Tangled Up In Pink – The Politics of Breast CancerWe’ve Said It Before
Furthermore, we said, studies ignored cultural factors that accompanied high-fat diets: total calorie consumption, cooking and preservation methods, preservatives, additives, hormones, fertilizers, pesticides and other toxins in the food chain, background radiation, and all the other things that are part of industrial societies (the U.S., northern Europe, Australia) where breast cancer rates are the highest. Environmental risk factors "have been largely ignored by the cancer establishment," reported Terry Allen in our February 1990 issue. Prevention of breast cancer is impossible, we said, until its causes are established. Still, mainstream medicine, like the Vermont Cancer Prevention and Control Project, mistakenly insisted that "early detection" was prevention. The mindset and the money were focused on diagnosis and treatment, partly because of the way science and medicine work, and partly because the drive for a cure was spurred by legions of women whose lives had already been affected by the disease.
Awareness is a StartAs the incidence of breast cancer soared, so did national awareness, thanks to an unprecedented level of activism by women who had the disease, or who knew someone who did. Breast cancer, historically a hidden ailment, became "the biggest cultural disease on the planet" — bigger than AIDS, cystic fibrosis, spinal injury, or even the more common killers of women: heart disease, lung cancer, and stroke — according to Barbara Ehrenreich, author and editor at Harper’s Magazine, in a first-person report back in 1991 ("Welcome To Cancerland," http://www.bcaction.org/PDF/Harpers.pdf). Breast cancer has inspired hundreds of Web sites, support groups, books, survivor literature, and four nationwide organizations. The pink ribbon is ubiquitous, with product placement on postage stamps, teddy bears, coffee mugs, hats, scarves, tank tops, trench coats, cosmetics, even lettuce (non-organic) at the supermarket. Meanwhile, women-run breast cancer organizations have raised millions for research. Under the pressure of activism, backed by research monies, treatments have evolved from the radical mastectomy — the one-shot deal of the 1930’s — to a smorgasbord of therapy: case-specific surgery; sentinel (rather than multiple) lymph node sampling; and continually refined radiation and chemotherapy protocols. Public understanding of the pathology of the disease has evolved rapidly. Anyone visiting the Susan B. Komen Breast Cancer Foundation Web site can get a clear and sophisticated picture of breast anatomy, the different cellular types of breast cancer, and the pathologic staging of tumors. Breast cancer is part of the culture. Despite all the awareness and research, despite advances in treatment and the huge investment in mammography, the breast cancer death rate has scarcely improved since the one-shot days of the 1930s. Some activists are calling for a different direction in research. "Now that we’re there on awareness, it’s time to stop the cancer from happening," says the Breast Cancer Action (BCA) group (at stopcancer.org). Protesting the ‘Cult of Pink Kitsch’Breast Cancer Action is one of several groups protesting the corporate focus of the Komen Foundation, the largest breast-cancer organization in the country. Such groups are saying that the consumerist pink-ribbon movement channels research money to drug companies, whose focus remains on therapy, not prevention. Activist organizations like BCA — also run by women whose lives have been changed by breast cancer — say that the pink-ribbon movement lulls people into complacency, making them think they are proactive while the numbers of women with breast cancer are still rising. Because the Komen Foundation is so large, and because its "Race for the Cure" campaign is so visible, the company has been the target of scrutiny (see box Komen). Among criticisms of the foundation are its politics, which are heavily Republican and corporation-friendly An activist group called the Toxic Links Coalition (TLC) organizes protests at Komen 5K races because the foundation focuses only on a medical cure for breast cancer, and not on the environmental conditions that cause it. TLC contends that Komen also ignores the problems of the uninsured and the political influence of corporations on medical policy. The Komen lobby did not support a bill for anticancer environmental legislation. The foundation is among those (including the American Cancer Society) who erroneously regard screening as prevention. Prevention: The Big Lie‘Prevention’ in the medical literature now means drugs for ‘women at risk,’ a small percentage of women who actually have known risk factors: family history, childbearing history, drug (hormone) history. More urgent is the fact that up to 75 percent of women with breast cancer have no ‘known’ risk factors. Most drugs deemed ‘preventive’ are really designed to prevent recurrence in women who already have certain types of breast cancer. Genetic research to stop breast cancer is blossoming, though only a small percentage of all cancers have a definite genetic familial component. In one sense, all cancer is ‘genetic’: a mutation in the genes of cells. Mutation happens for several reasons: heredity, individual biology, environmental influences. Genetic research is largely focused on defining and repairing mutations. Think AgainMammography is still the American Cancer Society’s only recommendation for the ‘prevention’ of breast cancer. In 2001, the British medical journal Lancet published a large study showing that mammography has little effect in preventing breast cancer deaths. Other studies have confirmed this finding, but American health companies are reluctant to reevaluate what has for years been a major cash cow. Though ultrasound appears to some to be a more reliable screening tool, providers have been slow to adopt it. Meanwhile, the incidence of breast cancer continues to rise.
Some practitioners say this is because more screening detects more cancers. "People often talk about mammograms to prevent breast cancer when what it’s done is to increase, not decrease the incidence of breast cancer," said Dr. Barnett Kramer, director of the National Cancer Institute’s office of disease prevention, in a story in the New York Times. Furthermore, as Barbara Ehrenreich points out in a 2001 LA Times story, repeated mammograms expose a woman to ionizing radiation, an "immediately preventable known cause" of breast cancer, according to the National Women’s Health Information Center (www.4women.gov). Prevention at the personal level — like quitting smoking to avoid lung cancer — seems less clear-cut for breast cancer. Healthy-lifestyle wisdom abounds in the popular literature, with advice about everything from eating broccoli to not wearing bras. A recent hit was The Breast Cancer Prevention Diet book, about the "powerful foods, supplements, and drugs that can save your life," by Dr. Bob Arnot, NBC’s chief health correspondent, who appeared on Oprah and Today. The American Council on Science and Health calls the book "misleading, unscientific and speculative." The Memorial Sloan-Kettering’s cancer prevention center in New York encourages healthy-lifestyle habits even while cautioning that clean living doesn’t necessarily prevent cancer; it just lowers one’s risk.
Toxins: Prevention is the CureWomen are leading the push for research for the causes of breast cancer, just as they led the race for the cure. Toxins and hormones in the food chain and the rest of the environment are key targets in this effort, which will require novel research approaches. One complicating factor is that breast cancer occurs in several cellular forms: ductal and lobular (the two most common), inflammatory, medullary, mucinous, papillary, squamous cell, tubular, cribriform, and Paget’s disease. Cancer is a multi-factorial disease; the causes are clear-cut for some (lung cancer, skin cancer), but less definite in others (lymphomas, breast cancers). Cancer genes like BrCa, which is strongly inherited, account for about five percent of cancers. Testing carcinogens, and finding where they occur in the environment, is just part of the problem; proving the effect of carcinogens on breast tissue is the other challenge, as a cancer may develop years after exposure to a toxin. The role of estrogens in hormone replacement therapy as a cause of breast cancer is clear. Oral contraceptives are also implicated (in a 2002 Scandinavian study on 100,000 women over ten years that was ignored in the U.S.). Hormone-mimicking substances are found among the thousands of chemicals in our soils, our water, and our food. The breast-cancer epidemic also seems to follow our heaviest use of known carcinogens like DDT, which, in the 1950s and ‘60s, was sprayed ubiquitously on crops and over mosquito-breeding areas in towns and cities. Pesticides are fat-soluble, and accumulate in the fatty tissues of humans and other animals; breast tissue is largely fat. Ten years ago, a National Cancer Institute study found high levels of DDT components in women with breast cancer, years after it was banned in the U.S. After DDT was banned here, other countries bought it from us and continued to use it. So, DDT residues on imported foods may be back to bite us. And that’s the tip of the iceberg. The Breast Cancer Fund and the Women’s Health Network offer these statistics: Since World War II, around 75,000 new compounds have been released into the environment; 2,000 more are introduced each year; thousands are made in excess of a million pounds apiece; and roughly seven percent have been tested for human safety. Sprinting for the CauseThe women of California are leading the charge to change the focus of breast cancer research beyond treatment and toward prevention. Among them are Breast Cancer Action and the Breast Cancer Fund of San Francisco. Breast Cancer Action criticizes cosmetic companies that advertise support for women’s health and still promote products containing phthalates and parabens. (www.thinkbeforeyoupink.org). BCA is acting to stop cosmetics companies like Avon, Revlon, Estee Lauder, and Mary Kay from using these chemicals in their products, and encourages the public to find out where their fundraising-event money is going. BCA is acting to shift the focus of prevention from pharmaceutical remedies to "innovative research into the causes of breast cancer." BCA has posted a readable paper that gives a meta-review of prevention research to date (www.bcaction.org/PDF/StateofEvidence.pdf). They’ve developed a five-point plan for addressing key issues in prevention (see box). Stopping the breast-cancer epidemic will require radical modification of the society that has spawned it.
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Back
in 1990, Vermont came in fourth in the nation for the highest mortality
rate for breast cancer; and nobody knew why. Vermont Woman reported sketchy
correlations between breast cancer and certain dietary and reproductive
patterns, but noted that no clear cause-and-effect relationship had been
established. Studies on dietary fat, which had been associated with breast
cancer early on, were contradictory.