Pink, pink everywhere. Let's get past breast cancer awareness to prevention

First it was the balloon at the grocery store in the shape of a pink ribbon, and the front page of the newspaper printed on pink paper. Then it was the specially-designed package of pink lipstick, and the NFL players decked out with shocking pink shoes, socks, and sweat towel. It's "Breast Cancer Awareness Month," and it’s pink, pink everywhere.

Others have been writing this month about pink-washing. That’s the phrase describing firms and organizations which sell products and host events to make the public think they are contributing in a meaningful way to the breast-cancer cause. (This week’s story is about the NFL’s pink promo for which only 8 percent of the funds benefit cancer research.)

Now that I have breast cancer, I been thinking a lot about pink-washing, but also about something more fundamental. I’ve been scratching my head and wondering: Is there really anyone out there who isn’t aware of breast cancer?  Wouldn’t you be hard pressed to find anyone who doesn’t have a mother, sister, grandmother or aunt who has had a breast cancer diagnosis, or know of a co-worker, neighbor or friend who has the disease. It seems to me we are well passed needing to be aware of breast cancer. The disease came out of the closet decades ago.  Personally, I think it’s time to retire Breast Cancer Awareness month. Let’s replace it with a month dedicated to demanding much more research and action to PREVENT the disease.

We know some of the risk factors associated with breast cancer, such as:

• Having a mother, sister or daughter with the disease (but only 5-10 percent of breast cancer cases is thought to be inherited)
• Experiencing menarche before age 12, or menopause after age 55
• Postponing childbirth to after age 30, or never giving birth
• Receiving chest radiation therapy during adolescence
• Inheriting a mutation in the BRCA1 or BRCA2 gene (which is relatively rare in the general population)[1]

Yet, far too many women develop breast cancer without having any of these known risk factors. (One little publicized risk factor is dense breast tissue. I wish I'd known that it is the single strongest predictor of breast cancer.)

Simply put, we know very little about what causes breast cancer, and many other cancers for that matter. I read that message loud and clear in the President’s Cancer Panel report issued in June 2010.  The group, appointed by President G.W. Bush, wrote this:

“Our Nation still has much work ahead to identify the many existing but unrecognized environmental carcinogens and eliminate those that are known from our workplaces, schools, and homes.”

They go on:

"Weak laws and regulations, inefficient enforcement, regulatory complexity, and fragmented authority allows avoidable exposures to known or suspected cancer causing and cancer-promoting agents to continue and proliferate in the workplace and the community. Existing regulations, and the exposure assessments on which they are based, are outdated in most cases, and many known or suspected carcinogens are completely unregulated. Enforcement of most existing regulations is poor. In virtually all cases, regulations fail to take multiple exposures and exposure interactions into account."

Finally, they add this kicker about the industries that produce, distribute and promote the use of certain toxic chemicals:

"Industry has exploited regulatory weaknesses, such as government’s reactionary (rather than precautionary) approach to regulation. Likewise, industry has exploited government’s use of an outdated methodology for assessing ‘attributable fractions’ of the cancer burden due to specific environmental exposures. This methodology has been used effectively by industry to justify introducing untested chemicals into the environment.”

Similarly, my colleagues at the Lowell Center for Sustainable Production wrote earlier this year:

"A respected group released a report on breast cancer prevention with a clear and urgent message: 'identifying and mitigating the environmental causes of breast cancer is the key to reducing the number of new cases.' The report of the Interagency Breast Cancer and Environmental Research Coordinating Committee (IBCERCC)…called for an urgent acceleration in environmental research on cancer prevention – identifying which chemicals and physical factors cause breast cancer.”

They went on to challenge our nation to figure out

“how to wean our economy from dependence on cancer-causing chemicals.  Many Americans assume that it is not legal to release carcinogens into our environment and food or to put them in the products we buy.  As we know, this is not the case.  And when we use carcinogens in our workplaces and put them in our consumer products, we are building our economy with chemicals that can cause cancer.  …Many environmental carcinogens have already been identified and there are already some great examples of government and private industry innovations that replace carcinogens in our economy."

I did a quick search today of the National Cancer Institute’s fiscal year 2012’s research budget.  By my calculation, just $27 million awarded by NCI to breast cancer researchers falls into the category “Exogenous Factors in the Origin and Cause of Breast Cancer.”  Of those, only $6.8 million involve population-based research on breast cancer causes, some of which we already know are associated with other cancers: radiation, diethylstilbestrol (DES), other hormones, and cadmium.

Our country needs to invest much more than a couple million dollars in breast cancer (and all cancer) prevention research. We need many more epidemiological studies such as the type published last year by a group of international researchers. This team investigated breast cancer rates among 2,100 Canadian women who were employed in small plants where automotive plastics were manufactured. Many plastics contain and release chemicals that mimic estrogens and/or are endocrine disrupting compounds. Plastics also contain substances that are known human carcinogens, such as vinyl chloride and butadiene. The female automobile plastics workers had breast cancer rates that were 2 to 5 times higher than those in the community reference group. In a companion qualitative study, the women spoke frankly about their exposure to chemical mixtures and inadequate controls for the hazards they face.

Funding for prevention research will only come from government and other non-profit sources.  Pharmaceutical companies are certainly involved in cancer research, but are not going to invest in prevention. Their research focus is developing compounds to treat cancer after it is diagnosed. They can’t earn a profit researching ways to prevent cancer. Chemotherapy and other treatments are important---I know this first hand---but preventing disease is the best way to reduce healthcare costs and to avoid the misery of cancer treatment and premature death.

For the next ten days of Breast Cancer Awareness month, I know my husband and I will see plenty more light pink-colored this, and dark-pink colored that. We’ll look at each other and say with a smirk, “are you aware of breast cancer?”  Unspoken we'll wish my breast cancer had been prevented.  More importantly, we'll hope that our sisters, nieces and friends will benefit from an investment in prevention, not just awareness.

------

Note [1]: BRCA1 prevalence in Hispanics is 3.5%, in African Americans 1.4%, in Asian Americans 0.5%, and in Caucasians less than 3%.  In individuals of Ashkenazi Jewish descent the risk is between 8-10%.