PERSPECTIVE ON MEDICINE : The Profit Motive in Breast Cancer : Research focuses on high-tech and on drugs that produce revenues for industries that support research.
News stories published in the past several days have given women worried about breast cancer three new reasons to feel nervous. Revelations of research fraud, “discrepancies” and an ensuing cover-up have cast doubts on a study concluding that lumpectomy is as effective as radical mastectomy in the treatment of early-stage breast tumors. Another report revealed that the breast cancer treatment drug tamoxifen causes three times as many uterine cancers as researchers had previously suspected. Finally, five female U.S. senators blasted the National Cancer Institute’s decision to stop recommending screening mammograms to women under age 50. These three developments have left millions of women thoroughly confused about what’s best for their health.
The lumpectomy research question seems to be the one most easily resolved. Any researcher who falsified data should be punished. The administrator of the international breast cancer study has already been removed. But the bottom line is that the relatively small amount of discovered fraud shouldn’t affect the study’s conclusion, that lumpectomy with radiation has a survival rate as good as mastectomy.
The other stories, though they got less news coverage, raise warning flags about the cancer Establishment’s willingness to endanger women. First, mammography:
It’s one thing to irradiate cancerous breast tissue to treat the disease, but quite another to do so in the name of early detection. Health physicists generally agree that there is no safe level of radiation, and that even today’s low-dose screening mammograms pose some cancer risk. In women over 50, available studies show that the benefit clearly outweighs the hazard, but in younger women the situation is less clear. While the five senators who urged the National Cancer Institute to reconsider its change of policy clearly want women to have the best health care available, their anger may be misdirected. If the institute is correct, then screening mammograms for asymptomatic women under 50 should go the way of the periodic chest X-ray, once touted for early detection of lung cancer.
The tamoxifen revelation raises equally disturbing questions. Researchers know that the drug helps prevent the recurrence of breast cancer in women who have been treated for the disease. But they are now testing the drug on women who have never had breast cancer but are considered “at high risk” for the disease, to determine whether it works for prevention. Researchers have stopped enrolling new participants. But they continue to give a potentially hazardous drug to about 10,000 women already in the study.
Both tamoxifen and mammography spring from a research mind-set that favors high-tech treatment. Both were developed by wealthy industries that have close ties to the major cancer organizations and help finance most public awareness campaigns. In fact, the cancer institute’s initial support of screening mammography for premenopausal women may fundamentally have been driven by an oversupply of mammography machines.
The processes that drive medical research toward expensive treatments also turn it away from preventive measures that do not hold the promise of corporate profit. For example, several recent studies suggest that the organochlorine family of chemicals (among them the pesticide DDT and the industrial pollutants dioxin and the PCBs) may contribute to breast cancer. Yet the relationship between these environmental toxins and breast cancer continues to receive scant attention from the research community.
Where they tend toward unquestioning belief when it comes to the efficacy of high-tech cancer treatment, many industry and government researchers suddenly turn skeptical when presented with evidence of the environmental causes of cancer. This is why $68 million of public money is being spent to determine whether tamoxifen may prevent breast cancer, while only a small fraction of that amount is directed to research analyzing environmental clues.
Industry is leading us down a self-serving road in environmental and medical research. More public money needs to go instead to research on the underlying causes of increasing rates of breast and other cancers.
What factors in our air, water and food turn on our bodies’ cancer-causing genes? What steps can we take to avoid becoming cancer patients in need of high-tech treatment? To answer these questions, the research community will have to gain some distance from both corporations that profit from the cancer business and those that produce environmental toxins. Often they are the very same corporations.
