By Jayla Burton, Program Manager
When it comes to breast cancer prevention, the dominant narrative is largely focused on changing individual behaviors, including diet and exercise; increased use of enhanced technology to screen for breast cancer; and/or simply being made aware that the disease exists.
We know that breast cancer prevention is not that simple, and it cannot be individualized. There is a complex web of economic, cultural, social factors that must be taken into consideration when advocating for prevention. Further, this complex web of factors may prevent an individual from opting for healthier choices that are commonly discussed, such as adopting a plant-based diet or even accessing a safe outdoors place to be more physically active. Moreover, Breast Cancer Action has long argued that better screening technology and more awareness alone will not going to stop breast cancer before it starts.
As the watchdog of the breast cancer movement, we have and will continue to radically disrupt the notion that breast cancer prevention can be achieved by these “solutions.” Our commitment to exposing the industries that are responsible for involuntary exposures to cancer-causing toxins in our environment and calling on the government and regulatory agencies responsible for reducing those exposures, is at the core of who we are. Additionally, it is imperative that we name and act on the fact that these involuntary factors are shown to be of greater impact on people of color who were assigned female at birth (POC AFAB) or those who of lower–income status.
As the Program Manager at BCAction, I have had the joy of leading the organization’s educational and advocacy campaigns, which are rooted in calling for systemic change. Large-scale, broad public health benefits are what we need to achieve if we want to create a healthier world, where people’s lives are not threatened and devastated by breast cancer.
In our 2020, Think Before You Pink® campaign we called on the National Cancer Institute (NCI)–the federal government’s principal agency for cancer research and training–for their lack of information on environmental risk factors. The agency’s breast cancer prevention patient page (i.e. the Physician Data Query patient page (PDQ) states “Avoiding risk factors and increasing protective factors may help prevent cancer.” Directly following, it listed breast cancer risk factors like “aging” and “an inherited risk of breast cancer” as top risk factors. We galvanized our members to contact the NCI demand that they stop denying deny the importance of environmental risk factors in developing breast cancer.
In response to our campaign, the NCI promised to make changes. Though the agency updated its patient prevention webpage in January of 2021, the changes failed to address our concerns and doubled down on a bad approach to primary prevention, which undermined multiple evidence streams that link harmful chemicals in the environment to increased breast cancer risk. Our community of activists kept the pressure on the NCI, and in August 2021 we held a meeting with the agency in which they acknowledged the downstream effects that their limited approach has on the field of breast cancer and public health.
With this history in mind, I attended the San Antonio Breast Cancer Symposium (SABCS) session, Fine Tuning Risk Assessment and Risk Reduction, where Dr. Brandy Heckman-Stoddard, from the National Cancer Institute, gave a presentation titled: Emergent pharmacologic interventions for prevention: Non endocrine treatments.
The presenter opened the presentation stating one thing the agency also tries to balance in prevention is the risk and the benefits “we want to develop agents that are both well tolerated and efficacious”, said Dr. Brandy Heckman-Stoddard. But what about the environmental risk?
Before explaining funding for the agency’s drug development programs, Dr. Heckman-Stoddard emphasized that the population they are serving through their prevention initiatives are healthy people who just happen to be at risk of breast cancer. In clinical settings generally when a patient is referred to as “high risk” it usually means they have a gene mutation (such as BRCA1 or BRCA2), have a known family history, or have already been diagnosed and are at risk of recurrence. But we know that the majority of women diagnosed with the disease have no inherited risk or family history for the disease (only around 10% of breast cancers), and a high-risk factor which is often ignored by the mainstream cancer industry is the fact that healthy people are being exposed to potentially toxic chemicals in the environment that increase health harms.
Over the last three years, the NCI has funded breast cancer prevention cancer studies, including studies on the topic of chemoprevention. None of the studies on the docket that Dr. Heckman-Stoddard reviewed explored the risk of harmful chemicals that can be found in our environment that may increase the risk of breast cancer.
Breast Cancer Action has historically opposed the idea of giving healthy people drugs to prevent the disease, also referred to as “pills for prevention,” another common topic of discussion. Any drug strong enough to “prevent” breast cancer could inevitably lead to disease substitution and open the door for even more adverse health effects and harm. We believe that focusing on pills for breast cancer “prevention” diverts attention from the true causes of the disease.
This session was a reminder of why we do this important work. Despite the billions of dollars and many decades spent on breast cancer research, we are far from understanding the causes and risks of breast cancer. We must do more.
Our team continues to work with our scientific partners and is in continued conversation with the National Cancer Institute to push the agency to stay up-to-date with the best science on breast cancer risk, to reduce environmental exposures, and to protect public health.