Commented the principal author of the study, Dr. Graham Colditz: "If a woman uses [hormones] long-term and stops, within two years, the risk goes back to that of a woman who never used the hormones."

Women have now been exposed to both long-term hormone treatment in the form of the birth control pill and long-term hormone treatment in the form of estrogen replacement. No one really knows what the combined effect might be on the intricate workings of the female reproductive system. There are several ongoing studies to evaluate that specific interaction. The results won't be available for ten to 20 years.

Post-menopausal women who are moderately overweight may have a slightly higher risk of breast cancer because of the increased amount of estrogen hormone produced by fat tissues.

Women exposed to DES during pregnancy have an increased risk of breast cancer 20 years after exposure.

SPECIAL NOTE, TAMOXIFEN IS NOT PREVENTION: With much fanfare, on April 29, 1992, the U.S. National Cancer Institute launched a study that will enrol 16,000 women over the course of the next two years in the U.S. and Canada. Eligible women will include those at high risk defined as age 60 or over, or age 35 with a positive family history. Only half the women will receive tamoxifen, the other half will receive a placebo.

Tamoxifen is an anti-cancer, anti-estrogen drug. Side effects such as hot flashes, nausea, and vomiting occur in 25 percent of women taking tamoxifen. Swollen ankles, irregular bleeding, vaginal discharge and skin rash occur less commonly. There can also be changes in the eye and liver enzymes.

In fact, in England, there have been five deaths from liver disease linked to tamoxifen. These deaths prompted Britain's Medical Research Council to refuse to back the tamoxifen trial. Four cases of liver failure have been linked to the drug, three of which were fatal. Five women developed hepatitis and one of these has died. Eleven other women suffered from liver complications and 15 more had abnormalities of their blood cells. These potential side effects are not mentioned in the information sheet for women participating in the trial.

Clearly this is not a drug to be given lightly to healthy women and clearly it has nothing to do with prevention whatsoever. Dr. Adriane Fugh-Berman, Director of The National Women's Health Network, and Dr. Samuel Epstein feel the side effects of tamoxifen are too toxic for a healthy population (The Lancet, 1992). They pose the question: "is this disease prevention or disease substitution?"

• BREAST SELF EXAM (BSE): "Very few women examine themselves and that includes women physicians," says Dr. Susan Love, "The reason is they're scared to find a lump."

The attitude with which you perform BSE is important. A study by a woman psychologist revealed that women who admitted they were afraid of discovering breast cancer, believing it was beyond their control anyway, were much less successful in detecting lumps than women with positive attitudes.

Dr. Baines says that women should only do BSE regularly but only from age 40 onwards:

1. If they want to.

2. If they have been taught well by a doctor or nurse.

3. If they have these instructions repeated every year.

Dr. Baines believes it is not good enough to hand a woman a pamphlet on BSE and expect her to learn competent BSE from it. She feels that no BSE is better than sloppily done BSE.

Dr. Baines emphasizes that BSE in women under age 40 is unwarranted because too many lumps are found and too many unnecessary biopsies may result.

Dr. Love believes that BSE has been wrongly presented to women. "The accent," she says, "should be on not finding anything. The idea is not to look for lumps but to familiarize yourself with your breasts in their normal state so you'll notice anything different."

• LEARN HOW TO ACCURATELY EXAMINE YOUR OWN BREASTS USING THE MAMMACARE LEARNING SYSTEM: The biggest obstacle to women is that they don't know what they are feeling for when they do a breast self exam. This kit addresses this problem head on. It is the result of a seven year research project at the University of Florida, partially funded by the U.S. National Cancer Institute.