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TOXIC BREAST SYNDROME: AN INTERNATIONAL EPIDEMIC
A shorter version of the following unpublished academic paper was published in the August/September issue of Uptown Express under the title "Toxic Breast Syndrome: Breast Cancer and the Environment."
"Breast cancer is the number one killer of women between the ages of 35 and 50." This message is printed on the back of a postcard distributed by the California-based Women's Cancer Resource Center (WCRC). The front of the card features an impactful message: A photo of a mastectomized woman, with scar and remaining breast exposed, carrying a placard that reads "INVISIBILITY EQUALS DEATH." Large white letters beside the photograph declare, "Since 1971, more than 1 trillion dollars have been spent on cancer research and treatment. Where has it gone?"
Over the past 20 years, despite diagnostic improvements and earlier detection, life expectancy rates for women with breast cancer have not changed (Northrup, 1995, p. 1).
Understanding the Statistics
"1 in 8" is the statistic etched into the minds of the American public by breast cancer organizations seeking attention for this growing health concern for American women. Based on a life expectancy of 95 years, the "1 in 8" figure is somewhat of a public relations artifact. Based on a life expectancy of 70 years, a more meaningful figure for most women, 1 in 14 women will get breast cancer in the course of their lifetimes (Hyman, p. 362).
Ruth Spear, founder of National Alliance of Breast Cancer Organizations, quoted in Betty Friedan's (1993) The Fountain of Age, had her own way of extrapolating meaning from published statistics. Since breast cancer affects 145,000 American women annually, and since breast cancers detected by mammogram have been growing for an average of eight years, Spear extrapolates that 1,160,000 women (8 x 145,000) are walking around with undetected breast cancer at any given time (Friedan, p. 489). Since, according to Friedan, only 30% of women submit to mammography, and since breast cancers detected by examination have been growing much longer than those detected by mammography, one could argue that Spear's figure is quite conservative.
While the confusing array of methods for estimating the impact of cancer may leave some doubt as to how serious the breast cancer issue really is, the frightening reality of the actual figures for death from breast cancer (Table 2) leave no doubt whatsoever. According to American Cancer Society (1994) statistics, while the population grew 38% between 1960 and 1990, the number of deaths from breast cancer grew by more than 82% during that time period (p. 5). In terms of absolute numbers of deaths caused by cancer, only lung cancer increased more than breast cancer. As shown in Figure 1 below, of the 237,740 increase in annual number of deaths from cancer, 1960 to 1990, 44.1% of the increase is attributable to lung cancer and 7.6% is attributable to breast cancer. It is interesting to note that one of the sites where cancer recurs following a breast cancer "cure" is the lung (Hyman, 1994, p. 363).
Northrup (1995) pointed out that, since use of mammography began in 1965, there has been "no substantial decrease in overall breast cancer mortality" (p. 1). This is a surprising statement when the widespread use of mammography has been justified on the basis of a better chance of survival with early detection.
The effectiveness of treatment is measured by a statistic called the five-year survival rate. The assumption is that, if a larger proportion of women are living more than five years after treatment than was the case at an earlier point in time, the treatments are successfully improving chances for survival. As Northrup (1995) observed, there are factors that may make the five-year survival rate less reliable than it appears. The statistics show an increase in the five-year survival rate over the past 10 years, but an increase in mortality over the past 20 years (Northrup, p. 2).
Cancers are being detected at earlier stages than was previously the case (Northrup, 1995, p. 2). Thus, 20 years ago a woman may have survived only a year after being diagnosed with a breast cancer that had been growing for 15 years. Today a woman may be diagnosed when her cancer has been growing for eight years. Her survival for six years past detection would improve the five-year survival statistic, when in truth she died one year sooner than her sister of 20 years ago. Read (1995) maintained:
Because all breast cancers are treated on diagnosis it is hard to know what would have happened with no treatment. Some cancers are very slow-growing and may never prove fatal. But, if a woman with such a cancer enters the medical system, is treated and survives, the credit goes to medical science. (Read, 1995, p. 21)
It would appear that only one statistic is reliable and without mystery, a larger proportion of the female population worldwide is dying from breast cancer than at any other time since statistics have been kept.
Early Detection: Just Another BFD?
Despite the continued push for educating women in breast self-examination, a federal panel determined that breast self-examination has not proved effective enough to be classified as a method of breast cancer detection (Hyman, 1994, p. 362). The most touted method of early detection, mammogram screening, is also under fire. "Despite the hype about mammography 90 per cent of women detect breast cancer for themselves," wrote Read (1995, p. 8).
To the extent that mammography contributes to a woman's lifetime exposure to X-rays, mammography may actually cause some breast cancers (Hyman, 1994, p. 363). Statistically, there is no benefit shown for younger women with mammogram screening. The Canadian National Breast Screening Study, utilizing randomized control trials in women aged 40 through 49, found no survival difference between screened and unscreened groups, but it "did find a higher death rate from breast cancer among women who had mammography" (Read, 1995, p. 41). However, studies in the United States and Sweden showed a 30% lower breast cancer death rate from regular mammogram screening in women over 50 (Hyman, p. 363; Read, p. 34). Even such a dramatic statistic could benefit from scrutiny. What are the characteristics of women receiving regular screening? Are they more affluent (with access to supplements and a better diet) than women not submitting to screening? Do they generally take more care with their health? What makes these women different from women not availing themselves of screening?
There are yet other drawbacks to mammography; it cannot distinguish between benign and cancerous lumps. Skillful interpretation by an experienced physician is essential, and overtreatment is one byproduct of poorly interpreted mammogram results. Hyman (1994) reported, "A mammogram can find lumps so small they are difficult to diagnose correctly under a microscope. Some of these lumps are cancers that may not spread, called in situ cancers. Women with such cancers may be misdiagnosed and treated as though they have rapidly spreading disease" (p. 363). In addition to the unnecessary trauma to the woman, overtreatment distorts statistics supporting the benefits of mammography. Women who never needed treatment in the first place are declared "cured," and the statistician marks up one more for mammography (Hyman, p. 363).
Read (1995) stated three reasons why mammography in the United States has limited impact: (1) It detects a higher proportion of slow-growing tumors that may never have killed; (2) its greatest users are women in their 40s for whom the technique shows no benefit; (3) early detection is no guarantee of appropriate treatment. Additionally, stated Read, screening impoverished women is useless when they cannot afford to receive treatment (pp. 42-43).
Many of its proponents have made a serious mistake in confusing early detection with prevention. . . . In the end, it would be impossible for mammography to eliminate breast cancer deaths unless there was a cure for breast cancer. Mammography can only ever be as good as the treatments offered to women whose cancer is detected. (Read, 1995, p. 49)
Northrup (1995) reported the development of a new method of early detection, one that could detect cancer earlier than mammography and with less risk. The new method, based on heat-detecting technologies developed for the military, is sensitive enough to detect, in the very early stages, the heat increases characteristic of tumor growth. The Food and Drug Administration (FDA) and the National Institutes of Health (NIH) showed no interest, "mostly because the mammography establishment is firmly entrenched and run by radiologists not open to new ideas," wrote Northrup (1995, p. 1).
The Japanese are now funding the research, and the new technology should be available in about three years (Northrup, 1995, p. 1). Whether or not it will be available in this country is difficult to say. The FDA and NIH have increasingly become the Fu Lion guardians at the gates of profit for drug companies and the medical establishment, more carefully guarding the interests of these economically powerful giants than the health interests of the population they were created to protect.
With very early detection, the five-year survival rate will improve dramatically, whether or not there is any actual improvement in mortality rates. Let's assume for the sake of argument that the average number of life years remaining from the beginning of cancer growth is nine years. If all women submitted to mammography and therefore all cancers were detected at the tumors' eighth birthdays, every woman with detected breast cancer would have one year left following detection; the five-year survival rate would be 0%. Now let's suppose that the cancer's life remains at nine years, but the cancer is now detected on its first birthday. Every woman with detected breast cancer would now have eight years left following detection, and the five-year survival rate goes from 0% to 100%--a vast improvement in the statistic, but the woman who begins growing breast cancer at age 25 will still die when she's 40, whether her cancer is detected when she's 26 or when she's 39.
There is thus a significant question as to whether or not early detection is meaningful. Northrup (1995) wrote:
There has been no research that convincingly illustrated that women submitting to invasive surgery, radiation, and chemotherapies actually survive longer than women who do not submit to these procedures. Given the importance of belief in the efficacy of a procedure, these methods should work just as well as any other if the woman believes in them. (p. 2)
Northrup (1995) cautions, "Diagnosing breast cancer earlier, even with a safe, accurate technique, won't help much in the long run without a significant change in how we think about and treat breast cancer. Earlier diagnosis alone will just lead to more women than ever recovering from ineffective surgery and chemotherapy" (p. 2).
The recognized risk factors for breast cancer include age, family history of breast cancer, reproductive factors including age of menarche and age of menopause, obesity, high-fat diet, alcohol consumption, and high socio-economic status. Read (1995) stated, "Together, these risk factors only account for a small proportion of all breast cancers, which has led some people to suspect that another overwhelming and as yet unidentified risk factor has still to be found" (p. 10).
The Estrogen Factor
Read (1995) reported that a recent study of 15,000 women showed women with higher estrogen levels were more likely to develop breast cancer (p. 87). There is a class of breast cancers known as estrogen-receptor positive (Hyman, p. 362). Laboratory research has demonstrated that estrogen feeds cancer cells that carry estrogen receptors (Read, 1995, p. 86). "A number of researchers feel that the link for all the known risk factors for breast cancer involves the metabolism of estrogen," wrote Friedan (1993, p. 489).
Many of the known breast cancer risk factors are related to events in women's reproductive lives that influence the level of lifetime exposure to estrogen:
1. Age at menarche. Women begin their menses at a much later age in countries with low breast cancer rates (Read, 1995, p. 88).
2. Age at birth of first child. Having a first child past the age of 35 shows a substantial increase in risk for breast cancer (Read, p. 89).
3. Parity (number of births). Breast cancer risk is reduced proportionately with each time a woman gives birth (Read, p. 89).
4. Late age at any birth. Read stated that "high age at last full-term pregnancy was a powerful risk factor, overwhelming the protective effect of an early first birth" (Read, p. 89).
5. Age at menopause. Late menopause (after age 55) increases breast cancer risk (Read, p. 89).
6. Use of contraceptive pills at an early age. The younger a woman is when she first uses contraceptive pills, the greater is the risk for breast cancer (Read, p. 91).
7. Breast feeding. The greatest protection against breast cancer occurs with at least three months of breast feeding, and the risk falls with each subsequent baby that is breast fed (Read, p. 93).
Estrogen Replacement Therapy
There is a known increase in breast cancer among women using estrogen replacement therapy (ERT) (Hyman, 1994, p. 364). Recently published research results have shown so many benefits for ERT that most health-care practitioners consider the breast cancer risk small in comparison to the benefits, the greatest of which is apparent protection against heart disease. These proponents of ERT point to the fact that many more women die of heart disease than of breast cancer, tipping the balance in favor of risking breast cancer in order to avoid the more lethal heart disease (Bilezikian, 1994, p. 280).
There is an interesting statistic, though, that makes the ERT choice not quite so clear-cut: A woman dying of heart disease loses, on an average, 8 years of life; a woman dying of breast cancer loses 19 years (Northrup, 1995, p. 1). Clearly this statistic needs to be converted to woman years lost in order to really understand the risk. Are we adding eight years of low-quality lifestyle for some women (presumably because of the infirmities of age) at the cost of subtracting 19 years of high-quality lifestyle for others? These are hard questions that need honest answers.
The Unused Baby Machine
Comparing characteristics of women with breast cancer to cancer-free women, on an international scale, creates an uncomfortable picture for Western feminists. Piecing risk factors together, the ideal, breast-cancer-free woman reached menarche at about age 17, had her first child at about age 19, had a large number of children (probably four or more), breast fed each of her children for one or two years, completed her childbearing between 29 and 35 years of age, lived in a rural area, and was physically active throughout childhood and adulthood.
This low risk for women who become mothers early and often is related to the level of lifetime exposure to estrogen. In the past, when women were pregnant throughout much of their premenopausal years, they experienced an average of only 30 menstrual cycles in their lifetime. Today, a woman with two children will likely experience 450 menstrual cycles in her lifetime (Read, 1995, p. 7).
The Genetic Factor
With major breakthroughs in 1994, scientists now know a great deal about the genes accounting for breast cancer that runs in families (Read, 1995, p. 107). There is not one gene, but several that are linked to hereditary breast disease. A woman inheriting a matched pair of dominant genes from her parents is more likely to get breast cancer than not. Dominant genes are believed to account for 5% of all breast cancers.
One of these recently located genes causes a rare, fatal nervous disorder when the gene is inherited from both parents. More common and less lethal is the presence of a single gene of this type. Carriers of this single gene are highly radiosensitive. Read (1995) reported that in a study of families with this gene, "over 50 per cent of the women with breast cancer had had extensive diagnostic X-rays compared with only 19 per cent of relatives with no cancer" (p. 111).
Read (1995) reported that "researchers in Scotland found fewer cases of breast cancer than expected among the grandmothers of women with a family history" (p. 104). Michael Steel, Professor of Medical Science at the University of St. Andrews, found this encouraging:
In the past women had children earlier and had more of them, had a later menarche and less to eat. All these factors probably acted to protect women who had inherited the gene. That means there are things we can do to lower the risk for women [emphasis added]. (Read, 1995, p. 105)
An interesting debate has emerged over the issue of whether or not families should know about their genetic propensities for specific diseases. Hubbard (1994) warns, "it may actually be harmful to think that our fate is in our genes and that there is nothing we can do to improve our health, because, though many factors are beyond our control, we can sometimes make beneficial changes in our lives" (p. 339). Proponents, of course, maintain that knowing of the risk in advance will encourage women to make positive changes at an early age (Hubbard, p. 369).
Psychologists have found that women who know they carry the gene tend to do nothing. Additionally, at least one case of survivor guilt was noted in a woman who learned that she did not carry the gene that had killed her mother and sister, just as another sister was being diagnosed with breast cancer (Read, 1995, p. 112).
The Diet Factor
For nearly 15 years, medical science has known that dietary factors play some role in cancer. Stated Read (1995), "Eminent scientists have estimated that 35-60 per cent of cancers are related to diet. The question is no longer whether breast cancer is related to diet at all but what part of the diet is involved" (p. 117). Commenting on the lower breast cancer rate in Japan, Read quoted Dr. Paolo Toniolo, Director of Epidemiology at New York University School of Medicine: "Japanese women living in Tokyo and Japanese women living in New York breathe the same polluted air and drink the same polluted water, the only thing that's really different is what they eat" (p. 118).
It has been generally accepted that a high-fat diet is a breast cancer risk since the 1940s when Albert Tannenbaum found that rats on high-fat diets developed more mammary cancers than rats on low-fat diets. The high-fat-diet link to breast cancer was seemingly discredited by the Harvard Nurses' Health Study of 89,000 women that concluded that there was no link between dietary fat and breast cancer. Critics of the Harvard study pointed to serious flaws in the analysis:
In the lowest group the average fat intake was 32 per cent of calories and the highest was 44 per cent. This . . . was far from comparing a low-fat diet with a high-fat diet; it was comparing a high-fat diet with a very high-fat diet. (Read, 1995, p. 119)
Disbelievers in the fat theory point to the fact that "the per capita Gross National Product, an indicator of affluence--showed an even stronger correlation with breast cancer than fat consumption" (Read, 1995, p. 119) and suggest:
total energy intake in relation to energy expenditure--particularly during childhood and adolescence--rather than fat, may explain the differences in breast cancer rates between countries. This is supported by a number of studies which show that taller women are slightly more likely to get breast cancer. Although tallness is partly genetically determined, children who are better nourished tend to grow taller. . . . diet in early life may also directly influence the eventual size of women's breasts. (Read, 1995, p. 121)
Thus the balance between energy intake and energy expenditure has two faces: how many calories one takes in and how much exercise one gets. The energy-balance theory is supported by the high-risk factor for breast cancer among the economically privileged, those who can afford to eat what they want and as much as they want, as well as having no need to use physical exertion in order to survive. There are studies showing a correlation between breast cancer risk and physical activity (Read, 1995, p. 121). Read pointed out "the easiest way to have a high calorie intake is to eat a lot of fat. Similarly, the easiest way to lose weight is to cut down on fat and increase exercise" (p. 121).
Proponents of the high-fat theory, though, found support in work done by Dr. Ross Prentice of the Fred Hutchinson Cancer Research Center in Seattle. Looking at the correlations between breast cancer and caloric intake in different countries, Prentice found that "calories from fat explained 58 per cent of the difference in breast cancer but total calories explained only 14 per cent of breast cancer" (Read, 1995, p. 122). Read proposed, "Fat, and other components in the diet, may alter the levels of oestrogen and other hormones in the blood, although the mechanisms for this are not understood" (p. 122). Read found a number of interesting findings to support her supposition:
1. British postmenopausal women had estradiol levels 171 percent higher than rural Chinese postmenopausal women, and the British women had 36 percent more fat in their diets (p. 123).
2. Vegetarian women, whose diets are naturally low in fat, tend to have lower levels of circulating estrogens than women who eat meat (p. 123).
3. In a New York study, women on a low-fat diet for three months had significantly lower levels of estrogen in their blood (pp. 123-124).
Read (1995) noted one exception to the crosscultural studies showing a link between fat intake and breast cancer:
The Finns have one of the highest consumptions of dietary fat in the world and one of the highest rates of coronary heart disease. But they have relatively low rates of breast and colon cancer. Internationally, rates of breast and colon cancer seem to travel together and high fat intake, particularly animal fats, is firmly recognized as a risk factor for the latter. One marked difference between the Finns and other Westernized nations is their fibre intake; a typical Finn consumes 30 g of dietary fibre a day as opposed to the 12-14 g of a typical American. (p. 124)
In a study where women's fat intakes were held constant at typical levels but fiber consumption was doubled, blood estrogen levels were lowered. It is particularly interesting that, in this study, wheat bran had the desired effect on estrogen levels, while corn bran and oat bran did not (Read, 1995, p. 124). A number of studies throughout the world have linked breast cancer risk to consumption of dairy products and red meat (Read, pp. 125-129).
Read (1995) stated, "In studies linking breast cancer with radiation, alcohol consumption, cigarette smoking and contraceptive use, the younger the age at exposure, the greater the risk" (p. 91). Even low levels of alcohol were found to increase breast cancer risk, and one study "found that all the increased risk was accounted for by alcohol use before the age of 30" (Read, p. 138). Read noted, "The breast is particularly sensitive to external influences before a woman's first pregnancy" (p. 138).
Studies of survivors of the atomic bombing of Hiroshima and Nagasaki showed that the breast cancer risk was directly proportional to age at exposure, with the highest risk for those who were under five years of age at the time of the bombing. Additionally, an analysis of the records of more than 30,000 women treated for tuberculosis in Nova Scotia between 1930 and 1952 found higher rates of breast cancer among irradiated patients that varied by age of first exposure. "Girls irradiated between the ages of 10 and 14 had a fourfold risk and girls irradiated between 15 and 24 had a slightly less than twofold risk of developing breast cancer compared to the general population" (Read, 1995, p. 161).
Studies have shown increased risk among women who used contraceptive pills in their teens and 20s (Read, 1995, pp. 91, 171-172). Further, a physically active childhood and adolescence has been shown to be protective against breast cancer (Read, p. 212).
There is a clear, emerging pattern. Exposure to any of several known risk factors in youth, when the body is developing and changing at a rapid rate, greatly increases a woman's chance of developing breast cancer in her lifetime.
The Environmental Factor
While it has long been accepted that lung cancer is largely an environmentally induced disease, there appears to be considerable resistance to classifying breast cancer in the same category. Hyman (1994) wrote, "Less than 25 percent of women with breast cancer fall into the currently defined high-risk categories. Therefore, there must be other ignored or unknown reasons for the increased number of women with breast cancer, especially in those areas with continued high incidence" (p. 370).
Read (1995) berated "the attitude of many scientists, who choose to ignore the environmental contribution to cancer in favour of the charade that cancer is a mystery that only clever scientists in expensive laboratories can cure" (p. 137).
Hyman (1994) points to the use of a class of industrial chemicals made from chlorine called organochlorines. These include DDT, PCBs, and dioxin, and thousands of other lesser known chemicals. These chemicals gather in the environment and accumulate in living organisms, passing up the food chains and into the bodies of wildlife and people, concentrating in the fat tissue of the body (p. 370).
As a group, women with breast cancer have higher levels of organochlorines in their tissues than women without breast cancer (Hyman, p. 370; Read, p. 157). Additionally, since the phasing out of organochlorine pesticides in Israel, which began in 1978, breast cancer rates and mortality among young Israeli women have dropped (Hyman, 1994, p. 370; Read, 1995, pp. 122, 155-156).
In 1962 in Silent Spring, Rachel Carson wrote of robins dead or sterile from DDT. In 1991, scientists meeting at the Wingspread Conference Center in Racine Wisconsin announced that research from many different disciplines was showing that the hormone function in humans and animals could be disrupted by many man-made chemicals previously thought to be safe (Read, 1995, p. 149). "Chemical contamination of the environment appears to explain diverse abnormalities among wildlife, from the high incidence of undescended testes among panthers in Florida to feminization of male alligators in Lake Apopka to thyroid disease among salmon in the Great Lakes" (Read, p. 150).
In the United Kingdom, tests were carried out where effluent from 28 different sewage works entered waterways. In all cases, male fish were generating large amounts of vitellogenin, an egg-yolk protein normally made only by female fish. Vitellogenin is produced through the stimulation of estrogen or chemicals which mimic estrogen (Read, 1995, p. 150).
Danish researchers noted a significant fall in sperm count among healthy men between 1940 and 1990, and, during the same time period, the incidence of undescended testes and testicular cancer also increased. In the United States and the United Kingdom, in the last 30 years, the incidence of undescended testes has doubled and testicular cancer has tripled. Researchers hypothesize that this is due to increased estrogen exposure in the womb (Read, 1995, p. 151). Read reported, "the disorders of development and function of the male reproductive tract paralleled abnormalities occurring in the sons of women exposed to the synthetic oestrogen diethystilboestrol (or DES) in pregnancy and the abnormalities which the Wingspread scientists had observed in wildlife" (p. 151).
Until the daughters of women who had taken DES during pregnancy began to develop rare uterine cancers, DES was thought to be a safe, effective medication to prevent miscarriage. Into the 1980s, it was used as a growth promoter in cattle and other livestock. Premature breast development in Italian children in the early 1980s coincided with discovery of the illegal use of DES to stimulate growth of veal calves whose meat was being used in baby food. In Puerto Rico, premature breast development coincided with the practice of using DES to fatten poultry. DES is now banned in all countries, but there is a growing use of illegal growth promoters such as angel dust (clenbuterol), which has been recorded in Spain, Italy and Belgium (Read, 1995, p. 153).
Xenobiotics is the term used to describe biologically active substances which are not normally found in the body. Xenobiotics that mimic estrogen are termed xeno-estrogens. The organochlorines found in higher concentration in the breast tissue of women with breast cancer are xeno-estrogens. "Many chemicals are persistent in the environment, concentrate in human tissues and are passed through the placenta and through breast milk from one generation to the next," reported Read (1995, p. 154).
Scientists have found chemicals in breast milk almost everywhere they have looked, even in remote villages in Papua New Guinea and India. Lactation effectively 'detoxifies' nursing mothers by shifting the chemical burden on to their infants and mothers nursing their second or third children have lower levels of pesticides in their milk than mothers nursing their first child. . . . it is worth remembering that alternative milks, including formula milk, have come from the same contaminated environment. (Read, 1995, p. 154)
From 1973 to 1980, breast cancer incidence increased 8% in women under 50 and 32% in women over 50. Dr. Mary Wolff of Mount Sinai School of Medicine in New York, stated:
this upward shift is consistent with the historical pattern of accumulation of organochlorine residues in the environment. That is, older women who were exposed to DDT in the past may have higher risk than younger women who are now less exposed, as a result of government regulation. (Read, 1995, p. 158).
Radiation, Nuclear Fission, and EMFs
The atomic bomb explosions in Japan and medical treatments involving high-dose irradiation have provided evidence that radiation causes breast cancer. In Long Island and Connecticut breast cancer has been connected to milk and water contaminated with nuclear fission products from nearby nuclear plants. Several studies have found a normally rare disease--breast cancer in men--among those who work around electromagnetic fields (EMFs), such as telephone linemen. EMFs are know to interfere with the normal production of melatonin, a hormone whose function includes regulation of estrogen.
The Case of Long Island
Geographic patterns suggest environmental factors are paramount in some breast cancers. Breast cancer mortality in the New York metropolitan area has been shown to correlate with cumulative airborne releases from two nuclear plants in the area (Hyman, 1994, p. 370). And on Long Island a controversy has been boiling for years over the extremely high breast cancer rates in that area.
In her 1962 Silent Spring, Rachel Carson described how, in 1957, the U. S. Agriculture Department sprayed millions of acres in the northeastern United States (including Long Island) with DDT in an effort to eradicate the gypsy moth (Read, 1995, pp. 143-144).
In the 1940s, Long Island was a farming community and one of the world's largest producers of potatoes. When an infestation of golden nematodes threatened the crop, Congress passed the Golden Nematode Act of 1948. An intensive pesticide campaign was begun. Despite the fact that Long Island was no longer a major agricultural center by the 1950s when residential construction began, the pesticide program was continued until 1984 when serious contamination of ground water could no longer be ignored. When tap water testing was begun in the late 1970s, many of the island's wells were closed (Read, 1995, pp. 146-148).
A study reported that Long Island women who had lived in the vicinity of large plants producing chemicals, rubber or plastics had an increased risk of breast cancer, and another study showed an increased risk among women living close to a nuclear power plant (Read, 1995, p. 148; Hyman, 1994, p. 371). At the local high school, 12 teachers had breast cancer, including one man (Hyman, p. 371). Read reported:
The Toxics Release Inventory requires larger manufacturers to report annually on the amount of chemicals released into the environment. According to this database, over 14 million pounds of toxins were discharged by 193 facilities in 1991 in the downstate New York Region. (p. 146)
1 in 9 Long Island Breast Cancer Action Coalition, a group of Long Island women with breast cancer, was formed in 1991 to organize political action to draw attention to the very high breast cancer rate on the island. The New York State Health Department, which conducted a study in response to lobbying by 1 in 9, concluded that the unusually high breast cancer rate on Long Island was due to the fact that a large proportion of the population was Jewish and affluent (Hyman, 1994, p. 371). Finally, in 1993, in response to a federal mandate, The Long Island Breast Cancer Study Project, sponsored by the National Cancer Institute and National Institute of Environmental Health Sciences, was launched (Read, 1995, p. 148). It will be several years before any results are available. Few places in the world have been subjected to the environmental assault suffered by Long Island with its history of pesticide use and large number of chemical plants. The island is a giant laboratory for research on the effects of environmental pollution, and its citizens are unwitting volunteers as the human subjects of a long-overdue research effort.
The Underwear Factor
Recently, Sydney Ross Singer and Soma Girsmaijer, researchers in medical anthropology, suggested that bras may cause cancer. With a carefully crafted questionnaire, they determined that 99% of women with breast cancer wore their bras more than 12 hours a day, while 80% of cancer-free women wore their bras for that length of time. Women who never wore bras, they found, had a 21-fold decreased risk of breast cancer (King, 1995, p. 24). Singer and Girsmaijer suggested that women massage their breast after removing their bras, implying the possibility that circulation may play a part in the formation of breast cancer (King, p. 26).
While these findings are interesting, there are a number of known risk factors that may enter into these findings. Large-breasted women are know to have a higher risk for breast cancer than small-breasted women. Large-breasted women are more likely to wear their bras for long periods of time, and women who do not wear bras at all are most likely to have small breasts. Perhaps a study that looks at breast size in conjunction with bra-wearing habits would shed more light on this interesting phenomenon.
The Synergy of Breast Cancer
Hyman (1994), in discussing the correlation between radiation exposure and occurrence of breast cancer, stated, "This radiation appears to act synergistically with other carcinogens, such as ordinary air pollution, cigarette smoke, diesel fumes, asbestos, exogenous hormones, and organochlorines; that is, the effects of each are greater in the presence of the other" (p. 370).
Dr. Arthur Knudson of the M. D. Anderson Cancer Center in Houston noted that certain exposures seemed to cause mutations of cells, resulting in cancer. Knudson suggested that
two 'events' (or mutations) were needed to get breast cancer. A high dose of radiation in adolescence might, for example, provide the first 'hit'. According to this theory cancer would not occur until a second environmental insult caused a second 'hit'. In women with hereditary breast cancer, the first 'hit' would have already happened. . . . increasing evidence suggests that the development of human cancer requires more steps, perhaps as many as four or six. (Read, 1995, p. 106)
A Systemic Disorder?
Dr. Jim Devitt, a retired surgeon from Ottawa has suggested that breast cancer is a widespread disorder of the body and not just a local disease of the breast. Treating cancerous lymph nodes does not improve a patient's outlook, Devitt explained, because the cancerous lymph nodes are a warning rather than a cause.
Devitt also pointed out that after lumpectomy there was a 30 per cent chance that the tumour would reappear in the breast. Irradiating the breast reduced the likelihood to 10 per cent and total mastectomy prevented it. But in clinical trials, survival was identical with each intervention. 'Are they too only local phenomena, only local regional manifestations of a more widespread disorder?' he asked. (Read, 1995, p. 61)
There are certainly powerful implications to support Devitt's assertions. It seems reasonable that dietary factors that influence breast cancer have a wide-reaching effect in the body, and the high estrogen levels that cause breast alterations must certainly affect other areas of the body as well. "Breast cancer is not the complete mystery many would have us believe. Its roots lie in Western women's lives, in our diets, lifestyles and environment," wrote Read (1995, p. 12).
The Politics of Breast Cancer
"The cure for breast cancer is political," declared Read (1995, p. 83). Women across the United States apparently agree, as they form groups that are big enough and loud enough to be heard in Washington.
The National Breast Cancer Coalition successfully lobbied for $200 million in federal research funds for breast cancer research in 1991 and $400 million in 1992. Massachusetts Breast Cancer Coalition, founded in 1991, influenced the state of Massachusetts to pass regulations on the quality of mammography equipment and the training of physicians who interpret mammograms. 1 in 9 Long Island Breast Cancer Action Coalition in New York is actively speaking out and conducting its own surveys on environmental causes for the high rates of breast cancer there. Women's Community Cancer Project, established in 1989, marshaled support for A Women's Cancer Agenda: The Demands to the National Cancer Institute and U. S. Government (Hyman, 1994, p. 37). These are only a few of the groups whose voices resulted in a revolution in breast cancer research.
A Fair Share
The American Cancer Society (ACS) (1994) reported that their 1993 research budget was nearly $100 million. "A number of investigations concentrate on breast cancer," said a promotional brochure distributed by ACS, "specifically on how women can be motivated to make use of mammography screening, and how to adjust to surgery, if such intervention becomes necessary." According to their own figures, more than 8.5% of all cancer deaths in 1990 were from breast cancer (ACS, 1994, p. 5). A proportionate share of research funds would be more than $11.5 million. The idea that $11.5 million may be spent on motivating women to use a detection method that is subject to question and help them "adjust" to the results of an invasive treatment that may be vastly overused is almost as scandalous as the likely reality that nowhere near $11.5 million is being spent on research in breast cancer. Federal research funds have historically been just as unavailable. Stanley West (1994) reported that only 13% of the NIH research budget was earmarked for women's health, and in a $9 billion research budget, the National Cancer Institute granted only $18 million for breast cancer research (p. 178), barely 2% of its rightful share of $765 million, based on number of deaths.
Campaign promises of the new administration were fulfilled when the National Institutes of Health (NIH) established the Office of Research on Women's Health in 1990. In 1991 NIH announced the Women's Health Initiative (WHI). With 60,000 women between the ages of 50 and 79 participating as subjects, the three-part trial which began in 1993 will study: (1) health effects of a 20% low-fat diet, (2) relationship between hormone replacement therapy and breast cancer, heart disease, and osteoporosis, and (3) the effect of calcium and vitamin D supplementation on prevention of osteoporosis and colon cancer (Read, 1995, p. 137).
Read (1995) blamed Western medicine's medical model of disease for the failure to address prevention:
Scientific medicine as practised today was founded on intervention. Until the beginning of this century physicians had very few therapies which actually worked.
In 1982 a breast cancer patient with a good prognosis was treated with mastectomy in five days for a cost of $7,000. Ten years later, in 1992, a patient with the same prognosis faced lumpectomy, re-excision, adjuvant irradiation, adjuvant chemotherapy for 9 to 12 months and a bill for $30,000. In addition, businesses have developed for support services, counselors, prosthesis manufacturers, and specialty clothing with prosthesis pockets.
Devra Lee Davis, Senior Advisor to the U. S. Assistant Secretary for Health, stated, "Prevention is less glamorous than treatment, and fewer profit financially if it succeeds" (Read, 1995, p. 10). Despite the market forces, which concentrate on pursuit of a highly profitable magic bullet to treat breast cancer, the political efforts of American breast cancer survivors have brought long-needed attention to the subject of prevention.
Unfortunately, the greatest effort is being focused on a drug. Tamoxifen, a synthetic anti-estrogen, is being tested as a possible preventative for breast cancer. Trials involving 86,000 women worldwide (with 8,000 to receive the drug) are being carried out, despite the drug's very serious side effects, which include increased risk for endometrial, liver, and gastrointestinal cancers (Read, 1995, p. 189). Though the projection is that 62 of the 8,000 women will be prevented from getting breast cancer, Michael DeGregorio and Valerie Wiebe of the University of Texas Health Science Center pointed out:
all the 8,000 women taking tamoxifen will be subjected to its side-effects. This includes 1,300 women who will have hot flushes, 1,136 who will have vaginal discharges, 480 who will have disrupted menstrual cycles, 272 will develop skin rashes, between 31 and 53 will develop endometrial cancer, 24 will have a deep blood clot requiring admission to hospital and 24 will develop life-threatening blood clots in the lungs. (Read, 1995, pp. 190-191)
Speaking of Dr. Richard Nicholson, editor of the Bulletin of Medical Ethics, Read (1995) wrote, "Nicholson has described the tamoxifen trials as having less value than castrating middle-aged men to see if it prevented prostate cancer" (p. 203).
Dr. Adriane Fugh-Berman and Victoria Leonard from the National Women's Health Network issued a statement protesting the tamoxifen trials: "Harm in a medical therapy is acceptable if the alternative of not using the treatment is worse. It should not be acceptable medical practice to potentially harm nine women for the unproven benefit of one" (Read, 1995, p. 191).
Analysis of diets comparing women with breast cancer to cancer-free women, and comparing populations with low breast cancer rates to populations with high breast cancer rates, has revealed eating patterns that are believed to be protective against breast cancer. Foods high in beta-carotene (a vitamin A precursor), vitamin C, and indole-30-carbinol (found in quantity in cabbage) top the list of dietary cancer preventatives (Read, 1995, p. 133). As stated earlier, experts are also espousing a diet that is low in fat (20% to 25% of total calories) and high in fiber (30 grams per day) (Read, p. 122).
Vegetarians using soy as a primary protein source and Japanese women who eat soy, in many different forms, enjoy a much lower breast cancer rate than the general population worldwide. In addition to being low in fat, soy has other properties that enhance its apparent ability to prevent breast cancer.
Soy contains several estrogens that exert a beneficial effect on the body. Isoflavones from soy are weaker estrogens than cancer-causing synthetics (such as diethylstilbestrol) or women's natural estrogens. "But they are just as good at attaching themselves to receptors in the breast," wrote Read (1995, p. 129). "As long as the foreign oestrogens are sitting on the receptors, endogenous oestrogens cannot stimulate them" (Read, p. 129). Additionally, another estrogen found in soy, genistein, discourages the development of the tiny blood vessels needed to support cancer (Read, p. 134).
Northrup (1995) cited studies suggesting that breast cancer is created daily in women's bodies and daily, in most women's bodies, the immune system destroys it. She suggested that, by studying women whose cancers grow and women whose cancers perish, factors may be identified so that women can be taught how to reverse a growing cancer and how to prevent its growth in the first place (p. 2).
Though she employed standard treatments as the occasion demanded, Northrup (1995) saw, in her own medical practice, breast cancer arrested or reversed using nutrition, mind/body interventions, and other noninvasive therapies. "What if we could all learn how to reverse the early heat changes in our breasts that signal trouble, and learn how to create healthy breast tissue daily?" she asks (p. 1).
In reminding us that early detection is not the same as prevention, Northrup (1995) wrote, "Whether or not you've ever had breast cancer, or any disease, for that matter, you have the power within you to create and maintain a healthy body. Your body is made up of dynamic, ever-changing organs that are affected not only by your immune system, but also by your thoughts, emotions, beliefs, and lifestyle habits. No machine, drug, or surgical procedure will ever be able to create a healthy body for you. . . . You don't have to be a sitting duck just waiting for disease to strike. When you begin to think that your ability to heal comes from within, not only from without, you're well on your way to creating health daily" (p.2).
The Prophylactic Power of Social Change
Read (1995) quoted Dr. Maureen Henderson:
to give our great-granddaughters and their great-granddaughters even better chances of avoiding breast cancer we should also seriously consider the viability of social and health policies to enable young women to bear children in their late teens and early twenties and provide the necessary support for young mothers to complete their education and establish their homes and careers. (p. 93)
To encourage early childbearing, stated Read (1995), we need "social, educational, work and child-care policies that do not penalize women for having children at younger ages. . . . To encourage breast feeding there needs to be a change in attitudes about public breast feeding and places at work for breast feeding" (p. 100).
Studies have linked lower breast cancer rates to physical activity, showing that moderate exercise in adolescence and childhood protected against breast cancer (Read, 1995, p. 96-98, 100). Read proposed encouraging programs that include aerobics and dance, activities which are generally more acceptable to young girls than the more competitive sports (p. 212).
Breast Cancer as Metaphor
When one considers the damage to our environment created by industrialization and modern lifestyles, a striking metaphor emerges. Our first food comes from our mothers' breasts, and at weaning we are nourished by the fruits of the earth. Both of these food supplies have been fouled by our frantic need to claim progress. Having gone beyond meeting needs to a point where we produce for the sake of producing, with little regard for its impact on our environment, the GNP seems a measure of how much too much we can produce. No wonder the size of a country's GNP correlates with its breast cancer rate.
Read (1995) quoted photographer Jo Spence describing her breast cancer experience:
So you go in with this 'bad' breast and the evidence of this disruption is destroyed, taken away from sight, taken away from you, without dealing with the causes which reside in the entire system. Rather in the way that the police and army act to drive 'dissent' or 'disruption' underground. You can then go on functioning as so-called normal. Nothing is treated systematically, neither in the sense of your social and economic situation, nor by treating the body as an environmental system. The main thing is GET RID OF IT. After investigation I decided I either had to radically change my lifestyle and make it far less stressful, eat very differently, calm myself down or I would go on degenerating physically. I was re-reading Silent Spring [by Rachel Carson] recently, and I began to see the analogies, that my body was like the land, depleted of all nourishment, filled with chemicals over the years, carved up, pushed around, outside my control. Of course I can't say what it did need, but certainly what my body had been getting was not what it needed to function well. It's not just that you are what you eat, but that, to use an economic metaphor, if you use up all your capital without paying anything into the bank, and drain your reserves, then you can only have a system which is depleted, incapable of functioning. (p. 62).
It is amazing that billions of dollars continue to be pumped into research to find miracle cures for disease states that could less expensively be prevented. It is mindful of an old joke: A man suffering terrible headaches is told by his doctor that castration is the only cure. When the headaches become unbearable, he agrees to the surgery. In a state of depression over his terrible loss, he decides to cheer himself up by buying new clothes. At the underwear counter he asked for a dozen pair of size 32 jockey shorts. "Oh, no," responds the clerk, "you need a size 34." In reply to the man's protests that he has always worn a size 32, the clerk replies, "Well, okay, but these are going to give you a terrible headache."
With what is known about the powerful influence of early lifestyle choices on breast cancer risk, it must seem that it is too late for too many, justifying the emphasis on treatment rather than prevention. Failure to dedicate adequate resources to prevention, however, condemn us to an ever-increasing drain on our resources, both human and economic.
Public funding for tamoxifen trials should be immediately discontinued, and these funds should be funneled into more effective (and less harmful) preventive measures. Improved nutrition in schools and regular classes in physical education most certainly will have a more enduring effect than a drug that exchanges one disease for another. Physical education has all but disappeared from our schools in an effort to marshal resources to improve academic performance. We cannot even point to a nation of well-educated, albeit disease-ridden, citizens. But rather our reward has been a nation of young people too unhealthy to perform scholastically, and academic performance continues to plummet nationwide.
The mammography establishment needs to be dismantled. Billions have been spent on this method of detection, which is minimally effective. Through massive public campaigns, the public is being led to believe that mammography is actually doing something about breast cancer when, in fact, there has been no decrease in deaths from breast cancer, despite the very expensive hype.
The political clout accumulated by the women's movement and breast cancer survivors needs to be aimed at the social changes that are required to rid our society of breast cancer and other cancers that are metaphorically and literally eating away our planet's resources. We need to build a society in which breast feeding is okay and pouring insecticides on plant life is not. Periodic cleanup of environmental pollution will never be as effective as not polluting, and treatment of cancers already manifest will never be as effective as not exposing our children to the toxic lifestyle that has made breast cancer a household word.
Read (1995) stated, "In some quarters breast cancer is seen as just another fault in a female machine which cannot quite tune in to sophisticated twentieth-century life" (p. 184). Read protested the propensity to find something wrong with the machine rather than the environment in which it operates (p. 186). She questioned the entire process of treating diseases of the female body as "design faults":
Is breast cancer simply a gender-specific way of self-destruction, like a salmon's demise after it has spawned its eggs? Do women have 'design faults' as some scientists would have us believe? If this is so, why do women live longer than men and why are older women far more active and powerful than old men in many societies around the world? (Read, p. 209)
One of Western medicine's problems in dealing with breast cancer stems from a generalized propensity to oversimplify--an attempt to apply the reductionist scientific model to the female body, an impossible task with the large number of hormones that work in symphony to keep all the parts working. Medical science is well aware that functions of most hormones are only partially understood and that hormonal functioning in the female body is far more complex than in the male (Cutler, 1990, p. 15).
Patriarchal medicine, even in the hands of female physicians, is trying desperately to simplify a complicated machine. It is not feminism's turn because the patriarchal system has failed, but rather it has gone as far as it can go without integrating new ways of thinking--feminist ways of thinking. Philosophically, the feminist view embraces the problem and everything about the problem, willing to accept experience as a real event, whether or not the pieces that constitute the experience have been microscopically examined.
In the London cholera epidemic of 1849, Dr. John Snow removed the Broad Street water pump. Snow had not conducted double-blind studies, and no one had any concept of cholera as a disease caused by bacteria. The simple observation that people who drank from the Broad Street pump got sick with cholera was sufficient (Read, 1995, p. 10). Our belief in the necessity to "prove" a link between breast cancer and the fouling of our enviornment in the face of such overwhelming observed evidence is an insane adherence to rigourous "scientific principles."
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