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The downside of awareness campaigns

Breast Cancer

Despite the pink ribbon push, cancer deaths have dropped only slightly. And the focus on awareness may be pushing more women into treatment unnecessarily.

October 04, 2010|By Christie Aschwanden, Special to the Los Angeles Times

As predictably as the leaves turn yellow in autumn, America turns pink each October with the arrival of National Breast Cancer Awareness Month. From shopping malls to football stadiums, the campaign's signature pink ribbons seem to be everywhere. Yet some experts are questioning whether this awareness campaign is truly helping women with breast cancer.

The stark reality is that in the 26 years since the campaign began, deaths from breast cancer have dropped only slightly — about 2% per year, starting in 1990. According to the National Breast Cancer Coalition in Washington, D.C., 117 women in the U.S. died of breast cancer every day in 1991; today that number is 110.

"I don't think people understand the lack of progress," says Fran Visco, the coalition's president.

Nor have the awareness campaign's objectives kept pace with advances in breast cancer research, says Dr. H. Gilbert Welch of the Dartmouth Institute for Health Policy and Clinical Practice in Lebanon, N.H. Doctors used to think the priority was to catch breast tumors when they were small — and presumably most treatable. As a result, they emphasized the importance of annual mammograms.

But now, Welch says, scientists have come to understand that breast cancer isn't one disease but many. Some tumors are indolent and never cause trouble. Others grow slowly and may eventually spread. The most aggressive cancers metastasize before doctors and patients even know they're there.

Unfortunately, doctors can't tell which tumors are harmless and which are truly dangerous — so they wind up treating all of them as if they were the worst kind.

But screening tests like mammograms and self-exams are most adept at finding the indolent cancers, Welch says. As a result, the more we screen, the more women we subject to surgery, chemotherapy and radiation for cancers that never would have harmed them. A paper published last month in the New England Journal of Medicine estimated that for every life saved by a screening mammogram, five to 15 other women needlessly became diagnosed and treated.

National Breast Cancer Awareness Month "was helpful at the time, but it has outlived its usefulness," says Dr. Susan Love, a breast cancer surgeon at UCLA's David Geffen School of Medicine and author of "Dr. Susan Love's Breast Book."

"You see this message that the best prevention is early detection, but that's not prevention, that's finding a cancer that's already there," Love says. "Early detection is a really nice message — it makes you feel in control, but it doesn't address our current understanding of how cancer works."

The organizers of the awareness campaign say there's no need to revamp their message.

"If it's not broken, I don't think we should try and fix it," said spokeswoman Laurie Casaday, senior manager of corporate affairs in oncology for drug maker AstraZeneca, National Breast Cancer Awareness Month's founding sponsor.

The campaign's website states that the organization remains "dedicated to educating and empowering women to take charge of their own breast health by practicing regular self-exams to identify any changes, scheduling regular visits and annual mammograms with their healthcare provider, adhering to prescribed treatment and knowing the facts about recurrence."

Other campaign literature highlights the stories of women who believe their lives were saved by a screening test. But the unsettling reality is that many of these lives were never actually threatened, says Gayle A. Sulik, author of "Pink Ribbon Blues: How Breast Cancer Culture Undermines Women's Health."

Sulik says the problems of over-diagnosis and over-treatment are rarely discussed in ads, promotional literature or advocacy messages. Neither of those terms appears anywhere on the websites for National Breast Cancer Awareness Month or Susan G. Komen for the Cure, the oldest and largest breast cancer advocacy group.

And that's no accident, Welch says.

"It's a common problem with disease awareness campaigns and patient advocacy groups," he says. "If you look into their funding sources, you'll often find a pharmaceutical company or device maker who stands to benefit from an expansion in the number of people with the condition."

Welch calls AstraZeneca's sponsorship of the awareness month "a huge conflict of interest," since encouraging women to get screened will invariably increase the number of breast cancer diagnoses and thus the market for their breast cancer drugs Arimidex, Faslodex, Nolvadex and Zoladex.

That charge is vigorously denied by Casaday. "This is not about selling a breast cancer drug," she says. "It's about making sure woman are educated about their breast health."

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