Real Risk Factors for Women

Townsend Letter for Doctors and Patients,  August, 2001  by Katherine Duff

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Life's Delicate Balance: Causes and Prevention of Breast Cancer

by Janette D. Sherman

Taylor & Francis, 7625 Empire Drive, Florence, Kentucky 41042 USA,

800-634-7064

Softbound, 255 pp., 2000, $24.95

In the United States, one in eight women will develop breast cancer in their lifetime. If that statistic is ever to improve there must be an honest effort at preventing the illness, not just treating it. Janette D. Sherman MD in her book, Life's Delicate Balance: Causes and Prevention of Breast Cancer, educates us about the causes of breast cancer and opens our eyes to the fact that most of those causes are known and preventable. She also makes us aware that powerful economic interests control the public agenda, which is to not address prevention at all, but focus on early detection and treatment instead.

Throughout this book, Dr. Sherman points out how language has been used to manipulate the public's perception of the breast cancer problem. An example of this would be the use of the word risk. The risks for breast cancer we hear about include lifestyle factors such as diet, family history of breast cancer and other considerations. But Dr. Sherman reminds us that risk is not a cause of illness, but rather, risk is the result of exposure to a hazard. Thus we would be well advised to pay closer attention to the hazards that have created the risk. An example of this would be the risk factor of obesity Popular culture would like to blame the obese woman for causing her own breast cancer, but the fact is that human adipose tissue is a reservoir for toxic chemicals. Understanding the behavior of those chemicals in the body and their role in cancer development is what will lead to prevention.

The author addresses several important factors for causing breast cancer: chemical carcinogens; hormone disrupting chemicals; genetics; and nuclear radiation. Though not commonly discussed, the link between radiation and breast cancer has been known for decades. And though we may not always be aware of it, we have all been exposed. Before nuclear testing was stopped in 1989, there were more than 800 tests conducted in this country alone. Nuclear reactors and X-rays, even mammograms, are other sources of exposure.

The nuclear age occurred before there were any official risk-benefit formulas, but that is not to say there were not such considerations. The testing of nuclear weapons was paramount to any health concerns for the population and even for the most acutely exposed, monitoring and follow-up studies were not done. In one alarming memo from the Atomic Energy Commission, the people downwind were referred to as "a low use segment of our population." Disregard, disinformation and denial defined the official position for health issues involved in nuclear testing. Later studies though have shown increased cancer, including breast cancer, in populations surrounding these tests.

Another major risk factor for breast cancer is estrogenic hormones. "Too much estrogen; estrogen too soon, as in a young girl's development; inappropriate timing of estrogen exposure; and the wrong kinds of estrogens are factors in the breast cancer epidemic." And we learn that estrogenic hormones are everywhere, including our air, water, food, clothing, cleansers, pesticides and medicines.

Dr. Sherman discusses a variety of the known estrogenic chemicals beginning with the synthetic hormone diethylstilbestrol, or as it is more commonly known, DES. This chemical was used to treat a variety of ailments, from headaches, dizziness and depression to the prevention of miscarriage. Though animal studies had shown several problems including liver toxicity and nausea and studies in humans cited nausea, elevated cholesterol and evidence 'of estrogen stimulation of babies born to mothers who took the drug, and despite warnings from eminent scientists, it was approved in 1941. DES was not only administered to women, but became a major food additive because of its ability to increase milk production in cows and increase weight in steers, swine and poultry. So whether we took a pill or not -- we have all been dosed with DES.

DES was finally banned in 1979, but there are a multitude of chemicals that are currently in use that have hormonal and carcinogenic effects in the body. The author discusses many of these and dedicates a chapter to tamoxifen, which is a drug intended for use by women already diagnosed with breast cancer and women at risk of developing breast, cancer. This chapter is a must read for all women.

In the discussion of genetics and breast cancer, we see just how misconceptions can obscure our understanding. When the lay public hears about genetically caused illnesses, the implication is that these illnesses are inevitable and there is not much that can be done to prevent them, other than the promise of gene therapy, of course. But Dr. Sherman asks us to consider how those genes have been compromised in the first place. For example, the discovery of the BRCA1 gene said to be associated with inherited breast cancer, was first found in cancer clusters that occurred in Utah, a state subjected to nuclear testing. As early as 1959, scientists testified before Congress that genetic injury from those exposures would not show up for possibly generations after the initial injury.