Last October during "National Breast Cancer Week," I attended a "Town
Meeting" sponsored by the cancer unit of our local hospital and by our
Anne Arundel County (Maryland) Health Department. At the podium, our
county health officer, Fran Phillips, described an "epidemic" (her
word) of breast cancer among the female residents of our county: one in
every nine women gets breast cancer now, and the situation grows a bit
worse each year.
I was expecting to hear then about the causes of breast cancer: too
much fat and too little fiber in the diet, and so forth. (See REHW
#389.) Given that this was 1994, I was wondering whether we might also
hear the word "pesticide" mentioned, or "estrogen" or "radiation." To
my surprise, Ms. Phillips described the causes of our breast cancer
epidemic this way: "Lifestyle factors, over which we have no control."
That single sentence was the only mention of causes, or prevention, of
breast cancer during the whole evening. For the remainder of the
meeting, locally-prominent surgeons and radiologists described a Breast
Cancer Center of Excellence now being built onto our local hospital
with federal funds, where breast cancer will be "managed" by up-to-date
techniques. The bulk of the meeting was given over to various
oncologists (cancer doctors), x-ray therapists, and plastic surgeons
who described the benefits of mammography, x-ray-guided needles for
taking breast-tissue samples, and reconstructive surgery.
Mammography means taking an x-ray picture of a breast to detect a
cancer growing inside it. Mammography has nothing to do with prevention
--it detects cancers that have already occurred. Reconstructive surgery
is a branch of plastic surgery. After a breast has been sliced off to
prevent a cancer from spreading and killing the patient, plastic
surgeons can build a new "chest mound" and can even dummy up a fake
nipple. I could tell from the tone of things that this was supposed to
be good news. In fact, the tenor of the evening was altogether up-beat,
positive, optimistic. The local medical community was clearly pleased
with its response to the epidemic of breast cancer that is sweeping
like a scythe through the women in our county.
It should be obvious to almost everyone that all of this really
represents a colossal failure. To be blunt, the measures outlined
during our Town Meeting add up to a jobs maintenance program for
oncologists, chemotherapists, plastic surgeons, and the large support
staff that a Center of Breast Cancer Excellence requires, and of course
for x-ray technicians and the corporations that make x-ray machines and
film. Breast cancer is an eminently preventable disease, in the true
sense of that word: making breast cancer NOT HAPPEN by preventing
unnecessary exposures to carcinogens (cancer-causing agents). One might
expect that the medical community would be taking the lead in
preventing breast cancer, not merely "managing" it after it happens.
But one would be disappointed in this expectation.
What is the major cause of breast cancer? Twenty-seven peer-reviewed
scientific papers and technical reports have now identified radiation
as a cause of breast cancer in women. The first such report appeared in
1965, and since then the evidence has mounted at the rate of nearly one
new study each year for 30 years. The evidence has been presented
repeatedly in the JOURNAL OF THE NATIONAL CANCER INSTITUTE; in the NEW
ENGLAND JOURNAL OF MEDICINE; in the LANCET; in the BRITISH MEDICAL
JOURNAL; in the BRITISH JOURNAL OF CANCER; in CANCER; and in RADIATION
RESEARCH. Evidence has been gathered by studying breast cancer among
women in many countries exposed to many different sources of radiation.
RADIATION IS A KNOWN CAUSE OF BREAST CANCER IN WOMEN; it is not
speculative or uncertain. It is widely accepted. It is just not widely
Radiation is not the ONLY cause of breast cancer. Inherited genes,
certain chemicals including natural estrogen and estrogen-mimicking
industrial compounds, some viruses, and perhaps other factors may also
cause breast cancer --whether alone or together with radiation. But
reducing radiation to women's breasts would definitely reduce the
number of future breast cancers; of this there can be no doubt. John
Gofman's new book, PREVENTING BREAST CANCER, examines this problem head
on. Here is what is known with certainty:
** Radiation of the female breast causes a particular "risk" of cancer
in the exposed individual. But when a large group of women are exposed,
an individual's RISK becomes a RATE of occurrence. When a group is
exposed, the risk no longer means maybe: it means cancer for someone.
For example, if an individual's risk from a mammogram at age 33 is one
in 1112 of getting cancer some time during her remaining lifetime as a
result of the mammogram, then in any group of a million women having
that procedure, the rate of breast cancer will be 1,000,000/1112 and
about 899 out of the million women can be expected to get breast
cancer, on average. [This does NOT mean that mammograms should be
abandoned. It means they should be given with the minimum radiation
dose and frequency really NEEDED to save lives. Doctors at the Anne
Arundel County meeting offered evidence that a series of annual
mammograms prior to age 50 doesn't save lives. Thus, for most women, a
single baseline mammogram in the early 30s, followed by annual
mammography after age 50, seems to save lives, according to current
knowledge. But PLEASE DON'T TAKE OUR WORD FOR IT; ask your doctor.]
** The latency period --the delay between irradiation of the breasts
and the onset of a resulting breast cancer --varies by decades for
people irradiated at the same age. Therefore, to explain today's
epidemic of breast cancer, it is necessary to study irradiation of
women decades ago.
** Breast irradiation received by females during infancy and childhood
increases their rate of breast cancer in adulthood. The increase first
appears as an increased incidence (occurrence) of breast cancer in
women younger than 35 ("early onset" cancer), but it continues for at
least another 40 years and perhaps longer.
** The response to radiation is most severe at the youngest ages.
Studies of Japanese A-bomb survivors irradiated at various ages (from
less than one to greater than 50) and studied for 35 years (1950 to
1985) have shown that each unit of radiation (called a rad) causes
about 10 times as much breast cancer among women age 9 and below,
compared to woman age 50 and above.
** Breast cancer is more easily caused by radiation than are other
kinds of cancers.
This information is also derived from the Japanese A-bomb survivors.
Compared to "all cancer sites combined," breast cancer is about 2.5
times as likely to occur from a certain exposure to radiation. For some
reason --not understood --female breasts are 2 to 3 times as
susceptible to cancer from radiation as are other human tissues and
** There is no safe dose of radiation. Again, this information has been
derived from direct observation of humans irradiated in Hiroshima and
Nagasaki. As John Gofman says, "By any reasonable standard of
biomedical proof, this issue has been settled..." Any exposure to
ionizing radiation carries with it some risk to the individual and,
where a group is concerned, that individual risk translates into a
specific rate of cancer occurrence. The only safe dose is zero.
Dr. Gofman calculates that at least 66% --and perhaps as much as 75% --
of today's 182,000 new cases of breast cancer each year have been
caused by past medical uses of x-rays, radium therapy, and fluoroscopy.
(A fluoroscope is an x-ray machine with the beam remaining "on" during
the examination. An x-ray is a snap-shot; a fluoroscope is a motion
picture, and it delivers considerably more radiation than an x-ray.)
The bulk of Gofman's book is a quantitative assessment of past
exposures of women's (and girls') breasts by an astonishing variety of
medical radiation given between 1920 and 1960: x-ray therapy for
enlarged thymus (a gland behind the breast plate); x-ray therapy for
acute or chronic mastitis (inflammation of breast or nipple); x-ray
during treatment of tuberculosis; mass x-ray screening to detect
tuberculosis; x-ray for teenage scoliosis (curvature of the spine); x-
ray therapy for bronchial asthma; pre-birth x-rays as a result of
mother's pelvic and abdominal exams during pregnancy; x-ray treatments
for hyper-thyroidism and for whooping cough; radiation from fallout
after A-bomb testing in the atmosphere; general diagnostic x-rays and
fluoroscopies; occupational exposures of nurses, doctors, and
technicians from x-rays and the gamma rays from radium-226; x-rays
during chiropractic exams; x-ray therapy for pneumonia. These exposures
are quantified, always erring on the low side, by Dr. Gofman.
But Gofman also discusses other x-ray exposures that he cannot
quantify, but which he knows occurred: x-ray treatment of 80 different
skin disorders by dermatologists; x-ray treatment of freckles and acne
by beauty-parlor operators (yes, some up-to-date beauty parlors had x-
ray machines installed); x-ray exposures to girls and women using, or
sitting near, fluoroscopic shoe-fitting machines in many shoe stores in
the '40s and '50s. The list goes on. X-ray therapy for arthritis; x-ray
treatment for many inflammatory diseases and for pus-forming
infections; for viral infections such as herpes; for bursitis and
tendinitis; for burns; for neuritis; for pancreatitis; for peptic
ulcer; for thyroiditis. You name it, someone probably tried to cure it
with x-ray therapy, and excessive use of radiation today is still
common, especially fluoroscopy.
Gofman says women need to protect themselves from this scourge, not
trusting anyone else to protect them. He offers 5 suggestions aimed at
preventing more unnecessary breast cancer:
(1) Inform the media that radiation is a KNOWN cause of breast cancer.
(2) Challenge your doctor by asking how much radiation you will be
getting and what the odds of harm are. Even if your doctor is referring
you to a radiation specialist for treatment, he or she should know what
the consequences of that referral will be for you --and for millions of
women like you. If your doctor won't tell you, chances are he or she
doesn't know. Make the medical establishment confront its own
(3) Meet with the deans of medical schools. Discuss how they are
educating tomorrow's doctors.
(4) Gofman suggests offering cash prizes to doctors and radiologists
who come up with new ways to minimize breast irradiation. Except in the
field of mammography, where exposures have already been minimized,
there are still many opportunities to minimize routine exposure of
breasts, he says.
(5) Existing and new watchdog groups could identify all sources of
radiation to women's breasts and see that each exposure is minimized to
the extent possible. Such a project (dull as it may sound) offers
unique, important organizing possibilities. Think about it.
GET: John W. Gofman, PREVENTING BREAST CANCER (San Francisco, Calif.:
Committee for Nuclear Responsibility [P.O. Box 421993, San Francisco,
CA 94142], 1995); $15.00 and a bargain at that price.
Descriptor terms: breast cancer; national breast cancer week;
carcinogens; prevention; chemotherapy; carcinogens; statistics;
morbidity; mortality; mammography; radiation; john gofman; hiroshima;
nagasaki; nuclear weapons; a-bomb; x-rays; fluoroscopy; scoliosis;
thymus; tuberculosis; asthma; thyroid disease; whooping cough;
occupational safety and health; pneumonia; dermatitis; arthritis