A Guide to Causes and Prevention of Breast Cancer

Lanie Melamed and Laura Shea

How comforting it would be to report definitive answers to the questions raised in the last two editions of the BCAM Bulletin on mammography screening. At this writing, the subject remains unresolved despite recent ‘definitive’ statements from the World Health Organization (WHO). Fortunately, the issue has become part of a public debate that is having ramifications worldwide. It is good to be reminded once again that what we read, whom we choose to believe and one’s general worldview all influence research results. This is true for writers of articles in this newsletter as well as New York Times editorials and—sad to say—medical journals. Recently, the Lancet and the New England Journal of Medicine reported that as many as 50% of their articles have been written, unbeknownst to the editors, by persons representing manufacturers of pharmaceeuticals or medical devices.¹

In an attempt to clarify the confusion, WHO issued what they considered to be a definitive statement. Recent criticisms, they claimed, were unsubstantiated. In their opinion, women who have been screened regularly have a 35% better chance of survival, with most benefits for women 50–69 years of age.²

Fran Visco, president of the National Breast Cancer Coalition in the US feels that instead of searching for clarity, we should be searching for truth. “The truth may be that there is no clarity. ” The best women may be able to do is make individual decisions based on personal risk factors in consultation with their physicians.³

Dr. Barron Lerner, author of The Breast Cancer Wars, argues that enthusiastic support of mammography may have as much to do with cultural and political concerns as with science. He writes, “As a practicing physician, I am happy when scientific data offer definitive answers to clinical questions. But as a historian, I have learned what happens when there are legitimate disagreements about the available evidence: Both sides dig in their heels, maintaining that their science is superior. But women making decisions about mammography deserve to know that those claiming certainty are influenced by much more than science.⁴

Some members of the breast cancer advocacy movement are encouraged by the current public discussion of these issues. There appears to be a new willingness to re-evaluate the evidence on screening and to press for more accurate and less invasive detection methods.

Politics, statistics and the precautionary principle notwithstanding, one thing we know for sure is that diagnosis and treatment cannot end the breast cancer epidemic. Prevention is the only thing that can!

1. Sarah Boseley. ‘Scandal of scientists who take money for papers ghostwritten by drug companies.' The Guardian, February 7, 2002.
2. ‘Breast cancer screening does reduce death rates, UN researchers say.' Medscape: Reuters Medical News, March 3, 2002.
3. Abigail Trafford. ”’Final Word’ on mammograms? Not yet” Washington Post, March 5, 2002
4. Barron Lerner, M.D. ‘What’s Behind It All’ Washington Post, March 3, 2002: B1