A: I think there is something outside of the individual. Whether it is a virus, carcinogens in the pesticides, hormones in the beef and cattle, whether it's smog, whether it's cadmium--we don't have a clue. Breast cancer is much more common in this country than in Third World countries. It's much more common in high-socioeconomic white women. It's less common in African-American women, in Hispanic women, in Asian women. Why is that? . . . It may be that some people, when exposed to pesticides, have mutations that lead to cancer and other people don't. Maybe if you could figure it out, you could give the people who don't have it the protection they need.
Q: How much might early detection account for some of the increase in breast-cancer rates in recent years?
A: Some of the increase is detection, but not a lot. It should be a lot more. For example, among women over 50, where mammography works best, only about a third of them are getting mammograms.
A: One reason is a problem of the media. Every article about breast cancer, and every women's magazine or TV show, always shows the 22-year-old's body. They never show a 65-year-old's. Yet breast cancer is more common the older you are. It's very uncommon in 22-year-olds. But we just throw away older women. They don't count . . . .
I have these TV shows call and say, "We want to do a show and could you find us a 35-year-old with two young kids?" Because it's so heart-rending. But it's also heart-rending when you're 65 years old, thank you very much. So, part of it is that older women don't see themselves at risk. If you ask them why they don't get mammograms, they either say, "I'm not at risk" or "My doctor didn't tell me to."
Q: Women have been led to believe that if they did breast self-examination and had regular checkups and mammography from age 40 on, they could hope not to die of breast cancer. Now they're being told early detection is a myth, that mammography misses 10% or 15% of all tumors and that it's not cost-effective to spend society's money to make mammography available to women under 50. Can you advise them?
A: The problem is, we oversold it, in the true American fashion. We made it sound as if every cancer goes through this nice little progression from a grain of sand to a BB to a pea to a walnut to a lemon to a grapefruit. And if you just did your breast self-exam and you got your mammogram, you could find them all as this grain of sand and we'd all be cured and life would be groovy. It's just not that simple . . . . It doesn't necessarily go from a grain of sand or a BB--it may show up as a walnut . . . . And some cancers that are very sneaky don't show up until they're grapefruit . . . .
If you have dense breast tissue, cancer and breasts have the same density and you're not going to see a difference in density, which is what you're looking for with mammography. Young women have dense breasts and, therefore, mammography is less accurate in young women. It becomes more accurate once you go through the menopause. Then all breast tissue fades away and gets replaced by fat and cancer shows up against that great. So, mammography works great over 50. It's never really been proven to work well in women under 50 . . . . The answer is: We need to find something that works better, not pay for something that doesn't work that well.
Q: And in the meantime?
A: And in the meantime, the answer's political action.