Detecting a Bad Breast Cancer Bill
Who could blame hundreds of Members of Congress for joining with a colleague and breast cancer survivor, Rep. Debbie Wasserman Schultz (D-Fla.), in co-sponsoring legislation aimed at promoting breast cancer education? The problem, according to leading breast cancer scientists and advocacy groups, is the bill would do more harm than good. Rep. Wasserman Schultz and her colleagues have the best of intentions, but they should defer to the experts on this one.[IMGCAP(1)]Unfortunately, the best thing about the Breast Cancer Education and Awareness Requires Learning Young Act is its acronym, the EARLY Act. Sure, detecting breast cancer early is critical, but Wasserman Schultz’s approach does little to further that goal. On the contrary, it represents a wholesale misunderstanding of what we know about breast cancer, especially with regard to younger women — like her — who develop it.The bill proposes a number of misguided initiatives that are not supported by science and will have the unintended consequence of distracting us from pursuing more promising approaches in the fight against breast cancer. EducationThe bill provides grants to educate high school and college students about breast cancer. But breast cancer is exceedingly rare in students. In fact, the National Cancer Institute reports that the chance a 15-year-old girl will develop invasive breast cancer by age 40 is less than one-half of 1 percent. Since the risk factors for breast cancer in young women are not modifiable, there’s very little a young woman can do to diminish her chance of getting cancer. Certainly, a young woman with risk factors should consult her doctor about appropriate screening, but an education campaign aimed at teenagers isn’t the way to go. The bill won’t promote practical education, just needless anxiety among a broad swath of the population.Self-ExamsThe bill also will establish a media campaign to encourage younger women to do breast self-exams. However, self-exams have been shown to give young women nothing more than a false sense of control. According to the National Breast Cancer Coalition, which opposes the bill, “breast self-examinations have been shown to be ineffective and potentially harmful,— because they lead to ambiguous findings that in turn inspire unnecessary breast biopsies. A campaign promoting the importance of early detection “would result in an extraordinary waste of funds and unnecessary exposure to the health risks associated with the additional interventions,— according to the NBCC.Media CampaignThe law also calls for a media campaign that will encourage young women “to be aware of their personal risk factors.— Sounds harmless and educational, right? But this approach ignores decades of established science that tells us there’s practically nothing a young woman can do to reduce her risk of breast cancer. One of the country’s leading federally funded breast cancer researchers, Dr. Leslie Bernstein, puts it best: “The most I could ever tell a young woman would be that she should drink in moderation, exercise, and breast-feed babies if she is able.— Bernstein, director of the division of cancer etiology at the City of Hope, opposed the bill, telling a bill sponsor that the law “cannot help reduce the burden of breast cancer in young women.—Genetic TestingThe bill also encourages young women of specific higher-risk populations, including African-Americans and Ashkenazi Jewish populations, to ask their doctor about getting genetic testing. Again, this has the potential to do more harm than good. The field of genetic screening is in its infancy, and widespread testing raises more questions than it answers. For instance, a finding of genetic mutation, while terrifying, not only offers little information, it may lead some women to overreact. Dr. Otis Brawley, chief medical officer of the American Cancer Society, explained in a letter to ACS volunteers that some women with positive results may choose a prophylactic bilateral mastectomy, a procedure wherein both breasts are removed to prevent a cancer they do not, and may never, have. He wrote that “many of these women will in reality have mutations of no significance.— In addition to unnecessary, disfiguring and risky surgery, “there are already scientific data to show that many women … will suffer significant emotional and mental harms— just from finding out they have the gene mutation.Environmental FactorsThe bill authorizes the Centers for Disease Control and Prevention to “provide education, through written materials, identifying evidence-based methods to lower the risk of breast cancer in young women through changes in lifestyle including diet, exercise, and environmental factors.— However, despite claims by environmental activists, there are no known environmental causes of breast cancer other than high doses of radiation, an exceedingly rare cause in young women. Yet groups such as the innocuously named Breast Cancer Fund suggest that chemicals such as bisphenol-A found in plastics are a risk factor for breast cancer. A bill calling for education about environmental factors gives credibility to these unfounded claims while taking our eye off the prize: pharmaceutical advances that have been proven not only to cure breast cancer in many women but to prevent it in high-risk women. Such approaches should be the centerpiece of any breast cancer legislation and educational campaigns.Feel-good approaches like those offered in Wasserman Schultz’s popular legislation will do more harm than good. No doubt, Rep. Debbie Wasserman Schultz’s courageous personal story is inspiring. But we shouldn’t mistake her courage for expertise.Jeff Stier is an associate director of the American Council on Science and Health.