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January 1, 2010
THE NEW, NEW THING: FIRST USE THE KNOWLEDGE YOU HAVE
Thousands of investigators and participants attended the annual San Antonio Breast Cancer Symposium last December. More than 1,100 scientific papers were presented and discussed at this prestigious event. Of these papers, approximately 0.8% were devoted to ways to prevent breast cancer — and of these paltry few — 70% were focused on chemoprevention, the taking of a pill to prevent disease. Only 0.3% of the papers discussed the possible causes of breast cancer, which is the first step in understanding how to prevent the disease. Given that experts believe that 30-40% of breast cancer is preventable, the meager 1% of papers devoted to understanding causes or preventing the disease seems pitiful — or outrageous — depending on your disposition.
Of the 1,100+ scientific papers presented at the SABCS in December, only one, conducted by the Saudis, discussed the role of diet, fat and estrogen levels in producing breast cancer. Reasonably, the Saudis concluded that the government ought to intervene and implement risk reduction strategies to reduce the incidence of the disease.
We might want to take a lesson from the Saudis, for if Americans had waited for the majority of it citizens to choose to use seatbelts, would it have ever happened? If lawmakers had not mandated that infants and children be secured in approved car seats, how many more children would have been thrown to their deaths in car accidents? If citizens had not gotten completely fed up with the disease and death produced by cigarettes, and acted upon their outrage by suing the tobacco industry, how much longer would we have waited before the tobacco companies owned up to the carcinogenic effects of cigarettes, warned against their use, and paid for the damages they inflicted?
So how much longer do we have to wait before policy makers insist that breast cancer risk reduction strategies be implemented in the United States? Is it not enough that we will have almost 300,000 new cases of breast cancer — and nearly 50,000 deaths — this coming year? How many more cases and deaths do we need before we as a country intervene to reduce the incidence of this most common disease?
If it is true, as the data suggest, that 30-40% of breast cancer is preventable, then I submit that at least 30% of all of the money that is devoted to breast cancer research be spent implementing the knowledge we already have about ways to prevent the disease, while we work to obtain new knowledge about its causes. The large and powerful breast cancer foundations, like Komen for the Cure and Avon Breast Cancer Crusade, as well as the American Cancer Society, might want to set the stage for this transformation by establishing a new policy whereby 30% of their funds will be spent researching the causes and prevention of the disease. This would be a refreshing demonstration of healthcare leadership — one that is long overdue.
Early detection is not prevention. Prevention is prevention. And if the past is a guide to the future, then, no doubt, prevention is the only way we are going to get our arms around this epidemic. 30%. That's the goal.
Regards,
Kathleen T. Ruddy, MD
Reference: Sprague B, Trentham-Dietz, A, Egan K, et al. Proportion of invasive breast cancer attributable to risk factors modifiable after menopause. American Journal of Epidemiology. 2008;168:404-411.
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