NATIONAL | summer 2002
Moving Beyond the Mammography Debate
Alarmed by headlines reporting increasing rates of breast cancer-a disease that will attack nearly 204,000 women in the United States this year - women have depended on mammograms to save themselves by detecting the disease early. We struggle to follow a barrage of lifestyle advice: eat right, exercise, have children young, take the pill, don't take the pill. We literally race for the cure in fundraising events and wait for recommendations from each new study. And lately, the scientific community that directs women to seek a yearly mammogram is raising questions about its effectiveness.
Groups of activists - who, not coincidently, live in locations with higher than average breast cancer rates - challenge mammography as the dominant strategy to fight the disease. The women from Cape Cod, New York's Long Island, and the San Francisco Bay Area demand a race for prevention: a search for the causes of the disease focused on environmental factors. It is a direction hotly debated in the scientific community, but environmental breast cancer activists cite several facts:
- In 1964, of all women who lived to age 80, one in 20 was diagnosed with breast cancer. Today the rate is one in eight, a rapid rise only partially explained by lifestyle, genetics, or early detection.
- When Japanese women, who have very low rates of breast cancer, move to the United States, their rates grow to match those of women born and raised here.
- Only 5 to 10 percent of breast cancer cases can be related to such genetic components as the BRCA-1 gene defect.
- Geographical concentrations of breast cancer argue against genetic and lifestyle explanations.
- A group of studies showing that chemicals in the environment disrupt development and reproductive systems in animals could suggest that the same process is taking place in humans, causing a global decrease in sperm count, increased infertility, and a rise in prostate and breast cancers.
- Recent studies have shown that carcinogenic chemicals accumulate in the fatty tissue of women's breasts.
"As long as the federal government and the cancer industry encourage women to believe that prevention of breast cancer comes in pills, we will never get to the end of this," says Barbara Brenner, executive director of Breast Cancer Action in San Francisco. Most treatment drugs have not been tested broadly enough for their long-term effectiveness or side effects. "Women have been guinea pigs for far too long," says Brenner. The need to broaden the scientific focus to include potential environmental causes is pressing. Every year, some 1,000 new chemicals pass easily through the Environmental Protection Agency's screening process, adding to many possible causes already present.
Environmental breast cancer activists point to the influence of such companies as AstraZeneca, which manufactures drugs meant to treat and prevent breast cancer and runs the Salick Health Care Centers where such drugs are prescribed. The company is the corporate founder and principle sponsor of National Breast Cancer Awareness Month. Activists argue that this allows an industry that profits from breast cancer to define the breast cancer debate for the American public.
Organized since the early 1990s, environmental breast cancer advocates draw strength and direction from related movements. From feminism and women's health advocacy, they derive the idea that the scientific research agenda should be accountable to women's needs. From environmentalism, they learn to connect health with the world around us. Following HIV/AIDS activists, they push for participation in research. Activists achieved a 1993 federal law creating the Long Island Breast Cancer Study Project, which has $30 million to investigate how environmental factors might explain the cluster of cases there. Others hope to shape the national research agenda by convincing the government to redirect some breast cancer stamp revenues to environmental scientists.
While scientists debate the impact of industrial chemicals, most agree that radiation is a proven environmental cause of cancer. Radiation from a mammogram is generally considered too low for concern, little is known about the effects of many years of exposure.
Environmental breast cancer activists are not satisfied with that kind of uncertainty. They have used their political savvy to shape studies investigating a range of environmental causes from electromagnetic fields around electric wires to noxious emissions from local military installations. Massachusetts activists gained government funding for the Silent Spring Institute. Solely devoted to studying environmental causes of breast cancer, it is named for a 1962 book by journalist Rachel Carson, who first pointed to the connection between health and the environment. "Environmental research on Long Island, Cape Cod, and in California would not be happening without activist input," says the facility's director, Julia Brody.
Nearly 10 years and 40 million dollars into their struggle, advocates know how hard it is to conduct environmental health research and how long it takes. None of the research they initiated has yet provided conclusive results, but it takes time to construct policy pertaining to research results. The nation cannot wait for scientific certainty before acting to lessen environmental risks. Most important, women must insist on breast cancer prevention, not just detection and treatment.