Does Rise in Breast Cancer Cases Constitute Epidemic? : Health: The media have implicated pollution. But the facts suggest that early diagnosis and a larger population are behind the increase.
The magazine cover is striking. A woman, clearly distraught, is naked to the waist--except for what appear to be two gas masks hooked together to form a crude brassiere.
“Breast cancer cover up,” says the cover line. “Why scientists ignore vital evidence about toxins.”
Less graphic--but no less scary--many newspapers last fall published stories saying scientists thought pesticides in the nation’s food supply “may be contributing to an alarming surge in breast cancer,” as the Los Angeles Times story put it.
There is a widespread perception in this country--shaped in no small measure by just this sort of intense coverage--that there is a new breast cancer epidemic among women, much of it attributable to post-World War II environmental pollutants.
But in April, the largest study on this issue to date found no evidence that breast cancer is caused by pesticide residues.
That doesn’t mean that a cause-and-effect relationship won’t be found in the future between breast cancer and pesticides--or some other environmental pollutant--but science hasn’t established that link yet.
Many women do have--and die from--breast cancer. Studies suggest that there is a 1-in-9 lifetime risk of the disease. But the risk of breast cancer rises dramatically as a woman ages, and it remains most likely to strike the very elderly. According to one study, a 60-year-old woman has one chance in 28 of developing breast cancer by the time she is 70.
That may still warrant the tag of epidemic. It is clearly a tragedy, one calling for massive research and human compassion. But it is neither as new nor as pervasive--especially among younger women--as most media coverage suggests.
The age-adjusted death rate from breast cancer in this country has remained almost constant for 60 years. According to one study, a white woman aged 50 to 94 has a 2.8% chance of dying of breast cancer; that same woman has a 31% chance of dying of heart disease.
Contrary to common perceptions, experts say, the primary reason there are more cases of breast cancer among younger women today is simple: There are more younger women--baby boomers born between 1946 and 1964.
Overall the number of new cases every year in the United States has been rising dramatically in recent years. Most of that increase is attributable not to the pernicious effects of technology but to its beneficial effects--specifically new diagnostic tools.
“There’s been an enormous increase in screening, in early detection, an enormous increase in the number of mammographic machines around,” says Malcolm Pike, chairman of the department of preventive medicine at USC, who has long specialized in the epidemiology of breast cancer. “Not all . . . (the increase) is due to that, but most of it” is, Pike says.
In other words, there appears to be more breast cancer largely because we’re able to diagnose (and treat) cases that in previous generations, we would not even have known about. Other factors are probably also involved in the increased incidence of breast cancer, but they are much less significant and there is little agreement on what they are and on precisely what role they play.
Nevertheless, the news media have devoted considerable space and time to the “new” epidemic. Breast cancer is perceived as a “hot” disease, in part because--after years of neglect and discrimination--many editors have been sensitized to issues of concern to women by the presence of more women in the nation’s newsrooms. Women now make up 40% of newsroom professionals and 30% of executives and supervisors, the editors who decide what stories are assigned, covered and played prominently.
Many women think breast cancer, like other women’s health issues, hasn’t received enough attention in the mainstream media. On many health problems, they may well be right.
But last year, breast cancer was mentioned 5,799 times in major newspaper and magazine stories, according to a search of the computerized Nexis database; prostate cancer--a disease that strikes only men, primarily older men--was mentioned 1,742 times.
Breast cancer killed about 46,000 women last year; prostate cancer killed about 38,000 men. Thus, breast cancer claimed 22% more lives but received 233% more media space.
Not surprisingly, given the influence of the media on government decision-makers, that difference is reflected in government spending for research on the two diseases. The National Cancer Institute spent $213 million for breast cancer research, $51 million for prostate cancer research, a difference (418%) that is much closer to the relative media coverage of the diseases than to the relative number of deaths.
Since the age-adjusted death rate for prostate cancer has increased 30% over the past 30 years, one could legitimately argue that it is prostate cancer, not breast cancer, that is the “new” epidemic.
But one would never know that from the media. Why not? There are several reasons, not the least of them being that cultural forces have made breasts uniquely important to most women’s self-image. There is a also--perhaps inevitably--a sociopolitical element to the battle against breast cancer. Moreover, men are generally more reluctant than women to discuss their intimate body parts, especially when sex or sexuality may be involved. The risk of impotence associated with treatment for prostate cancer makes most men especially squeamish.
Recent inroads by women notwithstanding, the key decision-makers in the nation’s media are still predominantly male. Thus, it’s probably not surprising that one does not see many Page 1, newsmagazine cover or top-of-the-evening-news stories on the prostate cancer “epidemic.”
Disparity in Spending and Coverage
Government spending on breast cancer research--an opposed to prostate cancer research--more closely reflects media coverage than actual death rates from the two diseases.
Breast Prostate Deaths (1993 deaths) 46,000 38,000 Media Coverage* 5,799 1,742 Research Spending $213 million $51 million (By National Center Center in 1993)
* Mentions in major newspapers and magazines in 1993
