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Last Words

Sierra Magazine
March/April 2000

Editor's Note: Reader response was unusually heavy to "Cancer, Inc.," a September/October feature by Sharon Batt and Liza Gross about why the major cancer organizations don't pay more attention to prevention of breast cancer. Three out of four correspondents applauded the article, describing it variously as "thorough," "courageous," "exceptional," and "inspiring."

Trish Heck, a registered nurse and 13-year breast cancer survivor, wrote, "I've been sad and mad at things I read in Sierra, but I never cried until I read 'Cancer, Inc.'" Deborah Dreuser said: "It was truly the most insightful and informative article on breast cancer I have ever read." Though fewer in number, our critics' letters were no less impassioned. We are devoting our "Letters" space to airing and responding to questions they raised.

Cancer Conspiracy?

As an oncologist, I am greatly disappointed and dismayed by your article linking breast cancer to environmental chemicals. The article postulates a vast conspiracy involving the chemical industry, pharmaceutical industry, American Cancer Society, National Cancer Institute, organized medicine, and leading medical journals in denying the existence of the chemical causation of breast cancer for the cause of greater profits. This notion would be laughable if it were not being promulgated in a publication that used to engender some respect. The increased incidence of breast cancer relates strongly to increased life expectancy, since the leading risk factor for developing breast cancer is a woman's age (the older the greater the chance).

Additionally, increasing use of mammography has resulted in the diagnosis of a large number of non-invasive cancers, a significant number of which would probably never become clinically significant. None of the leading textbooks on cancer mention environmental chemicals as a cause of breast cancer, nor do scholarly reviews regarding the etiology of breast cancer, perhaps for the simple reason that there is virtually no evidence suggesting it is so. What is sorely needed now is to pursue the causes, prevention, and treatment of breast cancer in a scientifically rigorous manner with a minimum of bias and interference from people with a political agenda and little scientific expertise.

Leonard R. Prosnitz, M.D.
Professor and Chairman Emeritus
Duke University Medical Center

Sharon Batt and Liza Gross reply:

Cancer is a lucrative business and the potential for enormous profits can influence decisions. Our article suggested that the profitability of diagnosing and treating cancer, coupled with the potential costs to industry of taking a preventive approach, have biased policies to favor treatment over prevention. This is not a "conspiracy" theory but an analysis of the underlying political and economic forces that shape cancer policy.

These conflicts of interest are more thoroughly discussed in Robert Proctor's The Cancer Wars, and corroborated by cancer-industry insiders such as Ralph Moss, former assistant director of public affairs for Memorial Sloan-Kettering Cancer Center, in his book The Cancer Industry. And in a 1997 article in The New England Journal of Medicine, Dr. John Bailar, a former National Cancer Institute epidemiologist, called the war on cancer a "qualified failure" and argued for a shift of research priorities away from treatment to prevention. Unfortunately, increased life expectancy and mammography don't fully explain rising breast cancer rates. Incidence statistics are adjusted to correct for the influence of age.

And while the fact that more women are getting mammograms accounts for some of the increase, it doesn't explain the steady rise before 1980, when mammography was not prevalent. And it doesnŐt explain the parallel increase in Great Britain, where mammography isn't as widely used. While you say there is "virtually no evidence" suggesting that chemicals cause breast cancer, The Breast Cancer Prevention Book by Dr. Samuel Epstein includes some 200 references to studies in peer-reviewed journals that suggest otherwise. Much of the scientific literature has expanded the definition of carcinogen to include not only agents that directly damage genes but also those that promote cancer by stimulating hormones and skewing cell growth.

No Revolving Door

The American Cancer Society considers the issues of determining and addressing environmental risk for cancer to be essential to its mission. We currently support 19 large research projects that investigate these associations. We provide the public with timely and accurate scientific information regarding cancer and the environment through our publications and a variety of multimedia information services. If your reporters had asked us about the unsubstantiated assertion that our senior executives "routinely move through a revolving door to board and executive posts at companies that make cancer-treatment drugs," they would have learned that no senior executives at the American Cancer Society have left for such positions in the pharmaceutical industry.

The American Cancer Society's Foundation is a separate corporation organized in 1990 solely to attract major gifts and endowments. The Foundation, unlike the Society's Board of Directors, does not set our policy or priorities. Suggestions that membership on the Foundation's Board of Trustees by current or former executives of pharmaceutical companies would cause the American Cancer Society to withhold any information from the public regarding cancer are wrong. Rigorous public debate of the most perplexing problems we face in controlling cancer is always welcome, but it must be both fair and truthful.

Harmon Eyre, M.D.
Executive Vice President
The American Cancer Society

Batt and Gross reply:

It's hard to reconcile your stated commitment to addressing environmental risk factors for cancer with the American Cancer Society's record. The latest ACS report, "Cancer Facts and Figures 1999," makes no reference to avoidable risks for ovarian cancer, childhood cancer, or non-Hodgkin's lymphoma. The discussion of fat under the section "Lifestyle-related factors and breast cancer risk" fails to mention potential risks from environmental contaminants known to accumulate in animal fats. The report doesn't even suggest that consumers choose organic produce to minimize risk from carcinogenic pesticide residues.

Furthermore, the society has never presented Congress with the scientific data necessary to support regulation of a wide range of carcinogens, prompting a group of 24 scientists, including Nobel laureate George Wald of Harvard University, to charge the agency with doing "little to protect the public from cancer-causing chemicals in the environment and workplace." Instead of referring to the American Cancer Society's ties to cancer-drug manufacturers as a revolving door, we should simply have noted the long-term residence of cancer-drug executives on the American Cancer Society Foundation's board and of mammography-industry executives in high-ranking positions in the ACS. Both industries are well-served by the agency's emphasis on detection and treatment at the expense of protecting healthy women. The ACS has consistently remained silent about avoidable risk factors. If industry ties don't explain this pattern, what does?

Sierra welcomes letters from readers in response to recently published articles. Letters may be edited for length and clarity. Write to us at 85 Second St., 2nd Floor, San Francisco, CA 94105-3441; fax (415) 977-5794; or you can e-mail us at:

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