by Neal Barnard, M.D
In 1991, the Physicians Committee for Responsible Medicine commissioned a survey asking how many women were not yet aware of the connection between diet and breast cancer. The results were dismal: Eighty percent of women had no idea there was any link. Although the federal government funds research on how diet causes breast cancer, it makes little effort to distribute this information to women. Brochures describing how foods affect cancer risk gathering dust at the National Cancer Institute.
What is worse is an active campaign that squeezes the prevention message out of air time and press space. For the past several years, October has been designated National Breast Cancer Awareness Month. The President signs an annual proclamation, and television programs and magazines pick up the story. But every year since its inception, the press packs mailed to newspapers and radio and television stations have included lots of information on finding cancer by mammography and self examination, and no information at all on the dietary steps that might reduce the risk of cancer. No mention that high-fat diets increase the body’s estrogen levels, leading to an over stimulation of breast cells. Not a word that the vitamin C in vegetables, the fiber in grains, and the phytoestrogens in legumes have a protective effect, or that wealthy populations who eat meat daily have eight times the breast cancer risk of poorer populations which rarely eat meat products.
What the press does not know is that National Breast Cancer Awareness Month is sponsored by a pharmaceutical company: Imperial Chemical Industries (ICI). This firm makes tamoxifen, the anti-estrogen drug used in the treatment of breast cancer. ICI funds the October program and holds approval rights over the materials that are used. And every year since it began, ICI has pushed the message that “early detection is your best protection.” Television news segments spread the message about finding cancer, and lifesaving prevention information is effectively squeezed out. Television and radio stations feel that they are spreading the latest word about breast cancer, not realizing that what they are disseminating is what a single drug company has decided people should hear.
This is not to say that tamoxifen is a bad drug. For women who have cancer, it has a very important role. But with cancer rates going up year after year, and treatments delivering little of what they promise, just finding cancer is not enough. We have no choice but to spread the prevention message far and wide.
It is not only American women who pay a price in the politics of cancer. A tragedy is unfolding in Japan, which, for years, has had the lowest rates of breast cancer in the world. The U.S. State Department has pushed Japan to accept American agricultural products, particularly tobacco and beef. And the influx of American fast-food chains and Western dietary habits has been met by willing victims. Japanese consumption of rice and green and yellow vegetables has dropped dramatically, while meat, poultry and egg consumption has increased eight-fold. Dairy consumption is 15 times higher than in 1950. Fat intake in Japan climbed from nine percent of calories in 1955 to 25 percent in 1987. As the higher-fat diet has increased estrogen levels in Japanese women, the age of puberty has dropped to match that of the United States and Western Europe, ; which underwent the drop in the age of puberty decades earlier. Meanwhile, breast cancer rates in Japan are climbing steadily.
Research on breast cancer is lost in politics. Cancer advocates have long recognized the need for a large scale test of dietary methods for preventing breast cancer in American women. But although the cost of treating breast cancer exceeds $50,000 per person, the diet trial was deemed too expensive and has been stalled for years. That may change. A new effort, the Women’s Health Initiative, aims to test a modestly low-fat diet for its effect on cancer incidence. The greatest risk of the trial is that the prescribed diet may be too weak to show results.
Meanwhile, another prevention experiment, putting healthy women on tamoxifen, has rushed forward, much to the manufacturer’s delight and despite potential risks. A bill that would have provided $300 million for breast cancer research was proposed earlier this year. It was part of a broad funding bill which, among many other provisions, included fetal tissue research. That made it unacceptable to the antiabortion groups backing the President. On June 23, the entire package was vetoed by President Bush.
Lest we think that cancer research would mean cures in the short run, the experience of AIDS funding is sobering. Researchers have managed to divert AIDS money into projects that are often of no more than academic interest, studying the leaves and twigs while the forest is forgotten and real progress remains stymied. All this will have to change. Because the leading killer of young women is no secret anymore. There is a new push for better treatments, and most importantly, prevention. And a new generation of doctors is fast learning that their patients expect American medicine to embrace not just surgery, chemotherapy and radiation for cancer, but to make vigorous efforts to stop cancer before it starts.
Free information on breast cancer prevention is available from the Physicians Committee for Responsible Medicine, Box 6322, Washington, DC 20015.
WHAT INCREASES RISK:
DIETARY FAT: ANIMAL FAT, ESPECIALLY, INCREASES ESTROGEN LEVELS IN THE BLOOD, WHICH IN TURN STIMULATE BREAST CELLS*
ALCOHOL: EVEN MODEST CONSUMPTION INCREASES RISK.
RADIATION, INCLUDING X RAYS: OF ALL THE PARTS OF THE BODY, THE BREASTS ARE THE MOST SENSITIVE TO X RAYS.
TOXIC EXPOSURES: LIMITED EVIDENCE LINKS CHEMICAL EXPOSURES TO BREAST CANCER.
ORAL CONTRACEPTIVES AND HORMONE REPLACEMENT: THE HIGHER-DOSE HORMONES OF THE PAST CLEARLY INCREASED CANCER RISK. THE DEGREE OF RISK POSED BY CURRENT PRODUCTS IS PROBABLY LESS, BUT MAY STILL BE SIGNIFICANT.
OVERWEIGHT: INCREASES RISK OF POSTMENOPAUSAL CANCER.
GENETICS: IN ABOVE FIVE PERCENT OF BREAST CANCER CASES, GENETICS PLAY A DECISIVE ROLE. ‘AS WE GO TO PRESS, A JUST-PUBLISHED STUDY FINDS NO LINK BETWEEN DIETARY FAT AND BREAST CANCER.
WHAT REDUCES RISK:
FIBER: ESTROGEN IS SECRETED INTO THE DIGESTIVE TRACT WHERE FIBER CARRIES IT AWAY.
VITAMIN C: VEGETABLES AND FRUITS SUPPLY VITAMIN C, WHICH BOOSTS IMMUNE DEFENSES AND HELPS PROTECT THE BODY’S CELLS FROM DAMAGE.
SELENIUM: THIS MINERAL, FOUND IN GRAINS, IS ESSENTIAL FOR ENZYMES THAT PROTECT THE CELLS FROM DAMAGING CHEMICALS.
PHYTOESTROGENS: NATURAL WEAK ESTROGENS IN SOY PRODUCTS SEEM TO REDUCE ESTROGEN’S STIMULATION OF BREAST CELLS.
DECREASED INTERVAL BETWEEN PUBERTY AND FIRST PREGNANCY: WOMEN WITH LATER PUBERTY AND EARLIER PREGNANCY HAVE A SMALLER RISK.
SHORTER STATURE: WOMEN UNDER 5’3′” HAVE HALF THE BREAST CANCER RISK OF WOMEN OVER 5’6″. THE REASON PROBABLY HAS TO DO WITH THE GROWTH HORMONE STIMULATION WHICH AFFECTS BOTH HEIGHT AND BREAST DEVELOPMENT DURING PUBERTY.
Neal Barnard is President of the Physicians Committee for Responsible Medicine, editor-in-chief of the Guide to Healthy Eating, an educational publication of PCRM, and author of three books on health and nutrition, the latest of which will be published by Harmony Press in early 1993.