The Opening Plenary Session: A report by Donna Roberts on presentations made by Dr. Annie Sasco, Rosa Meneses, Dr. Samuel Epstein, Dr. Devra Lee Davis and Prof. Zillah Eisenstein

Breast cancer is the number one cancer in women in the world, said Dr Annie Sasco, Head of the Program of Epidemiology for Cancer Prevention at the International Agency for Research on Cancer, in Lyon, France.

Breast cancer killed nearly half a million people in 1997, the last year for which global statistics are available. Meanwhile, the number of newly diagnosed cases has increased from less than 600,000 in 1980 to nearly 900,000 in 1997. The number of new cases of breast cancer is expected to exceed 1 million in coming years, an almost doubling of the annual number in 25 years.

Sasco compared rates of increase of breast cancer incidence in the industrialized world with that of the “developing world” showing a clear indication that environmental factors are playing an important role. She pointed out that since 1975 breast cancer rates have gone up in most parts of the world, yet there has been a smaller increase in countries where the disease was already frequent, such as most of the industrialized world. The greatest increase is seen in areas previously having low rates, i.e. the developing world. As developing nations implement industrial technologies on a larger scale, their rates of breast and other cancers increase.Fortunately, mortality rates show a more reassuring picture, with recent decreases in several countries.

North America has Highest Rates
To illustrate the worldwide situation, Sasco presented several maps showing the incidence of breast and other hormone dependent cancers, such as cancer of the endometrium, ovary, prostate, testes and colon. North America has the highest rates of all of these cancers.
Marked geographic differences still exist for breast cancer, with low rates in Africa and Asia, intermediate rates in South and Central America, South and East Europe and high rates in North America, North Europe and Oceania.

Based on studies of migrant populations, she said genetic history only explains a small proportion on breast cancer cases. “Lifestyle and environmental factors are very, very important.” Sasco said trends indicate a tendency towards high levels of breast cancer throughout the world. Her conclusion: urgent action is needed to change this gloomy
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Philippines Breast Cancer Network
Rosa Meneses, Founding President of the Philippines Breast Cancer Network, received a standing ovation after describing her courageous battle with cancer. She said, “recalling the pain serves a purpose. It reminds me that dealing with cancer is living with breast cancer.” She said her story is the same as that of every woman with breast cancer.

Meneses spoke of the need to change the attitudes of people in her country, where breast cancer survivors are viewed as the “walking dead” and treated as objects of pity. She said the Philippine government frequently seeks exemptions from environmental controls for incinerators and solid waste facilities, encourages chemical farming and advises people not to worry about small amounts of dioxins in food. Meneses said the local media focuses on rape and violence, without realizing that “the same violence is committed every day on the bodies of women with breast cancer.”

Politically speaking, Meneses recalled how the Philippine delegation which was to accompany her to the conference underwent a “radical mastectomy”. The Canadian Embassy in the Philippines, having never heard of the World Conference and doubting its legitimacy, denied visas to five women (a doctor, a nutritionist, a survivor and two physical therapists) to come to Canada to participate.

Avoidable Risk Factors
Dr. Samuel Epstein was his usual compelling self, declaring that there is a “massive body of avoidable risk factors and causes of breast cancer and the public has not been informed of most of it.” He stressed the role of estrogen, an incredibly important factor, particularly given the 125% increase in estrogen dependent breast cancers, compared to a 24% increase in estrogen receptor negative cancers.

Epstein ran down his list of the “dirty dozen” risk factors which includes oral contraceptives, hormone replacement therapy, and pre-menopausal mammography. He stated that compressing the breast in mammography can be enough to rupture a small tumour, causing the cancer to spread. Speaking of silicone gel breast implants, especially those wrapped in polyurethane foam, he said he could “think of no higher risk factor.” Prescription drugs like tranquilizers and anti-hypertensives were also named as risk factors.

Household Hazards
On the subject of diet, he said while fat itself is not a risk factor, animal fats, which tend to be contaminated with carcinogens, may be linked to breast cancer.

Household chemicals, pollutants from chemical and industrial plants and occupational exposure to chemicals like PVCs and petrochemicals all create higher risk. He said, “standing next to a (working) microwave is like standing next to a transformer.”

Aspirin for Prevention
Epstein pointed to research which shows that taking aspirin 3 times a week can create a 30% reduction in breast cancer risk, and pondered the political and commercial implications of promoting aspirin as a preventive measure, instead of the known carcinogen, tamoxifen.
Epstein said with so many identifiable medical, chemical and lifestyle risk factors, it is unconscionable for those in the field of public health to wait for scientific certainty. Instead, we must act on the association between risk and disease.

Apply the Precautionary Principle
Another strong advocate of the precautionary principle was Dr. Devra Lee Davis, Director of Health, Environment and Development at the World Resources Institute. She pointed out that we must “rethink breast cancer risk in the environment and see that the precautionary principle is applied. It is better to be approximately right, than definitely wrong.” Davis said we have failed when it comes to developing social policies that address this issue.

She elaborated on how environmental contaminants can increase the risk of breast cancer by loading our bodies with harmful hormones, or “bad xenoestrogens” and how wildlife the world over are being affected by pollution, citing hermaphrodite polar bears. If that’s what’s happening to the animals, she said, “what about us?”

Davis spoke about the junk food additive, red dye #3, and research 2 years ago linking it with increased growth of breast cancer cells.

She said we must examine the risk of doing something versus the risk of doing nothing. “We’ve been doing nothing for too long, but how much proof is enough is a public policy issue.”

Rethink the Politics of Breast Cancer
Professor Zillah Eisenstein encouraged participants to rethink the politics of breast cancer. Eisenstein called for a more radically focussed, inclusive, global breast cancer movement that embraces young women, women of colour, poor women and the concept of global access. The focus of the movement, she said, should be the girls who will be the women of the 21st century. “The pink ribbon needs to be radicalized... and access to breast cancer treatment must cross racial and class lines.”

The Second World Conference on Breast Cancer was held July 26 - 31, 1999 in Ottawa.