American women are canaries in the coal mine of modern life.
One hundred years ago, breast cancer was uncommon. But it has since become the most common cancer to affect women: 29 percent of all cancers in women start in the breast. And as if that wasn't enough, a new report tracking breast cancer statistics between 1976 and 2009 in the Journal of the American Medical Association reveals an alarming new pattern of disease: a higher incidence of metastatic breast cancer (spread beyond the breast and lymph nodes) in women age 25-39 (well below screening age).
These are not just statistics, data points filling up graphs and tables. These are our mothers, sisters, friends and neighbors -- women in the prime of their lives with so much at stake and so much more to give: children, spouses and partners, promising careers, civic service, etc.
So what's causing this serious public health problem? Here's what we know: Only 10 percent of breast cancers are largely due to an inherited gene. Ninety percent of breast cancers are mainly due to lifestyle, reproductive choices, and environmental exposures. And while our inherited genes haven't changed for hundreds of years, our environment and life today, are drastically different.
We're now exposed to vast and widespread use of hormonally active chemicals that didn't exist a hundred years ago: pesticides (like Atrazine and Roundup), flame retardants (polybrominated diphenyl esthers), plasticizers (like bisphenol A), antibiotics in livestock feed, hormones in the beef and dairy cattle industry, and pharmaceutical hormones for women (birth control pill and hormone replacement therapy), as just a few examples. What comes around goes around. All this junk gets into the food we eat, the water we drink, the air we breathe, the products we use -- and it all concentrates as it goes up the food chain. And developing fetuses and nursing babies are on the top of that food chain.
Breast cells soak up and respond to this broad range of hormonally active chemicals in the environments. Just as "we are what we eat," these chemicals can become ingredients in the construction of breast tissue during the extended period of breast organogenesis (fetal development and adolescence), and can thus affect the foundation of our girls' future breast health. The process of breast development is uniquely sensitive to the formation of genetic abnormalities (mutations) that can lead to a higher risk of cancer later in life. And, even after the breasts are formed, they remain immature and highly active until the first full-term pregnancy when they finally mature completely and become capable of milk production.
Extra hormonal stimulation of breast cells over time can lead to unhealthy breast cell growth, including cancer. Immature breast tissue is particularly responsive to hormonally active substances and other environmental exposures (like radiation). In addition, with today's new patterns of early puberty and late or no first full-term pregnancy, the period of breast immaturity and heightened sensitivity to environmental influences extends much longer than it did a century ago. Onset of puberty starts about age of 9-10 today, whereas it was around age 14 last century.
The obesity epidemic further complicates this dire situation. Not only do worrisome chemicals dissolve and remain in fat tissue, but extra fat makes extra hormones that can lead to extra unhealthy breast cell growth. Obesity is also associated with inflammation, wearing down the immune system and impairing its ability to repair the wear and tear of every day living, including mutations in breast cells. One hundred years ago, we were working in chemical-free farm fields, eating mostly unprocessed foods, and obesity was uncommon.
More women and girls are drinking alcohol today, and they are drinking more of it. The more one drinks the higher the risk. And another recent report in the Journal of the National Cancer Institute confirms that smoking is associated with a higher risk of breast cancer, and many women still smoke. Women weren't drinking and smoking 100 years ago.
Given the inherent vulnerability of the breast and these dangers of modern life, the reality that breast cancer is the most common cancer to affect women and the disturbing news about more aggressive cancers in young women should really come as no surprise. Those of us in the trenches, taking care of these women, know this reality all too well. That's because we're the ones who have to share the devastating diagnoses with these women and their families. We're constantly on standby for new treatments that might help save their lives -- but two-thirds of the women 25 to 39 diagnosed with metastatic disease will die in five years. We know: we console their families and attend their funerals.
It's time for doctors and nurses to pull the alarm: too many women get breast cancer. We need to learn from our infectious disease colleagues. When major infectious diseases threaten, like MRSA, they go straight to the source: overutilization of antibiotics in medical practice and in raising livestock, leading to the selection of more virulent and resistant strains of bacteria. There is now this urgent mandate for doctors to curtail the prescription of antibiotics, but what are we doing about the farmers raising our food?
Breast cancer prevention is the only real solution to this problem. We need much more powerful risk reduction strategies. Only about 10 cents on the dollar currently go to breast cancer prevention research. With projects like Prioritizing Prevention, issued February 2013 by the Interagency Breast Cancer and Environmental Research Coordinating Committee, let's hope we will undertake the urgent progress required. Breastcancer.org has been leading the way in the educational sphere, debunking the pervasive myths that breast cancer only runs in families and there's nothing you can do to lower your risk. We are providing practical steps and effective tools to women and girls, showing them how they can lower their risks of breast cancer, now and hopefully forever.
Taking Responsibility for Breast Cancer Prevention
The good news is that breast health equals women's health. Women need to hear from their doctors that taking steps to lower their risk of breast cancer should be mandatory -- not optional. Health care professionals need to help their patients succeed at sustained weight management, regular physical activity, healthy eating, alcohol limitation, smoking cessation, utilization of non-hormonal methods of birth control and postmenopausal symptom management, and avoidance of unnecessary radiation exposure from tests and treatment especially in adolescents and young women. Keeping a full and accurate family history of cancer, and making appropriate referrals for genetic risk assessment, are also essential to helping women better understand their genetic risk.
Regarding chemicals in our environment, we need to abandon the current irresponsible default attitude: "chemical exposures in the environment are unlikely to be dangerous." Instead, doctors need to invoke the precautionary principle: it's better to be safe than sorry. We already have enough compelling epidemiologic and basic science data showing unhealthy effects of hormonally active chemicals on breast cell growth and behavior.
But even with the most diligent risk reduction efforts by women and girls assisted by their doctors, the safety of their food and water supply and personal care products is largely beyond their control. To make our food safer will require full participation of food producers and distributors to change how our food is grown, prepared and labeled. We want our beef and dairy products hormone free; meat, poultry and fish raised with quality feed without antibiotics; we want our vegetables, fruits, grains, nuts, coffee, tea and spices grown without supercharged pesticides. We want safe food and beverage containers and pots and pans that don't leach chemicals into our food, like bisphenol A and nonstick polymers. And, we want our water supply free of these contaminants. That requires active public awareness and government support. We must make our voices heard.
We can't sit back. In the three minutes that it took to read this piece, another woman was diagnosed with breast cancer.