature review, so if anyone has better or more up to date information please please comment below.
PPS. Also, as ever, never get your health advice from random blogs on the internet, even mine!