Chicago Tribune, Sunday, October 26, 1997
This October marks the 13th anniversary of the National Breast Cancer Awareness Month (NBCAM), with its flagship Oct. 17 National Mammography Day. Enthusiastically promoted by the "cancer establishment" -- the American Cancer Society and the national Cancer Institute -- the American College of Radiology and mainstream women's group, NBCAM is dedicated to reducing breast cancer mortality through early detection by mammography screening. With an estimated 180,000 new cases and 44,000 deaths in 1997 -- breast cancer is second only to lung cancer as the leading cause of cancer death in women -- What could be a more worthy objective!
Unfortunately, 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 now 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. Moreover, international studies have shown that routine premenopausal mammography is associated with increased breast cancer death rates at older ages. Factors involved include: the high sensitivity of the premenopausal breast to the cumulative carcinogenic effects of mammographic X-radiation; the still higher sensitivity to radiation of women who carry the A-T gene; and the danger that forceful and often painful compression of the breast during mammography may rupture small blood vessels and encourage distant spread of undetected cancers.
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 aver-age of $125 per mammogram for approximately 20 million U.S. women age 40-50 -- which is more than the bud-gets of the National Cancer Institute and 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 women 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 though 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. As such, NBCAM is a masterful public relations coup for Zeneca.
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:
- Prolonged use of oral contraceptives and estrogen replacement therapy.
- 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.
- Exposure to petrochemical carcinogens in the workplace that put about 1 million U.S. women at increased risk.
- Exposure to carcinogenic chemicals from hazardous waste sites and petrochemical plants that pollute soil, air and water.
- Exposure to indoor air pollutants, including, carcinogenic pesticides and solvents.
- Prolonged use of black and dark brown permanent or semi-permanent hair dyes.
- Heavy smoking and drinking commencing in adolescence,
- 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.