Samuel Epstein Hi Darklady, he is a medically trained doctor. He\'s British and received his doctorate in medicine at Guy\'s.
He has some pretty radical views for example - opposes pre-menopausal mammography, opposed the trials on Tamoxifen as a possible prevention for breast cancer.
He made this statement in 1996:
\"A decade-old multi-million dollar deal between National Breast Cancer Awareness Month sponsors and Imperial Chemical Industries (ICI) has produced reckless misinformation on breast cancer,\" stated Dr. Samuel Epstein, a leading international authority on cancer-causing effects of environmental pollutants.
Zeneca Pharmaceutical, a U.S. subsidiary and recent spin-off of ICI, has been the sole funder of National Breast Cancer Awareness Month since 1984. ICI is one of the largest manufacturers of petrochemical and chlorinated organic products, such as acetochlor and vinyl chloride, and the sole manufacturer of Tamoxifen, the world’s top-selling cancer drug used for breast cancer. Financial sponsorship by Zeneca/ICI gives them editorial control over every leaflet, poster, publication, and commercial produced by NBCAM. NBCAM is promoted by the cancer establishment, the National Cancer Institute (NCI) and the American Cancer Society (ACS) with their corporate sponsors.
Imperial Chemical Industries has supported the cancer establishment’s blame-the-victim attitude toward the causes of breast and other cancers. This theory attributes escalating cancer rates to heredity and faulty lifestyle, rather than avoidable exposures to industrial carcinogens contaminating air, water, food, consumer products, and the workplace.
\" The ICI/NBCAM public relations campaign has prevented women from knowing of avoidable causes of breast cancer,\" concluded Dr. Epstein.\"
Right on Doc. Good to see a medical doctor wanting to discuss topics that governments, pharmaceutical industries, media and charities would rather ignore and good to see a clear eyed opinion on breast cancer awareness month, the spread of misinformation (hmm... Good Housekeeping breast cancer survival statistics come to mind) and the implication that women have caused their own breast cancer.
Maybe he\'s right, maybe he\'s not. I think he\'s largely right because we are exposed to so many chemicals that have never been tested for effects on human health so it would be remarkable if they were all harmless. We need more doctors like him to discuss the unpalatable, then we might actually get to the truth about what causes breast cancer. Meanwhile, I think it makes sense to avoid processed foods, try and eat organic and minimise exposure to synthetic chemicals in cleaning & decorating products and cosmetics. If enough people start demanding organic food and products and cosmetics containing safer chemicals, producers would soon fall into line as there would be a significantly reduced market for food and products that could not be proved to be safe.
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Lets Discuss Herceptin & Patricia Hewitt\'s intervention In the let\'s discuss thread, JaneRA posed the question:
\"Great as Herceptin is, was Patricia\'s Hewitt\'s intervention really the right one?\"
I thought I\'d start a new thread on this topic only as it makes things a bit easier to follow.
If PH had not intervened, many women with primary breast cancer who are now getting Herceptin would not be getting it. So her intervention is probably improving breast cancer survival for many women which is a good thing.
However, we are back to postcode lottery and, despite PH stating that no PCT should refuse to fund Herceptin for Primary Breast Cancer on grounds of cost alone, many PCTs are still refusing to fund. Since it is unlikely that doctors are recommending people for Herceptin without the clinical benefits being clear cut (why would they stick their necks out to recommend an unlicensed drug unless they were sure a patient would benefit?), I presume that some PCTs are ignoring PH\'s guidelines.
I think it was wrong of her to make this statement without giving a commitment to ensure that she would take action against PCTs who ignore it. When questioned about this at Breakthrough\'s Westminster Fly-In, she reminded us of the extra money the Government has allocated to the NHS and stated that finance should not be an issue for PCTs.
So why are so many of them bleating that they have no money and would have to take money away from essential services to pay for Herceptin? It\'s like a dam waiting to burst because when it does get licensed, what excuses will they make then?
Herceptin is only the start. In future, new cancer drugs will be developed and patients will have the same sort of struggle to get the drugs. The Government doesn\'t seem to give a stuff about preventing cancer (or other diseases for that matter), so they\'d better get used to a lot of ill people campaigning hard for drugs to keep them alive.
Breakthrough Breast Cancer has stated that the recent example of Herceptin has demonstrated that future breakthrough treatments need to be handled through a proper process rather than intervention from MPs and they will be sending out a survey about NICE to Campaign and Advocacy Network Members.
A decent, speedy, process to get new drugs licensed is good, but it doesn\'t deal with the problem of where the money is going to come from to pay for them.
I think that Herceptin should be available to every woman with primary breast cancer who will definitely benefit from it, but that doesn\'t stop me from resenting having my taxes poured into the ever-widening maw of a Government which thinks that a good health service is one that focuses entirely on treatment and does nothing about prevention. Remember, this is the Government that ignores the role of alcohol and smoking in cancer and other diseases and presides over a culture of binge drinking and hasn\'t got the guts to go for an outright ban on smoking in public places.
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Louise I agree that dietary and environmental factors play a part in causing breast cancer, but an increase in yearly cases in England diagnosed by 80% between 1971 and 2003 (source Office of National Statistics) is more than just bad luck. \"Official\" reasons put forward for the increase are changes in reproduction (people having no or fewer children, not breastfeeding), people living longer and the introduction of the national screening programme, none of which adequately explains such a huge increase in incidence, in my opinion.
I agree Jane Plant hasn\'t actually said people will die if they don\'t follow her diet, but that\'s how some people interpret it, due to the prescriptive tone of her writing.
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Jane Plant There have been many debates about Jane Plant on this forum in the past. I have a lot of time for her theories about diary. I tried giving it up about 14 months ago, after reading her book, and found it surprisingly easy so have carried on. I have a theory that the population consumes far more dairy produce of a different nature than used to be the case 20 -30 years ago.
People eat more processed foods now. If you look at the labels, it\'s very difficult to find any that don\'t have whey or skimmed milk in - I\'ve even seen milk as an ingredient in sausages for goodness sake. Milk is overproduced in Europe and the USA and makes a nice cheap ingredient to put in processed food. If you avoid processed food, you avoid hidden milk.
Then we come to what\'s in milk. If you live in the USA and consume US produced dairy products, you will be exposed to Bovine Somatotropin which causes cows to produce abnormally large quantities of milk and causes mastitis and health problems. This is provided courtesy of Monsanto under the brand name Posilac. One can only speculate as to what effect this stuff has on the breasts of women that consume the milk containing it.
Fortunately, in Europe, BST is banned, but, as Jane Plant says, cows have been bred to produce more and more milk, which suggests that cows now have higher levels of IGF-I than previous generations of cows. Add to this the antibiotics, drugs and GM animal feed and we probably have a nice cocktail of man made chemicals in non organic dairy produce. I can never understand why cattle aren\'t vaccinated against TB. I\'ve heard the argument used that consumers wouldn\'t want to consume milk or meat from vaccinated animals which seems bizarre given all the other unnatural stuff I\'ve already referred to that\'s probably in dairy.
People who disagree with Jane Plant tend to do so because they feel that it is wrong of her to suggest that people may die if they don\'t follow her advice and some people may become very distressed if they try to follow her diet and don\'t find it easy or if they follow her advice and get cancer or a recurrence.
I think if people agree with Jane Plant\'s views and find it easy to follow her advice, fine. I keep an open mind as to whether it really can prevent cancer. It certainly can\'t do any harm. However, if people would be made miserable by trying to follow her advice, I think they should just try to have a healthy balanced diet and have organic food and diary produce if possible.
I noticed something on the internet the other day which was about some research which suggested that post-menopausal women who eat low fat dairy products have a lower risk of breast cancer than those who don\'t consume low fat dairy. It was just a press piec e so I\'ve no idea as to whether the quality of research was any good. It also said that it was unclear whether the reduced risk might be due to the calcium and/or vitamin D in milk.
I believe the Breakthrough Generations Study may be looking at dairy (at least it\'s in their questionnaire for those who join the study) so maybe one day we\'ll get an answer about dairy. Until then, there\'ll always be debate.
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More thoughts I agree that prevention and treatment using hormone inhibiting drugs and genetic and cell biology manipulation is better than doing nothing and is helping people with breast cancer to survive longer and I support research into new prevention and treatments to help triple negative women. I agree that Susan Love gives a good and reasoned summary of breast cancer risks, including environmental factors. She says (of pesticides and other environmental hazards)
\"I think the issue is complex and must take into consideration time of exposure and other associated risk factors. There still might be an environmental relationship, but it is probably small. Nonetheless, this lack of definitive answers is no excuse for not cleaning up the environment. There are enough known health problems from environmental pollution to convince us that it needs to be seriously curtailed. This is a fairly new area of scientific study. Who knows what we\'ll find in the next 5 or 10 years\".
I have my doubts that we will know any more in the next 5 or 10 years about whether or not environmental factors have anything to do with breast cancer because mainstream cancer researchers seem to take the view that because there\'s no conclusive evidence that environmental factors don\'t affect breast cancer risk, it means that they have nothing to do with breast cancer (which seems an extremely foolhardy assumption to make) and therefore ignore it and concentrate on research into prevention and treatment that involves doing stuff to women\'s bodies. Other researchers strongly argue that environmental factors do affect cancer risk - for example, Samuel Epstein MD and Theo Colborn, and they argue the evidence is there. Judge for yourselves whether they are extremists. I think they raise important questions that need to be acknowledged and answered.
According to the WWF, there are 80,000 chemicals in the environment now that were not present 50 years ago. For many, little is known about their effect on human (and animal health) and that\'s why the EU is introducing the REACH programme - Regulation, Evaluation and Authorisation of Chemicals, but that will take years to actually do anything and the Chemical Industry has been very successful in watering down the original proposals.
Of course, the role of a woman\'s own hormones should be investigated in breast cancer risk and incidence, but equally, so should the possible role of all these chemicals that have never been properly tested and whose effect on human health is unknown. Are those scientists who say that there is no conclusive evidence that environmental pollutants cause cancer saying that, contrary to the WWF, there is evidence that all these 80,000 chemicals have been properly tested? If so, where is the proof that they have no link to cancer?
Until fairly recently, many scientists denied the links between environmental pollution and global warming. They were wrong and now it seems everyone (apart from the Bush Administration) accepts that global warming is man-made and actually far more advanced than many scientists thought. Maybe it\'s the same with environmental pollution and cancer (and other diseases). I hope not, but I\'ve no reason to suppose the link isn\'t there while mainstream scientists seem to be in denial like they were for global warming. I would also like to understand what relationships exist between cancer research funding and industry in case this sheds some light on why environmental factors get swept under the carpet. Breakthrough\'s longest standing corporate partner is Avon Cosmetics and they have raised over Ã‚Â£9m for the charity, which is great, but I suggest that this relationship may not be conducive to Breakthrough\'s scientists carrying out any independent research into the chemicals that are used in cosmetics to investigate whether they have any effect on breast cells and breast tumours.
If the best 21st Century science can do to prevent breast cancer in future is to offer high risk women drugs to shut down their hormone production, tinker with their genes and cell biology and have them consider prophylatic mastectomies and oopherectomies, that\'s just not good enough. And what about the majority of us who got breast cancer despite not being high risk. Will breast cancer incidence reduce from 41000 per year or will it increase and, if it increases, will the future for people like us be the offer of precautionary de-feminising treatments when we have had children or are sure we don\'t want any so we have no female hormones, no breasts and ovaries - a human husk?
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Quality of Life Holeybones,
I\'m glad you\'ve brought up the question of quality of life on Aromatase inhibitors because I\'ve been involved in some regular email correspondence about breast cancer prevention with my MP since the Westminster Fly-in organised by Breakthrough Breast Cancer.
I\'ve said that I don\'t like the way that research into prevention (for high risk women or those who\'ve already had BC) all seems to be directed at giving drugs to manipulate women\'s hormones or messing about with their genes and cell biology. I\'ve said that I think there are huge ethical questions here, especially about giving drugs to healthy women to prevent cancer when these are powerful drugs with side effects that can adversely affect quality of life. I would like to see greater public awareness and debate about what\'s going on with prevention and I want to know why all the focus is on fiddling with people\'s cells and hormones and ignoring (my perception) what\'s causing DNA mutations and reducing the population\'s exposure to the factors that cause these mutations.
You mention about aromatase inhibitors and effect on bones & joints. As part of the IBIS-II study (looking at Arimidex as possibility for prevention by giving it to high risk, healthy women), there is study monitoring cognitive function of people taking it during the 5 year trial. Oestrogen is thought to maintain cognitive function. After natural menopause, women still produce some oestrogen, but Arimidex shuts down oestrogen production completely and the researchers want to find out whether long term use of Arimidex affects memory and reasoning. If it doesn\'t - fine, if it does, they\'ll have to decide whether the benefits of recommending it for prevention outweigh possible quality of life issues for healthy, high risk women. Nice choices for everyone affected. Of course it doesn\'t matter for those of us that have already had cancer because we just take the drugs and hope they keep us alive and put up with any quality of life side effects. That\'s always ignored when triumphal statements are made by media, charities and medics about improved breast cancer survival.
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telling people I\'m a Project Manager and work with different sets of colleagues every few months. I would much prefer them all to know I\'ve had breast cancer because then it\'s easier for me to justify why I\'m not going to work stupid hours and why I don\'t behave like a \"headless chicken\" in a work crisis (because in comparison to having breast cancer, it\'s not that important) Some of them who\'ve worked with me before know I\'ve had cancer, but are discreet and seem to keep it to themselves.
I\'ve joined a new team of colleagues in the past few weeks and went out with them one evening last week. During the course of the evening, one of them revealed that he has three nipples, which didn\'t bother me, but I was tempted to say that I\'d only got one and why, but then that would have probably been a bit of show-stopper. Maybe I\'ll tell them when I know them better. I don\'t know. I just think it would be a lot easier if I worked with the same people all the time and they knew.
According to Breakthrough\'s magazine, the actor Mark Wahlberg has got an extra nipple and one in 18 people are thought to have as well. Perhaps they could donate them to those of us who haven\'t got any or only have one!
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Yes, I miss my real breast, even though I\'ve had reconstruction and was average size and I\'ve been without it two years now. I think I\'d miss it more if I hadn\'t had reconstruction - mainly because of the bony chest feeling and appearance. It was a part of me that I was fond of (as was my husband) and it\'s gone forever.
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Subliminal Misogyny? I was trawling through the Cancer Research UK website recently to compare risk factors for Breast Cancer and Prostate Cancer (I know how to live!) and I couldn\'t help wondering why the risk factors for Prostate Cancer listed in the section about the 27 most common cancers are all things which are outside men\'s control - age, family history, race and exposure to radioactive substances. Risk factors for Breast Cancer are listed as age, menstruation and menopause, family history, dense breasts, previous breast cancer, benign breast disease, long term exposure to radiation which are things outside women\'s control, but then we get the usual lifestyle factors trotted out which we can control - reproductive habits number of births, breast feeding, HRT, Contraceptive pill, also alcohol and obesity.
I recently heard a Prostate Cancer specialist speak on the subject and he stated that high consumption of red meat is believed to increase risk of Prostate Cancer. So how come CRUK ignore lifestyle factors like diet that can affect prostate cancer risk? Well actually, they don\'t because if you go into further detail about prostate cancer on their website, they do discuss diet, but come to no firm conclusions - and there is no mention of red meat.
It may be that it is simply a fact that breast cancer risk is far more affected by lifestyle than prostate cancer risk, but I doubt it somehow since CRUK states that research shows that around half of all cancers in the UK could be prevented by changes to lifestyle ( a statement I don\'t accept in view of my opinions about environmental factors), but if you do accept what they say, why doesn\'t CRUK expand on how men can change their lifestyle and reduce prostate cancer risk?
I think it\'s easier for researchers to get women to accept that the life they lead and the choices they have made have somehow contributed to their breast cancer, whereas men wouldn\'t accept that so readily about prostate cancer. I think women too often accept the concept that when they get a nasty disease, they must somehow be to blame.
CRUK recently told me this in an email:
\" It is now widely known that there is a link between high oestrogen levels and breast cancer.Ã‚Â In general, the higher a woman’s lifetime exposure to oestrogen, the higher her breast cancer risk.Ã‚Â This exposure is determined by several natural factors.Ã‚Â It tends to be higher, for example, in women who started their periods at a relatively young age, have children later in life (or do not have any children), do not breast feed their children or have a late menopause.Ã‚Â All these factors are known to slightly increase a woman’s breast cancer risk\"
I\'ve replied with this:
\"My main observation about the focus on lifetime exposure to oestrogen beingÃ‚Â a risk factor for breast cancer is that oestrogen (as far as I\'m aware) doesn\'t cause the DNA mutations which cause a breast cell to become cancerous. Oestrogen causes breast cancer cells and normal breast cells to proliferate, but it doesn\'t cause the cancer in the first place.
So on that basis, I get rather exasperated that researchers don\'t seem to pay much attention to what exactly is causing those DNA mutations. By pointing the finger at oestrogen, we have the situation where women who have had breast cancer or are at high risk of it are almost made to fear exposure to their own hormones.Ã‚Â The future for prevention seems to focus on manipulating womens\' exposure to their own oestrogen, using drugs (such as aromatase inhibitors) which may cause a reduced quality of life (for example increased risk of osteoporosis,) instead of finding out what substances cause the DNA mutations that cause cancer and reducing the population\'s exposure to them.\"
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research conference Anne, Breakthrough is going to publish the findings of the conference early in 2006. Meanwhile, those of us who attended it have been asked if we\'d like to volunteer to be interviewed by an Anthropologist who is carrying out research on patient involvement in breast cancer research and our views on the conference.
I\'ve got my interview Monday afternoon.
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Checkups Hi Kelley, I see my surgeon privately for regular checkups and an annual mammogram. The frequency is based on what he and I think reasonable, provided my insurer agrees to pay.
Do you feel you need to have more follow up than just seeing him if you have further symptoms? I use my appointments as much to ask questions that have built up since the last appointment as for physical reassurance so I feel that I\'m being taken care of psychologically as well as physically at these appointments and that\'s very important to me.
I think it\'s also the case that private insurers don\'t seem to have a straightforward process for their customers to have access to Breast Care Nurses so we need to make sure we aren\'t cast adrift after treatment (unless we want to be).
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Kelley ask your surgeon for a copy of the pathology report and then you\'ll see the exact number of lymph nodes that were removed and how many were tested. The surgeon may not have had time to count the number of nodes removed, but the pathologist may have found and counted them all. The surgeon should explain the pathology report to you if you want to go into the detail as well.
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Article I read the article, but haven\'t read the book \"Illness as a Metaphor\". It seems that Sontag\'s approach to her final cancer was a battle, despite what she may have said in her book, because she seemed to be battling against the inevitable. She did remarkably well defying the statistics up until her death.
Until we have to face death, we don\'t know how we would deal with it, but I hope I would reconcile myself to it earlier than Sontag seemed to.
The article was also interesting in that it covered the views of some experts about progress being made (or not) in dealing with cancer. Back to the early diagnosis/better prognosis debate.
I was looking for information on the NHS breast screening programme yesterday and found that the motivation for introducing it was to improve survival by early detection and treatment. The opponents of screening believe that this leads to unnecessary or over- treatment. I think we need more honesty about screening so that women fully understand the advantages and disadvantages (if they want to) and can make their own decisions about whether screening\'s right for them.
Based on my own experiences, I\'d have opted for screening from age 40, if it had been available, even if it would have caused me to have to make difficult decisions about whether to have DCIS treated, but that\'s just a personal view.
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Hi Liz Nice to see you back as well. Like you, I had invasive carcinoma and DCIS so I guess we are in the cancer incidence stats, not the DCIS incidence stats.
Like you I think that carcinoma is cancer, whether it\'s in situ or not, though if it never becomes invasive, it\'s not life threatening. I\'ve been reading Dr Susan Love\'s book recently and she regards DCIS as precancer, not actual cancer.
I\'ve had further thoughts about Mole\'s point on work for surgeons. If you think about it, ironically they probably have more work since breast conservation became commonplace because there are plenty of people like me who have breast conservation surgery first and then a mastectomy as the cancer & DCIS is more widespread than thought. In the old days, we\'d have gone straight to mastectomy.
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Research, incidence, etc One of the reasons for increased incidence is usually stated as the effect of the national screening programme, as Jane says, picking up cancer earlier than it would otherwise be found. (which assumes that without screening, many people would have breast cancer, but die of something else before it was ever diagnosed - not sure I agree that has made much of a difference to incidence rates)
I\'m just looking at my Office of National statistics incidence graph for England and what it shows is that incidence in 1971 was approximately 66 per 100,000 and had steadily risen to approximately 85 per 100,000 by 1988 when the screening programme was introduced so incidence rates didn\'t remain flat from 1971 in the run up to the screening programme. If they had, I wonder if the screening programme would have been introduced. In 2003, it had risen to 120 per 100,000. (Caveat with the 1971 and 1988 figures is that I\'m reading it off a graph which just shows an approximation)
The ONS says \"earlier detection and improved treatment has meant that survival rates have risen\"
But, do we have a common definition of what \"earlier detection\" means? To me it means it hasn\'t spread to lymph nodes.
For those wondering about the Natural History of breast cancer, studying it means that when you find Carcinoma in Situ, you don\'t treat it but leave it and observe what happens and whether and how it develops into invasive cancer. (assuming you identify enough people who are content to have it in their bodies and leave it)
The Research conference was organised by Breakthrough Breast Cancer and gathered together about 60 people representing academics/researchers, people affected by breast cancer, the charity to prioritise Breakthrough\'s research strategy over the next 10 years. It was a bit strange because a lot of the time was spent discussing funding mechanisms, and funding awards not that much on reaching a consenus as to what research Breakthrough should actually be carrying out. But all credit to Breakthrough for involving patients in the policy making.
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More on DCIS stats Hi Mole, here\'s an extract of the email I had from Cancer Research UK
\"In your e-mail, you specifically asked about breast cancer incidence figures.Ã‚Â Ã‚Â As you correctly stated, around 41,000 new cases of breast cancer are diagnosed every year in the UK.Ã‚Â This figure does not include cases of ductal carcinoma in situ (DCIS).Ã‚Â Approximately 3,000 cases of DCIS are detected annually in England.\"
Interesting that the 41000 is UK, but the 3000 DCIS is just England.
I think we are long overdue an explanation as to why incidence is so high. According to the Office of National statistics, breast cancer incidence has increased by 80% in England between 1971 and 2003 and by 16% in the 10 years to 2003.
OK people living longer and having fewer or no kids is a common explanation of the increased risk of breast cancer, but
It\'s not like lots of people were dying below the age of 60 in the 20 - 30 years before 1971 so they didn\'t live long enough to get cancer, nor were lots of people breeding like rabbits in the 40s, 50s and 60s (well they certainly weren\'t in my family - low libido, sussed out contraception, infertile or representative of many families?) so they were exposed to less oestrogen in their lifetime. Anyway oestrogen makes normal and cancerous breast cells grow, it doesn\'t (as far as I\'m aware) cause the DNA mutations that create a cancer cell.
It\'s all very good the stuff that\'s publicised about improved survival rates, but I\'d like to see improvements in incidence rates as well.
Joan - nice to find you on here as well. It\'s a bit like trying to locate people in fog at the moment.
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