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.
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
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.
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: email@example.com