The irony of Breast Cancer Awareness Month is that by the end of the month there was significantly more misunderstanding in the public about the disease. It would come as no surprise that women who listened to or read "news" reports throughout the month would believe they have a much higher risk of the disease than they actually do, and that as long as they take care of themselves and get regular mammograms, the disease could be found early and there would be a 98 percent chance of a cure. And if women want to avoid the disease all together they simply need to be vigilant about avoiding certain things in their lives, such as eating white rice or using certain cosmetics or cleaning products. None of it is true.
How many of you have been told to look around you and know that one in eight women you see will get breast cancer? Not so. Overall, a women's lifetime risk of developing cancer is about one in eight. That means that if a group of 100 women live until age 90, about 12 may develop breast cancer in their lifetime. Many women mistakenly believe that they have a one in eight risk every year. Others mistakenly interpret the statistic to mean that one in eight women have had a diagnosis of breast cancer.
During October, right here in The Huffington Post, I read that the way people can reduce their risk of getting breast cancer is to "avoid white rice, [and] white potatoes." Or to eat more broccoli or stop using mascara. The truth is, there are many unproven and uncertain risk factors for breast cancer cited in the media and among the public. There is no evidence that avoiding cosmetics or household cleaning products will have any impact on an individual's risk of developing breast cancer. There also is no evidence that avoiding the use of plastic water bottles or underarm anti-perspirants will actually lower the risk of breast cancer in women.
Most of these claims about avoiding exposures and decreasing breast cancer risk are based on research in laboratory animals, and have not been supported from data in human studies. For example, we have some clues from laboratory experiments on animals that certain chemicals found in some plastics (for example, bisphenol A (BPA)) might increase breast cancer risk, but we do not know if these clues tell us anything about human beings. More research in humans is needed to better define the possible health effects of these and similar substances. Of course, it is important to limit exposure to possible carcinogens whenever possible, while recognizing the limits of this approach in actually preventing breast cancer among individuals.
The overwhelming message about breast cancer during October is that it is curable if found early -- the five-year survival rate is 98 percent -- and that mammography screening is the means for finding it early. The reality is that mammography misses a significant number of lethal breast cancers, while leading to the over-diagnosis of non-threatening cancers. And most importantly, finding breast cancer early is no guarantee of avoiding death from the disease. Unfortunately, the fact is that five-year survival rates are not an accurate measure of the toll from breast cancer, as many women will experience recurrences and death beyond five years.
The unsettling truth is that we still do not know how to prevent recurrence and spread of the disease for most women, nor do we know how many women reported to have survived five years will go on to have a recurrence. Furthermore, the very screening that is promoted through the media so robustly during October greatly skews the five-year survival figures. The more screening there is, the more breast cancers are found. But it does not follow that more lives are saved. Because breast cancer can be slow-growing, finding breast cancer through screening mammography often increases the time women know they have breast cancer, but may not have any impact on final outcomes.
Too often, some in the media gravitate toward stories that are extremely hopeful, or extremely fearful. However, the truth often falls within the middle ground and in the small details. And it is rarely simple. Breast cancer is a complex issue that cannot be summarized into sound bites. As a result, the media sometimes gets the story right, but often they do not. So what should you do about it? You need to look at every piece of information with a critical eye. Find a resource you trust, someone who does research into claims, analyzes information and who doesn't have a stake in the outcome. Remember that with breast cancer, information changes. We invest in research to learn more and sometimes we learn that what we believed for years is no longer true.
This October, the National Breast Cancer Coalition made a decision to ramp up our work to change the conversation about breast cancer and help the public understand the reality of the disease. Because our take on breast cancer does not always fall into what would be categorized as "traditional thinking" but is based on science and evidence, we were challenged by some who prefer sound bites. It's not the first time we've been challenged. We have spent the past 20 years building our reputation of bringing evidence-based information about breast cancer to Washington, D.C. and state capitals, to laboratories and health care institutions, and to local communities everywhere. I'm proud of the reputation we've earned by challenging the status quo while doing our homework on the issues.
Breast Cancer Awareness Month 2011 is over. I am thankful. Really. With the celebratory spirit of the pink infusion, and all the news reports touting our progress in breast cancer, do not be misled. We need the truth and not the hype about breast cancer and we need it 12 months a year. It can be comfortable to simply pin on a pink ribbon and rely on the sound bites. But breast cancer is not comfortable. And ending it certainly requires that we take on the difficult, uncomfortable work of understanding the issues, challenging misinformation and recognizing that progress has been limited.
Misinformation is a distraction. It lulls the public into thinking we have the answers, that we know how to prevent breast cancer. It sends the wrong message that all we need to do is make certain everyone gets a mammogram and no one will die of the disease. And if we think we know, we won't look for the truth anymore. This year, 500,000 women around the world will die of breast cancer. We will never get to a different statistic -- to anywhere near zero -- if the public can not face the fact that we know so little and need to direct resources and research toward figuring out and answering the difficult truths. And comfort be damned.