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    Cosmic Embryo #5: Aiming For The Moon With All Rockets Blazing? A Critique Of Breast Cancer Deadline 2020
    By Richard (Dick) Go... | May 18th 2011 09:06 AM | 2 comments | Print | E-mail | Track Comments
    Cosmic Embryo #5:  Aiming for the moon with all rockets blazing? A critique of Breast Cancer Deadline 2020®  

    The multibillion dollar breast cancer enterprise has just issued its damning self-assessment:  

      “Given the attention and resources directed to breast cancer, the public understandably believes that we have made significant progress. As this report shows, that is not the case. We know little about how to prevent breast cancer or how to prevent deaths from the disease.”      

    Ending Breast Cancer: A Baseline Status Report. Washington, DC: National Breast Cancer Coalition http://www.breastcancerdeadline2020.org/2020/assets/pdfs/2011-progress-report.pdf

    Their goal is grandiose and honorable: 


    “The National Breast Cancer Coalition [NBCC] has set a deadline to end breast cancer: January 1, 2020.”  

    THE DEADLINE: IS IT IMPOSSIBLE? It is. The same way curing polio was impossible. The same way a 4-minute mile was impossible. The same way a man on the moon in nine years was impossible.”

    Is stopping breast cancer once and for all as easy as getting to the moon? The latter was primarily based on physics well known since Newton, who had already envisaged satellites circling the earth, and a long history of rocket engineering. Are we as ready to halt breast cancer?   

    Now, I’m sympathetic to the goal, having just published "Stop breast cancer now! Imagining imaging pathways towards search, destroy, cure and watchful waiting of premetastasis breast cancer" (Gordon, R. (2011) in Breast Cancer – A Lobar Disease. Ed.: T. Tot. London: Springer, p. 167-203. ) so we’ll have to get into the nitty-gritty of the NBCC proposal to see if they truly have all rockets blazing, or are lacking fuel or even aiming at the wrong target. Hints of the latter start with:   


    “We know little about how to prevent breast cancer or how to prevent deaths from the disease.”   

    There is an omission here:   

     1.       We can try to prevent breast cancer cells from ever forming. Methods here might include changing what we eat, avoiding carcinogens, genetic counseling to discourage passing on genetic proclivities, improvements in the immune system, tinkering with the growth of young girls’ breasts, etc.  

    2.       Once breast cancer starts, we can try to detect it early and destroy the tumors, while they are small, before they spread (metastasize). This search and destroy method is based on physics.

    3.       We can let tumors get bigger, but try to prevent them from metastasizing.

    4.       Once the tumors spread, we can prevent deaths by attacking them with surgery, chemotherapy, radiation therapy, prayer and hope. 

    Approaches #1 and #4 are not working, as stated above. The NBCC suggests that we all work cooperatively on #1 and #3:  


    “NBCC advocates believe that ending the disease requires focusing efforts on two key areas: learning the causes of and how to prevent metastasis, and learning how to prevent development of primary disease.”  

    But #2 is not mentioned at all by the NBCC. Let’s see if we can understand why:  


    THE UNCOMFORTABLE REALITY BEHIND EARLY DETECTION: A great deal of attention and resources have focused on the area of early detection. A mantra that has been drummed into our consciousness over the past forty years is that early detection saves lives. The reality is otherwise. About 70% of women in this country [USA] over age 40 have had a mammogram in the last two years. Unfortunately, randomized controlled trials for mammography have shown, at best, a marginal benefit.”  

    This is true. Finding a small breast tumor is like trying to find a rusty needle in a haystack of needles. The normal breast has an incredible amount of fine, variable texture, unique in every breast, and what we need to target is tumors under 4 millimeters (0.16 inches), most of which have not yet metastasized. Here’s the problem: taking an x-ray mammogram is like going to the edge of a forest and taking a picture of it using the light of the setting sun filtering through it as your light source. You may or may not spot the baby snake quietly perched on a limb deep in the woods. It is remarkable that radiologists do as well as they do.   

    Three dimensional imaging methods, pushed to their limits, might allow us to examine the forest tree branch by tree branch, leaf by leaf. Computed tomography (CT), magnetic resonance tomography (MRI), and a host of other potential 3D screening methods, are not mentioned in the NBCC report, let alone pairs of these methods, which are now common in general diagnostic radiology.   


    “Because of increased screening beginning in 1980, there has been a dramatic increase in the incidence of ductal carcinoma in situ (DCIS), abnormal cells contained within the milk ducts that have not spread to other parts of the body. Most of DCIS will never become cancer. However, we are not able to distinguish between the harmful kind of DCIS (that will develop into cancer) and the harmless kind; as a result, many women are treated with interventions that will not help them and could hurt them.”   

    This is again true. But let’s consider another cancer, melanoma. If you have a new or changed “beauty mark” or nevus on your skin, to paraphrase “we are not able to distinguish between the harmful kind of [nevus] (that will develop into cancer) and the harmless kind”. So we agree to let the dermatologist cut it out and then wait for the pathologist’s report. Why can’t this be a model for breast cancer? The answer is simple: breast tumors are inside. Cutting them out requires needle biopsy or surgery, which are expensive and somewhat unreliable. However, if we gave up insistence on getting that pathologist’s report, then small tumors and, indeed, small benign things that look like they might be tumors, could both be destroyed using any of a number of 3D ablation technologies. We’ll never know which is which, benign or malignant, but so what?  


    “Screening often detects cancer earlier than it would have been detected because of symptoms. In many cases, this means that screened people know they have the disease longer than unscreened people, but this doesn’t necessarily mean that people diagnosed through screening live longer, counting from the time the disease actually began. Life is not extended, only the amount of time a woman lives knowing the diagnosis.”  

    True again, but no one has yet reliably detected tumors small enough (less than 4 millimeters) to catch them before metastasis. Mammography often closes the barn door after the horses have already escaped.  


    “We need more focus on understanding the reality of breast cancer—how to prevent its development, how to stop the aggressive cancers that are not detected with mammography, how to stop breast cancer from recurring, and how to prevent it from metastasizing to other parts of the body and becoming lethal.”  

    We didn’t reach the moon by aiming a bow and arrow at it. We won’t stop breast cancer with mammography. Put a few billion dollars into competing and complementary physics approaches to 3D imaging and ablation of premetastasis breast cancer, with the goal of search and destroy, and we’ll get there, maybe even by January 1, 2020.  


    References:

    "Ending Breast Cancer: A Baseline Status Report. Washington, DC: National Breast Cancer Coalition" http://www.breastcancerdeadline2020.org/2020/assets/pdfs/2011-progress-report.pdf

    Gordon,R. (2011). "Stop breast cancer now! Imagining imaging pathways towards search, destroy, cure and watchful waiting of premetastasis breast cancer". In:  Breast Cancer – A Lobar Disease. Ed.: T. Tot. London: Springer, p. 167-203.   


    Comments

    Bonny Bonobo alias Brat
    Great article Dick and very good questions, especially the one which asks 'is stopping breast cancer once and for all as easy as getting to the moon?' Like getting to the moon there seem to be many factors to consider and there also needs a lot of planning, testing, money and coordination.
    I have quite a few women friends in their forties and fifties and in the last few years an alarming number of them, mainly in England, have developed breast cancer. What causes breast cancer? Why does it seem to often occur in clusters? No one seems to know for sure but according to this website there are many possible risk factors which they examine, here are some excerpts :-
    Gender: Being a woman is the main risk for breast cancer. While men also get the disease, it is about 100 times more common in women than in men.
    Age: The chance of getting breast cancer goes up as a woman gets older. About 2 out of 3 women with invasive breast cancer are 55 or older when the cancer is found.
    Genetic risk factors: About 5% to 10% of breast cancers are thought to be linked to inherited changes (mutations) in certain genes. The most common gene changes are those of the BRCA1 and BRCA2 genes. Women with these gene changes have up to an 80% chance of getting breast cancer during their lifetimes. Other gene changes may raise breast cancer risk, too.
    Family history: Breast cancer risk is higher among women whose close blood relatives have this disease. The relatives can be from either the mother's or father's side of the family. Having a mother, sister, or daughter with breast cancer about doubles a woman's risk. It's important to note that most (over 85%) women who get breast cancer do not have a family history of this disease.
    Personal history of breast cancer: A woman with cancer in one breast has a greater chance of getting a new cancer in the other breast or in another part of the same breast. This is different from a return of the first cancer (called recurrence).
    Race: White women are slightly more likely to get breast cancer than African-American women. But African American women are more likely to die of breast cancer. At least part of the reason seems to be because African-American women have faster growing tumors, but we don't know why this is the case. Asian, Hispanic, and Native-American women have a lower risk of getting and dying from breast cancer.
    Dense breast tissue: Dense breast tissue means there is more gland tissue and less fatty tissue. Women with denser breast tissue have a higher risk of breast cancer. Dense breast tissue can also make it harder for doctors to spot problems on mammograms.Certain benign (not cancer) 
    breast problems: Women who have certain benign breast changes may have an increased risk of breast cancer. Some of these are more closely linked to breast cancer risk than others.
    Lobular carcinoma in situ: Women with lobular carcinoma in situ (LCIS) have a 7 to 11 times greater risk of developing cancer in either breast.
    Menstrual periods: Women who began having periods early (before age 12) or who went through the change of life (menopause) after the age of 55 have a slightly increased risk of breast cancer. They have had more menstrual periods and as a result have been exposed to more of the hormones estrogen and progesterone.
    Breast radiation early in life: Women who have had radiation treatment to the chest area (as treatment for another cancer) earlier in life have a greatly increased risk of breast cancer. The risk varies with the patient's age when they had radiation. The risk from chest radiation is highest if the radiation were given during the teens, when the breasts were still developing. Radiation treatment after age 40 does not seem to increase breast cancer risk.
    Treatment with DES: In the past, some pregnant women were given the drug DES (diethylstilbestrol) because it was thought to lower their chances of losing the baby (miscarriage). Recent studies have shown that these women have a slightly increased risk of getting breast cancer. 
    Not having children or having them later in life: Women who have had not had children, or who had their first child after age 30, have a slightly higher risk of breast cancer. Being pregnant many times and at an early age reduces breast cancer risk. Being pregnant lowers a woman's total number of lifetime menstrual cycles, which may be the reason for this effect.
    Recent use of birth control pills: Studies have found that women who are using birth control pills have a slightly greater risk of breast cancer than women who have never used them. This risk seems to go back to normal over time once the pills are stopped. Women who stopped using the pill more than 10 years ago do not seem to have any increased risk. 
    Using hormone therapy after menopause: Post-menopausal hormone therapy (PHT) has been used for many years to help relieve symptoms of menopause and to help prevent thinning of the bones (osteoporosis). This treatment goes by other names, such hormone replacement therapy (HRT), and menopausal hormone therapy (MHT).
    Not breast-feeding: Some studies have shown that breast-feeding slightly lowers breast cancer risk, especially if the breast-feeding lasts 1½ to 2 years. This could be because breast-feeding lowers a woman's total number of menstrual periods, as does pregnancy. But this has been a hard area to study. In countries such as the United States, breast-feeding for this long is uncommon.
    Alcohol: The use of alcohol is clearly linked to an increased risk of getting breast cancer. Women who have one drink a day have a very small increased risk. Those who have 2 to 5 drinks daily have about 1½ times the risk of women who drink no alcohol. The American Cancer Society suggests limiting the amount you drink to one drink a day.
    Being overweight or obese: Being overweight or obese is linked to a higher risk of breast cancer, especially for women after change of life or if the weight gain took place during adulthood. The risk seems to be higher if the extra fat is around the waist.But the link between weight and breast cancer risk is complex. And studies of fat in the diet as it relates to breast cancer risk have often given conflicting results. T
    Lack of exercise: Studies show that exercise reduces breast cancer risk. 
    Diet and vitamin intake: Many studies have looked for a link between certain diets and breast cancer risk, but so far there are no clear answers. Some studies have seem to show that diet may play a role, while others found no evidence that diet has an effect on breast cancer risk. 
    Antiperspirants and bras: Internet e-mail rumors have suggested that underarm antiperspirants can cause breast cancer. There is very little evidence to support this idea. A large study of breast cancer causes found no increase in breast cancer in women who used antiperspirants. Also, there is no evidence to support the idea that bras cause breast cancer.
    Abortions: Several studies show that induced abortions do not increase the risk of breast cancer. Also, there is no evidence to show a direct link between miscarriages and breast cancer. 
    Breast implants: Silicone breast implants can cause scar tissue to form in the breast. But studies have found that this does not increase breast cancer risk. If you have breast implants, you might need special x-ray pictures during mammograms.
    Pollution: A lot of research is being done to learn how the environment might affect breast cancer risk. This issue understandably invokes a great deal of public concern, but at this time research does not show a clear link between breast cancer risk and exposure to substances like plastics, certain cosmetics and personal care products, and pesticides (such as DDE). More research is needed to better define the possible health effects of these and similar substances.
    Tobacco Smoke: Most studies have found no link between active cigarette smoking and breast cancer. An issue that continues to be a focus of research is whether secondhand smoke (smoke from another person's cigarette) may increase the risk of breast cancer. But the evidence about secondhand smoke and breast cancer risk in human studies is not clear. 
    Night Work: A few studies have suggested that women who work at night (nurses on the night shift, for instance) have a higher risk of breast cancer. This is a fairly recent finding, and more studies are being done to look at this.
    When I look at all these risk factors it's difficult to imagine anyone who doesn't have several of them, I know that I certainly do.

    My latest forum article 'Australian Researchers Discover Potential Blue Green Algae Cause & Treatment of Motor Neuron Disease (MND)&(ALS)' Parkinsons's and Alzheimer's can be found at http://www.science20.com/forums/medicine
    Great article and alot to think about. I truly believe the reason I had breast cancer was because of stress. While other factors may have been involved...it is imperative we limit the amount of stress in our lives. Its the quality of life as well that can help with preventing cancer. Diagnosed at 40, and never having a mamogram (which may or may not have detected the tumor) was a shock. If the money they spend on all the research could be spent on more clear scanning at an earlier age...many of the invasive cancers could be avoided.