Reconsider Cancer Detection
Mammograms are important, and screening mammograms are particularly crucial when they're the only way to catch women whose poor access to health care and information results in cancer detection at a more advanced stage. Women at high risk because of genetic and family history reasons will require more surveillance. But as the ACS announcement about the "overpromised" benefits of mammograms indicates, we need to reassess our reliance on them. The ACS announcement came on the heels of an analysis from the University of California at San Francisco of overtreatment for both breast and prostate cancer, which suggests that the strategy now should focus on distinguishing between harmless and destructive breast conditions, and reducing treatment for low-risk conditions.
So when can that start happening? Medical experts and researchers can work toward revising diagnosis and treatment guidelines now, says H. Gilbert Welch, Dartmouth University medical professor and leading over-diagnosis expert, such as a determination that miniscule breast masses not be biopsied and instead observed. More doctors are already taking a less aggressive approach, and acting on the fact that some problematic breast conditions and cancers will disappear over time. For example, a recent study showing that women who didn't get screenings for six years had less cancers than regularly screened women is leading more doctors to prescribe "watchful waiting" for women with few risk factors.
As medical consumers, we need to educate ourselves about actual risks, and recognize that while repeat mammography and other detection technology such as MRIs may seem to bring assurance, "looking harder" may not be the answer. As Welch puts it, "doctors who recommend less-aggressive mammography (less frequently, waiting until you are age 50, or stopping it when you are older) or are less quick to biopsy may not be bad doctors but good ones."
We need to demand full information from our health care providers about better ways to deal with conditions such as DCIS (ductal carcinoma in situ), at 60,000 annually one of the most commonly diagnosed conditions that may not need treatment. The info is there in spades: Concerned about overtreatment, a National Institutes of Health panel last month recommended in a lengthy analysis that the cancer-related "carcinoma" term in DCIS be abandoned and treatment guidelines reassessed to avoid unnecessary biopsies, surgery, radiation, and chemo.
Go beyond the mainstream cancer organizations to get more complete information. Check out this analysis from the National Breast Cancer Coalition of several over-diagnosis studies, including the most recent showing that one in three women may be unnecessarily treated. Consider that other similar nations view cancer risks differently: Most Western nations don't start mammograms until age 50, and overdiagnosis is roundly being debated in the UK. A large group of UK cancer experts charge overdiagnosis may affect half of UK women getting routine mammograms, and their outrage caused the National Health Service to recall risk-devoid mammogram campaign materials this July.
Check out what advocates recommend about determining benefits and risks, including over-diagnosis risks, radiation exposure from each mammo, and the fact that particularly for women with dense breast tissue (one-half of women, particularly younger ones), mammograms are only about 50% accurate, leaving women falsely assured that mammograms have "proved" they're OK.
Of course we need reliable ways besides (or in addition to) mammograms to find breast cancers that must be treated. There are alternatives: Regular self-exams yield critical information, and should be coupled with rigorously done, regular clinical exams that last at least two minutes. Other technologies that don't use radiation such as digital infrared thermal imaging and ultrasound are already used as adjunct (and for some, primary) detection methods--can't the government give these imaging techniques and others that aren't as risky as mammograms the research buck-bang given to say, smashing a $79 million satellite on the moon?
Re-vision Prevention--And We All Win
*Stop using cancer-causers, and tell everyone why. As the leading breast cancer prevention organization Breast Cancer Fund notes, speaking out about prevention is perhaps most important in October, when breast cancer awareness is high. After all, genetic causes account for only 5 to 10% of breast cancers, and while it's unquestionably beneficial to exercise and eat healthy, fitness is no guarantee of escaping breast cancer, which has steadily risen at the same time as the chemical proliferation of the last 40 years.
Get the big picture about environmental causes with BCF's comprehensive State of the Evidence 2008, including mammary carcinogens and endocrine disrupting compounds
as well as radiation from x-rays and other sources. There are plenty of specific tips on how to reduce exposure to risks, from the ubiquitous plasticizer BPA to dioxins to chemicals in beauty products from lipstick to shampoo and lotion. Check out the Campaign for Safe Cosmetics, and consider making your own beauty potions--we all care about how we look, but natural cosmetic recipes abound in books and the internet. And be sure to follow through with BCF's links that let you demand policy changes with Congress members, EPA, FDA and other regulators.
And remember: more "stuff" of just about any sort has a toxic burden in its manufacture and transport. Just stop buying junk you know you don't really need.
*Reconsider use of breast cancer-linked hormone drugs. Just as our reduction in chemicals improves life for everyone, our hormone drug reduction improves overall health, since much of the active ingredients in pharmaceuticals we use are passed through in our urine and end up in our water system and coming out of our taps.
The culpability of hormone replacement therapy (HRT) drugs used for menopause symptoms is clear: the landmark Women's Health Initiative study was halted in 2002 when women taking HRT experienced significantly more breast cancer, as well as heart problems and strokes. Subsequently, as the HRT usage rate dropped, so did breast cancer. A recent study shows HRT use is associated with increased rates of lung cancer, the top cancer killer of women; HRT use is also associated with developing denser breasts, which is linked with increased cancers.
Menopause symptoms are troubling for many, but as the HRT usage drop indicates, many women have coped without HRT. That's made a difference--both for the women who avoided cancer but for all of us exposed to risky hormones in the water supply.
Hormonal contraceptives also show potent links to increased breast cancer. Nonhormonal birth control alternatives are effective with careful and consistent use. Users feel better knowing they've reduce their cancer risk; we all get the payoff of less synthetic hormones in the water supply.
*Slow down on the sauce. Experts agree that drinking, which raises blood estrogen levels, increases breast cancer risk. No need to go cold turkey, but do we really always need alcohol to have a good time? Is that the example we want to set for our kids? If you drink more than the one a day max cited in cancer risk guidelines, think over why you drink, and explore alternative fun and stress relief tactics.
So starting this October, let's rethink our pink passion and take some steps that go beyond the conventional "wisdom" on breast cancer detection and prevention. With full disclosure and 360 gaze, our breast cancer activism could become a model for fighting and defeating our many health challenges.
Part 1: Rethink the Pinkocracy