and Breast Cancer
ENVIRONMENT & HEALTH WEEKLY #630
December 24, 1998
HEADLINES THE NEWS OF 1998, PART 1
continued to accumulate during 1998 that your diet can drastically
alter your chances of getting heart disease and cancer, including
good news is that eating monounsaturated fats (the kind found in
olive oil, canola oil, and nuts) seems to have a protective effect
against these major diseases. The nuts highest
in monounsaturated fats are hazelnuts, macadamias, pecans, almonds,
pistachios, Brazil nuts, walnuts, and peanuts.
bad news is that hydrogenated vegetable oil and partially hydrogenated
vegetable oil can have major harmful effects, increasing your
chances of heart attack and cancer, including breast cancer. It
is the trans-fatty acids in hydrogenated vegetable oils that seem
to be the culprits.
vegetable oils are mainly found in margarine and vegetable shortening,
which in turn are common ingredients of bread, cookies, crackers,
chips, candy bars, and many baked goods such as doughnuts. Many
french fries are now cooked in hydrogenated vegetable oils. If you
eat a normal American diet, it is hard to avoid large doses of hydrogenated
or partially-hydrogenated vegetable oils, but the evidence is mounting
that they are really bad news and should be avoided whenever possible.
Ascherio at the Harvard School of Public Health estimates that trans-fatty
acids are now killing at least 30,000 Americans every year.
Read the label and purchase wisely.
1998, evidence continued to accumulate indicating that a significant
portion of female breast cancer is preventable because it is caused
by exposure to cancer-causing agents (chemicals and radiation --
including hydrogenated vegetable oils) added intentionally or unintentionally
to the environment and food. (See REHW #571, #572, #573, #574, #575.)
182,000 new cases of breast cancer occur in American women each
year, and 46,000 deaths occur annually from the disease. In the
U.S., the occurrence of breast cancer has increased steadily at
the rate of one percent each year for the past 40 years.
"cancer establishment" -- the cluster of government agencies
and private corporations that controls the flow of cancer research
dollars (see REHW #571, #572) -- is feeling tremendous pressure
to demonstrate a preventive approach to breast cancer.
the National Cancer Institute announced in April that a drug
called tamoxifen had cut the occurrence of new breast cancers by
45% in a group of 13,388 women who were thought to have a high probability
of getting the disease. Government regulators
acted swiftly and the news media trumpeted the story. A committee
of the US Food and Drug Administration (FDA) announced in September
that it was recommending that the FDA approve tamoxifen as a drug
for "reducing the risk" of breast cancer. A spokesperson
for the FDA told the NEW YORK TIMES that "potentially tens
of millions of women" could be candidates for tamoxifen treatments
at a cost of $80 to $100 per month per person. Tamoxifen is marketed
under the name Nolvadex by Zeneca, the chemical company that sponsors
Breast Cancer Awareness Month each year. Tamoxifen has been used
for breast cancer chemotherapy for two decades.
FDA committee carefully avoided using the words "prevent"
or "prevention" because it said tamoxifen may merely
delay the onset of cancers and not actually prevent them; it is
too early to tell. Still, the message from the cancer establishment
was unmistakably one of prevention. The NEW YORK TIMES ran a front-page
story saying tamoxifen's approval by FDA "would be a milestone
in efforts to prevent cancer." Even before
the tamoxifen study was published, the TIMES wrote an editorial
about it, calling tamoxifen "a breast cancer breakthrough."
"For the first time, scientists have demonstrated that breast
cancer can not only be treated but actually prevented," the
TIMES editorial said.
it is not clear that tamoxifen represents a real victory for most
women. The TIMES acknowledged in its editorial that, if 1000 women
took tamoxifen for 5 years, 17 breast cancers would be avoided,
and bone fractures from osteoporosis would be reduced; however in
the same 1000 women during the 5 years tamoxifen would cause an
additional 12 endometrial cancers (cancers of the lining of the
uterus) and at least 10 potentially-fatal blood clots. The published
study also reported an increase in strokes and eye cataracts among
those treated with tamoxifen, compared to a control group.
its news story, the TIMES reported that the FDA committee "said
it did not yet have enough information to determine which women
were at high enough risk of breast cancer to make the drug's hazards,
including potentially fatal blood clots as well as cancer of the
uterine lining, worth its benefits."
National Cancer Institute has released a computer "risk
disk," a diskette containing a program intended to help women
judge their risk of getting breast cancer. The diskette is available
in both PC and Macintosh formats; telephone 1-800-4-CANCER or sign
up to receive the diskette by mail at http://cancertrials.nci.nih.gov.
course, no one should rely on a computer program -- or on information
they read in the news media -- to make decisions about their health
without consulting a qualified medical specialist.
smaller studies of tamoxifen and breast cancer were published in
September and neither of them showed any benefits from tamoxifen
Differences in criteria for recruiting women into the studies may
have produced the contradictory results. Nevertheless, definitive
evidence of tamoxifen's benefits and dangers must await further
late April, the NEW YORK TIMES reported on two unpublished
studies of a drug called raloxifene. According to the TIMES, both
studies show that raloxifene can reduce a woman's chances of getting
breast cancer without increasing her chances of getting endometrial
cancer. A study is now under way to compare the effects of raloxifene
us, the tamoxifen and raloxifene studies reveal a curious shift
in the cancer establishment's view of "prevention." To
most people, cancer prevention means preventing exposures to cancer-causing
agents. Instead cancer "prevention" is coming to mean
treating a woman with a potent drug year after year, in an attempt
to counteract the effects of her lifelong exposure to carcinogens.
The eagerness of the NEW YORK TIMES to promote this new view of
prevention on page 1, and in its editorial columns (often relying
on preliminary data from unpublished studies), is, itself, curious
and worrisome. It is as if the cancer establishment has abandoned
the struggle to get carcinogens out of the environment and the nation's
food supply, relying instead on drug treatments. It occurs to us
that there is simply no money to be made in old-style prevention.
It is hard to make a living by reducing women's exposures to radiation
and carcinogenic chemicals. But getting FDA approval for a new drug
can be extremely lucrative even if its benefits hardly outweigh
us, the most interesting study of 1998 was never reported in the
NEW YORK TIMES or any other of the mass media. In September, researchers
at the University of Birmingham in England reported exposing pregnant
rats to small amounts of dioxin on the 15th day of pregnancy.
[Dioxin is a highly-toxic, chlorinated byproduct of combustion,
incineration, metal smelting, and the manufacture of many chemicals,
including pesticides. All Americans carry amounts of dioxin in their
bodies that the U.S. Environmental Protection Agency considers dangerous.
(See REHW #390, #391.)]
female offspring of the dioxin-exposed pregnant rats were born normal,
but by the time they were 7 weeks old, their mammary glands had
developed an unusually high number of "terminal end buds"
-- the places in a breast where breast cancers develop. Four studies
have shown that there is a direct correlation between the number
of terminal ends buds in a breast and its susceptibility to breast
Birmingham researchers went on to expose these young rats (and a
control group) to a well-known carcinogenic chemical (dimethylbenz[a]anthracene).
Sure enough, the dioxin-exposed young rats developed many more breast
cancers than did the control group.
elegant study shows that (a) timing of exposure to dioxin (and presumably
to other toxicants) is critical; (b) exposure to a chemical before
birth can predispose an animal to breast cancer later in life even
if the chemical itself is known to INHIBIT breast cancer when exposure
occurs later in life, as is the case with dioxin; (c) present methods
of testing chemicals for their cancer potential are missing the
boat, failing to ask the right questions about the dangers of the
cancer-causing chemicals we are all legally exposed to year after
are important opportunities to prevent breast cancers, and other
cancers, in this world, and they do not require us to expose tens
of millions of women to powerful chemotherapy drugs year after year.
They simply require us to develop the political will to clamp down
on the murderous practices of industrial polluters and the food
 On the protective effect of nuts, see Janet
Raloff, "High-Fat and Healthful," SCIENCE NEWS Vol. 154
(November 21, 1998), pgs. 328-330. On the protective effect of olive
oil, see J.M. Martin-Moreno and others, "Dietary fat, olive
oil intake, and breast cancer risk," INTERNATIONAL JOURNAL
OF CANCER Vol. 58, No. 8 (September 15, 1998), pgs. 774-780, and:
N.R. Somonsen and others, "Tissue stores of individual monounsaturated
fatty acids and breast cancer: the EURAMIC study. European Community
Multicenter Study of Antioxidants, Myocardial Infarction, and Breast
Cancer," AMERICAN JOURNAL OF CLINICAL NUTRITION Vol. 68, No.
1 (July 1998), pgs. 134-141. On the protective effect of monounsaturated
fats in general, see A. Wolk and others, "A prospective study
of association of monounsaturated fat and other types of fat with
risk of breast cancer," ARCHIVES OF INTERNAL MEDICINE Vol.
158, No. 1 (January 12, 1998), pgs. 41-45.
Alberto Ascherio and others, "TRANS-Fatty Acids Intake and
Risk of Myocardial Infarction," CIRCULATION Vol. 89, No. 1
(January 1994), pgs. 94-101. And P. Pietinen and others, "Intake
of fatty acids and risk of coronary heart disease in a cohort of
Finnish men. The Alpha-Tocopherol, Beta-Carotene Cancer Prevention
Study," AMERICAN JOURNAL OF EPIDEMIOLOGY Vol. 145, No. 10 (May
15, 1997), pgs. 876-887.
A. Ashcerio and W.C. Willett, "Health effects of trans fatty
acids," AMERICAN JOURNAL OF CLINICAL NUTRITION Vol. 66 [4 Supplement]
(October 1997), pgs. 1006S-1010S.
The study was published in September. See B. Fisher and others,
"Tamoxifen for Prevention of Breast Cancer: Report of the National
Surgical Adjuvant Breast and Bowel Project P-1 Study," JOURNAL
OF THE NATIONAL CANCER INSTITUTE Vol. 90, No. 18 (September 16,
1998), pgs. 1371-1388.
Gina Kolata and Lawrence M. Fisher, "Drugs to Fight Breast
Cancer Near Approval," NEW YORK TIMES September 3, 1998, pgs.
"Breast Cancer Breakthrough [editorial]," NEW YORK TIMES
April 8, 1998, pg. A24.
Trevor Powles and others, "Interim analysis of the incidence
of breast cancer in the Royal Marsden Hospital tamoxifen randomised
chemoprevention trial," LANCET Vol. 352 (July 11, 1998), pgs.
U. Veronesi and others, "Prevention of breast cancer with tamoxifen:
preliminary findings from the Italian randomised trial among hysterectomised
women," LANCET Vol. 352 (July 11, 1998), pgs. 93-97.
Kathleen I. Pritchard, "Is tamoxifen effective in prevention
of breast cancer?" LANCET Vol. 352 (July 11, 1998), pgs. 80-81.
Lawrence K. Altman, "Studies Show Another Drug Can Prevent
Breast Cancer," NEW YORK TIMES April 21, 1998, pg. A16.
Nadine M. Brown and others, "Prenatal TCDD and predisposition
to mammary cancer in rats," CARCINOGENESIS Vol. 19, No. 9 (1998),
terms: cancer; breast cancer; prevention; vegetable oils; hydrogenated
vegetable oils; partially hydrogenated vegetable oils; canola; nuts;
diet and health; food safety; heart disease; mortality statistics;
tamoxifen; raloxifene; endometrial cancer; dioxin; chemotherapy.
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