The Guardian
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Cancer should do to survive


*Drink no more than two glasses of wine each week, do 20 minutes of daily exercise, lose weight if necessary

Women with breast cancer will be told to limit themselves to two glasses of wine a week and take regular exercise, if draft guidelines go ahead.They will be encouraged to lose weight – if necessary – so they are within the ‘normal’ range for their height.

The advice has been issued by the health watchdog Nice to try and boost survival rates by preventing the cancers coming back at a later stage.Patients will also be urged to take cheap hormonal pills including tamoxifen and aromatase inhibitors for up to ten years after undergoing surgery.

Currently, women are advised to take them for five years afterwards although many stop earlier due to debilitating side effects.Research has found that continuing their use for ten years or longer reduces the risk of breast cancer coming back by up to 34 per cent.Although the survival rates have dramatically improved since the 1990s, the illness remains one of the leading causes of death in women.

Nice has issued a series of draft recommendations for patients with early stage breast cancer which will be consulted on by experts over the coming months.These include urging doctors to limit their alcohol intake, exercise regularly and lose weight, if overweight or obese, which have all been linked to improved survival rates.

Ideally, women should drink no more than five units of alcohol a week – equivalent to two large glasses of wine.They should take regular exercise, even if they feel unwell, and this can include walking, gardening and housework.Ideally they should aim to do 150 minutes of physical activity a week although many women will struggle as chemotherapy can make them feel very weak and tired.

The guidelines also urge women to take tamoxifen and aromatase inhibitors for more than five years after treatment and possibly up to ten.Tamoxifen costs about 8p a day whereas aromatase inhibitors, which include letrozole and anastrazole, are just 5p a day.

But the pills cause debilitating side effects and many women will be reluctant to take them for prolonged periods when they are cancer-free.Approximately half of patients who take them experience hot flushes, difficulties sleeping and also the bone thinning condition osteoporosis.

Prof. Mark Baker, director of the centre for guidelines at Nice, said: “Although breast cancer survival rates have improved over recent decades, it remains the leading cause of death in women aged 35-49.

“Since the publication of Nice’s original guideline in 2009 there have been a number of advances in the way early breast cancer is managed and these are reflected in this updated guideline.“This will help healthcare professionals to provide consistent, high quality care for people with early breast cancer and ensure equal access to the most appropriate treatments, no matter where people live in England and Wales.”

The draft guidelines cover a range of recommendations for treating patients with early-stage breast cancer.They also state that women who have a mastectomy should be offered an immediate breast reconstruction, if they want one.Some women are denied the operation by cost-cutting health trusts who claim it is cosmetic and of low-priority.

Baroness Delyth Morgan, chief executive at the charity Breast Cancer Now, said: “These are really important steps in the right direction for patients with early-stage breast cancer.

“This update offers significant and much-needed guidance to help doctors and healthcare professionals translate critical research breakthroughs to NHS patients. “If now funded and implemented across the country, these steps could save and improve thousands more women’s lives.”

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Breast cancer
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