Originally published as a two part series in the Huffington Post, 03/18/2010.
One in eight. Such is the stark stat about an American woman's chance of a breast cancer diagnosis, and it's a constant backbeat to a pink whirlwind of walks, runs, and loads of pink purchases this month, which marks the 25th anniversary of October's National Breast Cancer Awareness Month.
Too bad it's a lie.
Yesterday, the American Cancer Society (ACS) finally admitted that many women are diagnosed and treated for breast cancer needlessly--that the "cancer" they have is in fact nothing that would spread or ever kill them or even be noticed without mammograms. Check out particulars here. Oh, and by the way, says ACS (one of the loudest of the "get-a-regular-mammogram-or-you'll-die breast cancer establishment voices), mammograms don't necessarily catch bad cancers either.
On the positive side, this means that the one-in-eight odds are actually somewhat better. On the down side, it's inexcusable that this ACS admission was so long in the making. Although ACS' chief medical officer told the New York Times that "we never sat back and actually thought, 'Are we treating the cancers that need to be treated?'", lots of others weren't so seemingly out of the loop. Breast cancer over-diagnosis and mammogram risks have in fact been actively debated for decades, particularly by women's health activists, and got much notice just a few months ago with studies showing an estimated one-in-three overtreatment rate among women tracked in Canada, Europe, the US, and Australia. Ditto for data about mammogram's low efficacy, particularly among the many women with dense breasts.
It's enraging that in part because of simplistic, patronizing messages from cancer health 'authorities' we haven't gotten further in the breast cancer battle--that 40,000 American women continue to die each year and another two million go through grueling treatment. Thus, I'd suggest the below three tactics toward healthier, more sustainable ways to deal with breast cancer. I'm no scientist--I'm a journalist who has two daughters and I want all three of us (and my husband, since 400+ men die of breast cancer annually) to strive toward keeping ourselves and every other citizen as healthy as possible.
One: We need to ask pointed questions about the game plan promoted by prominent breast cancer players, and educate ourselves so we can act on the smartest strategies. Two: Women need the full truth about routine mammograms, and we should demand that our providers and health officials get us (quickly!) better, less risky detection technology. Three: We need to amp up our prevention tactics with actions such as thoroughly avoiding pollutants (including those used in manufacturing many pink-linked beauty aids, baubles, and foods) that are likely more to blame than a woman's faulty genes or fitness quotient.
And we all must insistently remind our health officials that other countries (in Europe, Asia, even Mexico!) are doing much more to remove pollutants, so why aren't we doing more to reduce not only breast cancer but many other ailments caused by the unholy mix of hormone-disrupting pesticides, fertilizers, pharmaceuticals, and caustic chemicals that have ended up in our food, water, and air and put us all at risk?
Finally: Maybe we need a new color for this effort, like a manly navy blue (which would look good paired with pink). Because the same estrogenic endocrine-disrupting compounds (EDCs) linked with breast cancer are very bad news for males. A multiplicity of studies (and many, many august experts, including this grave new report from the 14,000-member international association of endocrinologists) are turning up increased genital abnormalities, prostate and testicular cancers, sperm quality and quantity drops, and other disturbing trends. Perhaps if men became just as dedicated to 'racing for the cure,' the race would be ending much more quickly!
RETHINK THE PINKOCRACY
October's pink push is problematic, with cancer victims aplenty angry that their pain is used as a marketing device that misleads the public and promotes 'slacktivism.' Most pink-promoting companies "are not donating their own money; they are just passing on their customers' money," says The Assertive Cancer Patient blogger Jeanne Sather in a Daily Finance piece noting how companies can profit hugely from increased pink sales yet divert just a few cents per product to cancer causes. Adds Breast Cancer Action (BCA) director Barbara Brenner, "people have come to believe that if they just do what they're told by corporate America, whether buying a product or doing a walk, they'll solve the breast cancer problem and not have to think about it."
Check out the wealth of info from pinkwashing critics such as Breast Cancer Action's Think Before You Pink campaign, which detail how many corporate backers profit from breast cancer or manufacture products using substances implicated in breast and other cancers, such as organochlorines, herbicides, or animal growth hormones.
For example, critics such as veteran women's health advocate and writer Barbara Ehrenreich note that AstraZeneca, long a leader in the global multi-billion-dollar breast cancer pharmaceuticals market, founded National Breast Cancer Prevention Month--the generator of Pink October frenzy--in 1985, when then-Zeneca was also in the business of making pesticides deemed "probable human carcinogens" by the EPA. NBCAM is still controlled by AstraZeneca and its single-minded 'get-your-mammogram' mantra echoed by cosponsoring radiological and oncology associations and cancer establishment organizations. Other breast cancer heavy-hitters such as the American Cancer Society and and the Susan G. Komen Foundation are also too influenced by corporate backers, say critics such as Pink Ribbons Inc. author Samantha King and No Family History author Sabrina McCormick. The result (seen most clearly in NBCAM materials) is that breast cancer's environmental causes are avoided or downplayed to focus instead on directives to get mammograms, stay fit, and when diagnosed, obey conventional treatment regimens.
So what's the best way to navigate pernicious pinkwashing and still support the breast cancer cause? Whatever you choose to do, speak out, advises BCA's Brenner: last year's BCA campaign to get Yoplait to stop using the dairy cow growth hormone rBGH succeeded. For instance, if you're seeing red because pink-marketed beauty products often contain ingredients linked to cancer, join up with groups such as the Campaign for Safe Cosmetics or just fire off an email or ten to companies. Check around for alternatives and join in with the many breast cancer organizations that fit your priorities. Or participate with ones you find problematic, but let leaders know your objections and suggestions for improvement.
Persistent advocacy from thousands of women and activist organizations have created much change in acknowledging and attacking all probable causes of cancer including environmental ones, writes Susan L. Ley in her new book, From Pink to Green: Disease Prevention and the Environmental Breast Cancer Movement, with mainstream groups and advocacy groups increasingly joining forces on research and prevention tactics. The result: We're all more informed and empowered.
Reconsider Cancer Detection
Mammograms are important, and screening mammograms are particularly crucial when they're the only way to catch women whose poor access to health care and information results in cancer detection at a more advanced stage. Women at high risk because of genetic and family history reasons will require more surveillance. But as the ACS announcement about the "overpromised" benefits of mammograms indicates, we need to reassess our reliance on them. The ACS announcement came on the heels of an analysis from the University of California at San Francisco of overtreatment for both breast and prostate cancer, which suggests that the strategy now should focus on distinguishing between harmless and destructive breast conditions, and reducing treatment for low-risk conditions.
So when can that start happening? Medical experts and researchers can work toward revising diagnosis and treatment guidelines now, says H. Gilbert Welch, Dartmouth University medical professor and leading over-diagnosis expert, such as a determination that miniscule breast masses not be biopsied and instead observed. More doctors are already taking a less aggressive approach, and acting on the fact that some problematic breast conditions and cancers will disappear over time. For example, a recent study showing that women who didn't get screenings for six years had less cancers than regularly screened women is leading more doctors to prescribe "watchful waiting" for women with few risk factors.
As medical consumers, we need to educate ourselves about actual risks, and recognize that while repeat mammography and other detection technology such as MRIs may seem to bring assurance, "looking harder" may not be the answer. As Welch puts it, "doctors who recommend less-aggressive mammography (less frequently, waiting until you are age 50, or stopping it when you are older) or are less quick to biopsy may not be bad doctors but good ones."
We need to demand full information from our health care providers about better ways to deal with conditions such as DCIS (ductal carcinoma in situ), at 60,000 annually one of the most commonly diagnosed conditions that may not need treatment. The info is there in spades: Concerned about overtreatment, a National Institutes of Health panel last month recommended in a lengthy analysis that the cancer-related "carcinoma" term in DCIS be abandoned and treatment guidelines reassessed to avoid unnecessary biopsies, surgery, radiation, and chemo.
Go beyond the mainstream cancer organizations to get more complete information. Check out this analysis from the National Breast Cancer Coalition of several over-diagnosis studies, including the most recent showing that one in three women may be unnecessarily treated. Consider that other similar nations view cancer risks differently: Most Western nations don't start mammograms until age 50, and overdiagnosis is roundly being debated in the UK. A large group of UK cancer experts charge overdiagnosis may affect half of UK women getting routine mammograms, and their outrage caused the National Health Service to recall risk-devoid mammogram campaign materials this July.
Check out what advocates recommend about determining benefits and risks, including over-diagnosis risks, radiation exposure from each mammo, and the fact that particularly for women with dense breast tissue (one-half of women, particularly younger ones), mammograms are only about 50% accurate, leaving women falsely assured that mammograms have "proved" they're OK.
Of course we need reliable ways besides (or in addition to) mammograms to find breast cancers that must be treated. There are alternatives: Regular self-exams yield critical information, and should be coupled with rigorously done, regular clinical exams that last at least two minutes. Other technologies that don't use radiation such as digital infrared thermal imaging and ultrasound are already used as adjunct (and for some, primary) detection methods--can't the government give these imaging techniques and others that aren't as risky as mammograms the research buck-bang given to say, smashing a $79 million satellite on the moon?
Re-vision Prevention--And We All Win
*Stop using cancer-causers, and tell everyone why. As the leading breast cancer prevention organization Breast Cancer Fund notes, speaking out about prevention is perhaps most important in October, when breast cancer awareness is high. After all, genetic causes account for only 5 to 10% of breast cancers, and while it's unquestionably beneficial to exercise and eat healthy, fitness is no guarantee of escaping breast cancer, which has steadily risen at the same time as the chemical proliferation of the last 40 years.
Get the big picture about environmental causes with BCF's comprehensive State of the Evidence 2008, including mammary carcinogens and endocrine disrupting compounds
as well as radiation from x-rays and other sources. There are plenty of specific tips on how to reduce exposure to risks, from the ubiquitous plasticizer BPA to dioxins to chemicals in beauty products from lipstick to shampoo and lotion. Check out the Campaign for Safe Cosmetics, and consider making your own beauty potions--we all care about how we look, but natural cosmetic recipes abound in books and the internet. And be sure to follow through with BCF's links that let you demand policy changes with Congress members, EPA, FDA and other regulators.
And remember: more "stuff" of just about any sort has a toxic burden in its manufacture and transport. Just stop buying junk you know you don't really need.
*Reconsider use of breast cancer-linked hormone drugs. Just as our reduction in chemicals improves life for everyone, our hormone drug reduction improves overall health, since much of the active ingredients in pharmaceuticals we use are passed through in our urine and end up in our water system and coming out of our taps.
The culpability of hormone replacement therapy (HRT) drugs used for menopause symptoms is clear: the landmark Women's Health Initiative study was halted in 2002 when women taking HRT experienced significantly more breast cancer, as well as heart problems and strokes. Subsequently, as the HRT usage rate dropped, so did breast cancer. A recent study shows HRT use is associated with increased rates of lung cancer, the top cancer killer of women; HRT use is also associated with developing denser breasts, which is linked with increased cancers.
Menopause symptoms are troubling for many, but as the HRT usage drop indicates, many women have coped without HRT. That's made a difference--both for the women who avoided cancer but for all of us exposed to risky hormones in the water supply.
Hormonal contraceptives also show potent links to increased breast cancer. Nonhormonal birth control alternatives are effective with careful and consistent use. Users feel better knowing they've reduce their cancer risk; we all get the payoff of less synthetic hormones in the water supply.
*Slow down on the sauce. Experts agree that drinking, which raises blood estrogen levels, increases breast cancer risk. No need to go cold turkey, but do we really always need alcohol to have a good time? Is that the example we want to set for our kids? If you drink more than the one a day max cited in cancer risk guidelines, think over why you drink, and explore alternative fun and stress relief tactics.
So starting this October, let's rethink our pink passion and take some steps that go beyond the conventional "wisdom" on breast cancer detection and prevention. With full disclosure and 360 gaze, our breast cancer activism could become a model for fighting and defeating our many health challenges.