The Geography of Breast Cancer
The woman who lives two doors down from me has breast cancer. Three years ago her oncologist gave her six months to live, but for the time being, she's beating the odds. The woman across the street had a lumpectomy one year ago, and her sister in Taos just began chemotherapy for her breast cancer.Eight of my acquaintances -- all in their 40s or early 50s -- have breast cancer; two were diagnosed within this past year. The first person I witnessed journey through the death process also had breast cancer -- it spread to her bones, leaving them fragile as dry twigs.This disease keeps circling closer and closer. My 88-year-old mother had a mastectomy last year; the cancer was termed slow-growing, and although she had two positive nodes, she eschewed radiation treatments. My sister, a physician, says my mother has a "good" scar, that the surgery was done well. There's no sign, yet, that the cancer has spread. My sister hopes, when the time comes, that death will choose another way to settle over our mother. Breast cancer, she says, "is a shitty way to die."I used to associate the doom surrounding the term "being diagnosed" with HIV infection. Now, for me, that heavy aura has shifted to the topography of breast lumps. Because of the number of my friends who have the disease, I've acquired a new lexicon of emotion-laden terms: aspiration, biopsy, benign, pre-cancerous, malignant, aggressive, invasive, metastasized.In the U.S., breast cancer is the leading cause of cancer death among women between the ages of 40 and 55. The American Cancer Society estimates about 180,000 women are diagnosed each year with the disease. Researchers now say, given a life span of 75 years, one in eight women will contract breast cancer. But as I grow older, those numbers seem too small, too safe, too arm's length. Breast cancer is beginning to seem almost inevitable -- not if a lump is found, but when. Today, 17 women work in the same office as me. The odds say at least two of us will contract -- or may already have -- this insidious disease. Which two? When? Why?Heart disease remains the major killer of women overall. But at least that disease is somewhat responsive to life-style choices. Eschew cigarettes and red meat, keep the cholesterol down, get regular exercise and your risk for heart disease plummets, barring any tenacious bad coronary genes.But breast cancer doesn't seem to care all that much if you run laps or pump iron, give up beef or cut down on sugar. Researchers have found that -- in a gothic twist of human biology -- many breast tumors thrive on estrogen, the hormone that makes us female, that gives us our hips, breasts and softness, as well as regulating our monthly cycles. Too much estrogen, though, leads to trouble: it stimulates the growth of fibroid tumors and has been increasingly linked with breast cancer.Experts say it's good for women to interrupt their lifetime flow of estrogen by having early pregnancies and breast-feeding their babies. Keeping weight and alcohol intake to moderate levels helps, and exercise might, too, but none of these measures qualify as full-blown preventatives. I spoke to four different women with breast cancer in the week before I wrote this essay -- three had children early, maintained mostly vegetarian diets and exercised regularly. Two of these women have been diagnosed with "very aggressive" cancers.A very small percentage of women have inherited a gene that vastly increases their chances of contracting the disease. A family history of breast cancer may give them some warning. But most women wake up one day, and find the cancerous growth there. Fingers find it, or a mammogram detects the cluster of abnormal tissue. The likelihood is that it's been "there" for years: Tiny, hard, unyielding and deadly. The wages of unknown sins, unknown causes.Many of us remember the '50s, '60s and '70s as decades during which the medical establishment was almost invincible. It had stopped polio in its tracks and was conquering hosts of diseases via antibiotics. We were all marching headlong into a rosy, high-tech medical future. Certainly we are not accustomed to viewing the medical establishment as being befuddled long by any disease. OK, HIV knocked them for a loop for a while, but look how far, in just 10 years, researchers have come.But with cancer, certainly with breast cancer, Western medicine is still scrambling. For years researchers have been in the middle of the "cure" process, gathering data, experimenting, trying and failing, trying again. At some point in the future, the image of rows of women lying hooked up to chemotherapy delivery systems in hospitals all over the U.S. may seem barbaric. But this is now, and now still means a lot of unknowns, a lot of groping in the dark trying to figure out exactly what makes these cells grow -- whether the culprit is indeed estrogen itself, or substances that increase the amount of the hormone in the body -- and what will make them stop.Western medicine has definitely proved its mettle at trying to detect breast cancer, and somewhat in treating the disease. Refinements in mammography technology (and now ultrasound) have meant more breast tumors are found sooner, especially in post-menopausal women. The result is that fewer women who have the disease die, and many live longer with it.But mammography is not prevention, as breast cancer advocates emphasize over and over. And Kay Dickersin, an associate professor of epidemiology at University of Maryland Medical School, says the procedure is not without its drawbacks. Much of what mammography is detecting in younger and older women is a precancerous condition known as ductal carcinoma insitu -- a non-invasive growth in the ducts. "And we just don't know how to treat it," she says.Researchers don't know that the condition automatically develops into invasive breast cancer; they suspect in many cases it doesn't, "but we don't know how to distinguish the ones that develop into invasive cancer," says Dickersin. Still, many women endure heavy-hitting treatments -- mastectomies, chemotherapy, radiation -- because of the diagnosis "And that may not be appropriate," she says.Chemo cocktails, radiation exposures and surgical techniques have all been refined over the years. Also, a recently introduced biopsy method may mean some women will not have to have lymph nodes -- located in the armpit near the affected breast -- removed to test for the spread of cancer cells. That news is good, because having lymph nodes removed produces the greatest and longest lasting post-surgical discomfort from surgical procedures for breast cancer. The "sentinel node" technique involves a doctor using a dye or radioactive solution to mark the one gland that is the "gateway" for cancer spread to the rest of the system. Once removed, the surgeon tests that node for cancer cells -- if it's clean, chances are excellent the cancer has not spread, and no more nodes need to be removed. If cancer cells are detected, the surgeon extracts all the lymph nodes.Yet despite such refinements in treatments there has been no decrease in the number of women who are contracting breast cancer. For years, breast cancer activists have been pounding on closed doors, trying to get someone to expend more effort on ferreting out the cause of breast cancer, and less on tinkering with treatment approaches.One huge area being overlooked, these activists say, is the possibility of a link between breast cancer and the synthetic chemicals that now permeate the air we breathe, the water we drink and the food we eat. Women now reaching middle age, they point out, are the first generation to grow up in "the chemical age," and breast cancer rates have risen right along with the increased amounts of those chemicals in our environment.Sandra Steingraber, author of the book Living Downstream: An Ecologist Looks at Cancer and the Environment, says some of the reported increase -- 25 percent from 1973 to 1991 -- is due to more cancers being found through mammography. But even allowing for improved detection, the increase has remained steady over the last five decades: 1 to 2 percent each year, since 1940. Breast cancer rates are also highest in industrialized countries, such as in North America and northern Europe, and are lowest in Asia and Africa.Researchers have been reluctant to open the Pandora's box of possible environmental causes. Keeping causal factors tied to women's exposure to her own internal estrogen is neat and tidy, and fits comfortably into known research models. In addition, a lot of breast cancer research is paid for by pharmaceutical companies -- the ones that make the drugs used in chemotherapy. But exploring the possibility of environmental causes for breast cancer presents a murky, convoluted and unwieldy challenge. Juggling all those variables. Selecting pure samples. Singling out chemicals, tracing down exposures. The time such tests would take. The money, not to mention pressure from chemical-dependent industries not to even investigate such possibilities.And, to make matters even more complicated, some researchers are now saying that many synthetic chemicals -- including many in the huge extended family known as organochlorines, which include known carcinogens such as DDT, PCBs, heptachlor, chlordane, polyvinyl chloride, dioxin and perc (used in dry cleaning) -- often masquerade, once in the body, as estrogens. These xenoestrogens, as they are called, can severely disrupt a woman's normal estrogen balance, by changing how estrogen is made or reacting with natural estrogens.Many of these estrogenic substances by themselves have only weak effects. But what recent research has found is that, when a number of these substances react with each other, they produce highly estrogenic effects, sometimes increasing their individual potency 1,000-fold. These xenoestrogens also don't break down quickly in the body, but tend to accumulate in fatty tissues, and can even be passed down to future generations. Some researchers suspect these xenoestrogenic effects as providing a breeding ground for estrogen-loving tumors.A year ago, in a report on pesticides and breast cancer, Carolyn Cox of the Eugene-based Northwest Alternatives to Pesticides (NCAP), wrote about studies that showed women who were exposed to organochlorine insecticides, such as the now-banned DDT, had from two to four times the risk of contracting breast cancer, because of the chemical's propensity to form xenoestrogens.Cox also wrote that atrazine -- one of the most widely used herbicides in the U.S. -- has been found to be as likely to form this "bad" estrogen as are the most potent DDT breakdown products. Exposure to atrazine, she wrote, is already known to produce malignant mammary gland tumors in female rats.The impact of these "findings" came home two weeks ago, when NCAP released the results of a study of the Willamette River conducted by the U.S. Geological Survey. The study found that atrazine was found in 90 percent of the water samples tested. Another similar compound, simazine, an herbicide used on corn and nut orchards, was found in 82 percent of the water samples. Previous tests have shown that female rats fed simazine also produce malignant mammary gland tumors.The Willamette River drains an 11,500-square-mile area between the Coast Range and the Cascade Mountains. The basin includes about 12 percent of Oregon's land area, and a large proportion of the state's population. The American Cancer Society estimates that of the 180,200 cases of breast cancer that will be diagnosed this year, 2,000 will be Oregon women.Research will go on, and some day, out of the current fog, fragments of answers will come. In the meantime, a diagnosis of cancer will continue to yank women out of their familiar lives into a maelstrom of information, questions, possibilities and unknowns -- all of which must be used to make crucial decisions. "I don't know if women who haven't been diagnosed can understand how scary it is," says one survivor. "It's absolutely terrifying."And even after a course of action is decided upon, there's still the living through it -- chemical menopause for some, hair loss, fatigue, radiation-induced headaches, emotional chasms. "The pamphlets they give you might mention depression as a side effect. But that word does not give a true picture of what the feelings are like," says another survivor. "You can't escape who you are -- all the doors are open. You're needy, you are very vulnerable, you need a lot of help."Everybody walks around trying to pretend we're not all dying, but people with breast cancer have that fact screamed in their faces. You think you have control over your body, but in fact the universe just does what it does, and you try and adjust."Anomalies do exist. Take Rita. She had children when she was young, ate well, didn't drink much. She had a routine mammogram at 50; it was clear. Four months later she found a lump, and immediately had another mammogram. "My doctor was shocked. He said the mammogram looked like I was someone who had cancer that had gone untreated for a long time."Her tumor was termed a "very aggressive malignancy." Rita had a modified radical mastectomy and a lymphectomy; seven of her nodes were positive for cancer cells. But when it came to chemotherapy, Rita put her foot down. If the chemo was only going to give her a slight chance of surviving longer, then it wasn't worth it, her reasoning went. "The odds just didn't look good to me. If I had only two or three years to live, why would I waste an entire year feeling like shit?"Rita had her ovaries removed, because her tumor was estrogen-positive. Then she went "alternative." She switched to a modified macrobiotic diet. She lost 50 pounds "because fat puts out estrogen." She got regular massage and chiropractic treatments, took vitamin and mineral supplements, drank a glass of wheat grass juice daily.It's been almost two years since her diagnosis. "And so far, I'm feeling great," she says. "I'm trying to buy myself quality time. And I hope to prove them wrong. If I can buy myself five years instead of two, I'm happy."On Saturday morning, Oct. 18, the Soroptimist club of Eugene held their annual Walk for Life The benefit raises money for a fund that helps women with breast cancer and their families. Scores of women, young and old and in between, met at Owens Rose Garden by the river. Many carried pink balloons on which were written the name of a friend or loved one who has -- or had -- cancer. Shana Penington, 21, was there. Her mom has breast cancer; so does her grandma, her aunt and her cousin. "I think I got the gene," she said, "but I'm hesitant to get tested. I'm only 21, and that's too young to know that I may or may not get it sometime in the future."As the walk started, a flotilla of pink balloons floated down the river path: Cheri, Susan, Auntie Bid Bid, Anica, Helene, Nancy, Diane, Laurie, Debbie, Maggie, Ann, Cheryl, Norma, Juanita, Irene, BJ, Nina, Aunt Janet, Ada, Filomena, Bonnie, Vivian, Sara, Mary Margaret, Bernice, Lillian, Rosemary, Marge, Jan, Teresa, Ada, Grandma June. My Momma.Katie, about 5, was carrying a bunch of balloons that said "Grammy." Her mother explained that they were happy balloons, because Katie's grandma was diagnosed six years ago, and there's been no recurrence. One of Katie's balloons, though, was without a name.Katie couldn't say why.