Here in the United States, where health care is a business rather than a right, the 182,000 women stricken by breast cancer annually are not only an epidemic, but also a market opportunity.
The market is dominated by some of the world's largest corporations--many of which also produce and release the toxic organochlorine chemicals now suspected of causing breast cancer (see main story). These companies have a vested financial interest in keeping breast cancer research and advocacy pointed away from possible causes--such as corporate pollution--and focused on the profitable businesses of cancer detection and treatment.
The relationships between these corporations and such organizations as the federally funded National Cancer Institute and the nonprofit American Cancer Society are complex, but many argue that industry has undue influence over the direction of cancer research. Here are a few troubling examples:
Cures and causes. United Kingdom-based Zeneca Group PLC is the undisputed leader in the breast cancer business, selling $470 million a year of a controversial treatment drug called Nolvadex. Zeneca also sells a carcinogenic herbicide called acetochlor, whose market is estimated at $300 million annually. The company has been in hot water for allegedly releasing organochlorines into the environment--in 1990 Zeneca (then a branch of Imperial Chemical Industries, from which it demerged in June 1993) was named in a lawsuit by federal and state governments for allegedly dumping DDT and PCBs into Los Angeles and Long Beach harbors. (The suit is pending.)
Nolvadex is Zeneca's trade name for tamoxifen citrate, a synthetic hormone. Tamoxifen is not a cure for breast cancer--it helps prevent recurrences in women who have been successfully treated for the disease. But tamoxifen is also thought to cause uterine cancer and a number of other health problems. In a study at the University of Pittsburgh that began in 1981, 23 of the approximately 4,000 women given tamoxifen contracted uterine cancer (as opposed to two from the control group), and four of them died of it.
It is not clear how long Bernard Fisher, the lead scientist in the study, knew of the uterine-cancer deaths. But until recently, women volunteering for Fisher's new Breast Cancer Prevention Trial of tamoxifen were told that "no deaths from uterine cancer were reported" as a result of the earlier study. (On March 29, Fisher stepped down as principal investigator of 14 federally funded studies. He had been heavily criticized for his delays in disclosing research fraud in several breast cancer studies, at least two of which recommended tamoxifen.)
Recruitment of additional women into the prevention trial has been temporarily halted, but the National Cancer Institute continues to spend millions of taxpayer dollars giving tamoxifen to women who don't have breast cancer to see if it will prevent them from developing the disease. Tamoxifen is already the world's best-selling cancer drug, but if it is approved for use as a prevention drug, Zeneca will be able to increase sales dramatically.
Zeneca is not alone in simultaneously releasing organochlorines into the environment and selling questionable and potentially dangerous breast cancer treatments. Du Pont and General Electric, which compete for the dubious distinction of having the highest number of EPA Superfund hazardous waste sites, are also big players in the breast cancer business. GE sells more than $100 million a year of mammography machines, while Du Pont makes much of the film used in those machines.
There are about 14,000 mammography machines installed in the United States. That's two to three times more than are needed, according to an analysis by the National Cancer Institute. Those machines perform about 24 million mammograms a year, nine out of 10 of which are routine screenings performed on asymptomatic women. Several scientific studies suggest that such routine mammography does not benefit women under 50, and some researchers propose that it may actually increase breast cancer risk. (See sidebar, opposite.)
Still, both Du Pont and GE aggressively market mammography to younger women. A Du Pont TV ad even boasts that the company's new film "makes it safer to start mammography early."
Although the National Cancer Institute recently stopped advising mammograms for women under 50, the American Cancer Society (to which both Du Pont and GE contribute) continues to advise women to have screening mammograms in their 40s.
Cancerous politics. Almost 15 years ago, in his book "The Cancer Syndrome," Ralph Moss described the complex arrangement of interlocking committees, boards of directors, funding, and investments that enable industry to exert substantial influence over cancer research and advocacy. The types of conflict of interest which Moss described are still in effect today, as are a few new ones.
Zeneca is a pioneer in new ways of influencing breast cancer activism. Take the example of the 10-year-old National Breast Cancer Awareness Month, which causes a talk-show frenzy each October and is supported by both the National Cancer Institute and the American Cancer Society. Few realize that Zeneca is the founder and sole financial sponsor of awareness month, and has spent several million dollars on the event. And the message awareness month spreads via hundreds of thousands of posters, pamphlets, radio spots, newspaper ads, and promotional videos? "Early detection is your best prevention . . . get a mammogram now."
This year, Zeneca is turning its attention to the workplace. Together with fellow pharmaceutical makers Glaxo and Merck, Zeneca launched the Industries' Coalition Against Cancer in April. Its goal is to encourage corporations to invest in "cancer screening/prevention programs" such as "a mammography unit on site, a mobile van program, or perhaps a partnership with a cancer center."
Through these forays into pseudo-activism, companies like Zeneca have made treatment, rather than root causes, the issue. The bottom line is this: There's little profit in preventing breast cancer.
Monte Paulsen is a reporter living in South Carolina. Research assistance was provided by Anna Snider.