=======================Electronic Edition========================
RACHEL’S ENVIRONMENT & HEALTH WEEKLY #443
—May 25, 1995—
News and resources for environmental justice.
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RADIATION CAUSES BREAST CANCER
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
RHWN #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 discussed.
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 organs.
** 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 ignorance.
(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.
                
                
                
                
     –Peter Montague
Descriptor terms: breast cancer; national breast cancer week;
carcinogens; surgery; prevention; chemotherapy; carcinogens;
statistics; morbidity; mortality; mammography; radiation; john w.
gofman; hiroshima; nagasaki; nuclear weapons; a-bomb; atomic
bomb; x-rays; fluoroscopies; fluoroscopes; scoliosis; thymus;
tuberculosis; asthma; thyroid; whooping cough; occupational
safety and health; pneumonia; dermatitis; arthritis;