The widespread anger forced Komen to reverse its decision, and it has certainly reinvigorated the women’s health movement. But the furor misses an important fact: Women have been led to believe that screening is the best prevention.
In reality, we still do not know what causes breast cancer, which means we really do not know how to prevent it, either. That has pushed us to focus on looking for cancers that are already there, a practice long based on the assumption that all cancers were the same, grew at a similar rate and were visible in the breast for a period of time before spreading. It made sense: If you could find cancers earlier, you could save lives.
Indeed, the original screening study done in the 1950s on postmenopausal women in New York demonstrated a 30-percent decrease in deaths from breast cancer. It also led to the conjecture that if we just carried out more screening at a younger age, and more often, we could improve these statistics and “win the war” on breast cancer.
But decades later, the success rate of screening remains nearly the same, even with much better imaging: routine mammography screening results in a 15- to 20-percent decrease in mortality in women over age 50.
Why hasn’t the situation improved? It turns out that there are at least five, and probably more, different types of breast tumors, growing and spreading at different rates. Some are so aggressive that they have almost always spread before they are visible on mammogram. But other tumors, if left alone, may never spread at all and do not need to be found.
This more complicated picture explains why mammography has not further decreased mortality. The X-rays find some cancers at a point that makes a lifesaving difference — but not all of them. British researchers estimated last year that one death from breast cancer is prevented for every 400 women ages 50 to 70 who are screened regularly over a 10-year period.
Does this mean we should stop screening? No, it is still the best tool we have. But we have to start looking for other approaches to decreasing deaths from breast cancer.
Consider cancer of the cervix. First, we screened for it with Pap smears; now, with the HPV vaccine we hope to prevent it altogether. This is where we need to be focusing our money and efforts in breast cancer: finding the cause, so that we can prevent it from happening in the first place.
At the Dr. Susan Love Research Foundation, for instance, we perform research on the breast looking for the cause, and we are encouraging scientists to recruit from over 360,000 women with and without breast cancer, our Army of Women, who have volunteered to help them in research to stop this disease. Other groups, including Breast Cancer Action and the Avon Foundation, are focusing on the potential environmental causes. The National Breast Cancer Coalition has set a deadline of 2020 to find a breast cancer vaccine.
We should continue to speak up when we think health care services are in jeopardy, but we cannot be satisfied with the status quo. We must move breast cancer advocacy to the next level, beyond screening for cancers that are already there, even beyond the cure, to finding the cause. That is true prevention.
Dr. Susan Love is president of the Dr. Susan Love Research Foundation in Santa Monica, Calif.
This article has been revised to reflect the following correction:
Correction: February 6, 2012
Because of an editing error, an earlier version of this essay misstated the affiliation of the Army of Women. It is a program of the Dr. Susan Love Research Foundation, not the Avon Foundation.
Source: New York Times Health Section 06/02/2012