Wishes, Lies and Profits
by Marilyn Kaggen
Breast cancer is epidemic. Early detection doesn't prolong life. Treatment hasn't changed survival rates in 60 years. Mammography is not only ineffective, it isn't even safe.
"The real beneficiaries of early detection are the providers of health care, who now have a longer time in which to treat the victims before they die."--Dr. John McDougall.
One in nine women gets breast cancer--up from one in twenty in 1960. There has been an incredible 178% rise since 1969, according to American Cancer Society (ACS) statistics. From 1982 to 1987 alone, it rose an alarming 32%. This year (1992) there will be 175,000 new cases and 43,000 will die. Breast cancer is the leading cause of death in women 40 to 45. Even cancer establishment apologists say improvements in early detection can't account for this precipitous increase. "Early detection would have absolutely nothing to do with the kind of increased incidence we've been seeing with the past few years," according to National Cancer Institute (NCI) statistician Dr. Sydney Cutler.
How curable is breast cancer? University of Dublin researcher Petr Skrabanek has written, "The evidence that breast cancer is an incurable disease is overwhelming." Despite the twenty year, multibillion dollar war on cancer, the death rate for breast cancer has not declined since statistics began to be compiled in the 1930's: 40% of women who get it die of it, regardless of their treatment. Physician and writer John McDougall goes further "In over 90% of [breast cancer] cases the ultimate cause of death will be cancer of the breast."
Early detection techniques such as breast self exam (BSEs) or mammograms don't necessarily extend a woman's life; they may just lengthen the period of time she knows she's sick, as well as the time during which she receives treatment. As Dr. McDougall puts it: "The real beneficiaries of early detection are the providers of health care, who now have a longer time in which to treat the victims before they die."
I found a breast lump during a BSE when I was in my early thirties. I immediately called my doctor. I remember that ride uptown to his office 15 years ago--sweating, crying, scared. It was nothing--monthly changes. My doctor's patronizing reassurances were both comforting and humiliating. The campaign to get us to do monthly BSEs sets the stage for blaming the victim. We're told that if we find a lump "early" enough, when it's still "small" enough, we'll save our lives. By the same logic, if we die of breast cancer it's our own fault. But the premise is wrong: the size of a cancer has no known relationship to its prognosis. Some very small tumors with no lymph node involvement are swiftly lethal and some huge ones prove to be innocuous. The benefits of BSE are unproven--Australian, Japanese and British studies have shown no differences in survival rates between those women who did BSEs and those who didn't. In a 1985 Lancet article, biostatistician J. W. Frank wrote that BSEs "may do more harm than good." And the harm is considerable--monthly anxiety, unnecessary biopsies and, of course, mammograms.
What is their effect on the course of this epidemic? The awful truth? They may well be accelerating it.
The American Cancer Society (ACS) now recommends regular mammograms for all women, starting at age 40. This policy is largely based on the 1964 Health Insurance Plan (HIP) study and a subsequent Swedish study, which found a benefit to women over 50. But Dr. Skrabanek estimates "the maximum benefit of the HIP study . . . was 1% fewer breast cancer deaths a year."
The data from the HIP study was reinterpreted in 1988, and a benefit to women under 50 was claimed. However, former National Cancer Institute Journal editor, Dr. John Bailar III, called this new analysis "seriously flawed," and well-respected Swedish and Dutdh studies failed to confirm that regular mammograms can save the lives of women under 50. On the other hand, there is considerable proof that younger women who are repeatedly exposed to low level radiation, including the x-rays used for mammograms, are twice as likely to get breast cancer, as are older women who receive the same exposure.
One result of the HIP study hasn't received adequate publicity. Mammography missed 40% of breast cancers. Mammograms today have false negative rates of 11% to 25%. Almost a quarter of women screened who are told they are healthy actually have breast cancer. And statistics show 30% false positives, with all the unnecessary anxieties, biopsies and mastectomies that they entail. The 1973 NCI-ACS sponsored Breast Cancer Demonstration Project (BCDP) resulted in 48 false positives--48 women were told they had breast cancer when they didn't--and at least 37 had healthy breasts removed. In 1989 the director of the Edinburgh Breast Screening Project, Dr. M. Maureen Roberts, wrote "We all know that mammography is an unsuitable screening test. Screening may not reduce mortality at any age."
Now the largest study to date has unearthed the shocking news that middle-aged women who have regular mammograms are significantly more likely to die of breast cancer than those who are not screened. While not one word about this study has appeared in the U.S. press, a June 2, 1991 front page Sunday Times of London article described the National Breast Screening Survey, sponsored by the National Cancer Institute of Canada, which tracked 50,000 women, age 40 to 49, from 1980 to 1988. The article estimated that the results would be published in a professional journal by December, 1991. However, at that time the study's director, Professor Anthony Miller, told me publication was at least six more months away. It seems the heat is on from the very pro-mammography cancer establishment and the researchers are triple-checking their data before they face the wrath of their colleagues. Significantly, the Canadian results are not without precedent: a previous, smaller study, published in the September, 1989 Annals of Internal Medicine, found more deaths from breast cancer in women under 55 who had been screened than in women who had not.
Warnings about the risks of mammography have continued to come from highly qualified critics. Professor of Occupational and Environmental Medicine and director of the activist group People Against Cancer Dr. Samuel Epstein advises: "Whatever you may be told, refuse routine mammograms to detect early cancer, especially if you are pre-menopausal. The x-rays may actuality increase your chances of getting cancer." In 1988 Professor of Radiology Dr. John H. Gohagan predicted that lowering the recommended age of mass mammography from 50 to 40 would increase radiation-induced breast cancer by about 300%. And Dr. Skrabanek admonished that women were not being told about the potential risk of getting breast cancer from the very test that is supposed to detect it.
While radiation exposure from mammography has supposedly decreased since the 1970s, due to improved equipment and techniques, the actual exposure a woman gets from a given machine can vary considerably. A 1988 FDA survey of mammography facilities revealed inconsistencies, with an alarming number of machines using much higher than necessary doses. Modern medicine has no idea what exposures to breast tissue are safe and will not induce breast cancer. Biostatistician Irwin Bross, in 1977 congressional testimony, charged that "The big science federal agencies, their industrial constituencies, and their allies . . . have been lying to the public about hazards of low-level ionizing radiation for 25 years." International relations expert Dr. John W. Gofman writes of "evidence . . . growing ever stronger that the cancer risk per rad of dose is worse in the low-dose range than in the high-dose range." We do know that the damage from radiation is cumulative and that the breast contains the human tissue that--second only to fetal tissue--is most sensitive to it.
Mammography is hazardous and ineffective, and we can't even say we haven't been warned. Dr Irwin Bross, testifying before a congressional subcommittee investigating the BCDP in 1977, predicted ". . exposure to diagnostic x-ray will probably result in the worst iatrogenic (medically caused) epidemic in breast cancer history."
Just what does "high risk" mean? The very notion is very subjective and relative. At age 39 I was told that my 1 in 139 chance of having a Downs Syndrome child was a "high risk." My midwives were every bit as horrified then, when I refused amniocentesis, as my gynecologist is now, when I refuse a mammogram at age 45. Having a one in nine chance of developing breast cancer seems high to me. And I don't want to Increase it by exposing my breasts to x-ray for no good reason. The cancer establishment now tells us we are at especially high risk if our sisters, mothers or grandmothers had bilateral, pre-menopausal breast cancer, or if we've had breast cancer ourselves. But look at it another way: "High risk women are the ones most likely to get breast cancer from the mammograms designed to save them from cancer,'" Dr. Bailar predicted in a 1977 article. Despite such warnings, "high risk" women are urged to get a "base-line" mammogram at 36, annual mammogram starting at 40.
Mammograms don't save our lives; it now looks like they may cause even more deaths from breast cancer. Treatment does not prolong our lives. High tech medicine, in spite of elaborate rhetorical and statistical squirming, has failed dismally in its war against this epidemic. What's a woman to do?
Plenty. It's called prevention.
Real News 1: Fatal Fat
We can, for a start, lower the fat in our diets. Animal and population studies have produced dramatic evidence that a low fat diet can reduce the risk of breast cancer. High rates are found in countries with high consumption of meat, particularly beef. Dr. Peter Greenwald of the NCI says "Countries that eat half the amount of fat calories that we do have half the incidence of breast cancer." Dr. Takeshi Hirayama, of Tokyo's National Cancer Research Institute, has found those women who eat meat daily face four times the risk of breast cancer of those who eat little or no meat. Death rates as well have been found to be affected by dietary fat: the less fat a woman eats in her lifetime. the more likely she is to prevent breast cancer.
Despite this evidence, the National Institute of Health (NIH) rejected research projects to study the role of dietary fat in breast cancer in 1985, 1989 and 1991. This policy--due in part to the agency's general reluctance to do research on prevention, as opposed to diagnosis and treatment--is sexist. The NIH spends less that 14°% of its budget on women's health issues, although 17.5% of cancer cases and 8.6% of cancer deaths are from breast cancer alone. Thanks to an outcry from congresswomen and vigilant women's organizations--most notably the National Women's Health Network and the National Black Women's Health Project--the NIH has directed the NCI to fund a study of the link between dietary fat and breast cancer. The Women's Health Initiative, which will involve 60,000 women over nine years, will begin next year.
In the meantime, with a 1 in 9 risk, we can't afford to wait for the results. A low fat diet, free of animal fats in particular, is the kind of preventive measure that can do no harm. At the very least, we would be reducing our chance of heart disease, not to mention our intake of the hormones, antibiotics and pesticides that permeate our meat and dairy supplies.
Real News 2: Use 'Em or Lose 'Em
One of the best-kept secrets in the breast cancer and infant formula industries is--breastfeeding prevents breast cancer. Yale School of Medicine Professor W. Douglas Thompson admits, "Aside from breastfeeding, there is not much researchers can recommend to prevent breast cancers.'' And Dr. Nancy Lee, epidemiologist with the Centers for Disease Control in Atlanta, has said, women who breastfeed have significantly lower rates of breast and ovarian cancer than mothers who don't.
Population studies reveal longer nursing is associated with fewer breast cancers. Countries with low rates practice prolonged breastfeeding, and the rise in breast cancer correlates internationally with the rise in bottle feeding. Canadian Eskimo women have large families, generally nurse for two or three years, and have the lowest rate of breast cancer of any group studied. The few reported cases have occurred in the unused breast among women who nursed only on one side. A 1977 study found that Tanka boat women, who traditionally nurse only on the right side, have a higher incidence of breast cancer in the left breast. Moreover, epidemiological studies suggest protection increases with longer periods of nursing. One 1986 study found women who nursed had half the risk of pre-menopausal breast cancer--the type with fastest-increasing incidence--compared to women who had never nursed. And women who nursed for two years cut their risk of breast cancer by a third. Hippocrates said in the 5th century, B.C.: "Use leads to health and disuse to disease." Breasts are for feeding--use them or lose them.
Back to the Facts
There's no profit for industry in breastfeeding or in eating differently--in preventing this scourge that's taking our lives in unprecedented numbers. Just as infant formula companies rake in billions while endangering the health of babies and mothers, mammograms, not to mention surgery, radiation and chemotherapy, produce huge profits without making a dent in the ravages of this epidemic. So the body count grows.
Editor's Note: Marilyn Kaggen's article first appeared in The Compleat Mother's Fall 1992 issue. It typifies that publication's gutsy approach to sensitive issues. Marilyn is a mother, writer, and teacher who lives in Brooklyn. Her work has appeared in Mothering, Z Magazine, And Then, Off Our Backs, Womannews, and The Compleat Mother. The original version of the article above was profusely footnoted. We've omitted the footnotes to save space. The article's original appearance in the Pure Water Gazette was in print issue #43 (Winter 93/94).
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