Thursday, October 21, 2010

The not so rosy side of breast cancer pink ribbons

National Breast Cancer Awareness month celebrates its 26th anniversary this year, and pink seems to be everywhere. Even football players are wearing pink. Have you ever wondered how this campaign began and what impact it is actually having on the prevention of breast cancer? Personally, I didn't give it much thought, that is until I was diagnosed with breast cancer. Before then, I rather naively assumed that anything pink was linked to a benevolent organization that was supporting the critical research needed to prevent the disease. That's why it came as a total surprise to realize that when it comes to the pink movement it seems there's a whole lot of gray.

Before I get to the gray, here's a brief history of the pink. Back in 1985, National Breast Cancer Awareness Month (NBCAM) was organized through the sponsorship of Astra Zeneca, a pharmaceutical company, the American Academy of Family Physicians, a medical society, and CancerCare, Inc., a non-profit. More on this later, suffice to say for now that their purpose in forming NBCAM was to "promote breast cancer awareness, share information on the disease and provide greater access to screening services." NBCAM's initial week long event spawned what is now an internationally recognized month devoted to breast cancer awareness.

On to the story of how breast cancer awareness became wrapped up in a pink ribbon. In the early 1990's, activist Charlotte Haley was inspired by the yellow ribbons tied on trees to honor American soldiers. She decided to make peach ribbons in her home and distribute them in an effort to raise public awareness about the National Cancer Institute's small percentage (5%) of their then $1.8 billion budget going towards cancer prevention.  Her efforts caught the attention of Estee Lauder and Self Magazine executives. They contacted Charlotte about joining her efforts.  She refused saying they were "too commercial". The attorneys at Self Magazine suggested that the color of the ribbon be changed in order for Self to use the concept. That's when the pink ribbon began to be associated with breast cancer, and shortly after Avon began their breast cancer cause related marketing campaign. 

Now, there is absolutely nothing wrong with pink ribbons, or raising money for cancer research, or providing greater access to mammography for the under or uninsured. When done altruistically, these are extraordinary  things. What is disconcerting is when pink ribbons are used to boost a company's profits or image under the guise of philanthropy. Unfortunately, it seems that breast cancer has become big business. It's because of those seeking to profit from breast cancer that some critics of NBCAM are now referring to it as "BCAM SCAM", or Breast Cancer Industry Awareness Month.  But how is it that such a noble and worthy cause has come to be viewed by some as a scam? To answer this question, a little research, along with some open minded consideration, is required.

When it comes to the public's health, the primary goals of health officials are prevention, intervention and eradication of disease, with prevention being preferable to intervention (McKenzie). For example, "immunizing to prevent a disease is preferable to taking an antibiotic to cure one" (McKenzie). Case in point, the human papillomavirus (HPV) vaccine and cervical cancer. Yet, when we look at the pink ribbon message, it focuses not on prevention, but detection and cure. Wait a minute. If prevention is preferable, why is the push for detection and cure? Because the detection and treatment of breast cancer has become a multi-billion dollar industry. Simply stated, prevention just isn't as profitable.

Skeptical? Perhaps a closer look at NBCAM might provide additional insight. Their organization was formed by Imperial Chemical Industries, the creator of Tamoxifen, a breast cancer treatment drug. In the 90's, Imperial Chemical Industries spun off Zeneca Group. Then Zeneca merged with Astra and became Astra Zeneca, which formed a non profit arm that is known today as AstraZeneca Healthcare Foundation, one of the largest financial contributors to NBCAM.  Astra Zeneca also created and markets Arimidex, another breast cancer treatment drug. CancerCares was also involved in the formation of NBCAM. A look at their donors reveals several pharmaceutical companies as well. So, what message would you want to spread if you were a drug manufacturer financially invested in breast cancer treatment medications? Probably not prevention. Might this explain NBCAM's focus on awareness and detection? To be clear, I'm in no way suggesting that awareness, screening and early detection of breast cancer is negative. The point is non-profit organizations accepting donations from companies that stand to gain from their philanthropy seems to represent a conflict of interest.

The pink campaign isn't only effected by conflicts of interest. There are also the companies that profit from linking their products to the breast cancer cause. At first glance this may seem altruistic, but sometimes things aren't always as transparent as they seem. For example, 12 years ago Yoplait began a pink ribbon campaign called Save Lids to Save Lives. A portion of the proceeds from the sale of their yogurt are donated for breast cancer research. The conflict resulted from their yogurt being made with milk from cows that were given a synthetic growth hormone, called rBGH. This chemical has been linked to breast cancer and is banned from use in many countries. You can read more about the topic here, and Oregon Physicians for Social Responsibility has an interesting video discussing rBGH and milk found here or click on the Videos tab in this blog.

The term "pinkwasher" has been used to describe a company "that purports to care about breast cancer by promoting a pink-ribboned product, but manufactures products that are linked to the disease" (Breast Cancer Action). When you consider that Yoplait was both contributing to and profiting from breast cancer, one could say they were successful at "pinkwashing." Thankfully, because of pressure brought about by health activist groups, like Breast Cancer Action and their "Put a Lid on It" campaign, as well as concerned consumers, to their credit as of 2008 Yoplait has stopped using rBGH milk in their yogurt.

The above is just one example of pink ribbon profiteering. Breast Cancer Action has some great information on their Think Before You Pink site to help guide consumers when purchasing "pink" products. They suggest asking the following questions:
  1. How much money from your purchase actually goes toward breast cancer?
  2. What is the maximum amount that will be donated? Sometimes contributions are capped at a certain amount. 
  3. How are the funds being raised? 
  4. To what breast cancer organization does the money go, and what types of programs does it support?
  5. What is the company doing to assure that its products are not actually contributing to the breast cancer epidemic? 
You can find a more detailed discussion of these points here.

In a recent post I mentioned my support of the Love/Army of Women, a non-profit foundation dedicated to stopping breast cancer before it starts.  At first inspection I felt this group represented something that I feel is of critical importance - the need for more research into the prevention of breast cancer. However, after closer scrutiny I realized that this group is funded through a grant from Avon. This cosmetics company uses a number of chemicals in their products that have been linked to cancer through standard laboratory feeding tests done on mice and rats by the National Toxicology Program. Their study results have been published and accepted by the International Agency for Research on Cancer. A perfect example of the importance of the need to "think before I pink."

A final thought. On my last visit to the doctor she mentioned that Tamoxifen is now being recommended as a breast cancer prevention treatment for women who are considered to be at high risk for developing the disease. I was hoping that more breast cancer prevention research would be focused on how to reduce our exposure to cancer causing agents, such as the above-mentioned chemicals. Sadly, this doesn't appear to be a research priority, but it's not that surprising.  All things considered, I suppose drugs would be the first line of defense offered for prevention, if the pharmaceutical and chemical companies are underwriting a great deal of the research being conducted in the area of cancer prevention. Evidently there isn't anything completely transparent when it comes to this issue. One thing is for certain, pink looked a whole lot rosier before I took off my rose-colored glasses.

McKenzie, J.,, An Introduction to Community Health, 5th Ed., Jones & Bartlett, MA, 2005
Lancet - Circulating concentrations of insulin like growth factor 1 and risk of breast cancer -
Potential public health impacts of the use of recombinant bovine somatotropin in dairy production -
Breast Cancer Action -

Friday, October 8, 2010

Health issues and natural gas drilling: Should we be concerned?

When my family moved to the sleepy, bedroom community of Flower Mound, Texas back in 1992, we never dreamed that we would be in the position we find ourselves in now. Flash forward 20 years and Flower Mound isn't so sleepy anymore. It has grown to a suburb of over 60,000 residents. The town was even recognized as a Gold Scenic City this year. The title is awarded by Scenic Texas, an organization that states, "we believe that growth is inevitable, but ugliness is not."

Perhaps you'll appreciate the irony of this statement when I tell you that it turns out my scenic suburban town sits on the Barnett Shale, a large shale natural gas deposit, and they are drilling in Flower Mound. The town is actually allowing around 24 gas wells to be put in the middle of suburbia. Drilling in the area isn't a new occurrence.  Over the last few years drill sites have popped up throughout the area.  However, the two dozen wells being drilled now at the Hilliard site will be less than 1500 feet from subdivisions, an elementary school, a middle school and there is a church nearby.  You can see the density of the area, as well as the proximity of the site to the schools and neighborhoods here, How is this not ugly?

Now, before I go any further, I acknowledge that I'm a natural gas consumer. I also know that natural gas is a cleaner source of energy than coal, albeit not as clean as solar, wind or other renewable energy sources. Also, in light of the recent oil drilling disaster in the gulf, it's probably a whole lot safer to extract gas than oil, right? Well, no, not really. Not the way it's being done right now and definitely not so close to schools, a church and densely populated subdivisions. Since horizontal gas drilling technology has become available, many environmental and health issues have come to light.

At this point you might be tempted to stop reading and call me "Chicken Little". Please consider that the quality of the air we breathe and the water we drink is at risk. We are all potentially affected by this situation, even if we don't live near an area where gas drilling is likely to occur. The risk to our health is the result of pollutants that are generated from the drilling and extraction process. As the map at left clearly shows, shale gas is located throughout the US and it is going to be extracted. It's also becoming a reality in Europe and other parts of the world where shale gas deposits are being found.

According to the Environmental Protection Agency (EPA), "...natural gas production facilities emit pollutants such as hazardous air pollutants (HAP's) and volatile organic compounds (VOC's). These pollutants can contribute to health problems..." "While regulations limit the amount of emissions [from these facilities], dangerous releases of HAP's can occur if [a facility] does not operate in compliance with regulations." Even though there are federal, state and local regulations in place that attempt to protect us from dangerous HAP's and VOC's, evidently the accidental and/or intentional release of dangerous pollutants into the environment is a very real consequence of gas drilling.

The issue of our ground water becoming contaminated is documented. In 2005, the oil and gas industry was granted an exemption from the federal Safe Drinking Water Act, which is in place to protect our drinking water supply. Earthworks Action states that, "at the state level, most oil and gas agencies do not require companies to report the volumes or names of chemicals being injected during [the gas drilling process]. Thus, neither the government nor the public can evaluate the risks posed by injecting these fluids underground..."  This is a result of the something called the Halliburton Loophole. Yep, you might recognize that name, especially if you're from Texas. Halliburton patented the hydraulic fracturing or "fracking" method used to help extract the natural gas. The exemption is believed to have resulted from Dick Cheney who was Vice President at the time and also happened to be the CEO of Halliburton.

Noteworthy are the public health agencies who have attempted to gather data about the health effects experienced by people living near gas drilling sites. One of these is Garfield County, Colorado's department of public health  which took on the task of assessing the health impacts relating to gas drilling that are affecting the people living in their area.  The following charts from their study illustrate some of their findings (click on charts to enlarge):


Clearly, health and environmental concerns are continually being raised with regard to shale gas drilling. Recent legislation has been passed by Congress that orders the EPA to study the chemicals used in the natural gas extraction process. Amazingly, many of the chemicals used in the fracking process have not been disclosed by companies because they consider them trade secrets.  As of the end of September, the EPA was holding hearings and had requested nine drilling companies to release information about the chemicals they use. A report should be completed by 2012. Although I'm hopeful that the EPA is working to protect our environment and our health, this is the same agency that previously filed a flawed report on fracking. The flaws were revealed by an EPA insider named Weston Wilson. Thankfully, he blew the whistle by writing a letter to congress about the risks he believes this process poses to drinking water.

The risk doesn't end with the HAP's and VOC's entering our air and water and potentially jeopardizing our health. Just consider the Gulf oil spill.  Wasn't that rig's blow out preventer supposed to be fail safe? Haven't we learned from the catastrophic gas well  "accidents" that have occurred in Virginia, Louisiana and Pennsylvania? These are only a handful of the disasters that have happened since gas drilling has accelerated. I don't even want to think about the possibility of an event occurring 1200 feet from an elementary and middle school.

It's a sad reality that our government officials are strongly influenced by lobbyists representing big business interests, and the oil and gas industry ranks up there with some of the most powerful. However, call me naive, but I believe that as their constituents we do exert some influence ourselves. With that thought in mind, if you're wondering like I was what actions we might take to protect our air, our water and our health, I suggest the following:
  1. We can let our government officials know that we want our water protected.  Contact them and ask them to support the FRAC Act here. 
  2. For concerns about air quality, if you live in Texas you can contact the Texas Commission on Environmental Quality (TCEQ), or contact your state and local elected officials and urge them to consider stronger regulation of toxic gases and VOC's that threaten our environment and our health.
As things stand, I feel the environment and our health are losing out to our ever increasing demand for energy resources. It's an ugly situation and I'm afraid it isn't going to get any better. That is... unless changes in the way we live occur and our focus shifts to cleaner more renewable energy sources. Unfortunately, the reality now is that shale gas wells will continue to pop up all over. Until the process of extracting the shale gas is mandated to adhere to best practice methods, the chemicals used in the process and their effects on our environment and our health are required to be openly disclosed, and the gas drilling companies are held more strictly accountable for accidents, I believe we need to proceed with caution. So, yes, I think we should be very concerned.

Update 10/10: I wanted to learn more about the natural gas drilling process. This educational video made by the Penn State Cooperative Extension, shows a natural gas well operation site. What I know about gas drilling could fill a thimble, so I submit my comments about the video mostly from the observational perspective.  What I notice:  1) the noise; 2) the amount of heavy equipment 3) the number of box cars for hauling water, chemicals, sand, etc? 4) site access roads. If we all work together to shift toward cleaner energy sources, perhaps your neighborhood can be spared all this "inconvenience."

Town of Flower Mound

Friday, October 1, 2010

Breast cancer jeopardy: cause vs. cure

Image from Memphis Flyer
Would you like to play a game called Breast Cancer Jeopardy? I'm going to assume a very firm and collective NO answer to this question. Unfortunately, the reality is regardless of whether or not we want to play, we are in the game. This is because when it comes to risks for breast cancer (BC), there are some we simply cannot avoid.

For example, if you're a woman who is aging, than you're playing breast cancer jeopardy because these are  the 2 biggest risk factors for breast cancer. Here are other risks both in and out of our control:
  • Being over 40 years old
  • Having genetic links, or family members with breast, prostate or ovarian cancer
  • Having high breast density on a mammogram
  • Never having children
  • Having your first child after age 35
  • Going through menopause after age 55
  • Being exposed to radiation, or having frequent x-rays in youth
  • Overweight after menopause or weight gain as an adult
  • Used or are using hormone replacement therapy
All of these up our stakes in the BC jeopardy game. Yet, even with all the information we have about the known risk factors, 80% of women in America who get breast cancer have no other risks besides being a woman.  According to the Dr. Susan Love Research Foundation, "more than 4 billion dollars has been spent on breast cancer research over the past 25 years". Yet, we still have no idea what causes this disease.  To date, doctors and researchers have focused most of their attention on curing breast cancer. Personally, I would rather not have gotten the disease in the first place!

Now, please don't get me wrong. It's wonderful that the focus on finding a cure has led to great strides in detecting and treating breast cancer. However, it seems to me to make more sense to turn our attention to what is causing breast cancer and stopping it before it starts. An ounce of prevention is worth a pound of cure, right?

A recent example of the medical community turning their research focus toward the cause and prevention of a disease is cervical cancer.  Through their study of women, researchers discovered that the disease was caused by a virus. Fortunately, a similar approach is being taken by some researchers, who are now looking into determining the causes of breast cancer and ultimately figuring out how to eradicate it once and for all. One of these research organizations is the Love/Avon Army of Women (AOW). Their goal is to enlist one million women (men are welcome too) to participate in breast cancer research studies aimed at determining the causes of breast cancer - and how to prevent it. They are doing this by connecting breast cancer researchers via the internet with men and women willing to participate in a variety of research studies which are prevention based, not necessarily clinical trials.

Signing up for the Army of Women doesn't mean you're signing up for a study. You are just signing up to be added to the AOW database. Then you'll be able to hear about studies being conducted in your area in which you can choose to participate. All ethnicities, all ages (18 and older), healthy women, women with cancer, and women who are survivors can participate, depending on the study.

There is NO COST to join and NO DONATIONS are being solicited. All that's needed is your willingness to be informed about studies. Than you decide if you want to participate and which type of study commitment best fits you. Studies require a variety of things, anywhere from answering an online questionnaire to being asked for a blood sample. It's totally your choice and entirely up to you. So far, there haven't been any opportunities in my area that I have qualified for, but I'm continually updated and can choose what works for me.

Need more info? Check out the AOW website here and also look for their monthly webinars presented by the healthcare experts doing research studies on understanding the causes of breast cancer.
Let's increase our odds of winning the breast cancer jeopardy game by joining together to help encourage, support and maybe even participate in research for the cause of breast cancer.  A world without this disease is in our hands. When it comes to breast cancer, prevention really is the breast, I mean best medicine!

Dr. Susan Love Research Foundation
Avon/Army of Women