Every October, sure as the leaves fall from the trees, pink ribbons and products blossom virtually everywhere you go. Breast Cancer Awareness Month has all the hallmarks of an effective public health campaign; people going about their regular routines can't help but notice all the pink and - especially while shopping - be encouraged to contribute to the cause. During a friendly gathering last year, an acquaintance of mine wondered aloud why football players on the TV in the background were wearing pink on their uniforms. The answer soon came. Awareness had been raised. Everyone in the room voiced approval; who wouldn't want to turn the tide on breast cancer?
The NFL's highly visible slogan - "a crucial catch" - reminds women that "catching" warning signs, through regular mammograms and self-exams, is the name of the game. This comes right out of the Public Health playbook, which unfortunately has not been terribly effective. These familiar measures (along with diet and exercise) have done some good, yet breast cancer mortality has only dipped slightly since the campaign began more than 25 years ago. And while screening can help save lives, it also subjects five to 15 times as many women to intense treatments or surgeries that turn out to be unnecessary - since many tumors are treated as though they were aggressively malignant even if they are later discovered to be benign.
The pink awareness campaign is packaged, quite profitably, as an expression of genuine concern about women's health. So surely it is reasonable to expect that such concern be matched by an accurate presentation of all the known risk factors, and by an insistence upon the very best corresponding prevention recommendations, right? After all, early detection measures such as screening are not nearly the same thing as solid prevention.
Indefensibly, however, most awareness efforts fail to feature some factors known to reduce breast cancer risk: having children, avoiding induced abortions, and refraining from oral contraceptives (OC). True, there is no guaranteed way for anyone to dodge or develop breast cancer, but that does not mean there are not risk factors. Women today are delaying childbirth as never before, and having fewer children. Younger women are using OC for longer periods of time. And well over a fifth of all pregnancies in America end in abortion - hardly the rarity its "safe, legal and rare" advocates say it should be. If you suspect that these reproductive risk factors might have something to do with the 40 percent increase in the incidence of breast cancer over the last 30 years, you have spotted the elephant in the room.
Public health authorities, however, dare not cross the cultural Rubicon with an army of politically incorrect facts - even in the name of women's health. Not even concern about breast cancer, it turns out, stands in the way of unbridled allegiance to absolute individual freedom, particularly in the arena of sexuality, which so characterizes today's culture. In saner times, the imperative to recommend what is truly best for women's health would prevail.
No one would counsel a woman to have a child, say, by her early 20s for the sole purpose of reducing breast cancer risk. But, simply put, a woman can do nothing more protective than having several children, beginning at an early age, and breastfeeding them all. Women who never give birth (including nuns) are at higher risk; having a first child later in life (over age 30) also heightens susceptibility.
The steroids taken by more than 100 million women around the world to prevent pregnancy -- oral contraceptives - are known human carcinogens, according to the International Agency for Research on Cancer. In 2006, the Mayo Clinic concluded that a woman who takes OC before her first full-term pregnancy stands a 44 percent greater chance of contracting breast cancer prior to menopause, compared with those who don't take OC before giving birth. Using OC for four of more years prior to first full-term pregnancy is even more risky.
Yet how many young women are informed - in that obligatory "Health 101" class, by their doctors, or through the pink media blitz - that "the pill" is a steroid (yes, think Mark McGwire and Barry Bonds), much less that it increases a woman's likelihood of developing breast cancer?
Induced abortion is also a major risk factor. A recent (2007) multi-country study found that having had an abortion was the greatest predictor of subsequent breast cancer. Going back decades, study after study (with only a few exceptions) has demonstrated the connection; a methodologically sound review of the available evidence determined that it raises the risk of breast cancer by approximately 30 percent. (See this exhaustive summary). Electing to have an abortion before one's first full-term pregnancy is even riskier.
I wonder how many of the more than one million women in America who annually choose abortion would reconsider if these risks were common knowledge? There is precedent; millions of post-menopausal women ceased taking Hormone Replacement Therapy (HRT) once they were apprised of its risks, and as a result the breast cancer rate among that cohort dropped within a few short years.
Remarkably, the preponderance of evidence has not stopped the once trustworthy Lancet, or the National Cancer Institute (NCI) from flatly denying the connection. Abortion, they seek to assure us, is nothing any woman concerned about breast cancer need worry about. But nature does not cooperate so willingly with the wishes of man, and never cooperates with the conclusions of shoddy science. The Lancet published a rigged but much heralded meta-analysis claiming no link in 2004 which was so replete with serious methodological errors (inexplicable omissions of very important and contradictory findings from valid studies, and the inclusion of scientifically invalid studies among other serious flaws) that it suggested a desire to conceal rather than reveal the truth. Indeed, that study's lead author, Oxford's Valerie Beral, proved downright Shakespearean in her role as the lady who doth protest too much the evidence of a connection. Indeed, most denials of the link in the literature are based on shoddy "studies".
When leaders of the healing profession resemble tobacco executives of decades past in turning a blind eye to a clear risk factor for cancer, lawsuits can't be far behind.
In the meantime, many people might wonder in exasperation what to believe, perhaps thinking that everyone just brings a preconceived bias to the issue. But principled opponents of abortion object to the practice on moral grounds - even if it involved no cancer-related consequences whatsoever. It falls squarely upon the shoulders of science - our medical and public health authorities - to soberly inform us, as best they can at any given time, of the known health-related risks, or lack thereof, associated with this or any other practice. Such questions require real evidence - not appeals to the authority of The Lancet or the NCI, although the lay reader should be able to have confidence in the pronouncements of scientific institutions with widespread name recognition.
Wouldn't reason dictate that public health authorities recommend a measure of caution if there was only a reasonable suspicion that these factors might raise the risk? That possibility alone may well persuade some women to consider alternatives. The desperation to deny or downplay evidence of the connection between abortion and breast cancer speaks volumes; conceding the linkage would threaten the status quo and the laissez-faire set of utilitarian "ethics" deeply embedded within our culture and enshrined into our laws.
Further consider that no one denies the protective effect of childbirth - so is it really that far-fetched to suppose that aggressively truncating or pre-empting that same naturally protective process could have negative repercussions? Indeed, nulliparity, abortion and contraception as risk factors have an essential ingredient of any solid epidemiological theory: biological plausibility.
The linchpin uniting the reproductive risk factors is their relationship to the hormone estrogen. Overexposure to estrogen is carcinogenic - which is one reason why oral contraceptives and Hormone Replacement Therapy leads to more breast cancer. And in the early phases of pregnancy, a woman is exposed to massive amounts of estrogen, which triggers a proliferation of the types of breast lobules (Type 1 and 2) most susceptible to cancer. It is only in the weeks prior to birth that other hormones begin to help transform those vulnerable lobules into (Type 3 and 4) cancer-resistant lobules. A woman who terminates her pregnancy thus experiences a dangerous spike in estrogen without acquiring the protective tissues that emerge only by bringing a child to term.
Most pink campaigns avoid any hint of these factors like the plague; the Susan G. Komen Foundation, a prominent advocacy and fundraising group, vehemently and unequivocally denies the link between abortion and breast cancer, citing Beral's shady "study". Komen is evidently content to ignore mounting epidemiological evidence along with current knowledge of breast physiology which makes such a link all the more creditable.
Curiously, Komen also funnels millions of dollars to Planned Parenthood - already a recipient of considerable governmental largesse. By doling out tons of contraceptives and providing for more abortion than any other outfit in the country, Planned Parenthood virtually ensures that the breast cancer epidemic will persist, not shrink.
You don't have to be a cynic to find this cozy relationship a bit fishy.
Yes, something is rotten in Pink Denmark - despite the good will that the awareness campaign evokes in many people, among other redeeming qualities. Awareness of Breast Cancer per se, of course, is not the problem. Forbidding awareness of highly relevant reproductive risk factors ineluctably undermines the overall effort, which reveals that it is committed to women's health - only up to a certain point.
I'm sure marketing gurus could figure out a way to raise awareness of these factors tactfully and succinctly at the supermarket check out counter, where everyone without fail is regularly asked to pitch in. Or if NFL players are man enough to wear pink on the field, why couldn't broadcasters mention these risk factors on the air - perhaps during a marquee game in New York City, where 40 percent of all pregnancies end in abortion? (The figure is 60 percent among African Americans - much higher than even Eastern Europe, which with 105 abortions for every 100 live births, has the highest abortion rate in the world.) Even if they framed it as "controversial", that would be some serious awareness-raising.
Someone has got to man up and bring the truth to light. But the NFL, like the supermarket chains and every other commercial enterprise, only follows the lead of the public health and medical establishment which has gone soft and disregarded its own standards when confronted with the demands of political correctness.
Pink campaigns strike a chord because we want to provide or procure everything we can to help women counter this dreaded disease; hopefully research will lead to new breakthroughs. But it's time even these politically incorrect risk factors get the awareness they deserve.