Prospects for primary prevention

Information on this webpage is drawn from our 2005 report: Breast cancer - an environmental disease: the case for primary prevention, available free as a pdf, see Downloads. For current statistics and data, see our homepage.

Some of the causes of breast cancer and related diseases can only be controlled by political and social action…
(Davis et al 1998)

Current breast cancer prevention options

Medical prevention is electively available to women perceived to be in the 'high-risk' category for breast cancer. The choices are:

oophorectomy – removal of ovaries (by surgery) or destruction of ovaries (by drugs or radiation) to eliminate a main source of oestrogen production
bilateral mastectomy – the surgical removal of both breasts.

Chemoprevention (prevention through the use of drugs) Designed to reduce or block the action of the hormone oestrogen, Tamoxifen and similar oestrogen-inhibiting drugs are currently used as a preventive measure for women perceived to be in high-risk categories either for disease onset or for disease recurrence.

UK government's Cancer Prevention Plans – the National Cancer Plan (NCP) 2000 and The Scottish Cancer Plan (SCP) 2001 – aim to reduce cancer death rates by 20% in people under the age of 75 by 2010. A large-scale public education campaign is targeting lifestyle changes (exercise, diet, alcohol consumption and smoking) regarded by both governments as key factors in cancer prevention. Ignoring the links between environmental and occupational exposures to carcinogens and EDCs as major and preventable factors in breast cancer, the government's prevention campaigns:

take no account of the vast amount of international scientific work establishing the association between breast cancer and environmental exposures to man-made carcinogens and EDCs
include no public warnings about man-made carcinogens and EDCs encountered in everyday life
propose no strategies for the primary prevention of breast cancer, e.g. banning production and use of man-made carcinogens and EDCs.

Primary prevention: how well-informed are decision makers?

The UK parliamentary system is served well by informational support from:

regular internal publications e.g. POST Technical Report 108 'Hormone Mimicking Chemicals' 1998; parliamentary proceedings (Hansard)
reports and briefings from government committees e.g. the All-Party Parliamentary Group (APPG)* on Breast Cancer.

[* APPGs have no power either to make or alter laws but they do serve as sources of expert advice and information to others in government and can therefore influence both government thinking and decisions on topics such as breast cancer prevention.]

Government also seeks and hears policy and planning advice from key people in academic institutions, from professional bodies such as The Royal Society and the British Medical Association, and organisations like the Pesticide Action Network (UK). Perhaps most significant, in terms of future change, is the information reaching national parliaments from the European Union (EU) – a newly expanded federation of 25 member states including the UK.

All of this points to the probability that most politicians are exposed to evidence that shows:

the relationship between environment and health
the environmental origins of most cancers
cancer (and breast cancer) as a largely preventable disease
the existence of scientific evidence supporting primary prevention actions and policies.

It would seem reasonable to assume therefore, that the majority of government members, their advisers and civil servants in related departments (health, industry, environment, public health), must be equally aware of the 'ethical' decisions and policy choices confronting government.

Who is responsible for breast cancer prevention?

Some of the causes of breast cancer and related diseases can only be controlled by political and social action aimed at reducing the production, use, transport and disposal of agents that directly or indirectly affect breast cancer risks … The public and private sectors could, for example, devise policies to prevent, restrict, or reduce exposures to agents in the household, workplace, and general environment that extend the duration and onset of breast growth or alter the hormonal environment.
Davis et al 1998

Responsibility for putting in place the legislative and regulatory measures for preventing the cancer which each year affects almost a quarter of a million British women lies first and foremost with government.

Science and industry bear responsibility for any adverse impacts of their actions and products on wildlife, people and environment. And trade unions have responsibility for ensuring that the health and safety of people at work are protected in accord with workplace regulations.

Science

Few scientists would disagree with the two means for attaining prevention in the following statement:

'The most effective means of reducing (cancer) risk are,

avoidance of tobacco use, consumption of appropriate diets, and
limiting exposure to occupational and other environmental carcinogens.'
(World Cancer Research Fund & American Institute for Cancer Research 1997)

Yet the second of the two remains consistently under-acknowledged as a preventive measure by the very community which once, among its most eminent cancer researchers, 'shared the belief that malignant diseases can be reduced significantly by determined efforts to identify environmental causes and to eliminate them or reduce their impact.'
(Rachel Carson 1962)

Any future hope for science leading and influencing primary prevention policies lies with those scientists who publicly acknowledge the association between environmental pollution and escalating cancer rates, and who take up new challenges in research and development, e.g. green chemistry and endocrine disruption. For example Dr Nicholas Leadbeater and his research group at King's College, London, are working in areas of organic and inorganic synthesis and are interested in new ways to make molecules and cleaner ways to do chemistry and to minimise waste: 'We want to make a product with no waste and no by-products and hence less chance of polluting the environment.'
(Royal Society Summer Science Exhibition London July 2002)

Hope rests also with those who are unequivocal about the task facing all governments. For example, Professor Dominique Belpomme, medical oncologist at the University of Paris, believes: 'Public health policies must now focus on the relationship between environment and health. Realistic primary prevention policies should be introduced with the aim of avoiding the deleterious factors which we introduce into the environment.'
(PAN Europe Pesticides News 2004)

There is a need for:

independent scientists to express their concerns in public forums
government to heed the voices and warnings of independent scientists.

Independent scientific opinion, free from the constraints of vested interests, will be crucial to the process of developing primary prevention strategies.

Science is a continuous endeavour. But it will only help to stem the breast cancer epidemic if its findings are put to use by government and others who make public policy.
(Read 1995)