Comment                                                                                             February 4, 1992


The Push for Mammography May Be Off Target

By Samuel S. Epstein



The Breast Cancer Coalition, a grass-roots group of women's consumer-health and provider organizations and the American Cancer Society, is holding hearings in Washington Wednesday to focus on the breast cancer epidemic now striking one in nine women.


Last year, the coalition succeeded in increasing the National Cancer Institute's budget by $30 million for research into causes, screening and treatment of breast cancer.  The coalition is now pressing for even more NCI funds, but it has been co-opted into supporting discredited policies of the lavishly funded cancer establishment.


The establishment—NCI and and American Cancer Society—concentrates on basic research, diagnosis and treatment.  Cancer cause and prevention net only about 5% of the $1.8 billion annual NCI budget.  The establishment is also closely interlocked with giant pharmaceutical firms whose cancer-drug sales net $1 billion annually.


Neither the establishment nor the coalition has recognized that the increase in breast cancer incidence, 57% since 1950, is similar or less than increases for other cancers:  44% for all cancer, 60% for male colon cancer, 100% for testis, prostate and kidney cancer, and over 100% for other cancers.


Also unrecognized is mounting evidence relating cancer increased to avoidable contamination of food, air and water and the workplace presence of cancer-causing industrial chemicals and radiation.


The establishment, with coalition support, is pushing for more mammography facilities.  But the General Accounting Office reports, "there are more than enough machines to meet screening needs."


The establishment is also pushing for annual mammograms over age 40.  There is general agreement that mammography improves cancer detection and survival in postmenopausal women, especially in modern facilities.  But there is no evidence of benefit for younger women in whom screening, especially with X-ray exposures common on the '70's, caused more cancers than detected.


These concerns are emphasized by a recent Canadian study reporting 50% increased breast cancer mortality in women over 40 given annual mammograms vs. those given physical examinations only.  Other studies have confirmed the dangers of routine mammograms in pre-menopausal women.


In spite of evidence since the '60's, women have never been warned of mammography risks.  The reasons may be explained by a confidential memo form an NCI physician in charge of large-scale NCI and ACS screening in 1973.    These programs, he confided, "will gain [us] a great deal of favorable publicity –and will assist in obtaining more research funds."


The coalition needs to rethink its policies on mammograms.  Screening young women should be abandoned.  Obsolete high-dose equipment should be banned, as should untrained mammogram entrepreneurs.  The role of past mammography in increasing cancer rates must be admitted and investigated.  Women must be informed of their X-ray dosage from each screening and warned of the cancer risk.


Apart from physical examination, safe alternatives to mammography, particularly transillumination with infrared light scanning, should be developed and made available on a crash basis.


The cancer establishment insists that fatty diet itself is a major cause of breast cancer, although proof for this is minimal at best.  There is, instead, growing evidence of the role of carcinogenic pesticides and other contaminants in fat, such as DDT and PCBs which accumulate in the breast and which mimic the hormonal effects of estrogens.   A related risk if lifelong exposure to estrogenic contaminants in dietary fat from their unregulated use of growth-promoting cattle-feed additives.


Public health is too important to be left to self-interested establishment professional and politicized bureaucracies.   But to be effective, grass-roots advocacy requires radical new thinking besides good intentions.


The Breast Cancer Coalition should heed today's Washington Press conference, representing 60-plus prominent scientists who demand a total overhaul of federal cancer policies and who charge the cancer establishment with disinterest in cancer prevention and with misleading the nation into believing that we are "winning the war against cancer" while the facts show the contrary to be the case.


Samuel S. Epstein is a physician and professor of occupational and environmental medicine at the University of Illinois at Chicago School of Public Health.