Breast cancer: the poor relation of cancers.

Breast cancer is one of the fastest growing killers in the United States; it is the leading cause of death for women aged 40 to 44. The statistics are staggering (see "The Numbers," p. 4). Incidences of breast cancer are up 53 percent since 1950. Today, one in nine women will get the disease in their lifetime (versus one in fourteen in 1960). Although breast cancer accounts for 32 percent of cancers in women and 16 percent of all cancers, it has received proportionately. much less funding and attention than other cancers and diseases. To put it in perspective, during the eight years of the Vietnam War, 54000 American died; in one year alone. 46,000 women will die of breast cancer. In the first ten years of the AIDS epidemic, nearly 133,000 Americans have died of AIDS; in that same time period, we lost more than 404,000 women to breast cancer. Women of color have the highest mortality rate--62 percent of African-American women with breast cancer will live more than five years versus 75 percent of white women--though African-American women get the disease less frequently.

Twenty-five years ago, breast cancer was a taboo subject. Women who had the disease often didn't tell even their closest friends or relatives outside their immediate families. Then in the 1970s, a number of prominent women led the disease and its sufferers out of the closet. Support groups for women with the disease began to form. Once the disease began to be talked about more openly, early detection through mammograms and self-examination began to be promoted. But a growing movement that includes women with breast cancer, doctors, scientists. environmentalists, and public health activists is decrying the focus of the cancer establishment--the National Cancer Institute, the American Cancer Society (ACS), and the nation's top cancer research centers--on detection and treatmentas detracting from the more important issues of cause and cure. That treatment usually consists of surgery, radiation, and chemotherapy, or as many sufferers describe it, "slash, burn, and poison." As Dr. Susan Love, director of the University of California at Los Angeles Breast Center and cofounder of the National Breast Cancer Coalition (NBCC), has said, "Early detection is not early enough." By the time mammography can detect a tumor, it could have been present as long as eight years.

Another charge against the cancer establishment is that research and recommendations for preventions have focused on the victim's personal risk factors like heredity, childbearing and menstrual history, and diet rather than on environmental factors. This focus on behavior rather than exposure to carcinogens shifts the blame from the producers of carcinogens to the cancer victims. However, studies have estimated that between 70 and 85 percent of women diagnosed with breast cancer have no family history or other risk factors such as early menarche, late menopause, or late or no childbearing. And the research on those risk factors does not factor in the environment. For instance, while women with a family history of breast cancer are statistically more likely, to get breast cancer, no study has established whether that is a result of heredity or shared environment. Women who move from countries with low rates of breast cancer to those with higher rates (e.g., Japanese women who come to the United States) soon develop breast cancer at the same rate as women in the new country. And genetic vulnerability cannot explain the jump from one in twenty women getting cancer in their lifetime in 1950 to one in nine now.

It has been shown that women with higher levels of reproductive hormones like estrogen are at a greater risk. That includes girls who menstruate earlier, women who don't bear children until late in life. and those who use estrogen-based contraceptives. But why are younger women starting menstruation earlier now than in the past? The cancer establishment has ignored environmental factors like eating meat with animal growth hormones and hormone mimicking chemicals, which might explain both higher breast cancer rates and early menarche.

Dietary fat has been correlated with higher breast cancer rates since the 1960s. Increases in fat consumption in the United States have corresponded with increases in breast cancer. But is it the fat itself (numerous studies have failed to show a consistent relationship to breast cancer) or the toxins stored in the body fat of the animals we eat that are the culprits?

There is much epidemiological evidence that suggests carcinogenic chemicals promote breast cancer: * the high rates of breast cancer in Long

Island's -Nassau and Suffolk counties.

which were subject to routine aerial

spraying of DDT in the 1950s * several studies showing higher rates of

breast cancer among female chemical

factory workers exposed to dioxin * high rates of the disease among women

golfers, who receive higher than average

exposure to pesticides because of their

heavy use on golf courses * an Environmental Protection Agency 

(EPA) study showing that those in

counties with hazardous waste disposal

sites are 6.5 times more like to get breast

cancer * studies showing high levels of organochlorines 

in women who already have

breast cancer * the decrease in breast cancer in Israel that

followed the phasing out of several

pesticides * higher than expected rates of male breast

cancer among telephone workers, electricians,

power station operators, and

railroad drivers, who have higher than

average exposure to clectromagnetic fields

(EMFs)

Others point out that percent increases in breast cancer throughout North America began appearing in the mid-1980s among women approaching 60 years of age. These women were in their 20s when the nuclear bombs were being developed and tested above ground in the mid-1940s through the early 1960s. As radioactive fallout from such tests. mostly in the western United States and the Pacific Ocean, drifted from west to east over the continent, measurable amounts of radioactive particles were found in milk, vegetables. meat. and fish throughout the United States and Canada.

Many of the 180 member groups of the NBCC are taking a cue from AIDS activists in their efforts to bring attention to the disease and gain support for more funding for research. Some of NBCC's efforts include rallies in Washington and nationwide petition drives. On October 18 they delivered petitions with 2,600 signatures to President Clinton demanding a strategic national plan to fight breast cancer. They are still collecting signatures (call 1-800-935-0434).

Their efforts have been successful in winning more funding for breast cancer research. The U.S. government's budget for research on the disease increased 50 percent from $90 million (out of a total of $150 billion for medical research) in 1991 to $133 million in 1992. The 1993 budget more than tripled to $410 million. The 1994 budget includes $300 million for breast cancer research at the National Institutes of Health and $2 10 million for research on the disease in the Defense Department budget. (Activists enlisted the support of U.S. Senator Tom Harkin (D--TA). who, though unable to get funds transferred from the defense budget to the domestic budget. was able to increase funding in the Defense Department from $25 million for breast cancer screening and diagnosis in 1992 to $210 million for breast cancer research. The ACS allotted only 4.5 percent of its $380 million budget to the diseasc in 1992, it increased its funding for breast cancer research to 10 percent of its $2 billion budget in 1993.

The Numbers

* Incidences of breast cancer are up 53 percent

since 1950. Today, one in nine women will get

the disease in their lifetime (versus one in

fourteen in 1960).

* A woman is diagnosed with breast cancer

every three minutes; every twelve minutes a

woman dies of breast cancer.

* Estimates of the number of women diagnosed

with breast cancer each year range from

146,000 to 183,000; of these one-third will die.

* There are currently 2.6 million women living

with breast cancer--1.6 million who know it

and 1 million who don't.

* Forty percent of all women with breast cancer

die within ten years.

* It is estimated that between 1. 5 million arid 2

million women will be diagnosed with breast

cancer and between 460,000 and 500,000 will

die of breast cancer in the 1990s.

* The overall mortality rate for breast cancer of

27 deaths per 100,000 women has remained

the same for 50 years, though the rate has

increased for women over 50 and decreased for

women under 50.

* Women of color have the highest mortality

rata--2 percent of African-American women

with breast cancer will live more than five

years versus 75 percent of white women--through

African-American women get the

disease less frequently.

Breastfeeding as a Preventive Measure against Breast Cancer

La Leche League International (LLLI) urges health care providers and breast prevention programs to provide and support breastfeeding as an important means of lowering the incidence of breast have around the world. Research and experience have repeatedly shown that women who breastfeed their babies are at significantly lower risk for developing breast cancer.

The continuous and long-term rise and fall of reproductive hormones, especially estrogen, in women who are not pregnant or breastfeeding has been implicated as a cause of breast cancer. When a woman breastfeeds, the reproductive cycle of conception, pregnancy, and childbirth continues, causing a more gradual return of a woman's reproductive hormones to pregnant levels. It is a well-researched and experienced fact that exclusive breastfeeding delays this return for a substantial period of time after childbirth.

Recent research documents a protective effect from just a few months of breastfeeding, the degree of protection increasing with each child breastfed. In areas of the world where extended breastfeeding of each child is the normal practice, there are very low breast cancer rates.

Researchers are exploring other ways in which breastfeeding can lower a woman's risk of breast cancer. Human milk may contain substances that protect delicate mammary tissue from the damaging effects of chemical compounds such as environmental contaminants. Furthermore, the very act of breastfeeding has a cleansing effect by removing secretions accumulated over time.

Information about breastfeeding as a preventive measure against breast cancer is available by contacting LLLI's Breastfeeding Reference Library and Database at [phone].

The Mammography Controversy

Researchers have recently begun to question the use of mammography screening for younger, asymtomatic women. Critics of the use of mammography point in particular to problems of inaccuracy and ineffectiveness.

In a statement in December 1993, the NCI said that while experts agree that mammograms every one or two years for women over age 50 reduce the death rate for cancer by a third, they do not agree on the usefulness of mammograms for women under age 50, and studies so far have failed to demonstrate that these screening tests save lives. Dr. Larry Kessler, chief of the applied research branch at the institute said that the statement was intended as "a statement of what works and what doesn't work. It's not a guideline." The NCI had previously issued formal guidelines for breast cancer screening and issued the statement as a deliberate attempt to get out of the guideline business on this issue, according to Dr. Edward Sondik, deputy director of the NCI's Division of Cancer Prevention and Control.

Studies estimate that mammography provides from five to ten false reports of tumors for every correct report. False-positive results can lead to reexamination, additional exposure to X rays, stress, and even unnecessary surgery. Mammography also fails to detect tumors more than two centimeters in diameter. The problem of false negative can obviously be much more deadly, some repeat mammograms have been known to miss advanced cancer spreading through both breasts.

The American College of Radiology instituted a voluntary mammography accreditation program in 1987 in response to this problem. Women who decide to have a mammogram should go to a center that is accredited by the college; other criteria for choosing a center include specialization in mammography, the performance of 20 to 30 exams a day, and technicians and radiologists who specialize in mammograms to the exclusion of other X rays, since these exams are difficult to do well, require practice, and are hard to interpret.

While proponents of mammography screening hope to reduce breast cancer deaths through early detection, they admit that mammography programs may increase breast cancer rates through cumulative X-ray exposure. Critics argue that iatrogenically induced breast cancers are too high a price to pay. A Canadian study of 50,000 women found that of those between 40 and 49 years of age who received mammograms, 44 developed breast cancer, of those in a comparable control group who did not receive mammograms, 29 developed the disease.

About 90 percent of breast cancers are actually detected by women themselves through manual self examination. However, this method has not been well-researched because it is difficult to study, variables like the timing and quality of self-examinations are not easy to quantify and observe. Nonetheless, montly breast self-examination remains the safest, least expensive, and least invasive preventive action available.

Imperial Chemical Industries: Benefactor or Profiteer?

Every October, during National Breast Cancer Awareness Month (BCAM), hundreds of thousands of posters, pamphlets, radio spots, newspaper ads, and promotional videos urge women to get a mammogram now, spreading the word that early detection is your best protection, warning them not to be an easy target. Few would guess that the cofounder of the event and its sole financial sponsor is a giant chemical corporation--Imperial Chemical Industries (ICI). But is the company motivated purely by a desire to benefit women or by a desire to protect its own enterprises from the suspicion of spreading carcinogens and to increase its profits?

ICI is one of the world's largest producers of chlorine- and petroleum-based products, including plastics, explosives, pharmaceuticals, and paint. Its environmental record is dismal: according to Environment Canada (a government agency), an ICI paint-pigment subsidiary in Quebec single-handedly contributes a third of the toxic chemicals damped into the St. Lawrence River.

Since ICI cofounded BCAM with Cancer Care Inc. (a support group) and the American Academy of Family Physicians nine years ago, the event has become an integral part of the cancer establishment's efforts. In return for spending several million dollars on the project, ICI can turn its thumb up or down on every poster, pamphlet, and advertisement BCAM uses. Can you say carcinogen? Well, BCAM can't. The word never appears in any of its literature.

One BCAM pamphlet warns that while "Researchers are investigating the role of heredity, lifestyle, and diet, . . . you can't assume that modifying your diet or lifestyle will make you safe from disease. Early detection is your best protection." And those who are found to have breast cancer can turn to ICI's spinoff, Zeneca Pharmaceuticals, for the leading treatment drug for breast cancer, Nolvadex (Zeneca's trade name for tamoxifen citrate), an anti-estrogen drug. Although generic tamoxifen is available in Canada and other countries for as little as 24 cents a tablet, Zeneca charges $1.38 a tablet for Nolvadex in the United States.

In 1992, the National Cancer Institute (NCI) began recruiting 16,000 women in the United States and Canada for its 10-year Breast Cancer Prevention Trial. (ICI used its BCAM contacts to persuade NCI to spend 70 million of tax money on the trial--over a third of NCI's total annual budget for breast cancer research of $196 million.) Researchers will give half the participants a placebo and the other half tamoxifen in an effort to see if those who receive the drug develop fewer breast cancers than those who receive the placebo.

However, tamoxifen is known to cause blood clots, uterine cancer, and liver cancer. NCI estimates that only 62 of the 8,000 women who take the drug during the trial will benefit by the prevention of breast cancer, the other 7,938 are left with the risk of negative effects for the sake of "science"--and ICI's profit. It's not hard to picture the shape of the critical company's sales curve if Nolvadex--already the world's top-selling cancer drug--were approved for use as a preventive drug ICI already sells almost $500 million worth each year of this treatment for a disease it might be causing by selling $26 billion worth of toxic chemicals each year.

Sources for these articles on breast cancer include the following:

Bertell. Rosalie, "Breast Cancer and

Mammography," Mothering, Summer

1992,49-57. Ferraro, Susan, "The Anguished Politics of

Breast Cancer," New York Times

Magazine, August 15, 1993, 25-27,

58-62, Kolata, Gina, "Avoiding Mammogram

Guidelines," New York Times, December

1993, 81-89, excerpted from Metro

Times, May 19, 1993.