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Exposed

The mammogram myth and the pinkwashing of America

By Jennifer Lunden

Published in the September/October 2013 issue of Orion magazine



Part One: The Diagnosis

ON THE DAY of my first mammogram, I walked through the sliding glass doors of the gleaming new hospital and fought the urge to turn right back around. I couldn’t shake the feeling that there was something wrong about this rite of passage. Nevertheless, I navigated a series of carpet-lined hallways to the Women’s Imaging Center and gave my name to the receptionist behind the glass. With an air of indifference, she led me to a small, windowless room, directed me to change into a johnny, and told me to wait for the mammography tech, Gert, to come fetch me. On the table to my right, beside a lacy pink photo album containing snapshots of flowers, lay Be a Survivor: Your Guide to Breast Cancer Treatment. I was forty-one years old, my nurse practitioner had urged me in for a baseline, and there I sat, complying.

It wasn’t too long before Gert, a no-nonsense woman in blue scrubs, rescued me from the antechamber and led me down the hall to the mammogram room. As she looked over my chart, I confronted the machine: a big, robotic contraption with metal arms bearing various sets of glass plates that I knew would be used to squeeze my breasts flat. A little Teddy Bear in a pink shirt with hearts on it perched on the left side of the machine. On the right side was a picture of a cherubic, chubby-faced child painted on what looked like it might have been a small fancy box for Valentine chocolates.

I had not worn deodorant, per instructions, and even though I had bathed just two hours earlier, a faint odor of me wafted up when I slipped off the right sleeve of my johnny. Gert grabbed onto my right breast, positioned it on the plate, and stepped on the pedal to lower the clamp down onto my breast. She said, “Compression is your friend.” I tried to think of compression as my friend. But in truth, I felt alienated from my body. I gazed into the distance and waited for it to be over. “Don’t move,” said Gert, and I held my breath while she slipped behind the clear plastic partition and pushed the button.

Don’t move? Where would I be going with my breast tightly clamped between two glass plates?


SOME OF MY MISGIVINGS about that mammogram can be attributed to a 2004 article I had read in The New Yorker. In “The Picture Problem,” Malcolm Gladwell reports on the low efficacy of mammograms and the fallibility of the radiologists who read them. Researchers in one study, for example, found a broad spectrum of accuracy when they asked ten board-certified radiologists to analyze 150 mammograms. One radiologist caught 85 percent of the cancers on first look; another, just 37 percent. Of course, the downside of consulting the high-scoring radiologist is that he or she also recommended additional tests—biopsies, ultrasounds, or more mammograms—on 64 percent of the women who didn’t have any cancer at all.

The other problem with mammograms, according to Gladwell, is that they generally catch slow-growing tumors. Some of these tumors are so slow growing that they will never make “cause of death” on a death certificate. The tumors more likely to threaten a woman’s life are the fast-growing ones that emerge between mammograms. In a study of 429 breast cancers diagnosed over a period of five years, 279 showed up in mammograms and 150 did not, either because they were hidden in dense tissue or because they were fast-growing tumors that didn’t exist at the time of the last mammogram. According to a 2003 paper that compiled eight different studies, mammography misses 10 to 30 percent of all breast cancers.

Gladwell notes, too, that mammograms identify substantial numbers of DCIS (ductal carcinoma in situ) tumors, most of which are not likely to metastasize. DCIS tumors appear inside the ducts that carry milk to the nipple. In one study, almost 40 percent of women in their forties who had died of other causes were found to carry DCIS or some other cancer in their breasts. Gladwell points out that since breast cancer is responsible for less than 4 percent of female deaths, most of the women in this study, even if they had lived longer, would have died of causes other than those tumors. The problem is that doctors can’t tell from looking at a mammogram whether a given DCIS tumor will metastasize, or whether it will be one of the majority of lesions that never prove to be life threatening. So in 35 percent of cases doctors perform a lumpectomy with radiation, and in another 30 percent they perform a mastectomy. About fifty thousand new cases of DCIS are diagnosed each year in the U.S. Before mammograms, the diagnosis was virtually unknown.

Three years after Gladwell’s essay appeared, I happened upon another mammogram article, this one citing a 2000 study by Peter C. Gøtzsche, MD, director of the Nordic Cochrane Center, an esteemed independent research and information center that provides healthcare analyses worldwide. In his review of all eight randomized mammography trials that had been conducted at that time, Gøtzsche found that the four trials judged to be of poorest scientific quality were also the ones whose data made the strongest case for mammography. The two studies found to have the highest scientific rigor showed no significant reduction in breast cancer mortality resulting from mammogram screenings.

Gøtzsche’s overall finding, based on all eight studies, including those of poor quality, was a breast cancer mortality risk reduction of just 0.05 percent for all women submitting to annual or semiannual mammograms. This is not a typo. This is point-zero-five percent. Meanwhile, according to Gøtzsche, mammography also led to overdiagnosis and overtreatment, resulting in a risk increase in 0.5 percent of cases. “This means for every 2,000 women invited for screening throughout 10 years, one will have her life prolonged,” said Gøtzsche. “In addition, 10 healthy women will be diagnosed as breast cancer patients and will be treated as such, unnecessarily.” That means undergoing any combination of treatments, from radiation and chemotherapy to lumpectomy or mastectomy—all to treat a tumor that would never have metastasized or else would have disappeared on its own. Studies have shown that somewhere between 25 and 52 percent of all breast cancers detected by mammography would have disappeared spontaneously if simply left alone.

Because breast cancer survival rates have increased significantly in recent years due to more effective treatment, Gøtzsche now contends that mammography screening no longer reduces the risk of dying from breast cancer at all.


AS A WOMAN in her early forties, I had come to think of my body as an ecosystem, and was determined to exert as much control as I could over what I inhaled, ingested, and submitted to medically. I resisted that mammogram because everything I’d read indicated that I was more likely to be overdiagnosed than I was to have my life saved by early detection. It didn’t occur to me to think at all about the radiation. But it should have. Americans are now exposed to seven times more radiation than they were in 1980. And scientists agree there is no such thing as a safe dose.

The National Center for Environmental Health, a division of the Centers for Disease Control and Prevention (CDC), categorizes ionizing radiation—the kind emitted during mammograms (as well as other X-rays and CT scans)—as an environmental hazard. According to the Breast Cancer Fund’s report State of the Evidence: The Connection Between Breast Cancer and the Environment, exposure to ionizing radiation is the “best- and longest-established environmental cause of human breast cancer.” Simply put, this means that the very test meant to save women from the ravages of breast cancer may over time actually increase their risk of the disease. Ionizing radiation promotes the DNA damage that causes cancer stem cells to form. It also triggers mutation of the p53 suppressor gene—known as the “guardian angel gene”—preventing it from doing its job, which is to suppress tumors by thwarting genome mutation. In essence, ionizing radiation, just like any other pollutant, upsets the delicate balance of the human body.

Each mammogram typically exposes a woman to 0.1 to 0.2 radiation absorbed doses, or rads. Since 1972, the National Academy of Sciences has maintained that each rad of exposure increases the overall risk of breast cancer by 1 percent. Forty mammograms add up to a total of four to eight rads in a woman’s lifetime, which translates to an increased risk of 4 to 8 percent. Several recent studies indicate, however, that the mutational risk of low-dose radiation, such as the kind used in mammograms, is actually two to six times higher than previously thought.

Damage from radiation is cumulative, and can amplify the effects of other carcinogens. Because breast tissue, like fetal tissue, is extremely sensitive to radiation, even small doses are harmful. And because younger women’s DNA is more easily damaged by radiation, the younger a woman is when her breasts are first exposed, the higher the risks.

And at least once in all those years of mammograms, the patient is likely to get a call-back. The New England Journal of Medicine reported that out of ten mammograms, a woman has a 50 percent chance of at least one false positive. That means another mammogram, and probably also an ultrasound. And maybe even a biopsy—a sometimes painful procedure whereby some or all of a suspicious breast growth is either cut out or suctioned out through a needle to be evaluated by a pathologist. Three quarters of all biopsies ordered by concerned radiologists come up benign.

For years, the U.S. government, along with the American Cancer Society, the National Cancer Institute, and the American College of Radiology, advocated annual to biennial mammograms for women starting at age forty. But then the research came in, and people like Gladwell started sounding the alarms. In 2009, the United States Preventive Services Task Force—a panel of experts in evidence-based medicine—changed the guidelines to recommend that women start mammogram screening at age fifty and get a mammogram every two years thereafter up to the age of seventy-four, thereby cutting radiation exposure by about two-thirds, and the risk of overdiagnosis nearly in half. (These new guidelines do not apply to women with increased risk for breast cancer due to a gene mutation. However, some research indicates that that very mutation causes its carriers to be even more vulnerable to radiation-triggered cancer than the general population.)

The Task Force report, published in the esteemed Annals of Internal Medicine, concludes that “the decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take into account patient context, including the patient’s values regarding specific benefits and harms.”

The new guidelines provoked a furor of confusion. It didn’t make sense to people that less screening could be equally effective. People suspected the U.S. government of putting economics ahead of women’s health. Women in their forties came out of the woodwork to tell reporters about how their lives were saved by mammograms.

Dr. Otis Brawley, chief medical officer of the American Cancer Society (ACS), responded to the Task Force report with a confession: “I’m admitting that American medicine has overpromised when it comes to screening. The advantages to screening have been exaggerated.” Nonetheless, the ACS maintained its stance that mammograms should begin at forty.

In an interview with Terry Gross on National Public Radio, Dr. Marisa Weiss, a breast cancer survivor, breast oncologist, and founder of the website breastcancer.org, countered the Task Force, saying its decisions were based on “old-fashioned studies using old-fashioned technology: film mammography instead of what we have today, which is digital mammography. And they use that old-fashioned literature to make futuristic predictions.” In fact, she said, “it is the younger woman who is going to derive the greatest benefit from today’s technology.” Indeed, in 2005, a comparative study found that digital mammography was “significantly better” than film mammography at detecting breast cancer in young women and women with dense breasts.

That may sound like good news for some. But better imaging doesn’t solve the radiation problem, and there’s reason to believe that it may actually increase the risk of overdiagnosis.


TWO DAYS AFTER my mammogram, the telephone rings.

“Could I speak to Jennifer Lunden, please?”

“This is she.”

“Jennifer, this is Bonnie Raymond calling from Mercy Hospital. The radiologist has asked me to give you a call because he found a suspicious mass on your right breast, and he wants you to come back for a follow-up screening.”

Something inside me freezes.

“Oh,” I say. “Okay.”

“Can you come in on Monday, March second, at nine a.m.?”

“Yes . . . uh . . . yeah, I can do that.”

I hang up the phone, lie down on my bed, and think about the radiologists in the Gladwell essay. I think about Gøtzsche’s data, and about slow-growing tumors.

But what if they find something? Then where will I be with all my facts?


I RETURN TO THE HOSPITAL on the appointed day with an odd mix of resignation and resentment. My mammography tech, Carney, whose cheeriness is a welcome contrast to Gert’s all-business demeanor, points out the little white spot on my X-ray and says, “It might be nothing, but it would help to look at it from a few additional angles.” She tells me her grandmother died from breast cancer because she wouldn’t go to the doctor, even after she found a lump. “It’s amazing how much you can miss someone,” she says wistfully, as she slides back the curtain to exit the room.

This time, the hospital has scheduled me for an ultrasound as well. Another room, another machine. The tech has a soft southern drawl and wears orange scrubs bearing the logo for the Dallas Cowboys. She applies a cold gel to my breast and moves the paddle across it while she scrutinizes the monitor. Back and forth. Back and forth. I stare up at the ceiling, which is painted sky blue with puffy cumulous clouds, and say, “So, when you do this, is it sort of like dredging the lake for bodies?”

“Sort of,” she replies.

Finally, after two hours of bouncing from room to room and submitting my right breast to various forms of imaging, the verdict, delivered by the Dallas Cowboys fan, is in. Everything is fine, she says. Two benign cysts.

Benign.

A week later, a letter from the hospital arrives in the mail, the results typed in all caps, immediately following three alarming little asterisks:


***THERE IS AN AREA ON YOUR RECENT MAMMOGRAM THAT WE BELIEVE IS NORMAL. HOWEVER, IN SIX MONTHS YOU SHOULD HAVE A FOLLOW-UP MAMMOGRAM TO CONFIRM THAT THIS AREA HAS NOT CHANGED.

But I have already promised myself and my breasts that I am not going back.

 

PART TWO: THE CURE

THE NATIONAL CANCER INSTITUTE’S online breast cancer risk-assessment calculator asks just nine questions. When I plugged in my information, I learned, perhaps predictably given the limited survey, that my results were exactly average. At age forty-one, my risk of breast cancer was 0.7 percent.

While I was relieved to see that my risk was so low, overall I was disappointed with the experience, because the risk-assessment calculator did not ask what I have come to know are very important questions when calculating a woman’s risk for breast cancer. For instance, it didn’t ask about my history of radiation exposure from X-rays, CT scans, and airport scanners. It did not ask how many cosmetic products I wear, whether I am exposed to air fresheners, what kinds of cleaning products I use. It didn’t ask if I’ve used birth control pills, and if so, for how long. There were no questions at all about endocrine-disrupting compounds or carcinogens. And none about my diet, my body-mass index, or how much I exercise.

Despite the prominence of breast cancer in our media and our culture, these questions are largely missing from the conversation.


CHARLOTTE HALEY wanted to change that. By the time she was sixty-eight, Haley had watched her grandmother battle breast cancer, and then her sister, and, finally, even her daughter. She was outraged by what seemed to be a dearth of research on how to prevent the disease. One day, she sat down at her dining-room table with some spools of peach-colored ribbon, a pair of scissors, and hundreds of little cards bearing this message: “The National Cancer Institute annual budget is $1.8 billion, only 5 percent goes for cancer prevention. Help us wake up our legislators and America by wearing this ribbon.” It was 1990. She sent her ribbons to prominent women all over the country, from former first ladies to Dear Abby, hoping to effect a sea change in the way the breast cancer epidemic was being addressed.

Two years later, as Self editor Alexandra Penney was busy preparing the magazine’s second annual Breast Cancer Awareness Month issue, she had her own ribbon idea. What if she took a page from the HIV movement and created a ribbon to promote breast cancer awareness? And what if Estée Lauder—whose senior corporate vice president, Evelyn Lauder, had guest edited the previous year’s issue—distributed the ribbon at its cosmetic counters?

When Penney learned of Haley’s campaign, she called her up and asked her to join forces with Self. But Haley declined, saying Penney’s plan was too commercial. So Penney consulted with Self magazine’s lawyers, who recommended she choose another color for her ribbon. With the help of a focus group tasked with identifying the color that was most reassuring and least threatening, she chose pink. That year, Estée Lauder distributed 1.5 million ribbons, and the pink ribbon movement was born.

Twenty-one years later, the emblem is as ubiquitous as the Nike logo or the golden arches. In “Welcome to Cancerland: A Mammogram Leads to a Cult of Pink Kitch,” critic and breast cancer survivor Barbara Ehrenreich lists what she describes as a “cornucopia” of pink ribbon products:

You can dress in pink-beribboned sweatshirts, denim shirts, pajamas, lingerie, aprons, loungewear, shoelaces, and socks; accessorize with pink rhinestone brooches, angel pins, scarves, caps, earrings, and bracelets; brighten up your home with breast-cancer candles, stained-glass pink-ribbon candleholders, coffee mugs, pendants, wind chimes, and night-lights; pay your bills with special Breast Checks or a separate line of Checks for the Cure.

Stacy Malkan, author of Not Just a Pretty Face: The Ugly Side of the Beauty Industry, adds a host of cosmetics to the list: “We can ‘shower for a cure’ with pink ribbon gel, dust our cheeks with ‘Hint of a Cure’ blush and ‘Kiss Good-Bye to Breast Cancer’ with Avon lipstick.”

Through the pink ribbon, corporate America has embraced cause-related marketing—reframing shopping as a way to fight disease. Estée Lauder blazed the trail, making breast cancer its cause célèbre. Avon and Revlon followed. Now, companies as diverse as Clorox, Evian, Ford, Mars, and American Airlines leverage the marketing power of the pink ribbon. Even agricultural biotechnology monolith Monsanto has jumped on the pink ribbon bandwagon. In 2009, a seed-development company called Seminis (a Monsanto subsidiary) launched a new variety of cherry tomato called the Pink Pearl, which was sold in packaging displaying—you guessed it—the pink ribbon.

In terms of visibility, the campaign has been a colossal success. What it is doing for women’s health may be harder to quantify. For one thing, the pink ribbon is unlicensed and unregulated. Which means not only that any company can use the symbol to sell its products, but that those companies don’t actually have to commit a dime to breast cancer research. Purchasing Procter & Gamble’s limited edition pink Swiffer sweeper, for example (released in October of 2009), wouldn’t have resulted in any money at all being donated for breast cancer research or detection—unless you also sent in a coupon from the company’s brandSAVER coupon book, which was distributed to newspapers on September 27 of that year. And then? Procter & Gamble donated two cents from your purchase to the National Breast Cancer Foundation.

Some companies are more generous than others. Estée Lauder’s pink ribbon lipstick and blusher raised $120,000 for the Breast Cancer Research Foundation (which was founded by Evelyn Lauder) between 1993 and 1995. And Evelyn Lauder, herself a breast cancer survivor, personally raised much of the $13.6 million necessary to build the Evelyn H. Lauder Breast Center at the Memorial Sloan-Kettering Cancer Center. Avon, Revlon, and Estée Lauder all donate funds to sponsor breast cancer awareness events.

It is surprising, given their commitment to the cause, that all three cosmetics companies would manufacture and market products with ingredients that include hormone disruptors and other suspected carcinogens. But both Revlon and Estée Lauder were singled out in the Environmental Working Group’s 2005 Skin Deep report for using toxic ingredients, scoring eighth and ninth, respectively, on the “Top 20 Brands of Concern.” All three companies—Avon, Revlon, and Estée Lauder—declined to sign the Compact for Safe Cosmetics, a pledge to produce personal-care products that are free of chemicals known or strongly suspected of causing cancer, mutation, or birth defects. In fact, through their trade association, the Personal Care Products Council, all three companies opposed a California bill that would require cosmetics manufacturers to disclose their use of chemicals linked to cancer or birth defects.

The hard truth is that a market-based approach to the breast cancer issue falls dramatically short when it comes to anything that might pose a threat to the corporate bottom line.


WHY ARE WE so fixated on awareness, anyway? Aren’t we all aware by now that breast cancer exists? That it is a bad disease? That it touches the lives of far too many women?

And why this fetishizing of mammograms? It is a testament to the monumental success of the breast cancer awareness movement that the majority of women continue to get annual mammograms despite the U.S. Preventive Services Task Force’s revised recommendations. According to a study published in April of this year in the peer-reviewed journal Cancer, nearly half of all women in their forties are still flocking to imaging centers all over the country. Even more troubling is the fact that all this awareness has somehow led 68 percent of women to believe that mammograms actually prevent cancer. But mammograms don’t prevent cancer. Prevention prevents cancer.

There are organizations, such as Breast Cancer Action and the Breast Cancer Fund, that are dedicated to preventing cancer through ferreting out its causes, empowering women to make healthier choices, and pressuring the U.S. government to change the policies that put all of us at risk. But why do their efforts seem so small in the sea of pink?

Answer: corporate sponsorship.

It is illuminating to examine the key players in National Breast Cancer Awareness Month. Or perhaps I should say “key player,” because for a long time there was just one: Zeneca, the pharmaceutical giant that became known as AstraZeneca following a merger in 1999. On the surface, the company’s decision to market and fund National Breast Cancer Awareness Month appears philanthropic. But when I learned that AstraZeneca is the maker of Tamoxifen, the most widely prescribed breast cancer drug on the planet, suddenly the focus on awareness seemed less than benevolent. Because the greater the number of women diagnosed, the greater the sales of AstraZeneca’s star drug.

Zeneca launched National Breast Cancer Awareness Month—and the slogan “Early detection is the best protection”—in 1985, and for the first few years the corporation was its sole funder. It still wields control over the marketing. Which means it wields control over the message. And the message is this: Breast cancer is an individual problem and an individual responsibility. The sensible woman gets annual mammograms and, when diagnosed, seeks cancer treatment.

Early detection is a gold mine for the drug company. In a 2002 PowerPoint presentation, Brent Vose, then head of oncology for AstraZeneca, described the corporation as having a “unique franchise in breast and prostate cancer,” and said that “the move into early disease represents an enormous expansion of the potential market.”

So prevention doesn’t get much attention during National Breast Cancer Awareness Month. Nor does the rampant production and marketing of products that contain ingredients known or suspected to cause cancer.

According to natural health advocate Tony Isaacs, Zeneca itself did not exactly have a stellar record when it came to carcinogenic products. The agrochemical arm of the company produced pesticides such as Paraquat and Fusilade—both classified by the Environmental Protection Agency (EPA) as “possible human carcinogens”—and in 1994 it introduced Acetochlor, which was classified as a “probable human carcinogen.” Zeneca’s now-defunct parent company, Imperial Chemical Industries, was the owner of what was once identified as the third-largest source of potentially cancer-causing pollution in the U.S. In 1990, the company was named in a lawsuit by the federal government for allegedly dumping DDT and PCBs into the harbors in both Los Angeles and Long Beach, and in 1996 it released fifty-three thousand pounds of recognized carcinogens into the air.

Why eliminate cancer-causing chemicals from your product line when you can profit from them coming and going? In 1997, sales of Acetochlor, the probable human carcinogen, accounted for approximately $300 million in profits for Zeneca, while sales of Tamoxifen, the cancer-fighting drug, added up to about $500 million. “Clearly, cancer prevention would conflict with Zeneca’s business plan,” wrote Peter Montague in Rachel’s Environment and Health Weekly. Other corporations that sell both pharmaceuticals and pesticides include Aventis, Dow Chemical, DuPont, Merck, and Monsanto.

But there’s plenty of conflict of interest to go around when it comes to the pinkwashing of America. Susan G. Komen for the Cure, a nonprofit that sits alongside AstraZeneca on the list of Breast Cancer Awareness Month sponsors, owns stock in several pharmaceutical companies, including AstraZeneca, and also in General Electric (GE), one of the largest makers of mammogram machines in the world.

In St. Louis, Missouri, the Race for the Cure is sponsored in part by Monsanto, whose genetically modified crops are almost singlehandedly responsible for tripling the use of the herbicide glyphosate since 1997, when its Roundup Ready seeds were first introduced. Until 2008, Monsanto was also the producer and distributor of rBGH, the artificial hormone given to cows to make them produce more milk. Because rBGH has been linked to breast cancer and other health problems in humans, it has been banned in Canada, Australia, Japan, and all twenty-seven countries of the European Union—but not in the U.S.

DuPont, which supplies much of the film used in mammography machines, is also well served by the National Breast Cancer Awareness Month push for early and frequent mammograms. A contributor to the American Cancer Society (ACS) and one of the world’s largest chemical companies, DuPont rivals GE—another ACS supporter—for Superfund sites.

Even the American Cancer Society itself—whose board members, over the years, have held ties to the Pharmaceutical Research and Manufacturers of America, to drug companies such as GlaxoSmithKline, and to industries that produce carcinogenic products, such as the Sherwin-Williams Company (think paint stripper)—is not free from blame. With reported annual net assets of over $1.5 billion, the ACS “is more interested in accumulating wealth than saving lives,” says the nation’s leading charity watchdog, the Chronicle of Philanthropy. The ACS has a long history of obfuscating links between chemicals and cancer, according to an article in the International Journal of Health Services, and was conspicuously silent on California’s Cosmetics Safety Act, which passed without the nonprofit’s support in 2005. The Cancer Prevention Coalition says the ACS allocates under 0.1 percent of its annual budget to investigating environmental causes of cancer. Five radiologists have served as its president.

More recently, there is some evidence that the ACS is beginning to give prevention its due. In 2009, it published a position statement recognizing “the essential role of cancer prevention in reducing the burden of disease, suffering, and death from cancer.” However, it’s hard to imagine how much headway the ACS can make on prevention when its major donors include companies like DuPont and AstraZeneca.

The Cancer Industrial Complex—that’s what Barbara Ehrenreich calls “the multinational corporate enterprise that with the one hand doles out carcinogens and disease and, with the other, offers expensive semi-toxic pharmaceutical treatments.” Given that breast cancer treatment is a $16.5 billion-a-year industry, it’s easy to see why Ehrenreich calls the disease “the darling of corporate America.”


OF COURSE, if we’re serious about trying to prevent breast cancer, we need to figure out what causes it. Studies indicate that fewer than 30 percent of breast cancers are genetically based. And what of the other 70 percent? Exact figures are uncertain, but researchers say that exposure to radiation and chemicals, as well as poor diet, high body fat, lack of exercise, and hormone replacement therapy, are all likely culprits. Even those cancers with a genetic basis may have been triggered into full expression by risk factors such as these.

It is difficult to pinpoint just how many breast cancers are caused by chemical exposures. Carcinogenic chemicals insinuate themselves surreptitiously, and their impact on the body makes its appearance so long after the fact that people rarely make the connection. According to testing done by the Centers for Disease Control and Prevention, we all have some combination of more than 212 industrial chemicals—including at least six known to cause cancer and dozens more that have been linked to the disease—lurking in our bodies: stealth toxicants.

In April 2010, the President’s Cancer Panel—a two-member panel that met with forty-five experts before coming to its conclusions—released a groundbreaking report, “Reducing Environmental Cancer Risk: What We Can Do Now,” which criticized the U.S. government for its failure to adequately regulate environmental toxicants. In their cover letter to the president, the panelists wrote that they were “particularly concerned to find that the true burden of environmentally induced cancers has been grossly underestimated.”

While many people believe that the government regulates chemicals in order to keep Americans safe, the effectiveness of such efforts is limited at best, in part because industry insiders are calling the shots. For example, in 2009, President Obama put Monsanto lobbyist Michael Taylor in charge of regulating his own industry by appointing him Senior Advisor to the Commissioner of the FDA. And in 2012, the FDA was caught spying on its own employees—five whistle-blowers who were e-mailing documents to legislators and lawyers that showed the agency was using faulty review procedures to approve GE mammogram machines that did not reliably identify breast cancer and/or exposed patients to dangerous levels of radiation. A review by the U.S. Office of Special Counsel later found “significant likelihood” that those and certain other radiological devices approved by the FDA posed “a substantial and specific danger to public safety.” To this day, the FDA does not require the cosmetics industry to demonstrate the safety of its products.

And then there’s the Environmental Protection Agency, which is charged with protecting us from environmental chemicals such as pesticides. In the thirty-five years since the Toxic Substances Control Act of 1976 was enacted, the EPA has restricted the uses of just five of the eighty thousand chemicals in circulation. A full 95 percent of chemicals in use have never been tested for safety.

If you review the Breast Cancer Fund’s 127-page report State of the Evidence: The Connection Between Breast Cancer and the Environment, you’ll find a jaw-dropping list of chemical compounds known or suspected to cause breast cancer. These include benzene, found in cosmetics, including nail polish, and also in gasoline fumes, car exhaust, and cigarette smoke; 1,3-butadiene, found in hair mousse and gels, shaving creams, and cigarettes; ethylene oxide, found in fragrance; urethane, found in mousses, gels, and hair sprays, and in cosmetics, including nail polish, mascara, and foundation; perfluorocarbons (PFCs), found in nonstick coating on cookware, and in stain guard on furniture, carpets, and clothing; and toluene and resmethrin, found in pesticides.

But carcinogens are not the only cause of breast cancer. According to functional medicine specialist Dr. Elizabeth Boham, “the most damaging environmental toxin when it comes to breast cancer is estrogen and substances that mimic it.” Endocrine-disrupting compounds—which are stored in fat and bioaccumulate—can emulate natural hormones, particularly estrogens, and since high exposure to estrogen is known to increase the risk of breast cancer, the Breast Cancer Fund recommends avoiding these chemicals as much as possible.

Not an easy thing to do, it turns out. A list compiled by researcher Dr. Theo Colborn, author of Our Stolen Future, documents around eight hundred potential endocrine disruptors. Culprits include Bisphenol A (BPA), which is in the interior lining of almost all metal food and beverage cans; phthalates, found in air fresheners, perfumes, nail polish, baby-care products, cleaning products, and insecticides; parabens, found in underarm deodorant and cosmetics, including creams, lotions, and ointments; synthetic musks, found in fragrance; nonylphenol ethoxylate, found in cleaning products and air fresheners; alkylphenols, found in hair products and spermicides; bovine growth hormone (rBGH/rBST), found in most cow’s milk and other commercial dairy products; many pesticides and herbicides; and polycyclic aromatic hydrocarbons, found in charred or grilled meats and in cigarette smoke. Oral contraceptives and hormone-replacement therapy have also been found to increase the risk of breast cancer.

A woman attempting to steer clear of all these toxicants would find it virtually impossible.


GIVEN THE COMPLEX WEB of industries with their hands in the breast cancer money pot, it’s not hard to see that a focus on prevention would threaten to collapse the whole enterprise. It’s a shell game of monumental proportions. These masters of illusion instill us with fear, then with a little sleight of hand distract us from the real problem. And the real problem is that the majority of breast cancers are triggered by environmental factors, including exposures to toxicants. And toxicants are everywhere.

Instead of obsessing about detection, we ought to be promoting precaution. It’s a simple idea, really: when in doubt, play it safe. The European Union is paving the way with REACH, a law implemented in 2007 that requires manufacturers and importers to register the chemicals in their products with the European Chemical Agency, and to include in their registration packets data on the hazards of each chemical. Chemicals are evaluated and then either authorized or restricted. Thanks to REACH, some of the cosmetics companies peddling products containing questionable chemicals to Americans are already selling those very products, but with less-hazardous chemicals, to our neighbors across the pond.

Why are American women not outraged by this fact alone?

“We used to march in the streets,” says Ehrenreich. “Now, we’re supposed to ‘Run for a Cure.’” Imagine what change could be effected if all those women in pink turned their energies toward working to pass legislation that would protect all of us from the chemicals that cause cancer. Imagine if the millions of dollars spent searching for a “cure” were instead invested in researching causes and prevention. Because if we truly want a cure for the breast cancer epidemic, we don’t need more mammograms. We don’t need more ribbons. What we need is to face a truth that is not pretty, not pink, and not reassuring at all. Chemicals are in our bodies. They are causing cancer. And all the pink ribbons in the world aren’t going to fix that.

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Jennifer Lunden is the winner of a Pushcart Prize and Maine’s 2012 Social Worker of the Year award. She is an affiliate practitioner at True North Health Center in Falmouth, Maine.

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