The pattern of increasing prevalence of breast cancer in the western world over the past 50 years and its ebb and flow more recently calls for a macro view. The endless micro dissection of statistical methods, and complicated statistical argument which has typified the debate right accross the medical literature will never resolve the issue. We are now 50 years on and none the wiser. This level of silo warfare is obfuscating the truth of the issue and distracting the focus from the real issue. The real issue is that breast cancer has been of epidemic proportions and in particular amongst relatively young women.

The real question is why. Is it normal? I would say absolutely not since it contravenes the "normal" prevalence patterns of cancer, which is a disease of older people. The last big cause and effect cancer debate was the lung cancer cigarette one. There is also the colon cancer western diet/obesity one. What is the breast cancer one? Is there "ONE" ie a predoninant cause? Common sense and raw data trends of breast cancer are convincing that something must be driving these high rates especially in young women. What is it? The statistical battles about mammography versus HRT versus diet and lifestyle will go on indefinitely and never will agree on a culprit. There will be multidisciplinary inadequate sophisms about diet, sunlight,smoking, exercise...etc and these are all carcinogenic in there own way but not the major player. Their impact on cancer is on a rising tide type mechanism, in that the more of these unhealthy behaviours you do the more the risk of all types of cancer, and not especially of breast cancer you are exposed to.

The one big elephant walking the western world in different guises for the last and only the last 50 years, is the enormously increased consumption of female hormones predominantly in the forms of the oral contraceptive pill and HRT. Air brush the pill and HRT from the landscape with a sophisticated ststistical tool and hey presto the prevalence of breast cancer would be seen to plummet to "normal" levels of any non induced cancer. This is impossible to do, but as long as this fruitless tit for tat (excuse the pun!) discussion ccontinues there cannot be clarity around causation of breast cancer.

Competing interests: None declared