Bras and breast cancer: is there a link?

Lucy Mellersh wonders why the business of investigating whether theres a link between bra-wearing and breast cancer is not being taken more seriously.

I’m starting a lingerie business, a job that brings pleasure to many and gives me a good excuse to talk about sex all the time. It was during my research into lingerie that I chanced upon the internet rumour that bra-wearing might be one of the primary causes of breast cancer.

I went to several respected cancer websites where I was assured that there is no connection between bras and breast cancer, but it irked me that they cited no research to back up their confident assurances. I was sure that I could put my mind at ease with scientific fact, so I looked for research that would disprove a connection. My searches came up with nothing. Zilch. Nada. Niente.

Bras and breast cancer illustration Black Robin Design 2Little to go on

The only relevant study published in a scientific journal appeared in the European Journal of Cancer in 1991 and found that ‘Premenopausal women who do not wear bras had half the risk of breast cancer compared with bra wearers’. This could be partly attributed to the known risk associated with obesity – slimmer women are more likely to go bra-free – but it seems unlikely that this would account for such a large risk difference, so the research seemed to support, rather than disprove, the theory that wearing bras could contribute to breast cancer. At the very least, it seemed that the possibility of a connection should be looked into.

I also found a couple of interesting studies that didn’t appear in scientific journals. One of these is discussed in the book Dressed to kill by Sydney Ross Singer and Soma Grismaijer, and describes a case-controlled study of over 4500 American women, half of whom had breast cancer. The authors interviewed these women about their past bra-wearing habits and found a strong correlation between a woman’s risk of developing breast cancer and how frequently she reported wearing a bra. For example, they found that three out of four women who had worn a bra night and day developed breast cancer, whereas women who reported never having worn a bra had a one in 168 chance of developing breast cancer – the same breast cancer rate as men.

Women who reported never having worn a bra had a one in 168 chance of developing breast cancer – the same breast cancer rate as men.

This study is frequently dismissed as unscientific, although I had to look hard and ignore much vitriol to find out what exactly was supposed to be wrong with it. Of course, correlation does not imply causation, but also, case-controlled studies are renowned for ‘recall bias’: as soon as you’re diagnosed with cancer you’ll probably start racking your brains to remember anything you did that might have caused it, whereas control groups tend to under-report exposure to potential risks. But to my untrained eye, the sheer scale of differences warranted further investigation.

One anonymous reviewer on Amazon.com criticises the authors for not including their data, a detailed statistical treatment of the data, or a discussion of the statistical methods used. There is also some criticism of their methods for recruiting test subjects. The main criticism seems to be that other risk factors, such as obesity, number of pregnancies, lifestyle and family history, weren’t matched, recorded or held constant between the two groups.

When I asked Sydney Ross Singer about this, he said, ‘We did include our data and its analysis in the book. We also included age and breast-feeding history, income and other factors. Other breast cancer risk factors are small, while the bra link is huge. Genetics, considered the most significant risk factor, increases incidence about threefold, while the bra increases incidence over a hundred fold. You cannot explain away our findings based on other risk factors, since none is large enough to account for the bra effect.’

Singer suggests turning the argument around: we should question the validity of all breast cancer research that has not considered the effect of wearing a bra.

The milky way

How could wearing a bra lead to breast cancer? What effect could a bra possibly have on the breast that would make cancer more likely to develop there? The authors’ conclusion that bra-wearing constricts the breasts, resulting sluggish lymph drainage, is also called into question by critics.

Martin Ledwick, head of cancer information nurses at Cancer Research UK, says, ‘A bra would need to be unbearably tight for lymphatic drainage to be restricted.’ On the other hand, respected breast surgeon Simon Cawthorn, says, ‘Most women are unaware that their breasts are active throughout the menstrual years, making milk in case pregnancies develop. This milk has to be absorbed and gets out of the breast through lymphatic channels from the nipple outwards to the armpit. Forcing the breast into a garment that applies pressure to enhance shape causes fluid to build up.’

Bralessness reduces breast pain?

Another study, led by British breast experts Simon Cawthorn MD and Professor Robert Mansel, investigated the effects of bra-wearing on breast pain – cyclical mastalgia. Women suffering from breast pain and benign lumps were asked to go bra-free for three months. Over half of the premenopausal women studied reported a reduction in pain during the bra-free period, pain relief kicking in around about the fourth week. When not wearing a bra, these women had, on average, seven per cent more pain-free days. The effects on breast lumps – fibrocystic disease – could not be measured in the study’s short duration.

When not wearing a bra, women had, on average, seven per cent more pain-free days.

Why the lack of research?

The correlation was first noted in a scientific journal eighteen years ago, but there have been no serious follow ups, just unscientific denials and general pooh-poohing. It would surely put the rumours to rest if someone repeated Singer and Grismaijer’s research under rigorous scientific conditions, corroborating or refuting it once and for all, but for some reason this hasn’t happened.

Although they have over 60 ongoing breast cancer trails, Cancer Research UK doesn’t seem interested in looking into this: ‘There is no scientific reason to suspect that there is a connection between a woman wearing a bra and developing breast cancer,’ adding that, ‘applying pressure to cells will not make them turn cancerous.’ Let’s hope they’re right.

Could the reason for the lack of interest in further research be related to how clinical trials are funded, rather than reasons of scientific rigour? ‘Science does not exist in a vacuum,’ writes epidemiologist Elizabeth Pisani in her book Wisdom of Whores, ‘It exists in a world of money and votes, a world of media enquiry and lobbyists, of pharmaceutical manufacturing and environmental activism and religions and political ideologies and all the other complexities of human life.’

Singer suggests a more sinister reason: The lingerie and medical industry’s fear of class-action suits, as well as the medical industry’s vested interest in treatment rather than prevention. The latter seems more relevant to countries that lack nationalised healthcare, but, as Singer reminds us, the mainstream medical establishment doubted the connection between smoking and lung cancer for many years.

The mainstream medical establishment doubted the connection between smoking and lung cancer for many years.

What should I do?

One in eight British women will contract breast cancer at some time during her lifetime. Early diagnosis has an enourmous impact on recovery chances, so regular self-checks are indespensible, as are regular mammograms if you’re over 50.

Some ways of reducing breast cancer risk are more or less under our control, such as staying slim and not smoking. Others are more difficult to arrange, such as being non-white, living in a developing country, having several babies while you’re young and breastfeeding each one for a long time. If bras did turn out to be a contributing risk factor, not wearing one would be the easiest prevention of all.

Until further scientific research can paint a clearer picture of the risks, some options might be:

  • choosing camisoles instead of bras,
  • wear softer bras rather than underwire, or
  • reducing the daily hours spent wearing a bra by taking it off as soon as you get in from work.

Make sure the bras you do wear are well-fitting and comfortable (research does at least tell us that most women are wearing the wrong sized bra) and avoid bras that leave red marks or indentations on your chest or shoulders. Even better, save bra-wearing for times when you know it’ll come off more or less straight away.

Will going braless make my breasts sag?

The short answer may be, ‘Who cares?’ But you may still be interested that the idea that a well-fitting bra will prevent our breasts from drooping is unproven – in fact, the opposite may be true.

A French study investigated whether taking part in sports without a bra affected breast droop. 33 volunteers aged 18–25 who engaged in at least four hours’ sport each week were asked to stop wearing a bra completely, not only during sport, for a year. Many of the women reported some discomfort during the first six weeks, but by the end of the study, 29 of the women reported more comfort and a greater freedom of movement. Not only that, their breast tone and shoulder muscles were improved. Contrary to expectations, their breasts did not droop more after a year without a bra.

Japanese research asking eleven women to wear a well-fitted bra for three months then to go without one for three further months found that bra-wearing increased the droop.

According to scientists, breast sagging is due to genetic factors, number of pregnancies, breastfeeding and extreme weight fluctuation. We often hear that our Cooper’s ligaments will stretch without a bra, but there also seems to be evidence that the ligaments will atrophy through lack of use.

Because none of these studies lasted longer than a year, we have no data about the long-term effects of bra-wearing on sagging.

Even Playtex CEO John Dixey says, ‘We have no evidence that wearing a bra could prevent sagging.’

So, what the hell are they for? They’re a recent invention, less restrictive than the corset, which was deemed just as vital a hundred years ago. They may give your breasts a fashionable shape while they’re on, they may hide nipple protrusion with a layer of foam padding and reduce that uncomfortable flopping when we run. But it seems that whether we each decide to wear one is not quite as simple as, ‘Well, why not?’

Writer Lucy Mellersh lives in Munich, Germany and runs her own lingerie business, Tantalize. Illustrations by Black Robin Design.

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