Over the past two to three decades, advocacy groups have worked to increase public awareness of breast cancer.
Many of the awareness campaigns have focused on mammography screening for early detection of cancer as the main action step that women should take in response to their general awareness of breast cancer as a health risk.
Presumably in large part as a result of these awareness efforts, more women are now being screened for breast cancer. In a 2011 survey by the Centers for Disease Control and Prevention, 66% of women over 40 reported having had a mammogram within the past two years.(1)
But is this enough for us to be able to say that the breast cancer advocacy movement has been a “success”?
The problem that sparked the advocacy movement–the high level of deaths each year from breast cancer–has not gone away. And we still have very limited understanding of the causes of breast cancer and don’t know how to prevent it. We are very far indeed from being able to declare success in the fight against breast cancer.
Perhaps it’s time to reframe how we think about breast cancer awareness, including placing information about breast cancer into context with the impact of all types of cancer on our health today. A more meaningful awareness campaign could start with messages like these:
1. Lung cancer is responsible for the highest number of annual cancer deaths, and breast cancer the second highest number of annual cancer deaths, for women in the United States today.
Cancer is the second leading cause of death in the United States, after heart disease. The American Cancer Society (ACS) reports that there will be an estimated 273,430 deaths from cancer among females in the United States in 2013. These are the top five cancer sites by annual deaths and estimated 2013 deaths for U.S. females:(2)
Lung & bronchus – 72,220 (26%)
Breast – 39,620 (14%)
Colon & rectum – 24,530 (9%)
Pancreas – 18,980 (7%)
Ovary – 14,030 (5%)
(Although these statistics are about women, it’s important to recognize that men get breast cancer too. It is estimated that 410 U.S. males will die from breast cancer in 2013.)
2. Mortality rates, or deaths per unit of population each year, have shown only modest improvement for some cancers, and even that is not evident across ethnic groups.
For U.S. females, of the top five cancer sites listed above, only two–breast cancer and colon cancer–have had only moderate declines in mortality rates over the past twenty years. Over that same time period, mortality rates for cancers of the lung, pancreas and ovary have remained essentially unchanged.(3)
The ACS reports that, after slowly increasing between 1975 and 1990, breast cancer mortality rates decreased 2.2% per year between 1990 and 2007. However, even that modest improvement has not been consistent across ethnic groups. Breast cancer mortality trends for African American and white women began to diverge in the early 1980s. And by 2007, death rates were 41% higher in African American than white women. This divergence reflects the broader reality, noted by the ACS, that African Americans are more likely to develop and die from cancer than any other racial or ethnic group.
3. Five-year survival rates need to be viewed with caution.
Trends in five-year survival rates are frequently cited to demonstrate progress against breast cancer. But five-year survival rates can be very misleading when used this way. One reason is that they don’t reflect the fact that some cancers, including breast cancer, can recur long after the five-year mark. They also don’t distinguish between individuals who have “no evidence of disease” at the five-year point and those who do or have already had recurrences.
The second reason that five-year survival rates can be misleading is that increased screening itself produces higher five-year survival rates. That is because some patients included in these statistics will simply have become aware through screening that they have breast cancer sooner than they otherwise would have, but will not actually live longer than they would have anyway. Others, whose conditions meet the definition of cancer but would not have been fatal in any case, will be diagnosed as having cancer and will be included in the five-year survival statistics.
4. The long-term adverse side effects of treatment for cancer can have a major impact on quality of life and are sometimes fatal.
The short-term and temporary side effects of cancer treatment are pretty well known. But many people don’t know that serious side effects can occur long after treatment has ended. For example, removal of lymph nodes as part of breast cancer surgery can cause a chronic condition, known as lymphedema, which results from the build-up of fluid in the arm and causes swelling and pain.
Damage to the heart is a risk with some forms of chemotherapy and with radiation treatment. Chemotherapy drugs can cause damage to other organs, including the lungs, kidneys and reproductive organs, and can cause damage to the nervous system. Chemotherapy and hormone therapy have been shown to cause cognitive problems including learning, memory and attention difficulties. And some treatments for cancer increase the risk of a new cancer occurring later on.
5. Current screening technologies have serious limitations.
Some suggest that more screening for breast cancer using existing technology is the answer. Yet, current technology is not anywhere near as effective as it needs to be. It misses many cancers and it cannot distinguish between a lesion that would never be harmful, a precancerous lesion and an invasive cancer.
In my case, as is true for most younger women, who generally have denser breast tissue, a lump that could be felt was not visible on a mammogram. My experience happened twenty years ago, yet it would be the same today — breast cancer screening technology, as it is widely used, has changed very little in the last twenty years.
Where Do We Go From Here?
When it comes to awareness efforts, it’s time to change course. Meaningful awareness, followed by relevant, responsive action, is what is needed now. We need to insist on more coordinated efforts to find less toxic treatments that really save lives. And we must develop much better screening methodologies for breast cancer and other cancers that can enable us to intervene in the disease process early enough to prevent actual cancer from developing.
For More Information
A discussion of the problems with five-year survival rates,“Five Year Survival Rates Can Mislead,” can be found at Health News Watchdog.
A more detailed summary of the “Long-Term Side Effects of Cancer Treatment” is available at the American Society of Clinical Oncology (ASCO)’s Cancer.Net. An article in CureToday, “Heart of the Matter: Cardiac Toxicity”, provides an in-depth discussion of heart health problems related to cancer treatment.
Breast Cancer: Where Are We After Twenty Years?
(1) Source: American Cancer Society (ACS), Breast Cancer Facts & Figures, 2011-2012
(2) Source: ACS, Cancer Facts & Figures, 2013
(3) ACS, Cancer Facts & Figures, 2013 (Based on deaths per 100,000 females, age adjusted to the 2000 U.S. standard population, 1990-2009)