What About Those Other Cancers? Prevent What You Can, Fight What You Can’t

 

DDTTime to put on my skeptic’s hat.

The news has again been filled with various reports on cancer, cancer prevention, and cancer treatment. Some of this news has shown up in my mail – both snail and electronic. First came the plea for contributions from the American Cancer Society, with the optimistic headline that says “Yes, we are beating cancer!” This headline is backed up by statistics stating there’s been a 25% decline in cancer death rates since 1991, and that “more than 2.1 million cancer deaths have been avoided during this time!”

Their crystal ball must be pretty good to be able to see what *didn’t* happen during this time span. A decrease in cancer deaths, while great news, doesn’t tell you that cancer rates are expected to rise.

Then there was the email notice from the Cancer Prevention Institute of California (motto: “Preventing Cancer. Promoting Life.”) that includes an “infographic” (a.k.a., chart) of ways that you can reduce your risk of cancer by one third to one half. The list has the usual steps: eat a balanced and healthful diet, get exercise, protect yourself from the sun, get the HPV vaccine, and avoid smoking and eating too much red meat. This is useful – but not exactly cutting edge – information indicating that the 30% to 50% risk reduction relates primarily to cancers of the colon, lung, skin, and a basketful of general cancers not entirely specified.

Also in this email is a link to a press release about a study of triple negative breast cancer, which found that “women under the age of 50 who breastfed for at least 24 months over their lifetime had a lower risk of developing TNBC. For women with three or more full-term pregnancies, risk increased two-fold if they did not breastfeed or only did so for less than a year. No increase in risk was seen for women who breast-fed for more than a year.”

Feeling confused? So am I, and I even try to keep up with the research on TNBC. These latest findings still don’t explain why I ended up with that particular cancer. According to this study – and the fact that I generally lived by the tips on the infographic — I should have been at low risk for cancer in general.

At this juncture on Cancer Road, I’ve stopped thinking there will ever be a single cure for cancer, or even one cure for everyone with a single type of cancer. The more research is done, the more clear it becomes that the term cancer covers an ever-increasing number and variety of cell abnormalities. Though there may be cures for some specific cancers, this disease will always be a few steps ahead of science.

I am grateful for (and contribute to) the researchers who dedicate their life’s work to finding cures, and appreciate the various organizations that try to educate us about risks and prevention. Though I understand the need for optimism and see the value in charting progress, none of it explains why — if you do the math — 50% to 70% of cancers don’t seem to be preventable, at least not by controlling the factors listed in the infographic.

If we can control some of the risks that lead to certain cancers, there must be ways to prevent others as well. But the prevention information peddled to the general public doesn’t address how to do this. The information largely puts the burden of prevention on the individual – do this, don’t do that — and ignores the larger picture.

During this month, which honors cancer prevention, I’ve been reading a book that, at first glance, doesn’t seem directly related to the topic: Silent Spring, by Rachel Carson. Published in 1962, the book details the drastic increase in the use of pesticides and herbicides since 1945, and their catastrophic effect on fish, plants, wildlife and — it turns out — humans throughout the 1950s. This book is generally credited with advancing the environmental movement, though Carson herself died of breast cancer two years after the book came out.

Carson’s findings aren’t news to those who know her work or are active in the environmental movement. Reading Silent Spring reminded me of the environmental chemicals I was exposed to over the years (weed killers, insecticides, household cleaners, chlorine in swimming pools), some of which I had control over and most of which I didn’t (DDT wasn’t banned in the U.S. till 1972, when I was 12).

Connecting these various dots, I’d like to propose two steps:

  1. Prevent what you can: Along with eating well and giving up smoking – activities we have control over — we should give up using harmful environmental chemicals whenever possible. (Throw away those ridiculous air fresheners and welcome the weeds in the lawn.)
  2. Fight what you can’t: Petition the manufacturers of such chemicals to assign some of their scientists to cancer studies in search of a cure. After all, if they’re going to create cancer-causing agents, the least they can do is try to repair the damage.

Maybe then we’ll see a decrease not just in cancer deaths, but in the rates of those other cancers too.

For a list of top 116 cancer-causing chemicals and activities, click here. See how many of these you can remove from your life.

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Starbucks, Sins, and the Lies about Breast Cancer

I was talking yesterday with friends about the headline news that Starbucks is giving their employees free tuition to attend college.

At first glance, this seems like a fantastic move, exactly the sort of thing corporations ought to do for their low-paid employees, the ones who do the hard work that guarantees those high executive salaries.  But the fine print of the agreement divulges the lie of the headline.  The tuition certainly isn’t free, and it’s not actually being paid by Starbucks. The more we dig below the glossy surface of the story, the more this “deal” looks like a marketing ploy by Starbucks and Arizona State University. So it turns out that the initial announcement and headlines were, essentially, a lie.

And so I got to thinking, what sorts of lies lurk under the surface of the news we read about breast cancer?

When it comes to lies, there are two kinds: lies of commission and lies of omission. Lies of commission are deliberate falsehoods told to cover up the truth.  Lies of omission neglect to disclose (or maliciously withhold) information and thus reshape the truth. The Starbucks story is an example of both – a headline that gives a false impression, and a withholding of details that disclose the full picture.

When it comes to breast cancer, the lies tend to be ones of omission rather than commission, and they are not usually intended to be malicious. Part of the problem in reporting on breast cancer is that the story is too wide and deep to be covered in the space of a computer screen.

The first lie of omission is that breast cancer is one disease. To date, researchers have defined 6 major types of breast cancer. These groups are then divided into many subtypes according to hormone receptivity, cell type, and other factors. Unfortunately, the information published about breast cancer in the mainstream media implies that all women with breast cancer are in the same boat, rowing with the same oar, dealing with the same disease, which is simply not true. Most studies are done on women with hormone positive cancers, which leaves people like me (with the triple negative variety) and those with other types (inflammatory, lobular, DCIS, etc.) out of the picture. Together, we make up as much as 25% to 30% of breast cancer patients, but yet the focus of news is on the hormones.

Now, take a look at the list of risk factors for breast cancer currently available on the Mayo Clinic website. (This list has changed significantly since I first was diagnosed 5 years ago.) Mayo is a highly regarded institution, and rightfully so, but even a perusal of the solid information presented here inadvertently introduces the sin of omission.

The fourth and fifth items on the list are a family history of breast cancer (mother, sister or daughter) and a genetic mutation. But neither of these items mentions the male side of the equation – men with breast or prostate cancer.  The genetic mutations that can lead to breast cancer in women can also lead to breast and prostate cancer in men. So to focus only on female relatives is to omit the real possibility that the genetic defect can come to you through your dad.

But the bigger lie here is the impression that many breast cancers are hereditary and this lie is heightened by celebrities who are opting for preventive mastectomies. In fact, 85% to 90% of breast cancers are *not* hereditary.

This list also says nothing about breast density, even though legislation in 17 states now requires doctors to tell women that they have dense breast tissue. We now know that mammograms, already questionable as an effective means of screening, are even less effective in finding tumors in dense tissue, and there is a suggestion that dense tissue itself might be a risk factor. The controversy on this topic will continue, and Dr. Susan Love interprets the current situation well.

The list also says nothing about the use of oral contraceptives, which has been a complex and controversial topic for a long time. Some studies have found a connection between use of the pill and breast cancer; some have not. Because of the changing nature of birth control pills over the years, research on the effects is rather like shooting arrows at a moving target.  Still, the question is worth addressing, in light of a recent study.

The Mayo list does raise the issue of childbearing, another area clouded with complexity. According to the list, having children late in life or not at all is a risk factor. But the finer points of this factor are explained by the Komen Foundation as follows:

“In general, women who have given birth to more than one child have a lower risk of breast cancer than women who have never given birth. However, women may not get this protective benefit of childbearing for triple negative breast cancers. On the other hand, although having a child at a later age tends to increase the risk of breast cancer, it does not appear to increase the risk of triple negative cancers.”

So it seems this risk factor might not actually apply in many cases, and so,  out of necessity, the site concludes by saying “these topics are under active study.”

There are some unusual omissions from the Mayo list: that risk increases with height, and that cancer occurs slightly more often in the left breast than the right.

Further down the Mayo Clinic’s risk list is exposure to radiation as a treatment during childhood.  The sin of omission here concerns the radiation women are subjected to through mammography. Most of the current research still indicates that the amount of radiation from mammograms is not of concern, even cumulatively. So this omission actually works against women’s peace of mind.

With regard to risk factors, the biggest lie of omission is that any of these lists is comprehensive. (The Mayo list does at least state that many women who develop breast cancer have no known risk factors.) It’s easy to assume that, if none of these factors fit you, you’re safe.  That’s what I thought when those telltale signs showed up in me. Before my diagnosis, I had only two of the risk factors on this current list. And of the risk factors for triple negative cancer – younger age, African American heritage, genetic mutation, obesity – I have none. As a short, slender, middle-aged, white woman with no previous or family history or genetic mutation, who has eaten well and exercised for years, with normal hormonal changes and not taking HRT, I was not a likely candidate for breast cancer, much less the triple-negative variety. And I know of many other women in this same boat with me – not at obvious risk.

So here’s the obvious point:  if you’re female, you’re at risk.

Another lie is that women can prevent breast cancer through the hat trick of diet, exercise, and taking tamoxifen as a preventive, which implies that we have more control over the development of breast cancer than I believe we do. If you read only the headline and lede of this article, you’re given the impression that it’s easy — eat well, exercise, and take tamoxifen if you’re at high risk. The article never mentions that there are likely environmental and chemical influences at work, things that are out of control, things that Rachel Carson – who herself died of breast cancer — warned us of back in 1962. The organization that bears the name of her landmark book makes those environmental threats clear.

The underlying message with this disease is that it is somehow the individual’s fault if she gets cancer, that cancer is out there and it’s just up to us to figure out how to avoid it, like a pothole in the road. This continues our “do-it-yourself” and “blame the victim” ways of thinking. Although we do generally have control over how we live, there has been a constant focus on diagnosis and treatment, with more and more tips for prevention – all of which is valuable. But this approach omits a clearer focus on the causes and what we’re doing collectively, at the societal, environmental, and political levels, that leads to harm.

Medical researchers do the best they can to find the answers to our many health problems. But much of this research takes years and, because it usually takes place in hindsight, after we’ve defined the problems, it is at best always a step or two behind reality.  Despite what researchers actually do find and accomplish, when this information is brought to light by the media, it is often skewed to make headlines or garner hits on a website. The ever-increasing pressure for media to be first to the story means that the critical and often the most important news is passed over because it isn’t easily carved into the crystal of a sound bite.

To avoid the sins, whether of omission or commission, it’s up to us to read between the lines and ask what’s missing from the information published about cancer, breast cancer, and even Starbucks.

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