In the pink
Even the NFL supports Breast Cancer Awareness Month. But why is everyone ignoring some of the biggest risk factors?
Every October, sure as the leaves fall from the trees, pink ribbons and products blossom virtually everywhere you go. Breast Cancer Awareness Month has all the hallmarks of an effective public health campaign; people going about their regular routines can’t help but notice all the pink and – especially while shopping – be encouraged to contribute to the cause. During a friendly gathering last year, an acquaintance of mine wondered aloud why football players on the TV in the background were wearing pink on their uniforms. The answer soon came. Awareness had been raised. Everyone in the room voiced approval; who wouldn’t want to turn the tide on breast cancer?
The NFL’s highly visible slogan – “a crucial catch” – reminds women that “catching” warning signs, through regular mammograms and self-exams, is the name of the game. This comes right out of the Public Health playbook, which unfortunately has not been terribly effective. These familiar measures (along with diet and exercise) have done some good, yet breast cancer mortality has only dipped slightly since the campaign began more than 25 years ago. And while screening can help save lives, it also subjects five to 15 times as many women to intense treatments or surgeries that turn out to be unnecessary – since many tumors are treated as though they were aggressively malignant even if they are later discovered to be benign.
The pink awareness campaign is packaged, quite profitably, as an expression of genuine concern about women’s health. So surely it is reasonable to expect that such concern be matched by an accurate presentation of all the known risk factors, and by an insistence upon the very best corresponding prevention recommendations, right? After all, early detection measures such as screening are not nearly the same thing as solid prevention.
Indefensibly, however, most awareness efforts fail to feature some factors known to reduce breast cancer risk: having children, avoiding induced abortions, and refraining from oral contraceptives (OC). True, there is no guaranteed way for anyone to dodge or develop breast cancer, but that does not mean there are not risk factors. Women today are delaying childbirth as never before, and having fewer children. Younger women are using OC for longer periods of time. And well over a fifth of all pregnancies in America end in abortion – hardly the rarity its “safe, legal and rare” advocates say it should be. If you suspect that these reproductive risk factors might have something to do with the 40 percent increase in the incidence of breast cancer over the last 30 years, you have spotted the elephant in the room.
Public health authorities, however, dare not cross the cultural Rubicon with an army of politically incorrect facts – even in the name of women’s health. Not even concern about breast cancer, it turns out, stands in the way of unbridled allegiance to absolute individual freedom, particularly in the arena of sexuality, which so characterizes today’s culture. In saner times, the imperative to recommend what is truly best for women’s health would prevail.
No one would counsel a woman to have a child, say, by her early 20s for the sole purpose of reducing breast cancer risk. But, simply put, a woman can do nothing more protective than having several children, beginning at an early age, and breastfeeding them all. Women who never give birth (including nuns) are at higher risk; having a first child later in life (over age 30) also heightens susceptibility.
The steroids taken by more than 100 million women around the world to prevent pregnancy — oral contraceptives – are known human carcinogens, according to the International Agency for Research on Cancer. In 2006, the Mayo Clinic concluded that a woman who takes OC before her first full-term pregnancy stands a 44 percent greater chance of contracting breast cancer prior to menopause, compared with those who don’t take OC before giving birth. Using OC for four of more years prior to first full-term pregnancy is even more risky.
Yet how many young women are informed – in that obligatory “Health 101” class, by their doctors, or through the pink media blitz – that “the pill” is a steroid (yes, think Mark McGwire and Barry Bonds), much less that it increases a woman’s likelihood of developing breast cancer?
Induced abortion is also a major risk factor. A recent (2007) multi-country study found that having had an abortion was the greatest predictor of subsequent breast cancer. Going back decades, study after study (with only a few exceptions) has demonstrated the connection; a methodologically sound review of the available evidence determined that it raises the risk of breast cancer by approximately 30 percent. (See this exhaustive summary). Electing to have an abortion before one’s first full-term pregnancy is even riskier.
I wonder how many of the more than one million women in America who annually choose abortion would reconsider if these risks were common knowledge? There is precedent; millions of post-menopausal women ceased taking Hormone Replacement Therapy (HRT) once they were apprised of its risks, and as a result the breast cancer rate among that cohort dropped within a few short years.
Remarkably, the preponderance of evidence has not stopped the once trustworthy Lancet, or the National Cancer Institute (NCI) from flatly denying the connection. Abortion, they seek to assure us, is nothing any woman concerned about breast cancer need worry about. But nature does not cooperate so willingly with the wishes of man, and never cooperates with the conclusions of shoddy science. The Lancet published a rigged but much heralded meta-analysis claiming no link in 2004 which was so replete with serious methodological errors (inexplicable omissions of very important and contradictory findings from valid studies, and the inclusion of scientifically invalid studies among other serious flaws) that it suggested a desire to conceal rather than reveal the truth. Indeed, that study’s lead author, Oxford’s Valerie Beral, proved downright Shakespearean in her role as the lady who doth protest too much the evidence of a connection. Indeed, most denials of the link in the literature are based on shoddy “studies”.
When leaders of the healing profession resemble tobacco executives of decades past in turning a blind eye to a clear risk factor for cancer, lawsuits can’t be far behind.