Breast cancer awareness (?) month

Maria Dweggah, a concerned woman

Statistics

Breast cancer is the leading cause of cancer mortality in women and the most common cancer among women worldwide. Breast cancer is the second most frequent cancer in the world and is increasing, with a total number of cases of 1 050 100 in 2002 against 572 100 in 1980. World wide the ratio of mortality to incidence is about 36%. Breast cancer causes 370,000 annual deaths representing 13.9% of cancer deaths in women. It is the most prevalent cancer in the world today, with incidence rates highest in industrialized countries. (Parkin, M, Global cancer statistics in the year 2000, Lancet, Oncol. 2001, 2, 533-43).Canada has the second highest incidence of breast cancer in the world trailing only the United States) followed by Great Britain and other European countries. (CBC News, 6 June 2002, web page) Incidence rates of breast cancer are increasing in most countries and the changes are usually greatest where rates were previously low. The less developed countries are quickly catching up.

Last year at this time I wrote a small article to mark Breast Cancer Awareness Month (NBCAM) which focused primarily on the importance of early detection in reducing mortality through breast self examination and mammograms. The positive feedback from the readers, both female and male who thanked me for writing the article, encouraged me to once again include an article on the subject. However, instead of just visiting the web site of the NBCAM as I did last year, thus limiting it to just another reminder to women to go for a mammogram, I decided that this year I would do a bit more research to better understand this disease and to write a more informative article or at least one that would spark enough interest to send the readers to their computers and local libraries to find out more.

How much do we really know ?

As often happens when researching a topic, the more I read, the more I realized the quantity of information there was out there and how ignorant and misinformed I was; and, when I discussed with people, I found out that many were equally misinformed. I also discovered that things aren’t always so black and white or so simple. Most important I experienced a growing feeling of empowerment as I delved into the subject matter. As with any health related decision, it is vital that individuals be better informed on the overall implications and options available to be able to make educated choices. With breast cancer in particular, it is important to realize that while it is true that mammograms are instrumental in detecting early stages of cancer and thus save lives, the causal risks or influential factors of breast cancer should not be neglected nor the steps that women and men can take to reduce these risks.

Genetics ? Environment ?

Many women are unaware of the risk factors of breast cancer or the ways to minimize their exposure to cancer causing agents. For example, we often believe we are risk free because there is no breast cancer in our family. Yet, though genetics play an important role in helping identify individuals at risk for a specific cancer, thus leading to preventive or screening strategies, the potential role of genetic factors should not be overstated. Studies have shown that in fact the primary determinants of most cancers are lifestyle factors, such as tobacco, dietary and exercise habits, and even infectious agents rather than inherited factors. For example, probably only 5% of all breast cancers occur in women with a genetic predesposition to the disease. (WHO, National Cancer Control Programmes; Policies and Managerial Guidelines 2nd edition.
2002).

Partial awareness

The National Breast Cancer Awareness Month (NBCAM) was initiated in the US in 1985. The original intent of its sponsors was to increase awareness of breast cancer issues, especially the importance of early detection of breast cancer, specifically citing mammograms as the first line of defense. The current NBCAM web pages encourage women to recognize the importance of early breast cancer detection by participating in National Mammography Day on October 18, 2002. However, there is very little information, relating to avoidable causes, risks of cancer and practical means of prevention. This omission has prompted a number of cancer activists to protest that the mammography industry and drug manufacturers are influencing public health policy. Such a person is Dr Samuel Epstein, M.D. Emeritus Professor of Environmental and Occupational Medicine at the University of Illinois School of Public Health, and Chairman of the Cancer Prevention Coalition.

In an article which appeared in the Chicago Tribune, Sunday, October 26, 1997, entitled “Awareness month keeps women perilously unaware” Dr Esptein argues that:

…“The primary focus of NBCAM reveals profoundly misguided priorities and a disturbing lack of commitment to prevention. NBCAM is based on the insistence, exemplified by the American Cancer Society’s statement in its “Cancer, Facts and Figures 1997”, that there are no “practical ways to prevent breast cancer... Since women may not be able to alter their personal risk factors, the best opportunity for reducing mortality is through early detection” by mammography. Similarly, The National Cancer Institute’s 1995 Special Presidential Commission on Breast Cancer maintained that breast cancer is “simply not a preventable disease,” while requesting more funding for research on detection and treatment.

In fact, the benefits of annual screening to women age 40 to 50, who are not being aggressively recruited, are at best controversial. In this age group, one in four cancers is missed at each mammography. Over a decade of premenopausal screening, as many as three in 10 women will be mistakenly diagnosed with breast cancer.

… Apart from the dangers and questionable value of premenopausal screening is its apparently unrecognized and prohibitive cost of $2.5 billion annually – based on an average of $125 per mammogram for approximately 20 million U.S. women age 40-50 – which is more than the budgets of the National Cancer Institute and the American Cancer Society combined.

While the benefits of postmenopausal screening are less controversial, there is little evidence that the usual U.S. overkill of taking four or more mammograms per breast annually is any more effective than the more restrained European practice of a single view every two to three years. Furthermore, there is no evidence that screening at any age is more effective than monthly breast self-examination, especially by someone trained in this procedure, combined with an annual clinical examination whose costs are minimal.

Underlying this indifference to prevention are interlocking conflicts of interest between the cancer establishment and the cancer drug industry, and between the American Cancer Society and American College of Radiology and the powerful mammography machine and film industries. More significantly, NBCAM was conceived and funded in 1984 by Imperial Chemical Industries, one of the world’s largest petrochemical manufacturers, and its
U.S. Subsidiary and spinoff Zeneca Pharmaceuticals.

Zeneca is the sole manufacturer of tamoxifen, the world’s top-selling cancer drug, widely used for treating breast cancer and also for ill-advised trials to see whether it can prevent the disease in healthy women even through it is itself strongly carcinogenic. Of further concern, Zeneca has recently acquired 11 major cancer centers from Salick Health Care, posing disturbing and precedent-setting conflicts of interest between drug manufacture and prescription. Financial sponsorship by Zeneca gives it editorial control over every leaflet, poster, publication and commercial produced by NBCAM.

With this background, it is hardly surprising that NBCAM fails to inform women how they can reduce their risks of breast cancer. In fact, we know a great deal about its avoidable causes, which include:

ﾀ Prolonged use of oral contraceptives and estrogen replacement therapy.

ﾀ High-fat animal and dairy product diets that are heavily contaminated with chlorinated pesticides that are estrogenic and carcinogenic to the breast, and meat contaminated with potent sex hormones following their use to fatten cattle in feed lots prior to slaughter.

ﾀ Exposure to petrochemical carcinogens in the workplace that put about 1 million U.S. women at increased risk.

ﾀ Exposure to carcinogenic chemicals from hazardous waste sites and petrochemical plants that pollute soil, air and water.

ﾀ Exposure to indoor air pollutants, including carcinogenic pesticides and solvents.

ﾀ Prolonged use of black and dark brown permanent or semi-permanent hair dyes.

ﾀ Heavy smoking and drinking commencing in adolescence.

ﾀ Inactivity and obesity.

Making women aware of these avoidable risks rather than fixating just on early detection should be the goal of a truly effective National Breast Cancer Awareness Month.”

For each of the risk factors Dr Epstein lists in his article, there are practical preventive measures that each of us can take. They include regular exercise, eating a high-fiber, low animal protein diet; learning as much as possible about sexual and reproductive factors (benefits of breast-feeding, use of estrogens to treat menopause, use of oral contraceptives, nulliparity, etc.); reduction of alcohol and tobacco use; learning about and supporting actions for monitoring and reduction of risks in the general and professional environment, and of course regular visits and discussion with our own physician or relevant caregiver.

As a woman and as a non-specialist I still feel it is important that public attention be alerted to the scourge that breast cancer represents worldwide, and to the need for medical check ups. I will leave it to the experts to debate how frequent and at what age these check ups are best carried out. In this regard, all advocacy efforts are welcome. After all, it was thanks to NBCAM that I myself was motivated to do my own research and spread the word.

But I also better understand now that there is a need for each of us to do our own homework and research the various views and sources of information that are out there for us to explore.