How old is BCAM and how did it get started?

• In September 1991, five Montreal women with breast cancer formed a group to raise awareness of breast cancer issues, to advocate for better diagnosis, treatment and care; and to give women a voice in decisions about treatment, services, health policy and research. Originally formed as a non-profit organization, BCAM became a registered charity in February 1993 (retroactive to July 1992). In November 1994, it was incorporated and granted non-profit status in Quebec. The first Annual General Meeting was held in September 1995. (More history)

How is BCAM different from other breast cancer organizations?

• BCAM takes its inspiration from Breast Cancer Action, an organization in San Francisco that has been in existence since 1990. While applauding the accomplishments of other breast cancer organizations, BCAM is concerned that over 95% of the funds raised for research into breast cancer are devoted to improvements in screening and treatment, leaving very little for research into the causes of this disease. BCAM strives to put the spotlight on the reasons why breast cancer develops and why more and more women are being diagnosed. Our hope is that, one day, breast cancer can be stopped before it starts.

Why doesn’t BCAM accept contributions from pharmaceutical companies?

• In order to provide unbiased information about the primary prevention of breast cancer, its diagnosis and treatment, BCAM must be free of any appearance of conflict of interest. Accordingly, BCAM will not accept financial support from corporate entities whose products or services are known to BCAM to include cancer diagnosis or treatment. (For more information on this, see BCAM’s Policy on Corporate Contributions.)

What is the Precautionary Principle?

• The precautionary principle, a term in use since 1988, expresses the idea that “an ounce of prevention is worth a pound of cure.” In other words, if the consequences of an action are unknown, but are judged to have potential for major or irreversible negative consequences, then it is better to avoid that action. In practice, the principle is most often applied to considerations of the impact of new technology on the environment. (See more on the Science & Environmental Health Network)

How can we use the precautionary principle to protect our health?

• The precautionary principle comprises the following: Act now, even before definitive scientific proof of harm, to reduce and eliminate practices that are suspected to harm human health or the environment; Seek out alternatives to activities that pose a threat to human health or the environment; Shift the burden of proof so that those who make and profit from products and activities must prove that they are safe; Employ an open, informed and democratic process that involves affected communities in decisions being made about their health and their environment.
• You can use the precautionary principle in your home by switching to non-toxic cleaning products and safer body care products and by shopping organic. You can also reinforce the need for the precautionary principle in letters to the federal Ministers of Health and/or Public Health Agency of Canada. (Both can be addressed c/o the House of Commons, Ottawa, ON K1A 0A6. No stamp required.) Your letters should express the need for more stringent safety standards in cleaning and body care products, cosmetics, carpets and upholstery — products that contain potentially dangerous and untested chemicals. The intent is to shift the focus to “How can we prevent harm?” from the present risk-management strategy of “What level of harm is acceptable?” Bear in mind that the alarm was sounded about the dangers of smoking to health long before there was actual proof that it caused lung cancer and exacerbated the risks of many other diseases. Similarly, BCAM wishes to alert the public to the dangers of the thousands of environmental contaminants that threaten our health and the health of those around us. Read more about the precautionary principle at: www.TakingPrecaution.org

Why does BCAM discourage healthy women from taking tamoxifen to prevent breast cancer?

• As with other drugs, there are side effects to tamoxifen — risk of blood clots in the lungs, cancer of the lining of the uterus (endometrial cancer), and hot flashes. Nor do we know much about possible long-term effects of this drug. Although it has proved useful in reducing recurrence of breast cancer for women who have already had some experience with this disease, giving tamoxifen to women who have not had breast cancer, and who are not at particular risk, invites “disease substitution” — a condition induced while trying to avoid a disease. In other words, the benefits rarely outweigh the risks. As it stands now, women who take tamoxifen following surgery for breast cancer, are advised to discontinue the drug after a maximum of five years. If healthy women are given tamoxifen to prevent breast cancer, but go on to develop the disease, they may be immune to any benefits following initial treatment. Does tamoxifen merely delay the onset of cancer? How will taking it while healthy affect later treatment of the disease?

What is BCAM’s policy on mammography?

• Mammograms necessarily involve low-dose radiation and the effects are cumulative. Since radiation is a known cause of cancer, BCAM recommends that mammograms be kept to a minimum and advocates for the development of more effective, low-risk way of screening for breast cancer. Currently, the Canadian Cancer Society recommends mammography every two years for women aged 50 to 69. (In British Columbia, it is recommended starting at age 40.) It was long believed that cancers caught “early” (by mammography or by breast examination) were less likely to be fatal. It is now known that some cancers are more aggressive than others, and that the time of diagnosis or the size of the tumour may have little to do with long-term prospects. Moreover, thorough breast examinations (i.e., performed by a trained health professional and lasting up to ten minutes) have been demonstrated to be as effective as mammography. For all these reasons, BCAM believes that women should make their own decisions about regular mammography. There are difficult choices to be made but those women who do opt for regular mammograms deserve up-to-date machines, sensitive technicians and prompt results.

What is BCAM's policy on screening?

• Whether using breast self-exam, clinical breast exam—by a trained health professional—or mammography, there are serious issues of false positives and false negatives. Each screening method has its limitations. All options should be available to women. Furthermore, we believe that clinical breast exams should be part of the provincial screening program in Quebec.

How do I decide if Herceptin is right for me?

• Women who have been diagnosed with HER2 positive cancer may be offered Herceptin as part of a treatment plan. At BCAM, we can’t make recommendations about appropriate treatment — that is a decision to be made by each woman after a discussion with her breast cancer team. However, to help you ask the right questions of your doctor, here is some information about Herceptin:

  Herceptin (trastuzumab) is designed to combat the HER2 (human epidermal growth factor receptor 2) gene present in about one quarter of diagnosed breast cancers. This gene helps control how cells grow, divide, and repair themselves by directing the production of special proteins, called HER2 receptors. If the body produces too many copies of the HER2 gene or too many receptors, it may result in a more aggressive form of the disease. This means that HER2+ cancers may recur earlier than other forms of breast cancer and may not respond as well to standard therapies.

  Testing for the HER2 gene is done on tumour tissue and should ideally be performed at the time of diagnosis. Patients who wish to have their HER2 status checked should ask the physician to have this done at the time of biopsy or surgery, or on their stored tumour tissue.

  Currently, the cost of Herceptin is covered for all HER2+ tumours in British Columbia, Alberta, and Saskatchewan and on a case-by-case basis in Manitoba , Quebec, New Brunswick, and Newfoundland and Labrador. Some provinces may cover Herceptin for treatment of tumours that are 1 cm or greater.

  Herceptin is manufactured in the U.S. by Genentech, Inc., of San Francisco, and in Canada by Hoffman-Laroche (also known as Roche Canada) of Mississauga, Ontario.

  Herceptin is administered intravenously. Side effects commonly occurring during initial treatment include fever and/or chills and, less frequently, pain, weakness, nausea, vomiting, diarrhea, headaches, difficulty breathing, or rashes. These side effects generally become less severe after the first treatment.

  Long-term treatment with Herceptin can cause damage to the heart muscle and can lead to heart failure. Herceptin can also affect the lungs, causing severe or life-threatening breathing problems and/or allergic reactions. For this reason, women who might benefit from Herceptin should be evaluated very carefully before the medication is prescribed.

  In making your decision, we recommend that you read and/or ask your doctor about the information in the article “Adjuvant Trastuzumab in HER2-Positive Breast Cancer” by D. Slamon, W. Eiermann, N. Robert et al, in the New England Journal of Medicine (October 6, 2011; Vol. 365, No.14). The abstract follows:

  Background

  Trastuzumab improves survival in the adjuvant treatment of HER-positive breast cancer, although combined therapy with anthracycline-based regimens has been associated with cardiac toxicity. We wanted to evaluate the efficacy and safety of a new nonanthracycline regimen with trastuzumab.

  Methods

  We randomly assigned 3222 women with HER2-positive early-stage breast cancer to receive doxorubicin and cyclophosphamide followed by docetaxel every 3 weeks (AC-T), the same regimen plus 52 weeks of trastuzumab (AC-T plus trastuzumab), or docetaxel and carboplatin plus 52 weeks of trastuzumab (TCH). The primary study end point was disease-free survival. Secondary end points were overall survival and safety.

  Results

  At a median follow-up of 65 months, 656 events triggered this protocol-specified  analysis. The estimated disease-free survival rates at 5 years were 75% among patients receiving AC-T, 84% among those receiving AC-T plus trastuzumab, and 81% among those receiving TCH. Estimated rates of overall survival were 87%, 92%, and 91%, respectively. No significant differences in efficacy (disease-free or overall survival) were found between the two trastuzumab regimens, whereas both were superior to AC-T. The rates of congestive heart failure and cardiac dysfunction were significantly higher in the group receiving AC-T plus trastuzumab than in the TCH group (P<0.001). Eight cases of acute leukemia were reported: seven in the groups receiving the anthracycline-based regimens and one in the TCH group subsequent to receiving an anthracycline outside the study.

  Conclusions

  The addition of 1 year of adjuvant trastuzumab significantly improved disease-free and overall survival among women with HER2-positive breast cancer. The risk–benefit ratio favored the nonanthracycline TCH regimen over AC-T plus trastuzumab, given its similar efficacy, fewer acute toxic effects, and lower risks of cardiotoxicity and leukemia.

  (Funded by Sanofi-Aventis and Genentech; BCIRG-006 ClinicalTrials gov number, NCT00021255.)

What is the cancer industry?

• Cancer is now so prevalent that a whole industry revolves around it — not only health care providers and cancer clinics, but manufacturers of the machines, devices and tests used to detect or treat it, pharmaceutical companies that produce oncology drugs, advertising and public relations organizations, cancer research institutes, cancer funding agencies, etc. This “cancer industry” keeps thousands of people employed and pumps masses of money into the economy, all of which divert attention away from the need to find the causes of cancer. BCAM asks that you be particularly alert to drug companies that make money from cancer-treating drugs while also producing cancer-causing chemicals, to car manufacturers that loudly support cancer research while producing vehicles that spew cancer-causing emissions into our environment, and to cancer agencies that ignore or downplay the potential carcinogens in the thousands of environmental contaminants that surround us on a daily basis.

Where did Breast Cancer Awareness Month start?

• The designation of October as Breast Cancer Awareness Month began in 1984 and was promoted by the drug company — now called AstraZeneca — that manufactures tamoxifen. At one time, AstraZeneca was owned by ICI, a company that on the one hand, produced drugs to treat breast cancer and, on the other, profited from the sale of a cancer-causing herbicide. Nowadays, growing numbers of manufacturers and retailers urge you to buy products identified by a pink ribbon or to participate in activities in aid of breast cancer research. Generally very little information is available about the proportion of the sale price or the amount of the donation made or, indeed, about the kind of breast cancer research supported. The vast majority of money intended for breast cancer research will fund improvements in detection or treatment. BCAM recommends that you ask questions before buying any pink ribbon product or participating in pink-ribbon-marked events. BCAM further recommends that you donate directly to a breast cancer research organization while stipulating that your money be used for research into the causes of breast cancer. Read Profits in Pink.

Where did the pink ribbon come from?

• In the early 1990s, an American grandmother, Charlotte Haley, began making peach ribbons by hand in her home. Her daughter, sister and grandmother all had breast cancer. She personally distributed thousands of ribbons with cards that read: “The National Cancer Institute annual budget is $1.8 billion. Only 5 percent goes for cancer prevention. Help us wake up our legislators and America by wearing this ribbon.” Executives from the cosmetic giant, Estée Lauder, and Self magazine asked Haley for permission to use her ribbon. Haley refused, saying that her ribbon was not to be commercialized. So the decision was made to go with another colour and pink was chosen. Charlotte Haley’s peach ribbon was eclipsed by the PR machine of the pink ribbon which has now become a recognized symbol for breast cancer. The pink ribbon has proliferated. Attaching it to a product enhances the image of the manufacturer, retailer or sponsor. They make money mostly for themselves and express very little interest in what happens to the small portion that goes to breast cancer agencies. (See more at Profits in Pink.)

Should I buy this pink ribbon product? Who benefits from your purchase?

• How much money goes towards breast cancer programs and services? (Is it a proportion of the sale price? If so, what proportion? Or does the manufacturer/retailer donate a fixed amount for each sale?) What kind of product is involved? (Cosmetics may contain carcinogens or potential carcinogens. Ditto for household cleaning products. Be alert to this kind of double-dealing.) Don’t be exploited by companies that make themselves look good at your expense. What kind of research will be supported? Is the money going to a Foundation that funds programs in other communities, but not yours? Will the donation swell the amount going to research into detection and treatment while research into the causes of breast cancer goes begging?

Why is BCAM skeptical of pink ribbon causes?

• (This full length report on this issue is available here.) Breast cancer has become the darling of corporate Canada. From yogurt lids to motor vehicles, the pink breast cancer 'awareness' ribbon is showing up on more and more products. Breast cancer is an easy disease to market since everyone loves to think about, talk about, and look at breasts. Marketing it is even easier when it is seen as a feminist issue — without the politics.
• In the summer and fall of 2004, as an intern with Breast Cancer Action Montreal, I looked into the nature of breast cancer cause marketing in Canada. I found layer after pink layer of marketing campaigns, both national and local, in the search for transparency, accountability, corporate awareness of the breast cancer issues being supported, and potential conflict of interest. The results left me anything but tickled pink.
• What exactly is breast cancer cause marketing? Tri-Marketing, an on-line Canadian marketing and publicity firm, defines cause marketing as "a partnership between a for-profit company and a non-profit organization which increases the company's sales while raising money and visibility for the cause."¹ Note that, in almost all breast cancer cause marketing campaigns, it is the consumers' money that raises funds for the cause, not the corporation. The corporation uses the pink ribbon to grab consumers' attention and money while attracting a little more visibility for the cause.
• Yoplait splashes the pink ribbon on the lids of their yogurt pots. However, it is up to the consumer to mail the lids to Yoplait before the company donates ten cents to the Canadian Breast Cancer Foundation. This is a lot of effort (and postage) from the consumer. Most consumers will purchase the product because of the pink ribbon, and then throw out the lid. Cause marketing uses the disease to attract the sympathy of consumers and to get their products to the cash register.
• How much money is being raised through cause marketing — and is it being well spent? These are impossible questions, not only because of the large (and growing) numbers of corporations jumping on the breast cancer bandwagon but also because the money side of breast cancer cause marketing transactions is often explicitly confidential.
• Belvedere International, a company that manufactures health and beauty products, puts a pink ribbon on its Down Under Natural's, Salon Mode, Nature's Basics, and European Formula products. However, Belvedere refuses to disclose the portion of the sales of these products earmarked to breast cancer research, nor will they disclose what specific breast cancer efforts these funds support. Is it because they simply don't know.
• There are other examples: Chatelaine/Flare Magazine claims to be "committed to raising awareness for breast cancer"² but they have a strict confidentiality agreement with the Canadian Breast Cancer Foundation and will not disclose any information, financial or otherwise, about their sponsorship. This lack of transparency naturally raises questions: If they are doing good works, why would they hide this information? The problem is compounded by the fact that corporations are not accountable for how these monies are used.
• Clearly, money is being made for breast cancer research. But most of this money is directed to already wealthy organizations; organizations known to be conservative in their approach to breast cancer issues and often with troubling ties to major pharmaceutical companies and/or corporations whose products contribute to the incidence of breast cancer.
• A probe into breast cancer cause marketing issues reveals conflicts of interest or 'two-timing' corporations. The wealthiest and most visible breast cancer charities rarely mention crucial issues such as primary prevention (stopping breast cancer before it starts) or potential environmental links to breast cancer. It forces one to speculate that perhaps these issues are being ignored because the environmental toxins that lodge in the fatty tissue of our breasts can be traced to 'pink ribbon' face creams from our local pharmacy.
• We all know Johnson & Johnson, and this brand supports both the Canadian Breast Cancer Foundation and Quebec Breast Cancer Foundation. Although Johnson & Johnson never replied to my inquiries into their cause marketing campaign, some information is available elsewhere. The 'Skin Deep' section of the Environmental Working Group's website³ tests popular products for toxins, possible carcinogens and other health risks. Of the 42 Johnson & Johnson products tested, seven contained possible human carcinogens (and posed a cancer risk), 18 contained impurities linked with breast cancer, and 29 contained impurities linked with other cancers and/or possible human carcinogens. (The numbers don't add up because often the products fit into two or more categories.). Thirty-three of the 42 Johnson & Johnson products tested are intended for use on babies.
• Ford is another example of a two-timing corporation. Ford is a major sponsor of the CIBC's "Run for the Cure." Ford's internal combustion engines, like all internal combustion engines produce 1,3 butadiene and polycyclic aromatic hydrocarbons (PAH's), toxins linked to breast cancer incidence. In cases like these, breast cancer cause marketing seems more like damage control than philanthropy.
• As mentioned above, primary prevention is an approach significantly lacking in the literature issued by wealthy breast cancer charities involved in cause marketing. This may well be due to the conflict of interest deriving from funds received from major pharmaceutical companies. An example is AstraZeneca, the maker of tamoxifen, the initiator of National Breast Cancer Awareness Month, and supporter of the Quebec Breast Cancer Foundation and Willow Breast Cancer and Support Resources Services (in Ontario). The AstraZeneca company, formerly known as Zeneca, was originally owned by Imperial Chemical Industries, a multibillion-dollar producer of pesticides, paper, and plastics. Along with tamoxifen, Zeneca produced fungicides and herbicides including the carcinogen, acetochlor. Its Perry, Ohio, chemical plant is the third-largest source of potential cancer-causing pollution in the United States.⁴ Major international breast cancer awareness events like National Breast Cancer Awareness Month turn a blind eye to primary prevention issues because any discussion of the causes of breast cancer would necessarily focus on companies like AstraZeneca —major producers of potentially carcinogenic and certainly harmful environmental toxins.
• With so much information purposely hidden from the public concerning questionable corporate involvement in the development of breast cancer (such as AstraZeneca's), it is not surprising that the issue of primary prevention receives so little attention. In fact, less than 5% of all monies spent on breast cancer research goes toward true primary prevention.⁵ By not asking where their money goes or how it is spent, firms involved in breast cancer cause marketing contribute significantly to this appalling situation. Instead of thinking of toxins in relation to environmental aspects of breast cancer, the focus is kept on the woman herself. She is told to quit smoking, to keep alcoholic consumption to a minimum, to exercise, to eat low-fat foods, to perform breast self-examinations and to book regular mammograms. These are ways to maintain general health, but none will prevent the disease. A major problem with this imbalance is that, if a woman gets breast cancer, she may believe that it is her own fault. And this attitude is widespread.
• For example, WonderBra is including two million manuals on breast self-examination with their products. According to the company, this 'You've Got the Power' campaign helps connect Canadian women to the Canadian Breast Cancer Foundation, while empowering them to take responsibility for their own breast health".⁶
• No woman (or man) can be held completely responsible for her/his own health; there are millions of factors that influence our bodies' behaviour over which we currently have little or no control. Corporations like AstraZeneca, Johnson & Johnson and Ford produce toxin-containing products that are absorbed into our bodies no matter how many times we run around the block. Breast cancer is a public health issue, and not merely a personal battle.
• This is just a peek behind the pink façade but it reveals a plethora of pink ribbon bruises and blues. The current context of breast cancer cause marketing in Canada is lacking in transparency, accountability, a feminist agenda and a public health perspective. Corporate interests are 'pinkwashing' away the political issues that become clear with a little probing. Unfortunately our purchases cannot sweep away the disease, no matter what breast cancer cause marketing would have us believe. What we can do is sing our pink ribbon blues, to corporations and to breast cancer charities, loud and clear.
• Ways to sing the pink ribbon blues: Get informed. Find out more about breast cancer issues and research. Ask critical questions. Email or telephone a corporation involved in breast cancer cause marketing and ask basic questions about what they contribute, to whom and why. Challenge the company to make an informed and private donation that will benefit an issue that is important to the members of the corporation, rather than putting a pink ribbon on a product to increase sales. Talk to your friends. If you know someone who is interested in breast cancer issues, spread the word about the problems with breast cancer cause marketing. Support your cause. Instead of giving to questionable corporations for an unknown and distant breast cancer effort, why not donate directly to a research project or breast cancer organization that you think is important and has meaning to you? Inform your Breast Cancer Foundation. If you think your breast cancer foundation is too heavily involved with questionable corporate cause marketing, tell them. Get involved. Contact Breast Cancer Action Montreal (www.bcam.qc.ca) for ways to make a difference.
• Sources 1. http://www.nonprofits.org/npofaq/08/19. html, last retrieved March 29, 2005 2."National Run Sponsors," The Canadian Breast Cancer Foundation, available from http://www.cbcf.org/corp/sponsors.html last accessed September 14, 2004. 3. www.ewg.org
  4. Sharon Batt and Liza Gross, "Cancer Inc." Sierra Club, 2000, available online at: http://www.sierraclub.org/sierra/199909/cancer.asp, last retrieved September 16, 2004 5. www.bcam.qc.ca, last retrieved March 3, 2005. 6. www.cbcf.org/corp/partners.html accessed September 16, 2004, emphasis mine

What does BCAM think about the various fundraising runs/walks for breast cancer?

• Before you support a fundraising event, either by participating yourself or by sponsoring someone else, ask where the money is going. This means not only how much of the money is going to the cause, but also what kinds of programs or research are being supported. If an adequate answer is not forthcoming, or if you don’t like the answer, BCAM suggests you make a donation directly to an organization whose work you support.

I’ve been asked to click for a mammogram. Is this a good idea?

• The click for a mammogram website is offered by The Breast Cancer Site which, in turn, offers advertising plans to their sponsors. This is an American site and, according to our sister organization, Breast Cancer Action San Francisco, it takes over 18,000 clicks to pay for one mammogram. The money generated from the advertisers is sent to the National Breast Cancer Foundation in the U.S. The NBCF, in turn, grants money through designated programs. Whether these programs actually fund mammograms is not disclosed. The problem with any campaign to increase detection of breast cancer is what then? What if an American woman who cannot afford a mammogram (presumably because of a lack of medical insurance) is diagnosed with breast cancer? Who will pay for her treatment?

What environmental factors are linked to breast cancer?

• A significant body of evidence suggests that synthetic chemicals in the environment must be factored in as possible causes of breast cancer. The evidence includes, but is by no means restricted to:
• The Women’s Health Initiative trial, a study discontinued in 2002 when postmenopausal hormone replacement therapy (estrogen + progestins) was found to cause a 26 percent increased risk of breast cancer;
• A study from Duke Comprehensive Cancer Center establishing that ethylene glycol methyl ether (EGME) — found in varnishes, paints, dyes, fuel additives — can boost the activity of estrogens and progestins inside cells by 8- to 10-fold;
• The Long Island Breast Cancer Study Project implicating polycyclic aromatic hydrocarbons (PAHs) — found in tobacco smoke, soot, diesel exhaust and smoked or grilled foods — as a risk factor for breast cancer; — the fact that daughters of women who were administered diethylstilbestrol (DES) during pregnancy are at increased risk of breast cancer;
• Research from the University of California at Berkeley that found that a 10-fold increase in dioxin levels more than doubled the risk of breast cancer. [Dioxin is an endocrine- (hormone-) disrupting chemical linked to several types of cancer as well as to birth defects, learning disabilities, and suppression of the immune system. It is found everywhere.] — researchers evaluating data on breast cancer incidence from the Nurses’ Health Study concluded that the study of PCB exposure in genetically susceptible women warrants serious investigation. [Although banned, PCBs persist in the environment and have been implicated in many forms of cancer.]
• Two Swedish studies concluded not only that environmental factors play a more important role than genetic inheritance in the origin of most cancers, but that this risk is largely established during the first 20 years of life. 
• A report from the University of Massachusetts Amherst concludes that “The sum of the evidence ... justifies urgent acceleration of policy efforts to prevent carcinogenic exposures. ... To ignore the scientific evidence is to knowingly permit tens of thousands of unnecessary illnesses and deaths each year.” (Executive Summary) Note: the link for this reference is no longer valid. You may visit the site using this link. 70 percent of people with breast cancer have none of the known risk factors. The so-called known risk factors, like late menopause, having children late in life, and family history of cancer are present in only 30 percent of breast cancer cases;non-industrialized countries have lower breast cancer rates than industrialized countries. People who move to industrialized countries from countries with low rates develop the same breast cancer rates of the industrialized country; ionizing radiation from x-rays and nuclear waste is a proven cause of breast cancer;weed killers and pesticides (banned in some regions) are recognized as unsafe and can be tracked into the house on the soles of shoes and can remain in carpet fibres for years. Products used on household pets — insecticidal flea collars, sprays, dusts, shampoos, and dips also contain unsafe chemicals. Breast cancer rates continue to rise around the world and, within this broad demographic picture, there is a discernible relationship between the rates of breast cancer and the widespread use of man-made chemicals. For more, see State of the Evidence: The Connection Between the Environment and Breast Cancer.

I’m interested in organic foods. What should I look for?

• More and more consumers are asking for organic foods and supermarkets are responding — as are special ecologically-friendly outposts in major cities. In many centres, organic farmers will often deliver baskets of seasonal produce to a central depot where it can be picked up on a regular basis.
• Certain foods are more consistently contaminated with pesticides than others. The U.S.-based Environmental Working Group provides lists of ‘best’ and ‘worst’ foods based on the results of tests on pesticides in produce. Fruits and vegetables most likely to have pesticide residue are strawberries, raspberries, apples, peppers of all kinds, peaches, nectarines, pears, cherries, imported grapes, spinach, celery, and potatoes. Fruits and vegetables least likely to have pesticide residue are sweet corn, avocado, cauliflower, asparagus, onions, peas, broccoli, pineapples, mangoes, bananas, kiwi and papaya.
• Non-organic fish, meat, poultry and dairy products are a major source of pesticides, hormones, and other chemicals in our diet. Organic fish are either wild, or farmed fish free of antibiotics, likely fed organic feed and given a little more swim room. Only two nations in the world, Scotland and Ireland, certify organic fish. Check the website of Environmental Defense for best and worst choices in buying fish and seafood.
• Butchers that carry only hormone- and antibiotic-free meats, including poultry, are becoming easier to find although their wares are not nearly as affordable as fish or produce. Because environmental contaminants tend to lodge in the fatty tissue of the body, meat and dairy products are often highly suspect in adding to our “body burden” of toxic chemicals.
• Reducing our dependence on meat can have healthy consequences. Buying organic not only reduces our exposure to pesticides and unwanted hormones, but encourages this kind of farming — a kind of farming that is healthier for farm workers. More information is available in State of the Evidence: The Connection Between the Environment and Breast Cancer.

What non-toxic alternatives can I use to clean my house?

• Common cleaning products and other household products are rarely tested for safety and are known to contain chemicals that are unhealthy for both the individual and the environment. Safe and simple substitutes are ammonia, borax, vinegar, and baking soda. For more, see the EnviroSense Fact Sheet

Why shouldn’t I use plastic in the microwave?

• It is well recognized that lifetime exposure to estrogen has an impact on breast cancer risk. Aside from the small proportion of women who inherit a breast cancer gene, almost all of the established breast cancer risk factors — early onset of menarche (first menstrual period), late menopause, late or no childbirth — are linked to lifetime exposure to estrogen. Some compounds — DEHA (diethylhexyladepate), phthalates, and bisphenol-A — that are added to plastics to make them soft, mimic the hormone estrogen when they enter the body. These compounds can also leach from plastic into food when heated to microwave temperatures. Although we have no absolute proof that these have negative effects, it is just one more way that dangerous chemicals can affect us. (See the question about antiperspirants.) The problem is that even small amounts, when added to the other estrogen-like chemicals in our environment, could have cumulative effects. BCAM recommends that, when cooking or heating food in the microwave, you use ceramic or glass cookware.

Are antiperspirants linked to breast cancer?

• Parabens — a chemical preservative commonly used in cosmetics and body-care products — have been found in samples of breast cancer tumours. This demonstrates that parabens can be absorbed through the skin from frequently applied products such as antiperspirants and creams, and can persist and accumulate in breast tissue in their original form. Parabens and phthalates are two kinds of chemicals that are often used in cosmetics and body care products. They have been banned from products sold in the European Union but they are still commonly found in products available in North America. Although most major cosmetics companies claim their products are safe, 89 percent of the 10,500 ingredients used in products sold in the U.S. have not been assessed for safety, according to the Food & Drug Administration. No such statistic exists for Canada. As of November 16, 2006, Canada will require ingredient disclosure on cosmetics or personal care products. For more information check out Skin Deep or the Safer Products Project.

Are underwire bras linked to breast cancer?

• There are no scientifically valid studies that show a correlation between wearing bras of any type and the occurrence of breast cancer. Two anthropologists made this association in a book called Dressed to Kill. Their study was not conducted according to standard principles of reliable research and did not take into consideration any of the known risk factors for breast cancer. There is no other, credible research to validate this claim in any way.

I’m newly diagnosed, what should I do?

• Never feel pressured to make a decision quickly — you have the right to take the time you need to think about your options and come to the decision that is right for you. Don’t be afraid to ask for help, from friends and from your doctor. If you don’t understand something your doctor says, keep asking questions. Remember that it’s not your fault that you have breast cancer and it is not a death sentence. There are millions of women today living with breast cancer. We recommend Dr. Susan Love’s Breast Book and her website as excellent resources on all aspects of breast health and breast cancer.

My friend or family member was just diagnosed, what can I do?

• A true friend will allot as much time as possible to support the person dealing with this diagnosis. Sometimes it is worth seeking a second opinion. Perhaps this is such a situation. In any case, there will be tough decisions to make and the possibility of demanding treatment. Your primary role is as a sympathetic listener but you can add to this role by doing research about the options, going with your friend or family member to appointments and taking notes for her, asking the questions that she forgets to ask. Don’t give advice unless you’re asked for it. There are also more tangible ways in which to help — providing meals, doing laundry, running errands. (With thanks for this response to Breast Cancer Action San Francisco.)

What books do you recommend reading to learn more about breast cancer?

• For newly diagnosed women we recommend Dr. Susan Love’s Breast Book for its detailed and easy-to-read description of all aspects of breast cancer. For those interested in environmental links to cancer, we recommend the well-researched and beautifully-written Living Downstream: An Ecologist Looks at Cancer and the Environment by Sandra Steingraber, as well as her more recent book, Having Faith. Patient No More by Sharon Batt (a founder of BCAM) offers an incisive analysis of the politics of breast cancer and the grassroots activism that has challenged the cancer industry and is one of the most important breast cancer texts in print. More books

How can I tell if I have breast cancer?

• You probably can’t. The most common sign of breast cancer is a lump in the breast or chest, but most lumps aren’t cancerous. In younger (premenopausal) women, only 12 percent of reported lumps turn out to be cancer. But you can’t tell whether a lump is cancer by the way it feels. Any new lumps, or a thickening of the breast, should be checked by a doctor as soon as possible. A diagnostic mammogram may help, but the only way to tell if breast cancer is present is to have a biopsy. This involves removing part of the lump to check for cancerous cells. Another source of alarm may be breast pain. Most breast pain occurs on a monthly basis, can be related to fluctuating hormone levels during the menstrual cycle, and is rarely serious. Pain that is not cyclical and is in one particular area may be a sign of cancer but chances are it has nothing to do with cancer. However, it may be worth checking out with your doctor or a specialist. Pain that occurs deep in the middle of the chest may be arthritis or may be referred pain from another part of the body. Other signs of breast cancer can be redness of the skin of the breast, a rash on a nipple, or dimpling of the skin. No matter what the changes, if it worries you, get it checked. Better to be sure than to worry for nothing.

What is inflammatory breast cancer?

• Inflammatory breast cancer (IBC), the most aggressive form of breast cancer, afflicts less than 6 percent of all women diagnosed, and it looks and acts differently from other forms of breast cancer. The first signs of IBC are usually visual: the breast becomes red, swollen, warm, and looks infected. In some instances, the skin around the breast will begin to pucker or to develop dimples — like the skin of an orange — and the nipple will retract and lay flat against the breast. Swollen lymph nodes under the arm or above the collarbone are another symptom of IBC. Because these symptoms are similar to those of a breast infection called mastitis, doctors will first try to treat the signs of infection with antibiotics. If the antibiotics don’t cure the infection within a week, the doctor will then do a punch biopsy of the skin to see if cancer cells are present. Because mastitis is much more common than IBC, it would not make sense to biopsy all women who have a red breast or swollen lymph nodes. IBC can spread rapidly from the breast to the lymph nodes and it quickly metastasizes (spreads to other parts of the body). In fact, because IBC is so aggressive, it usually has metastasized by the time it has been diagnosed. Treatment for IBC begins with chemotherapy, which is followed by surgery and radiation. For more information, including pictures, personal stories, and links, visit the Inflammatory Breast Cancer Research Foundation

What is Paget’s Disease of the breast?

• According to Dr. Susan Love’s Breast Book (3d ed.), pp. 403-404: “Paget’s disease of the breast is a form of breast cancer that shows up in the nipple as an itchiness and scaling that doesn’t get better. It’s often mistaken for eczema of the nipple - a far more common occurrence. Paget’s disease is almost never found in both breasts so, if you’ve got itching and scaling on both nipples, you’ve probably got a fairly harmless skin condition. However, if it doesn’t get better, you should check it out, whether it’s on one or both nipples. After a diagnostic mammogram, your doctor can biopsy the skin of the nipple, removing only about a millimeter or two of skin. If it’s Paget’s, the pathologist will see little cancer cells growing up into the skin of the nipple. “There are probably two variants of Paget’s disease: one associated with an invasive cancer in the breast and one that involves only the nipple. Paget’s disease that involves only the nipple has a better prognosis than regular breast cancer. It tends not to be too aggressive, and usually the lymph nodes turn out to be negative.” Like any other change in the breast, a change in the nipple should not be ignored. If you feel that you are not being given the treatment you deserve, speak up.

What are aromatase inhibitors?

• Aromatase inhibitors reduce estrogen by blocking an enzyme called aromatase and keeping it from converting androgens into estrogen. Both pre-and postmenopausal women can use tamoxifen as hormonal therapy. But only postmenopausal women can use an aromatase inhibitor. That’s because the ovaries of postmenopausal women no longer produce significant amounts of estrogen so they get most of their estrogen from the conversion of androgens into estrogen by the aromatase enzyme, while premenopausal women get most of their estrogen directly from their ovaries
• Breast tumours can either be sensitive to estrogen (ER-positive), sensitive to progesterone (PR-positive), sensitive to both (ER-positive/PR-positive), or to neither (ER-negative /PR-negative). If a woman’s tumour is hormone-positive (ER-positive or PR-positive), some type of hormonal therapy may slow or stop the growth of the cancer.
• Until fairly recently, surgery was employed to reduce hormones in the system — either removing the ovaries of pre-menopausal women or removing the adrenal glands in postmenopausal women. In an effort to alter the hormonal milieu, a number of drugs have also been used to change the hormonal milieu and treat women with metastatic disease — including synthetic estrogens, synthetic progesterones, and a synthetic testosterone.
• Nowadays, it is recommended that most postmenopausal women be treated with an aromatase inhibitor, either anastrozole (Arimidex), letrozole (Femara) or exemestane (Aromasin). This means that tamoxifen, which first began to be used in the 1980s, is no longer the standard of care for postmenopausal women. Tamoxifen does, however, remain very important for premenopausal women. Arimidex and Femara are approved for postmenopausal women with hormone receptor-positive breast cancer and are usually administered following surgery. They may also be used as a second- or third-line treatment after another hormonal therapy has stopped working. Aromasin is a steroidal aromatase inactivator, able to stop the aromatase enzyme’s production process permanently and is called an irreversible aromatase inhibitor. It is currently only approved for use as a second- or third-line treatment in postmenopausal women whose tumours no longer respond to tamoxifen

What is ductal carcinoma in situ (DCIS)?

• Ductal carcinoma in situ (DCIS) refers to the most common type of noninvasive breast cancer. DCIS is confined to milk ducts in the breast and abnormal cells have not spread into the fatty breast tissue or the lymph nodes. Often detected by mammography, DCIS may appear as specks of calcium, called microcalcifications. Suspected DCIS is confirmed by a breast biopsy, in which a small sample of tissue is removed for examination under a microscope. This may use fine needle aspiration or wide needle excision. DCIS can, however become invasive if not treated. This happens in less than half of diagnosed cases. The problem is that current technology cannot determine whether it will become invasive or not. Chances are that many women have DCIS and don’t know it, living out their life span in blissful ignorance. Women who are diagnosed with DCIS may be advised to have a mastectomy, lumpectomy, lumpectomy followed by radiation, or simply “watchful waiting” to see whether and how the DCIS progresses. The decisions have to do with the oncologist and with the woman’s method of dealing with uncertainty. The cure rate for DCIS is close to 100% and a diagnosis is not considered an emergency medical situation. Women have time to weigh possible treatment options before making a decision.

What are microcalcifications?

• Microcalcifications are tiny calcium deposits in the breast, the detritus of dead cells. They may indicate cancer, even when no lump is felt. Four out of five cases of microcalcification are found to be benign; these are usually large, few in number, scattered and round in shape. Microcalcifications associated with malignancy are usually more numerous, clustered, and shaped differently (rods, branches, teardrops). There are also calcifications that fit somewhere between these two, often labelled “indeterminate.” If calcifications are considered benign, the woman will be asked to have a mammogram on a regular basis (usually annually or biannually). If the microcalcifications are considered suspicious, a fine needle biopsy or a wide needle (stereotactic) biopsy is recommended. The tissue will be examined for cancer cells and recommendations for treatment will be based on these findings. 

Why do some women consider themselves cured of breast cancer?

• The word “cure” is used very loosely nowadays, usually based on 5-year survival rates. The risk of recurrence of breast cancer is greatest in the first two years after diagnosis, and 19 out of 20 women diagnosed by mammography are alive five years after their initial diagnosis. Many women who have experienced breast cancer live to a ripe old age and die of something else but, as most of us know, being free of cancer five years after treatment is not a guarantee against recurrence.

How much radiation does a mammogram involve?

• A single view dose of radiation should not exceed 0.3 centi-grays (cGy) or 0.3 rad (radiation absorbed dose). A rad used to be the scientific unit for ionizing radiation; it is now being replaced by the gray, which is 100 times a rad. A standard mammogram consists of two views per breast, although women with particularly big breasts may require three or four. Because radiation is a known cause of cancer, and because there are cumulative effects, BCAM recommends that you take seriously any decision to be X-rayed, mammography included. The risk of harm from radiation is highest in tissue where cells are rapidly changing, such as the growing breast tissue of adolescent females, but there is continuing growth in the breasts of women to the age of 35, as well as changes induced by menstruation and breastfeeding. Mammography screening continues to be a subject of controversy, particularly with respect to its use among premenopausal women and its advocacy by those who prefer to ignore its documented disadvantages.

Why does BCAM say mammograms aren’t prevention?

• (verbatim from BCA) “Prevention” means to keep something from happening while “detection” means to discover something that has already happened. By the time a mammogram detects breast cancer, it has been growing for seven to ten years. True prevention of breast cancer means understanding and eliminating the causes of the disease so that people don’t develop it at all.

How can I find a doctor who practices alternative medicine?

• The best way to find a competent practitioner of alternative medicine is probably by word of mouth. Anyone can call him/herself a naturopath, homeopath, acupuncturist, osteopath or nutritionist but this does not mean that they are accredited. This is definitely an area where “caveat emptor” (let the buyer beware) is too, too true.
• The occupations of naturopath and naturopathic doctor are regulated at the provincial level only in B.C., Saskatchewan, Manitoba, and Ontario. In other provinces, you need to inquire about a person’s training and experience. The Canadian College of Naturopathic Medicine keeps a registry. Most naturopaths, whether trained at recognized schools in North America, or in Europe, are also qualified to practice homeopathy. The Dietitians of Canada has a list of registered dietitians to advise about nutrition. Osteopathy is an American specialty but the Medical Council of Canada has recently agreed to issue a Canadian Licentiate to osteopaths who complete 12 months of postgraduate supervised training in this country. A qualified acupuncturist usually has at least three years of training but there are only three acupuncture schools in Canada, all in BC. The website www.aworldofacupuncture.com suggests how to go about seeking a qualified acupuncturist.

Should I have genetic testing done to find out if I have the breast cancer gene?

• The benefit of genetic testing is that it can soothe concerns about abnormal risks of developing breast cancer. Most women who seek genetic testing have a strong family history of the disease, but even if she is one of the 5 to 10 percent of women with a hereditary form of the disease, she may not have an inherited genetic mutation — BRCA-1 or BRCA-2 The drawback to genetic testing is that there is no universal solution when someone receives a positive result. “Breast cancer genes” do not absolutely dictate the development of breast cancer; they mean that you are at much greater risk than a woman without these genes. Some women elect to be followed more closely (i.e., have mammograms and/or clinical breast exams more often); others elect to have their breasts removed. But even prophylactic mastectomy is not a guarantee, because not all breast tissue can be removed. How to handle the situation remains a difficult and very individual decision.

How do I know if a new medical breakthrough is really important?

• Over the last decade or so, pharmaceutical companies have been jockeying for position in the marketplace. This has too often meant cutting corners — halting trials of promising drugs to announce positive results (often prematurely), or trumpeting the introduction of new drugs that are virtually no improvement over existing medications (but are often more expensive). For those who follow developments in breast cancer treatment, it doesn’t take long to build up a healthy case of skepticism about such “breakthroughs.” The best course of action is to ask questions about the initial report* and then pay attention to the follow-up — letters to the editor, small articles that temper or refute the original claims, articles that corroborate claims made in the first report, internet sites that provide more objective information — until you get a more balanced story. *How big was the study? How long did it last? Who funded it? How was it designed? (It helps to know the advantages and drawbacks to case-control studies, cross-sectional surveys, cohort studies, crossover designs, and randomized controlled trials. This latter is the gold standard. It is also worth considering who will benefit from the results. (See www.cebm.net/index.aspx?o=1001)

Aren’t breast cancer rates increasing simply because more women are being screened?

• It’s true that, for a long time, breast cancer was treated as a secret, often a shameful secret. Then, in the mid-1970s, a number of high profile women announced that they had breast cancer and urged other women to get mammograms. At this point, there was a sharp rise in diagnosed cases but, as mammography became more acceptable and more routine, this “bump” in diagnosed cases smoothed out. In fact, the incidence of breast cancer was rising long before it “came out of the closet” and it continues to rise despite the fact that there has been no surge in mammography in the last few years.

We often hear that One in 9 Canadian women will develop breast cancer. What does this mean?

• It means that, if all women lived to age 85, one out of every 9 would develop breast cancer sometime in her life. The one in nine number is calculated by adding up the risk for each age group and dividing by the average number of years a woman lives. It does not mean that, in any group of nine women, one will have breast cancer — although it may sometimes seem like that. When calculating individual risk, age is an important factor. The risk between ages 35 and 39 is about one in 1,500. At age 75, the risk is about one in slightly more than 200. The one in 9 has proven useful to alert women to the possibility of breast cancer but it is not an accurate measure of any individual woman’s risk. (In 2011, an estimated 23,400 women will be diagnosed with breast cancer and 5,100 will die of it.)

How many men get breast cancer?

• In 2011, an estimated 190 men will be diagnosed with breast cancer, and 55 will die of it.