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THE TRUTH ABOUT BREAST CANCER--PART 1
Background
More American women have died of breast cancer in the past two decades than all the Americans killed in World War I, World War II, the Korean War and the Vietnam War combined.[1] The average woman killed by breast cancer loses 20 years of her life. Thus with approximately 46,000 American women killed each year by breast cancer, we are now losing nearly a million person-years of life each year from breast cancer.[2] The costs of this epidemic are incalculably large.
About 182,000 new cases of breast cancer arise each year among U.S. women.[2] Furthermore, since 1940, the incidence (occurrence) of breast cancer has been creeping upward 1% each year. This relentless increase cannot be explained by an aging population or by better detection such as mammography screening.[2] The 1% annual increase is real. Since 1940, a woman's chance of getting breast cancer has doubled.[3]
Everyone now accepts that breast cancer has environmental and "lifestyle" causes. Two basic facts make this conclusion inescapable. First, breast cancer incidence is five times as high in some countries as in others. Secondly, when women migrate from a country with low incidence of breast cancer to a country with high incidence, their daughters acquire the breast-cancer risk prevailing in the high-incidence country.[4] Clearly, something in the environment (air, water, soil, food, or electromagnetic spectrum [for example, x-rays]) is at work here.
Until recently, the search for causes of breast cancer has ranged from nonexistent to lackadaisical --perhaps because of racism (the most rapid rise in breast cancer is occurring among African-American women[2]), or perhaps because in the U.S. women are simply not valued as highly as men. (We know, for example, that in the U.S. women's work is not valued as highly as men's --women are paid only 70% as much as men for equal work.[5])
For years, breast cancer research (centered at the National Cancer Institute [NCI] in Bethesda, Maryland) has focused not on prevention but on therapy and treatment --earlier detection, better chemotherapy, better radiation, and better surgery.[6] These approaches have allowed many women to survive the disease (most of them without their breasts) but they have done little or nothing to prevent the scourge.
This non-preventive approach has been promoted aggressively by "Breast Cancer Awareness Month," an annual campaign that surfaces every October, sponsored by 17 governmental, professional, and medical organizations, including the National Cancer Institute.[7]
Breast Cancer Awareness Month was initiated in 1985 by a British chemical conglomerate called Imperial Chemical Industries (ICI), now known as Zeneca Pharmaceuticals. Breast Cancer Awareness Month is "focused on educating women about early detection of breast cancer."[7] Breast Cancer Awareness Month has promoted the slogan, "Early Detection is Your Best Prevention," but this is nonsense --if your cancer can be detected it's too late to prevent it. Breast Cancer Awareness Month --with all the authority of those 17 sponsoring organizations --consistently diverts attention away from real prevention.
According to a recent investigative report on Breast Cancer Awareness Month (BCAM) by Monte Paulsen (DETROIT METRO TIMES, May, 1993), "ICI has been the sole financial sponsor of BCAM since the event's inception. Altogether, the company has spent 'several million dollars' on the project, according to a spokeswoman. In return, ICI has been allowed to approve --or veto --every poster, pamphlet, and advertisement BCAM uses."[8] Thus the lack of a prevention message from Breast Cancer Awareness Month has not been accidental, and the 17 sponsoring agencies have adopted and endorsed Imperial Chemical's program and message.
Breast Cancer Awareness Month thus reveals an uncomfortably close connection between the chemical industry and the cancer research establishment in the U.S. Imperial Chemical --with revenues of $14 billion --is among the world's largest manufacturers of pesticides, plastics, pharmaceuticals and paper. ICI is also a major polluter. For example, one of its Canadian paint subsidiaries has been held responsible for 30% of all the toxic chemicals dumped into the heavily-polluted St. Lawrence River which separates the U.S. from Canada.[9]
In recent years, breast cancer research has begun to focus somewhat more on causes, but until very recently the emphasis has been on "lifestyle" factors --specifically obesity, alcohol, fat in the diet, age at first pregnancy, number of pregnancies, breast feeding, and so forth. Six years ago, 600,000 women wrote letters to Congress saying they wanted federal researchers to cast a wider net in the search for causes of breast cancer.[6] Two years later, SCIENCE magazine titled a major story, "Search for a Killer: Focus Shifts from Fat to Hormones."[3]
Actually hormones have been at the center of breast cancer research for at least 20 years because everyone agrees that 30% of breast cancers can be explained by exposure to naturally-occurring estrogen, the female sex hormone.[10] (Breast cancer may be caused by other things as well, but exposure to natural estrogens in the blood stream is widely accepted as an important cause.) After a woman's period begins, each month her blood stream is flooded with natural estrogens. If she has a baby, the estrogen flow is interrupted. If she breast feeds, the estrogen flow is interrupted. When she goes through menopause, the estrogen flow is greatly diminished.
One of the effects of estrogen is to cause cells to grow in the breasts. Many studies have now confirmed that women who start menstruating later than the average and who go through menopause earlier than the average have a reduce likelihood of breast cancer --presumably because they have a reduced exposure to estrogen. Women who have their first child early have a reduced risk. Women who have many children have a reduced risk. Women who breast feed have a reduced risk.
After a woman goes through menopause, her natural flow of estrogen is greatly reduced. In the past 20 years, about 30% of American women aged 50-65 have been taking estrogen replacement pills after menopause.[11] There are real benefits from this "estrogen replacement therapy" (or ERT) --reduced osteoporosis (thinning of the bones) and reduced likelihood of death from heart disease. Unfortunately, taking ERT pills for 10 years increases a woman's chances of getting breast cancer by anywhere from 30% to 100%, and the longer she takes ERT the worse her outlook for breast cancer.[11,12,13]
In the past 5 years researchers have begun asking, "If some pesticides and plastics and other chlorinated chemicals can interfere with both male and female sex hormones in wildlife and humans,[14] and if 30% of breast cancer is known to be caused by naturally-occurring female sex hormones, isn't there a reasonable likelihood that some of these chlorinated chemicals contribute to the rising incidence of breast cancer?" It seems a reasonable enough question.
Researchers Devra Lee Davis and Leon Bradlow with Cornell University formally proposed a hypothesis, suggesting ways in which environmental estrogens (or, as they are sometimes called, xenoestrogens --xeno meaning "foreign") might cause breast cancer.[15] The research world began to buzz with interesting new work, asking whether chemicals that mimic, or block, estrogens might contribute to breast cancer.
It seemed a rather straightforward and obvious scientific question to be asking --and one with great consequences for public health. But to the chemical industry it looked like something more than merely an important public health question. With billions of dollars riding on the outcome, they saw it as a political struggle, less about saving lives than about maintaining profits, power and, above all, control. The Chemical Manufacturers Association (CMA) and its subsidiary, the Chlorine Chemistry Council (CCC), quickly developed a strategy to protect their interests against those of the 180,000 women afflicted by breast cancer each year. (See REHW #495.) They hired a scientist to begin casting doubt on the Davis/Bradlow hypothesis by saying this line of research is a dead end, a huge waste of time and taxpayers' money. (Manufacturing doubt is a strategy that has served the tobacco industry handsomely for 50 years, and the chemical industry has now adopted it --all, of course, in the name of "good science.") And they hired a sleazy, third-rate public relations firm --Mongoven, Biscoe and Duchin of Washington, D.C. --to develop a plan for discrediting Devra Lee Davis herself.
[Continued next week.] --Peter Montague
Here is our situation. We are all passengers (or crew) on a long rickety train heading south at 40 miles per hour, not rushing toward doom but steadily chugging southward toward general environmental and social destruction. Many of us are alert to the dangers and for several years we have been earnestly walking north inside the train.
As we plod from train car to train car we stop to congratulate ourselves on our progress. We slap each other on the back or we hug, and we recount the many train-cars we have managed to pass through, thanks to our stubborn persistence.
But if we would only pause to look out the window, we could all plainly see that we are now further south than we were when we last stopped to congratulate ourselves on our progress. Despite our best efforts, we have been unable to reverse the direction of travel. We are all being carried southward against our will, deeply violating our sense of justice.
Maybe this is happening to us because we have spent our time engaging the conductor in conversation. This seems like the natural thing to do. After all, it is the conductor who sets and enforces the rules inside the train --that's what conductors do. Furthermore, the conductor seems pleasant and intelligent, and he also seems genuinely interested in helping us make our way north through the train. He keeps emphasizing how well we are doing, and, when we become discouraged, he urges us on, reminding us that walking northward is a noble journey, and that eventually we will get to the promised place.
Unfortunately, it has been many years since we asked ourselves the fundamental questions: what fuels the locomotive? Who is the engineer with his hand on the throttle? And what will it take to make him change direction?
The time is long overdue when we must ask ourselves what it would take to change our trajectory, to permanently alter our direction of travel. Even if the means for actually changing direction are not visible at the moment, we know that change is needed and has to come.
We also know that things can change quickly, unexpectedly. But if, today, we were offered the opportunity to set civilization on a new path, most of us would not have a clear idea what to do. We need to think this through. We need a vision of a workable alternative to the present, a clear set of goals (and benchmarks) and some principles to guide us, if we are to make the shift whenever the opportunity presents itself.
(We know of only one organization that is gearing up to tackle this difficult, all-encompassing task, and to do it from the ground up starting with economic redevelopment of local communities: Sustainable America in New York City --telephone Elaine Gross at (212) 239-4221 or E-mail: sustamer@sanetwork.org or https://www.sanetwork.org.)
Some things we know. For example:
Define Big Technical Enterprises
** Small IS beautiful, but in the coming world we will always need some large aggregations of capital. We will always need large technical enterprises like a telephone system, energy systems, broadcast media, and large reuse/recycling parks to meet our needs for materials, for example. How can we be sure that those aggregations will remain responsive to the needs of humans and communities and not merely to wealthy elites? How can large enterprises be DEFINED so that they cannot become tyrants in the communities they are set up to serve? This is perhaps our most compelling problem and one we must think through and solve. (In the U.S., our predecessors discussed these questions continuously from at least 1770 to at least 1920 but found no workable, lasting solutions --the large corporations decisively defeated those who favored democratic controls in the election of 1896 and our democracy has simply never recovered.[1])
Now that the survival of the human species (along with many nonhuman species) is endangered by mountainous aggregations of private wealth and power, it is essential that our democracy be given a new life. As we contemplate the nature of the transnational corporation, we must ask ourselves, if we could replace it, what would we replace it with? How would we avoid merely creating another Monsanto or another Union Carbide thus replacing one set of deadly forms with another?
Learn to Measure Well-being
** Many of our problems are worsening --wages are declining, inequalities of income and wealth are rising, chronic disease is increasing, our central cities are crumbling, vast numbers of our children are poorly cared for, poorly educated, and undisciplined. Yet the government insists that the economy and American life have never been better. This can only happen because our official measures of well-being are counting the wrong things.
Nationally, our main measure of well-being is Gross Domestic Product (GDP) --the amount of money spent by households to purchase goods and services, plus the amount spent by businesses on investment, plus the amount spent by federal, state and local governments on goods and services.
GDP counts everything as positive growth. It works like a calculator without a minus sign. The costs of emergency room services, prisons, toxic waste cleanups, homeless shelters, lawsuits, and cancer treatments are all counted as positive additions to GDP. No wonder people feel disconnected and out of touch --the President keeps telling us the economy has never performed better (measured by GDP), but people know from their own experience that something is not right.
As a result of this faulty accounting system, we take remedial measures that aren't helpful --measures intended to increase GDP. As economist Herman Daly has pointed out,[2] when we work to maximize GDP, we are really working to maximize depletion of our natural resources, and we are working to maximize pollution. (As we saw in REHW #516 and #518, better measures of well-being are available, and they indicate that the U.S. hasn't been making progress for about 20 years.) Meanwhile, people feel the powerful "bads" in their lives and know things aren't right.
As Herman Daly[2] and Paul Hawken[3] have pointed out, the reason we need new indicators of well-being is that our situation has changed drastically. Two hundred years ago, when the industrial revolution was getting cranked up, natural resources were abundant and humans were relatively scarce. Now the reverse holds true --natural resources have been badly depleted and there is no shortage of humans. Therefore, ancient policies aimed at substituting energy and natural resources for human labor no longer make sense. We need to count the depletion of natural resources among the "bads" and we need to devise ways to use more human labor (not less) to build a better world. This means --at the very least --redefining the "productivity" of labor.
We can begin these changes at the local level, where we live. Happily, smart people are developing "cookbooks" that can guide us as we develop local measures of well-being. For example, the organization called Redefining Progress in San Francisco has published an excellent "how to" manual called THE COMMUNITY INDICATORS HANDBOOK.[4] Such local measures can tell us where we are, where we are going (including where we are going wrong), and can focus our political attention and our public investments on making real improvements.
If we don't measure where we've been and where we are, we can't know where we are going. This seems fundamental --yet relatively few communities today are taking such measurements. Jacksonville (Florida), Seattle (Washington), and Pasadena (California) are leading a new movement that has started measuring quality of life and using the measurements to guide investment and effort.[4]
Tax Bads, Not Goods
Herman Daly[2] and Paul Hawken3 also agree that we should tax the things we don't like --depletion, pollution, and waste --and we should avoid taxing the things we DO like, such as investment and labor. (We would still have to tax the highest incomes to reduce inequalities of opportunity and power, for the purpose of preserving democracy.)
As Paul Hawken says, the goal of the tax system should be to close the gap between prices (which individuals pay) and costs (which society pays). Individuals pay the price of gasoline, but society pays the costs of hurricanes, droughts, and floods caused by the global warming which results from gasoline-powered automobiles. If taxes caused prices to reflect full costs, then alternatives to gasoline-powered cars (such as light-weight hybrid hydrogen-and-electric vehicles) could be competitive today --good for the economy and good for the environment.
A tax on toxic dumping would discourage this antisocial practice. Even better: a tax on toxic raw materials would induce users to seek less-toxic alternatives, thus eliminating the possibility of problems rather than merely reducing the likelihood of problems.
Search for Least-Damaging Alternatives
We must insist that all reasonable alternatives be examined before decisions are made, and that the least-damaging alternative be given greatest weight. We could certainly embed this decision-making principle in our public institutions, starting at the local level --and eventually we will have to embed this guiding principle in private decision-making as well.
As biologist Mary O'Brien says, "Our society proceeds on the assumption that toxic substances WILL be used and the only question is how much. Under the current system, toxic chemicals are used, discharged, incinerated, and buried without ever requiring a finding that these activities are necessary."[6] We need to institutionalize the search for least-damaging alternatives and give priority to the least-damaging alternative once it has been identified. (How do we measure least-damaging? This goes back to measuring well-being, discussed above.)
Catalog What Works
We need an ongoing catalog of "what works." What innovations at the local level are working? We need a place where we can all go to find out. One effort in this direction is the magazine called YES! A JOURNAL OF POSITIVE FUTURES7 but we also need a much more ambitious, cumulative database of "what works" for sustainable development.
[There are other principles that should guide us, but we will suspend this series for a time and return to it later.]
--Peter Montague
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