The Hidden Forces Behind the Breast Cancer Epidemic
The numbers are appalling: The average person's lifetime chance of getting cancer is now four in 10. Breast cancer and skin cancer are the most common kinds of cancer among women in the United States, and breast cancer is the most common cause of cancer death among women under 54.At least 175,000 women were diagnosed with invasive breast cancer in 1999 (one every three minutes); 39,900 women were diagnosed with ductal carcinoma in 1999; and 43,700 American women died from breast cancer in 1999 (one every 12 minutes).In 1964, the lifetime risk of developing breast cancer was one in 20; today, it's one in eight. The rate has not only increased dramatically during this century, it has more than doubled over the past 30 years. Overall, white women have the highest rate of breast cancer. However, African-American women under 40 have a higher rate than their white counterparts.Breast cancer costs this country more than $6 billion each year in medical expenses and lost productivity.The triggerEstrogen, the hormone that regulates a woman's menstrual cycle and fertility, also prompts normal breast cells to multiply, mutate and become cancerous in certain circumstances. Every time estrogen comes into a breast cell, the cell divides more frequently -- and since imperfectly replicated cells can lead to cells that don't know when to stop dividing, this increased breast-cell division increases the risks for developing cancer. Women who menstruate early in life, or who have children late, are at higher risk because of the high estrogen levels that are in their bodies for longer periods of time.Some studies indicate that for every year before a woman starts menstruating, the risk for breast cancer is reduced by 5 to 15 percent. Likewise, women who have earlier menopause (i.e., before age 45) have only half the breast-cancer risk of women who go through menopause ten years later. Prolonged use of hormone-replacement therapy (such as estrogen) after menopause is widely considered to be another major risk factor.PreventionStrategies to prevent breast cancer include limiting alcohol consumption (two drinks a day can drive your risk up by 70 percent), getting enough vitamin A, eating whole grains, fruits and vegetables, and reducing total fat intake -- particularly animal fat in meats, dairy products and cooking oils -- to less than 30 percent of total daily calories. The last recommendation is based on the fact that breast-cancer rates are significantly lower in Japan and China, where traditional plant- or fish-based diets include lower levels of fat -- and decreased fat intake decreases estrogen levels and thus the risk of breast cancer. As Japanese women increasingly change their diet to include more fat, their breast-cancer rates are rising -- and women emigrating out of Asia take on the breast-cancer risk of the country they move to in as little as one generation.But even though women with more body fat have higher estrogen levels, Andrea Martin, founder of The Breast Cancer Fund, reports that in "the largest and most recent study it was found that neither the type nor amount of fat a woman consumes affects her breast cancer risk." Is that conclusive? No, says Martin. "Of the 88,795 women studied, fewer than 1,000 had consumed less than 20 percent of their daily calories as fat." In other words, so few American women have low-fat diets that the benefits aren't showing up in studies.The mysterious culpritThe only known causes of breast cancer are exposure to ionizing radiation and inherited genetic defects in breast cells. But "breast-cancer genes," while getting lots of research dollars, account for less than 10 percent of all cases, while other risk factors have produced contradictory numbers in different studies. This suggests that other, undiscovered factors are working in tandem with the known risk factors. Could it be, for example, that breast-cancer risk depends not just on how much animal fat is in your diet, but on what pollutants are hidden in that fat?A rapidly growing number of researchers now believe that environmental pollutants are the most likely cause of our breast-cancer epidemic. According to The Breast Cancer Fund, "Exposures to certain chemicals and hormone-mimicking compounds contribute to the development of breast cancer.""Hormone mimickers," or "endocrine disruptors," are synthetic chemicals found in pesticides like DDT, as well as some fuels, plastics, detergents and pharmaceutical drugs. Just as real estrogen binds with receptors in mammary glands, signaling cells to grow, these estrogen-mimicking chemicals (also called "xenoestrogens") grab on to the same receptors and prompt the cells to replicate out of control, leading to the formation of tumors. These chemicals accumulate in body fat, such as breast tissue.The chlorine connectionHigher levels of organochlorines in the blood also seriously increase the risk of breast cancer. Chlorine mostly exists on the Earth in the benign form of common salt. Organochlorines are produced by the chemical industry in huge amounts -- millions of pounds per year -- by releasing chlorine gas from salt and combining it with various organic chemicals. Over 40 percent of the chlorine in the US goes to make PVC (vinyl), which produces toxic chemicals during its manufacture, use and disposal."Chlorine chemistry is a Pandora's box, opened less than 100 years ago and still spewing its demons into the environment," says Joe Thornton, a research fellow at Columbia University. In his new book Pandora's Poison: Chlorine, Health and a New Environmental Strategy (March 2000, MIT Press), Thornton calls for an end to the whole chlorine-based plastics and pesticides industry. " While governments, cheered on by those who benefit from the open box, tried to chase down each and every tiny demon that escapes," he says, "we miss[ed] the simplest and most obvious solution -- close the lid."Closing this multi-billion-dollar industry is not going to happen soon. Chemical corporations and government funders control the research dollars, and not much money is being spent to trace the effects of organochlorines on human health. Instead, corporate America would rather pump money into finding a "cure," while telling us that prevention is our individual responsibility.Dioxin: a primer for other carcinogensThe most well-known of the organochlorine "hormone mimickers" are dioxins. Dioxins are created by burning various chemicals, pesticides and commercial lumber; from medical, municipal and hazardous wastes; and from metal smelting and paper-making. Many cities allow municipal sewage sludge containing dioxin to be used as fertilizer. (Cigarette smoke also contains dioxins.)Rachel's Health and Environmental Weekly, which calls dioxins "a public health disaster," reports a British study that found that lab animals contaminated with dioxin in the womb developed a high number of "terminal end buds" in their mammary glands. These end buds are the sites where breast cancer develops, and the British researchers found that when the animals were dosed with another synthetic chemical known to cause cancer, the group "primed" with dioxin grew many more tumors.The US government is ever so cautiously edging toward an acknowledgment that organochlorines are a serious health problem. Last fall, the National Research Council of the National Academy of Sciences released a 4-year study of hormone-disrupting chemicals in the environment. Although the committee included chemical-industry representatives, it concluded that "adverse reproductive and developmental effects have been observed in human populations, wildlife and laboratory animals as a consequence of exposure to HAAs [hormonally active agents]." Even more disturbing than this admission is the fact that these chemicals are made and distributed by the very companies that frantically hype "the search for a cure," mammograms, and the notion that individuals are responsible for self-detecting their breast cancer in time to survive it. Pharmaceutical companies, in particular, want breast-cancer research focused on drug therapies such as Tamoxifen and away from environmental pollution. Breast Cancer Awareness Month was initiated by the chemical giant Zeneca, the maker of Tamoxifen, pesticides, plastics, other pharmaceuticals and paper. Zeneca is a spin-off of Imperial Chemical Industries, which was sued in 1990 by state and federal agencies for dumping DDT and PCBs in California's harbors. Recently, Zeneca merged with Swedish pharmaceutical giant Astra to become the world's third-largest drug concern. AstraZeneca continues to be the primary sponsor of Breast Cancer Awareness Month and can approve or veto any promotional or informational material put out under the BCAM banner. Predictably, AstraZeneca keeps the BCAM focus on detection and treatment, avoiding the question of cause.The chemical companies dispute the environmental-chemicals theory by pointing out that we eat natural estrogen-mimickers in soy products and veggies; but humans have had millions of years of evolution to adjust to plant estrogens, while man-made estrogen-mimickers have only been present in the environment since the 1940s. And while plant-derived compounds can be broken down quickly, some of the human-made estrogen-mimickers can persist in our bodies for decades.TBCF's Andrea Martin points out that the average human consumes two to three pounds of food a day, which means that eating is our largest single exposure to the environment. According to Martin, even if prevention advocates are right that changes in diet can protect us against cancer, the problem is that "no one is talking about the impact on our health of the man-made chemicals and contaminants that are also in the food we eat. The American diet is a product of the use of pesticides, growth hormones, antibiotics and gene modification. Until we are willing to address how these practices create the very carcinogens and free radicals that we are eating to get rid of, it is foolish to think we can prevent breast cancer through diet."We need new research on these chemical pollutants immediately. "If exposure to chemicals in the environment was shown to be associated with only 10 to 20 percent of breast cancer cases," says Martin, then eliminating the hazardous chemicals would prevent "between 9,000 and 36,000 women from contracting the disease each year."Currently, just 2.4 percent of the NIH's budget goes to the National Institute of Environmental Health Sciences, which researches the intersection of the environment and health. And in 1996, a committee of scientists and experts set up by the US Environmental Protection Agency called for a program to test the toxicity and hormonal effects of 15,000 chemicals. To date, the program is badly underfunded, with tests that do not screen for toxicity during the crucial prenatal and early development period.Breast-cancer advocates and researchers cite three important types of research that are still neglected by the government. These are the testing and screening of industrial chemicals and pesticides for toxicity and hormone-mimicking effects; measuring the levels of these chemicals in our bodies ("bio-monitoring"); and learning how girls and women are being exposed to these chemicals.***Sidebar One: Risk factorsToday, only half of all breast cancers can be attributed to known risk factors; the rest remain unexplained. According to the Breast Cancer Fund, you are at increased risk of developing breast cancer if you: - Began menstruation before the age of 12 (increasingly common among American girls);- Started menopause after the age of 50;- Have never had a child or waited until after 30 to bear your first child;- Are tall or overweight;- Have been exposed to high levels of ionizing radiation;- Have a family history of cancer, especially breast cancer;- Did not breast-feed your children;- Have a high-fat diet.Having an abortion or using oral contraceptives have not been shown to increase (or decrease) the risk of breast cancer.***Sidebar Two: Detection and treatmentMammograms and self-examinations are the two best methods for detecting breast cancer -- in fact, 90 percent of lumps are found by the patients themselves. A mammogram can sometimes detect cancer up to two years before a lump is felt, but women under 35 have denser breast tissue, which hides the lump about 40 percent of the time.Conventional treatment options are lumpectomy (removing the cancerous lump of cells and a small amount of healthy tissue), lumpectomy followed by local radiation treatments, or mastectomy (amputating the breast). After surgery, chemotherapy or the estrogen-blocking drug Tamoxifen (Nolvadex) is usually recommended to kill any cancer cells left in the bloodstream. Chemotherapy is usually the preferred course for premenopausal women and Tamoxifen for postmenopausal women.There are other options as well. So many women have reported beating their cancers with herbs, meditation, visualization and other alternative healing techniques that anyone stricken with the disease should consult with support groups, survivors and alternative healers while they are seeing their regular medicos.