Issues

  • Breast Cancer and Social Inequalities of Health

    Social inequalities of health play out in breast cancer as with other major illnesses. The Canadian Partnership Against Cancer’s 2016 Cancer System Performance Report shows that the five-year net survival rates for breast cancer are highest in high-income populations, while lower-income populations have lower survival rates. Furthermore, there is evidence in the scientific literature that lower-income patients are less likely to have their symptoms recognized and investigated early, resulting in a more advanced diagnosis when treatment is less effective, and ultimately, in a poorer prognosis[1].

    In addition, the Public Health Directorate of Montreal has identified breast cancer as an important example of the impact of social inequality affecting health because poorer women tend to have slightly lower rates of diagnosis of the disease, but higher rates of mortality[2].

    The overall trend of breast cancer incidence (how many women are diagnosed with the disease) is relatively stable. But within that trend, different populations of women experience very different rates of incidence and mortality. Some populations, for example certain women who are recent immigrants, have incidence rates of breast cancer that have risen significantly; other populations, particularly Black women, have disproportionately high mortality rates. We need to better understand these trends, learn from them, and inform women who may need specific information about their health and screening.

    These are some of the critical issues to which Breast Cancer Action Quebec (BCAQ) is dedicated. The public is amply aware of breast cancer; the time has come for us to truly advance the debate by tackling the most complex questions raised by this disease.

    To tell the truth, the omnipresent “awareness” messaging is often an insult to women’s intelligence, and it has the effect of undermining any inclination toward deep-seated change. By opposing fundamental research on environmental issues, such as the link between cancer and endocrine disruptors (EDs), powerful interest groups prevent any change to the dominant paradigm regarding toxicity and chemical regulation. This current paradigm allows the presence of chemical agents in products until their deleterious effect has been proven.

    Currently, chemical substances are authorized before their safety for humans and the environment has been demonstrated—a practice contrary to the precautionary principle. Activists and academic researchers are forced to fight to obtain the withdrawal of harmful chemicals present in products already on the market. Furthermore, risk assessment is done on a case-by-case basis, one substance at a time, without regard for potential interactions between chemicals, and data on prolonged or age-related exposure is usually not taken into account.

    Breast Cancer Action Quebec works diligently to ensure that more funds are dedicated to fundamental research on breast cancer prevention. We also strive to publicize current social inequalities that affect health, and their impacts on breast cancer, in order to make this issue a public health priority.

    We collaborate with a wide range of groups with the goal of eliminating harmful chemical substances, or those suspected of being dangerous, from our environment. Additionally, we are working on the implementation of a national strategy on endocrine disruptors, following the example of the one developed by the French government.

    Enough procrastination. We are all amply aware of breast cancer—BCAQ has existed for over 30 years. We must act on the difficult questions we are facing. Right now.

    [1] Canadian Partnership Against Cancer (2016). The 2016 Cancer System Performance Report. Toronto (ON): Canadian Partnership Against Cancer; July. 128p.

    [2] Agence de la santé et des services sociaux de Montréal (2011). Rapport du Directeur de santé publique 2011 : Les inégalités sociales de santé à Montréal. Montréal, Direction de la santé publique. pp. 80-82.

     

     

  • Breast Cancer and the Work Place

    Breast Cancer is an Important Workplace Health and Safety Issue

    Tonie Beharrell, the lawyer representing Katrina Hammer, Patricia Schmidt and Anne MacFarlane who claimed they had developed breast cancer as a result of conditions in their laboratory workplace, was quoted, after the Supreme Court of Canada ruled in their favour on June 24th 2016 saying,  “Hopefully workers who have been hesitant to argue causation will be encouraged to pursue their claims, knowing that they don’t actually need a medical opinion that says ‘your work caused your cancer’” She continued, “They can rely on a range of evidence to make those claims.”

    Some of the evidence used during the case included (from APPELLANTS’ FACTUM):

    a. Likely past exposure by laboratory technicians at the workplace to solvents and reagents which were known carcinogens;

    b. Past complaints of poor air quality due to incineration of very odorous and potentially hazardous compounds;

    c. A finding that the workers’ cancers were part of a larger and statistically significant “cancer cluster” at the hospital laboratory: laboratory workers at the hospital were experiencing breast cancer at approximately 8 times the rate of women in the general BC population;

    d. A body of scientific literature which demonstrated an association between laboratory technicians and increased cancer levels.

    This is the first time in Canada that any woman has established compensation for this disease in spite of the overwhelming evidence of the risks that so many women face.

    Read the article on the Vancouver Sun website: Lab environment in Mission led to cancer, court rules

    Read the article from CBCnews: B.C. healthcare workers win breast cancer claim against Fraser Health Authority

    Read the full Supreme Court decision: British Columbia (Workers’ Compensation Appeal Tribunal) v. Fraser Health Authority

    Breaking Point: Violence Against Long-Term Care Staff

    James Brophy, Margaret Keith and Michael Hurley whose past studies exposed the brutal truth about the high prevalence of breast cancer amongst workers in the plastics, auto, farming, canning and casino industries have accomplished more ground breaking work. Their new study focuses on the lived experience of caregivers in long- term facilities in Ontario. “While the media report regularly on incidents of resident-on-resident violence and on caregiver-on-resident violence, little has been written about the much more prevalent assaults against caregivers” The authors point out how the structural factors influencing violence in healthcare are associated with tolerated violence against women in our society.

    Drs Jim Brophy and Margaret Keith are lead authors of Breast cancer risk in relation to occupations with exposure to carcinogens and endocrine disruptors: a Canadian case-control study, published in Environmental Health (November 2012). Their research which involved over 2100 women demonstrated how Ontario automotive workers and those working in food canning plants were five times more likely to have breast cancer before menopause than other women living similar lives. This research into occupational exposures and breast cancer was co-winner of the American Public Health Association (APHA) Scientific Award in the Occupational Health category.

    Read the full study here

    Breast cancer research has long neglected occupational and environmental hazards. However the science linking breast cancer and occupational risk factors is growing. The American Public Health Association (APHA) has issued an important policy statement calling for making research on breast cancer as an occupational health and safety issue a priority. Read the APHA Policy Statement.

  • Safe Cosmetics: FemmeToxic

    The average woman uses 12 cosmetic and personal care products everyday, exposing her to 126 unique chemicals. Canada’s weak cosmetic regulations, and the influence of the powerful $5.4 billion Canadian cosmetic industry, allow compounds such as carcinogens, mutagens and reproductive toxins, for example, to be used in our cosmetic products. It has reached a point where the financial costs of reformulating outweigh and undermine the impacts and concerns these chemical have on our health. Marketing schemes have been successful in skewing a woman’s perspective on true beauty. The small dose, long-term exposure from these cosmetic toxins accumulate and add to the body burden of women who have already been overloaded with other environmental contaminants that pollute our bodies. Did you know that over 200 unique chemicals have been found in the average person’s body? The sources of these chemicals have been traced back to our food, water, air, soil and other consumer products. As individuals we may not yet be able to control the chemicals used in the many areas of industry, but we should be able to control what we decide to put on our bodies..

    In the spring of 2009, a passionate and dedicated committee from Breast Cancer Action Quebec (BCAQ) decided to develop a youth-oriented campaign for safe cosmetics. Soon to join the organization were several young women, coming from different backgrounds, who were alarmed by the current state of cosmetic regulations in Canada. FemmeToxic was created because of the strengths of this unique group of women and their desire for stronger legislation to make safer cosmetics the norm.

    FemmeToxic is a campaign focusing on the toxins in the environment, particularly those found in cosmetic and personal care products, which are detrimental to human health and can increase the risk of cancer and other health-related disorders. The goal of FemmeToxic is to advocate for stronger cosmetic regulations. More specifically, the group wishes to change the ways in which Health Canada labels cosmetics and oversees the substitution and removal of toxins in personal care products. FemmeToxic seeks to empower women and increase their awareness of these toxins in products they use, their impact on health and the safer alternatives, while motivating them to join us in giving the beauty industry its long overdue makeover.

    FemmeToxic also hopes to inspire all women of every age to adopt a lifestyle that is not as heavily reliant on cosmetic and personal care products and to have them re-evaluate the need of the products they use. For too long women have been led to believe that beauty comes from a tube of lipstick or in the wave of a mascara wand. In reality, true beauty is revealed through the development of confidence and character, not with the application of the latest shade of nail polish. FemmeToxic hopes to dilute the toxic message of the beauty industry through empowering women and to significantly reduce toxins in our bodies through changing Canadian legislation. Hopefully this change can be the first step in the detoxification of our environment.

  • Breast Cancer and the Environment

    The month of October, aka Breast Cancer Awareness Month, is an odd time of year for us at Breast Cancer Action Quebec (BCA-Qc). We are exceedingly aware of breast cancer, and the trauma, upheaval, and profound fear it burns through women’s lives. We also keenly feel the precious lives lost to this disease. And finally, we are all too aware of the wide range of tough, unanswered questions surrounding breast cancer.

    Proponents of Breast Cancer Awareness Month are unrelenting in their message of awareness. In their view, awareness is achieved when women take care of their own health by getting mammograms, staying trim, exercising, and limiting alcohol consumption. In other words, risk reduction equates with personal responsibility—rarely is there any mention of the environmental causes of breast cancer that individuals have almost no control over. Women are only encouraged to raise large amounts of money to find a cure while the root causes of this ubiquitous disease are ignored by this campaign.

    The problem for us at Breast Cancer Action Quebec is that this message has become hegemonic. It is the only message that reaches many women. It pushes all other voices that are asking important and difficult questions to the margins of discussions about breast cancer, including ours at BCA-Qc. The following are just a few examples of the issues that concern us.

    Research on environmental links to breast cancer is marginalized

    Many breast cancer researchers agree that direct environmental exposures to carcinogens and toxic substances are the cause of breast cancer in at least 20% of cases. Only 5-10% of breast cancer is attributable to genetic causes. Yet environmental causes receive only 2per cent of breast cancer research funds and only 3-4% of those funds go to breast cancer prevention.[1] Furthermore, those studying breast cancer now recognize that its causes are most likely multifactorial—that is, most breast cancers are caused by certain genetic predispositions interacting with environmental as well as lifestyle factors. Given this complexity, we need to look at the following tough questions:

    Breast cancer and endocrine disrupting chemicals

    The problems created by endocrine disrupting chemicals (EDCs), which comprise a wide range of substances that interfere with our bodies’ delicate hormonal system, require us to completely rethink our current definitions of toxicity and exposure. Many EDCs are estrogenic (act like estrogens in the body), and increased exposure to estrogen in any form is a major risk factor for breast cancer.  And yet, while money is raised for the cure, funding for research on EDCs is slim.

    Breast cancer and workplace exposures

    Researchers James Brophy and Margaret Keith published ground breaking research showing significantly increased rates of breast cancer—most following occupational exposures to endocrine disrupting chemicals—for women involved in the farming sector, plastics manufacturing, food canning, metal working, and in bars and gambling establishments[2].  Brophy and Keith were refused funding to further their research. However, the American Public Health Association recently published a policy statement saying that research on occupational and other environmental causes of breast cancer must become a national priority[3].

    Breast cancer and pesticides

    The researcher Luc Gaudreault, professor in the Department of Biology at the University of Sherbrooke, is studying the link between pesticides that are known endocrine disrupters and certain cancers, in particular breast cancer and prostate cancer. Finding funding for this research has proven difficult[4].

    Breast cancer and traffic-related air pollution

    On another question concerning the link between environmental toxicants and breast cancer, researchers from the Research Institute of the McGill University Health Centre published results of their study showing that post-menopausal women living in areas with the highest levels of traffic-related air pollution in Montreal were twice as likely to develop breast cancer as those living in the least polluted areas[5].  Researchers in California furthered this research and identified the mammary gland carcinogens in traffic-related air pollutants[6].  Yet, very few groups—including the major breast cancer foundations—are looking at or funding research into this issue.

    Breast cancer and the social inequalities affecting health

    Concerning the issues surrounding women’s health justice, the Public Health Directorate of Montreal has identified breast cancer as an important example of the impact of social inequality affecting health because poorer women tend to have slightly lower rates of diagnosis of the disease, but higher rates of mortality[7].

    The overall trend of breast cancer incidence (how many women are diagnosed with the disease) is relatively stable. But within that trend, different populations of women experience very different rates of incidence (getting the disease) and mortality (dying from the disease). Some populations of women, for example certain women who are recent immigrants, have incidence rates of breast cancer that have risen significantly; other populations of women, particularly Black women, have disproportionately high mortality rates. We need to better understand these trends, learn from them, and inform women who may need specific information about their health and screening.

    These are just some of the issues driving our work at Breast Cancer Action Quebec. As a society, we are already highly aware of breast cancer. Now, we must move the discussion significantly forward to tackle the most complex breast cancer issues. Frankly, the pervasive message of awareness is insulting to women’s intelligence and undermines any momentum toward substantive change. Powerful interests working to resist basic research on environmental issues, such as the links between cancer and EDCs, prevent changing the dominant paradigm concerning toxicity and chemical regulation—an approach that allows chemicals to enter all products, unless or until they are proven harmful. Therefore, rather than FIRST establishing that a chemical is safe for humans and the environment (see precautionary principle), activists and academics must fight to have harmful chemicals removed from products already in the marketplace. In addition, risk assessment is based on looking at individual chemicals without studying their interactions with other chemicals; also generally ignored are assessments concerning long exposure periods or age-related exposure.

    Breast Cancer Action Quebec works diligently to ensure that more funding is used for fundamental research on preventing breast cancer. We also focus on addressing the existing social inequalities affecting health—and their impacts on breast cancer—to make these a public health priority.

    We are working with a wide range of groups to get harmful chemicals, and those suspected of being dangerous, out of our environment. And, we are working toward the implementation of a national strategy for endocrine disrupting chemicals comparable to the Strategy developed by the French Government[8].

    Enough is enough. We are all thoroughly aware of breast cancer—BCAM was established 24 years ago.  We need action on the tough questions facing us today. And we need it now.

    By Jennifer Beeman, former Executive Director, Breast Cancer Action Quebec

    Our 25th Anniversary Panel of researchers on endocrine disrupting chemicals, held on October 26, 2016 in Montreal, inspired an audience of both young people and long-time members.

    Our sincere thanks to Dr. Isabelle Plante, Dr. Bernard Robaire and Dr. Lise Parent for giving us the science in such clear and compelling terms.

    We also thank our partners for this event: the David Suzuki Foundation, CINBIOSE, the Centre for Interdisciplinary Research on Well-Being, Health, Society and Environment, and the Réseau des femmes en environnement.

    Watch three powerpoint presentations with audio from the live presentations.

    [1]International Cancer Research Partnership (2012). Cancer Research Funding from an International Perspective: Report from the International Cancer Research Partnership, 2012.

    [2]Brophy, James, Margaret Keith, et al. (2012). Breast Cancer risk in relation to occupations with exposure to carcinogens and endocrine disrupters: A Canadian case-control study. Environmental Health. 11:87.

    [3]American Public Health Association (2014). Breast Cancer and Occupation: The Need for Action. Policy Number: 20146.

    [4]Radio-Canada (2015). « Un chercheur de l’Université de Sherbrooke s’intéresse à l’impact des pesticides sur les cancers. » 29 juin 2015.

    [5]Crouse, Dan L., Mark S. Goldberg, Nancy A. Ross, Hong Chen et France Labrèche (2010). Postmenopausal Breast Cancer Is Associated with Exposure to Traffic-Related Air Pollution in Montreal, Canada: A Case–Control Study. Environmental Health Perspective. 118 (11) 1578-1583.

    [6]Garcia, Erika, Susan Hurley, David O. Nelson, Andrew Hertz et Peggy Reynolds (2015). Hazardous air pollutants and breast cancer in California teachers: a cohort study. Environmental Health. 14:14.

    [7]Agence de la santé et des services sociaux de Montréal (2011). Rapport du Directeur de santé publique 2011 : Les inégalités sociales de santé à Montréal. Montréal, Direction de la santé publique. pp. 80-82.

  • Gender Inclusivity

    At BCAQ, we believe that knowledge is power. We are committed to developing analyses and language that are as inclusive as possible of gender diversity in all our work.

    Here are four facts to raise awareness about trans and non-binary people’s health:

    → Top surgery does not eliminate all breast cancer risk

    While top surgery does significantly reduce the risk of developing breast cancer, it usually leaves some breast tissue and therefore does not eliminate the risk completely. Chest self-exams and routine checks by your doctor are recommended.

    → Hormone therapy & cancer

    While hormone therapy is essential for many people, it is important to note that certain hormone therapies can change risks for certain cancers. This is one reason why check-ups are important. Talk to your doctor about this question and what you need to know.

    → Access to health services

    Seeking medical attention can be very challenging. We have compiled a list of groups who offer support and advocacy for trans and non-binary people in Quebec.

    → We all play a part in inclusivity!

    BCAQ is committed to the inclusion of LGBTQIA2+ communities in our work. The issues we work on touch people of all genders!

    We are proud to be joining more than 100 feminist and social justice organizations across Canada, declaring our support for a trans-inclusive feminist movement. We reject anti-trans ideologies.  Read more

    List of support and advocacy groups for trans and non-binary people

    In the province of Quebec :

    ➡ Quebec Trans Help Action: website and Facebook page – the organisation offers accompaniment services for medical appointments among other services

    ➡ Aide aux trans du Québec: website and Facebook page

    ➡ AlterHéros: website and Facebook page

    ➡ LGBT+ Family Coalition: website and Facebook page

    ➡ Fierté Trans – Euphorie dans le genre: website and Facebook page

    ➡ Interligne: website and Facebook page – help line in French and English

    In Montreal :

    ➡ Centre for Gender Advocacy: website and Facebook page

    ➡ Jeunesse Lambda: website and Facebook page

    ➡ Project 10: website and Facebook page – the organisation offers accompaniment services for medical appointments and has a referral list, among other services

    ➡ TransMontréal: website and Facebook page

    ➡ West Island LGBTQ2+ Centre: website and Facebook page

    In regions :

    Estrie

    ➡ Groupe de discussion pour jeunes personnes trans et non-binaires de l’Estrie: Facebook group

    ➡ Iris Estrie (Projet caméléon): website

    ➡ Trans Estrie: website and Facebook page

    Gaspésie

    ➡ Répertoire du Réseau des personnes alliées LGBTQ jeunesse et adultes: website

    Lanaudière, Laval or the Laurentides

    ➡ Le Néo: website and Facebook page

    Outaouais

    ➡ Gender Mosaic: website and Facebook page

    ➡ Jeunesse Idem: Facebook page

    ➡ Trans Outaouais: website and Facebook page

    *There are many more support groups from all across Quebec on Facebook – not all are listed here

    Pan-Canadian group:

    ➡ Trans Lifeline: website and Facebook page – hotline

    Other useful resources :

    ➡ CACTUS Montreal: website and Facebook page: the organisation works with injecting and inhaling drug users, sex workers, and trans people

    ➡ Chaire de recherche du Canada sur les enfants transgenre et leurs familles: website and Facebook page

    ➡ Heads and Hands: website and Facebook page: the organisation offers medical services to young people, among other services

    ➡ Institute for Sexual Minority Health: website

    ➡ Professionnel.le.s en santé des personnes trans et non binaires: Facebook group

    ➡ Quebec Trans-affirmative Provider List: on the ISMH website – contains a list of health professionals

    *Some groups may not offer in-person services at the moment because of COVID-19.

    Do not hesitate to send us additional suggestions at info@acsqc.ca

  • Medical Information and Support

    The Canadian Cancer Society offers clear and complete information on breast cancer and other cancers as well as a range of support services.

    http://www.cancer.ca/en/?region=qc

    The Breastcancer.org is an American nonprofit organization dedicated to providing the most reliable, complete, and up-to-date information about breast cancer.

    http://www.breastcancer.org/

    Hope and Cope is a wellness center devoted to helping people with cancer. It is open to all and easily accessible at the facilities of the Segal Cancer Centre at the Jewish General Hospital.

    http://hopeandcope.ca/

    Cedars Cancer Support offers complete medical, educational and support services for cancer patients and their families.

    http://www.cansupport.ca/

    For more resources, consult our links page.

  • Pinkwashing

    What is the cancer industry?

    Cancer is now so prevalent that a whole industry revolves around it — not only health care providers and cancer clinics, but manufacturers of the machines, devices and tests used to detect or treat it, pharmaceutical companies that produce oncology drugs, advertising and public relations organizations, cancer research institutes, cancer funding agencies, etc. This “cancer industry” keeps thousands of people employed and pumps masses of money into the economy, all of which divert attention away from the need to find the causes of cancer. BCAQc asks that you be particularly alert to drug companies that make money from cancer-treating drugs while also producing cancer-causing chemicals, to car manufacturers that loudly support cancer research while producing vehicles that spew cancer-causing emissions into our environment, and to cancer agencies that ignore or downplay the potential carcinogens in the thousands of environmental contaminants that surround us on a daily basis.

    Where did Breast Cancer Awareness Month start?

    The designation of October as Breast Cancer Awareness Month began in 1984 and was promoted by the drug company — now called AstraZeneca — that manufactures tamoxifen. At one time, AstraZeneca was owned by ICI, a company that on the one hand, produced drugs to treat breast cancer and, on the other, profited from the sale of a cancer-causing herbicide. Nowadays, growing numbers of manufacturers and retailers urge you to buy products identified by a pink ribbon or to participate in activities in aid of breast cancer research. Generally very little information is available about the proportion of the sale price or the amount of the donation made or, indeed, about the kind of breast cancer research supported. The vast majority of money intended for breast cancer research will fund improvements in detection or treatment. BCAQc recommends that you ask questions before buying any pink ribbon product or participating in pink-ribbon-marked events. BCAQc further recommends that you donate directly to a breast cancer research organization while stipulating that your money be used for research into the causes of breast cancer. Read Profits in Pink.

    Where did the pink ribbon come from?

    In the early 1990s, an American grandmother, Charlotte Haley, began making peach ribbons by hand in her home. Her daughter, sister and grandmother all had breast cancer. She personally distributed thousands of ribbons with cards that read: “The National Cancer Institute annual budget is $1.8 billion. Only 5 percent goes for cancer prevention. Help us wake up our legislators and America by wearing this ribbon.” Executives from the cosmetic giant, Estée Lauder, and Self magazine asked Haley for permission to use her ribbon. Haley refused, saying that her ribbon was not to be commercialized. So the decision was made to go with another colour and pink was chosen. Charlotte Haley’s peach ribbon was eclipsed by the PR machine of the pink ribbon which has now become a recognized symbol for breast cancer. The pink ribbon has proliferated. Attaching it to a product enhances the image of the manufacturer, retailer or sponsor. They make money mostly for themselves and express very little interest in what happens to the small portion that goes to breast cancer agencies. (See more at Profits in Pink.)

    Should I buy this pink ribbon product? Who benefits from your purchase?

    How much money goes towards breast cancer programs and services? (Is it a proportion of the sale price? If so, what proportion? Or does the manufacturer/retailer donate a fixed amount for each sale?) What kind of product is involved? (Cosmetics may contain carcinogens or potential carcinogens. Ditto for household cleaning products.) What kind of research will be supported? Is the money going to a foundation that funds programs in other communities, but not yours? Will the donation swell the amount going to research into detection and treatment while research into the causes of breast cancer is neglected?

    Why is BCAQ skeptical of pink ribbon causes?

    Breast cancer has become the darling of corporate Canada. From yogurt lids to motor vehicles, the pink breast cancer ‘awareness’ ribbon is showing up on more and more products. Breast cancer is an easy disease to market since everyone loves to think about, talk about, and look at breasts. Marketing it is even easier when it is seen as a feminist issue — without the politics.

    What exactly is breast cancer cause marketing? Tri-Marketing, an on-line Canadian marketing and publicity firm, defines cause marketing as “a partnership between a for-profit company and a non-profit organization which increases the company’s sales while raising money and visibility for the cause.”1 Note that, in almost all breast cancer cause marketing campaigns, it is the consumers’ money that raises funds for the cause, not the corporation. The corporation uses the pink ribbon to grab consumers’ attention and money while attracting a little more visibility for the cause.

    Clearly, money is being made for breast cancer research. But most of this money is directed to already wealthy organizations; organizations known to be conservative in their approach to breast cancer issues and often with troubling ties to major pharmaceutical companies and/or corporations whose products contribute to the incidence of breast cancer.

    This is just a peek behind the pink façade but it reveals a plethora of pink ribbon blues. The current context of breast cancer cause marketing in Canada is lacking in transparency, accountability, a feminist agenda and a public health perspective. Corporate interests are ‘pinkwashing’ away the political issues that become clear with a little probing. Unfortunately our purchases cannot sweep away the disease, no matter what breast cancer cause marketing would have us believe. What we can do:

    Get informed. Find out more about breast cancer issues and research.

    Ask critical questions. Email or telephone a corporation involved in breast cancer cause marketing and ask basic questions about what they contribute, to whom and why.

    Challenge the company to make an informed and private donation that will benefit an issue that is important to the members of the corporation, rather than putting a pink ribbon on a product to increase sales.

    Talk to your friends. If you know someone who is interested in breast cancer issues, spread the word about the problems with breast cancer cause marketing.

    Support your cause. Instead of giving to questionable corporations for an unknown and distant breast cancer effort, why not donate directly to a research project or breast cancer organization that you think is important and has meaning to you?

    Inform your Breast Cancer Foundation. If you think your breast cancer foundation is too heavily involved with questionable corporate cause marketing, tell them.

    Get involved. Contact Breast Cancer Action Quebec (info@acsqc.ca) for ways to make a difference.

    What does BCAQ think about the various fundraising runs/walks for breast cancer?

    Before you support a fundraising event, either by participating yourself or by sponsoring someone else, ask where the money is going. This means not only how much of the money is going to the cause, but also what kinds of programs or research are being supported. If an adequate answer is not forthcoming, or if you don’t like the answer, BCAQ suggests you make a donation directly to an organization whose work you support.

    Breast cancer is a disease, not a marketing opportunity.

    • Despite the billions of dollars raised in the name of breast cancer we are no closer to finding the cause of this devastating disease than we were decades ago. The primary interest of all women is to not get breast cancer, ever.
    • Breast cancer research must move beyond its current emphasis on treatment and cure, (to the virtual exclusion of prevention) to focus on the causes of the disease, and ways of preventing it.
    • Only 50% of all cancers are attributable to genetics and lifestyle. What is causing the other 50%?
    • More women are diagnosed with breast cancer today than 20 years ago. Science implicates our environment in rising rates of cancer.
    • During the last five years, only 3-4% of research spending was allocated to breast cancer prevention and the environment. It’s time to spend more money studying the environmental links to breast cancer.

    It is time to move past pink-ribbon shopping to prevent breast cancer.

    Don’t be misled by what we are calling the little pink lies of breast cancer.

    After so many years there is very little money devoted to finding the root causes of this disease.

    Read on and learn more about the myths and misconceptions that are out there.

    Little Pink Lie #1:
    WE’RE CLOSE TO FINDING A CURE

    It’s the tagline for Breast Cancer Awareness Month, and we hear it every October.

    It’s repeated over speakers at fundraising events, reprinted in every newspaper and magazine article on the subject.  And it’s one of the biggest of the little pink lies.

    With the exception of hormonal therapy, women diagnosed with breast cancer today face the same treatment options – surgery, radiation and chemotherapy that they did forty years ago, when the War on Cancer was first declared. Dr. Susan Love, America’s best known breast-cancer surgeon and activist, calls these treatments “slash, burn and poison”.

    We have learned that breast cancer takes many forms, but the cure or cures remain elusive despite enormous sums of money poured into research. And the answers may continue to elude us as long as the research community continues to be fragmented, with reports of studies replicating extensive work already done, while several areas of potentially critical importance have received little or no attention.

    With all the organizational, corporate and media attention focused on this elusive “cure,” relatively little attention has been paid to prevention.

    Little Pink Lie #2:
    RATES OF BREAST CANCER ARE DECREASING    .

    Although the death ratesamongst women diagnosed with breast cancer are decreasing in both the U.S. and Canada[1], the number of diagnoses worldwide is increasing[2].

    The decrease in mortality is attributed to reduced use of hormone replacement therapy (HRT), following the acknowledgement by the scientific community that HRT use increases breast cancer risk[3]. But breast cancer remains the most common cancer in women globally, and will affect 1 in 9 Canadian women in their lifetime[4].

    Moreover, breast cancer rates are increasing in developing countries. That’s where half of breast cancer cases are estimated to occur[5], and the majority are diagnosed at later stages of the disease[6]. This increase in breast cancer incidence in the developing world is likely the result of the proliferation of synthetic chemicals in the environment[7], and is no way countered by the pink ribbon campaigns.

    Little Pink Lie #3:
    PINK RIBBONS MEAN COMPANIES CARE

    The wide range of pink ribbon products that appear every October allow the companies that produce them to label themselves as supporters of the fight against breast cancer – and they encourage us to feel we’re contributing to the cause by buying these goods. But it’s often unclear what proportion of the sale price will be donated, or if there’s a cap on donations.  Too often, the manufacturer fixes a predetermined amount they will donate, regardless of the volume of sales. In other cases, we’re told that a portion of sales will go to support breast cancer research – but the specific organization or organizations that will benefit go unnamed.

    Even more troubling are the pink ribbon companies that support breast cancer research while also manufacturing products containing ingredients that may cause breast cancer. An automobile manufacturer may claim to support the fight against breast cancer while making and selling vehicles that emit carcinogens or mutagens (e.g., polycyclic aromatic hydrocarbons). Cosmetic companies feature pink-ribbon products containing known or suspected carcinogens (e.g., lead in lipstick) or endocrine disruptors (e.g., phthalates in perfumes). There are food giants who pack soups in cans lined with bisphenol-A, a recognized toxicant, and then stick a pink ribbon on the label. Even worse are those multinationals that create and sell both cancer-causing pesticides and the drug used to treat the disease.

    We call this pinkwashing. And it’s poisonous.

    Bottom line: there are certainly corporate entities who channel some of their profits into serious efforts to combat breast cancer but the nature of the marketplace is such that most companies care about making a profit and projecting a positive image.  They don’t care about preventing breast cancer.

    Little Pink Lie #4:
    GOVERNMENT REGULATIONS PROHIBIT THE USE OF KNOWN
    OR SUSPECTED CARCINOGENS IN CONSUMER PRODUCTS

    Forget it.

    On June 20, 2011, the Federal Government introduced the Consumer Product Safety Act. In the government’s press release (available at <http://www.hc-sc.gc.ca/ahc-asc/media/nr-cp/_2011/2011_81-eng.php>), Federal Health Minister Leona Aglukkaq stated that she was “pleased that our Government now has the power to remove dangerous products from the store shelves”, and that “as a mom, the new legislation gives me more confidence in the toys and products I give to my child”. The stated purpose of this Act is commendable – as noted on the government’s website (<http://www.hc-sc.gc.ca/cps-spc/legislation/acts-lois/ccpsa-lcspc/index-eng.php>) it was designed to protect the public by addressing or preventing dangers to human health or safety posed by consumer products in Canada, including those that circulate within Canada and those that are imported.

    The Consumer Product Safety Act does not include carcinogens. Yet, the presence of a carcinogen in a product clearly meets the Act’s definition of ‘danger to human health’.

    Until the day the government issues an outright ban on these ingredients, strictly-enforced labeling regulations are the very least we can demand.

    BCAM is asking Health Canada to:

    • Prohibit the use of any chemicals that are inherently carcinogenic or mutagenic, as well as those that have been identified as reproductive toxins in products sold in Canada. This echoes the Precautionary Approach already taken within the European Union, and Canada should at the very least implement the same standards.
    • Mandate that manufacturers of consumer products supply full and complete safety data tests for all chemical ingredients and nanoparticles used in their formulations. Currently, many ingredients including those used in cosmetics are not reviewed for safety before they are released to consumers. For example, cosmetic companies are only required to send an ingredient list to Health Canada ten days after the product goes on the market.
    • Mandate that producers supply full environmental and health data on each chemical used in their formulations to Health Canada. Currently, most chemicals lack comprehensive testing information.

    BCAM has created an online petition to lobby for these regulatory changes. To read and sign the petition, please click here.

    Little Pink Lie #5:
    WE LACK EVIDENCE THAT ENVIRONMENTAL FACTORS AFFECT BREAST CANCER.

    At least 100,000 chemicals have been introduced into our environment in the past 60 years. They are formulated and engineered into an infinite number of products and processes in commerce today. During roughly that same period, breast cancer incidence in Canada has risen from one in 40 women to one in 9.

    There is a wide and growing body of research on how chemicals, radiation and other environmental factors are carcinogens. Yet, this is still not clearly understood by the public.  For example, many women wonder if they have a genetic predisposition for this disease.  Yet only about 5% to 10% of breast cancers are estimated to be influenced by family history[8]. We know that exposures to common chemicals contribute to the unacceptably high incidence of breast cancer.

    The evidence continues to mount, both in terms of breast cancer and a host of other chronic diseases and conditions – Parkinson’s disease, learning disabilities, infertility, lymphoma, and so on. Note these important findings:

    • synthetic chemicals often mimic the action of estrogen
    • the greater a woman’s lifetime exposure to estrogen, the greater her risk of breast cancer;
    • estrogen-like chemicals are bisphenol-A, polyvinyl chloride, phthalates like dibutyl phthalate and DEHP – plasticizers found on shelves of your local grocery store and in your beauty salon;
    • we are constantly exposed to a ‘chemical soup’, chemicals that can have a cumulative, synergistic and even multiplier effects;
    • while low-dose, long-term, chronic exposures have been understudied, there is convincing evidence of harm.

    Even when exposure to certain chemicals has not been proven to cause breast cancer, many environmental epidemiologists advocate the reduction of exposure to environmental pollutants. This advice adheres to the Precautionary Principle, a “safety first” premise that states that preventive action must be taken when there are reasonable scientific grounds for believing a process or product may not be safe, or cause-and-effect relationships are not fully understood.

    There is an inescapable relationship between rates of breast cancer and the widespread use of man-made chemicals. To learn more, read State of the Evidence: The Connection Between the Environment: The Connection Between the Environment and Breast Cancer (6th ed., 2010).

    [8]http://www.cancer.org/Cancer/BreastCancer/OverviewGuide/breast-cancer-overview-what-causes

    Little Pink Lies

    I don’t tell lies
    I never do
    I just say what
    they tell me to.

    Like…

    Run or shop
    for all things pink
    and cancer will
    go down the sink.

    Besides, breast cancer’s
    in decline
    And hey, you want a “good news” sign?

    The poisons that
    we eat and drink
    and use to wash the kitchen sink

    Have no effect
    on cancer rates,
    Hell, those are simply
    old debates

    The cure is nigh
    ‘cause corporations
    right across developed nations
    sell pink lipsticks,
    blenders, pens
    I swear there’s no carcinogens

    In any product
    that they make
    Like, why would I say something fake?

    C’mon…
    They wouldn’t “spin” breast cancer
    (Would they?)
    If you want the answer…

    [7] http://tuftsjournal.tufts.edu/archive/2003/february/oped/index.shtml

  • Endocrine Disrupting Chemicals

    Hands Off My Hormones

    Endocrine Disrupting Chemicals and Human Health: What are the implications?

    The New York Times said they may be the tobacco of our time; Adria Vasil says they’re worse than that, since they’re found in so many products from cosmetics and cleaners to canned foods and cars. They are linked to breast and prostate cancer, autism, thyroid problems, ADHD and more.

    What are Endocrine Disrupting Chemicals?
    The endocrine system is our exquisitely balanced system of glands and hormones. Hormones are chemicals such as insulin, thyroxin, estrogen, and testosterone that interact with specific target cells by a number of means.

    An easy way to picture this is with the image of a lock and key. For example, target cells such as those in the uterus contain receptors (locks) into which specific estrogenic hormones (keys) can attach and thereby cause specific biological actions, such as regulating ovulation or terminating pregnancy. Similarly, hormones regulate such vital functions as body growth, response to stress, sexual development, production and use of insulin, among others.
    Synthetic chemicals trick target cells into believing they are true keys to these cells’ locks (e.g.: estrogen-mimicking chemicals) and thus wreak havoc with this sensitively balanced system.

    Timing
    There are many periods of vulnerability during which exposure to EDCs can be particularly harmful. The most well studied critical periods are prenatal and early postnatal development. Effects of early life exposure may not manifest until much later in life. Effects in one generation may be transmitted to future generations through mechanisms involved in programming gene activity, referred to as epigenetic changes.

    Synthetic Endocrine Disrupting Chemicals
    Over the past 60 years, through technological advances, a growing number of synthetic chemicals have been used in the production of almost everything we purchase. They have become a part of our indoor environment, found in cosmetics, cleaning compounds, baby and children’s toys, food storage containers, furniture and carpets, computers, phones, and appliances.

    EDCs and Breast cancer
    Two decades of research suggest that phthalates disrupt hormonal systems and may be linked to breast cancer. Phthalates have also been shown to cause proliferation of breast tumor cells, rendering anti-estrogen treatments, such as tamoxifen, less effective against breast tumors. Parabens are estrogen mimickers disrupting the delicate endocrine balance in our bodies. Concentrations of parabens were identified in biopsy samples from breast tumors in 2004. A similar study was repeated in 2012 in England where again, concentrations of parabens were measured at locations across the human breast using human breast tissue collected from 40 mastectomies in England. Triclosan is also suspected of disrupting the hormonal system.

    Some tips and advices to avoid endocrine disruptors:

    • Eat more fruits and vegetables, less meat and dairy products because many endocrine disruptors accumulate in animal fat.
    • Buy organic foods to avoid pesticides.
    • When plastic is heated or worn, the BPA and phthalates in it can leach into food. Avoid warming food in a plastic container and recycle your plastic containers if they have become scratched or worn.
    • Most aluminum cans contain BPA. Opt to purchase fresh, frozen or dried foods.
    • Say no to receipts, since thermal paper is often coated with BPA
    • Read the labels of personal care products and avoid those that contain the terms: parabens, phthalates, triclosan
    • Avoid products that are highly perfumed as they likely contain phthalates.
    • Avoid “antibacterial” products because they may contain triclosan.
    • Vacuum often to remove dust that contains multiple endocrine disruptors.
    • Replace damaged or worn out furniture
    • Dust electronics regularly with a damp cloth

    Links for more information:

    Dirty Dozen List of Endocrine Disruptors, Environmental Working Group

    How Chemicals Affect Us, by Nicholas Christof, New York Times, 2012

    Dying for Us, by Adria Vasil, Now Toronto, 2013

    MENU

    Preventing Environmental and Occupational EDC Exposures: February 2012

    Frequently Asked Questions

    State of The Science of Endocrine-Disrupting Chemicals, the United Nations and World Health Organization’s 2012 Report

    12 Hormone-Altering Chemicals and How to Avoid Them

    Creating Healthy Home Environments for Kids: Top 5 Tips

    Why EDCs Matter to Me

    Welcome to Hands off My Hormones!
    We have messages for you from five BCA-Qc members.
    All of them answer the question: “Why do I care about endocrine disruptors?”
    ELLE CHAVEZ-JEREZ

    “Breasts! Now that I’ve gotten your attention, watch this clip to learn why this Endocrine Disruptors Campaign is important to me.”

    LAURIANNE LAMARCHE
    “Intoxicate myself every day, no thank you! Take a couple of minutes to listen why it’s important to take a stand against endocrine disruptors.”

    DEENA DLUSY-APEL
    “How long will it take? I thought my government would look after me. See my video about my concerns.”

    ROSANNE COHEN
    “We can no longer stand by and watch rates of cancer and other chronic diseases go up. We have to do everything we can to stop it. I fight this fight for my son and grandchildren. Who are you fighting for?”

    PATRICIA KEARNS
    “Before they are even born, children ‘s lives can be affected  by endocrine disruptors. That really bothers me.”

     

    Frequently Asked Questions

    1) We’ve heard a lot in the media recently about endocrine disrupters, or endocrine disrupting chemicals (EDCs). What exactly are they?
    EDCs are mostly synthetic chemicals that, when absorbed into the body, may interfere with the body’s endocrine system. The endocrine system is the exquisitely balanced system of glands and hormones that regulates our bodies’ vital functions such as growth, response to stress, sexual development and behaviour, production and utilization of hormones, rate of metabolism, intelligence and behaviour. EDCs can affect the body’s development, growth and hormone balance by mimicking, blocking or disrupting the body’s natural hormones.

    2) Where are EDCs found?
    EDCs are found in cosmetics, cleaning compounds, baby and children’s toys, food storage containers, furniture and carpets, computers, phones, and appliances.  We encounter them as plastics and resins every day in our cars, trucks, planes, trains, sporting goods, outdoor equipment, medical equipment, dental sealants, and pharmaceuticals. Many of the personal care products (creams, shampoos and cosmetics) are fragranced, and these fragrances contain the EDC- phthalates, a plasticizer. Not only are phthalates found in our perfume, moisturizers, nail polish and hair spray, but they are in paints, floor tiles and sex toys.

    3) Why are EDCs potentially so bad for us: men, women and babies?
    Human health depends on a well-functioning endocrine system to regulate the release of certain hormones that are essential for functions such as metabolism, growth and development, sleep and mood. Chemicals used in everyday products and industrial processes can affect the body’s development, growth and hormone balance by mimicking, blocking or disrupting the body’s natural hormones. Researchers have linked EDCs to breast and prostate cancer, changes in immune system function, obesity, early menopause, as well as the development of non-descended testes in young males and early puberty in girls.

    One very clear example of how EDCs are linked to negative health effects in humans is the case of DES daughters. Between 1950-1960, pregnant women were prescribed diethylstilbestrol (DES), a synthetic estrogen, to prevent miscarriages. It not only failed to prevent them, but in 1971, doctors began reporting high rates of unusual vaginal cancers in teenage girls. Investigations traced the links back to their mothers that took DES. Other health issues these women suffered were birth defects, and immune system suppression.

    4) How are EDCs potentially linked to the risk of breast cancer?
    Endocrine-disrupting chemicals influence our risk of breast cancer indirectly by changing the body’s natural hormonal balance. Certain cancers, including breast cancer, are sensitive to hormonal changes.
    Two decades of research suggest that phthalates, one of the most common EDCs, disrupt hormonal systems and may be linked to breast cancer. (1). Phthalates have also been shown to cause proliferation of breast tumor cells, rendering anti-estrogen treatments, such as tamoxifen, less effective against tumors. (2)
    Parabens are estrogen mimickers (3), disrupting the delicate endocrine balance in our bodies.  Concentrations of parabens were identified in biopsy samples from breast tumors in 2004. (4) A similar study (5) was repeated in 2012 in England where again, concentrations of parabens were measured at locations across the human breast using human breast tissue collected from 40 mastectomies in England. Triclosan is also suspected of disrupting the hormonal system. (6)

    5) There is a lot of attention paid to EDCs in North America and Europe. What is Canadian policy on regulating, or restricting the use of EDCs? How does our policy differ from policy, say, in Europe?
    Within the EU several legislative initiatives have been taken to limit the use of high concern chemicals. Since 2007 the broad and horizontal REACH regulation gives a framework for regulating and restricting the use of the most hazardous substances. The use of chemicals is also regulated in sector specific product directives which restricts the use of hazardous chemicals in for example toys, cosmetics and electronic products.
    REACH aims to place the burden of proof on industry, which has to collect or generate the data necessary to ensure the safe use of chemicals. There is also an on-going EU discussion about criteria for endocrine disrupting chemicals. Within the scope of the pesticide regulation, the European Commission will present criteria for the determination of endocrine disrupting properties by the end of 2013.
    Canada, in 2008, became the first country to ban plastic baby bottles with bisphenol A after concluding the chemical was toxic. While this action is applauded, the possibility that a particular chemical might mimic a hormone like estrogen is not accounted for in any regulation standard. The most notable effect that is being tested for is whether a substance causes cancer and at what levels of exposure. That usually sets the standard although there might be other adverse health endpoints such as respiratory damage. Current standards ignore whether a substance is a hormonal mimicker or not.
    Within Canada, under The Canadian Environmental Protection Act (CEPA), the Chemical Management Plan does not include a gender analysis nor does it refer to EDCs as a separate category of chemicals. Neither does the labelling of consumer products under the Canada Consumer Product Safety Act (CCPSA), previously the Hazardous Protection Act, of Health Canada include EDCs as a distinct category, nor does it include a gender analysis. And unfortunately in Canada we have not yet placed the burden of proof on companies to show their chemicals are safe.

    1. Jobling S, Reynolds T, White R, Parker MG, Sumpter JP (1995). A variety of environmentally persistent chemicals, including some phthalate plasticizers, are weakly estrogenic. Environmental Health Perspectives 103(6):582-7.

    2. Kim IY, Han SY, Moon A (2004). Phthalates inhibit tamoxifen-induced apoptosis in MCF-7 human breast cancer cells. Journal of Toxicology and Environmental Health 67: 2025-2035.

    3. Darbre, P. D., & Harvey, P. W. (2008). Paraben esters: review of recent studies of endocrine toxicity, absorption, esterase, and discussion of possible health risks. J Appl Toxicol, 28, 561–578. 

    4. Darbre, P., Aljarrah, A., & Miller, W. (2004). Concentrations of parabens in human breast tumours. J Appl Toxicol, 24, 5–13. 

    5.  L. Barr, G. Metaxas, C. A. J. Harbach, L. A. Savoy and P. D. Darbre (2012) Measurement of paraben concentrations in human breast tissue at serial locations across the breast from axilla to sternum (pages 219–232) 

    6. Gee, RH et al. (Jan 2008): “Oestrogenic and androgenic activity of triclosan in breast cancer cells.” Appl Toxicol.28, 1,78-91.

  • Environmental Racism

    Chemical Valley in Sarnia, Ontario. Photography by Peter Kovacs

    Environmental racism refers to the disproportionate exposure to pollution experienced by communities of color, First Nations and poor communities, and the subsequent negative health effects, as well as the unequal environmental protection provided through laws, regulations, governmental programs, enforcement, and policies.

    In Canada, there are far too many cases of highly polluting mines, dumps, oil and gas wells, pipelines, refineries and chemical plants being in or near First Nations and Afro-descendent communities and communities of color despite the opposition of these communities and contaminating their air, water, and soil as well as exposing them to greater impacts of climate change. Members then face serious and complex health problems due to the pollution with little or no accountability on the part of corporations or governments that should have protected their health and wellbeing in the first place.
    To understand more about environmental racism, we suggest There’s Something In The Water, written by Dr. Ingrid Waldron. It has been made into a documentary of the same title, currently available on Netflix.

    Bill C-226: Advocates celebrate the Senate’s passage of Canada’s first environmental justice bill, marking a historic milestone.

    Advocates for social justice and equity, environmental protection and public health celebrate the Senate’s passage of Bill C-226, the National Strategy on Environmental Racism and Environmental Justice Act (Environmental Justice Strategy Act). June 14, the Environmental Justice Strategy Act passed the Senate’s third reading vote, with royal assent expected soon and representing that final step in the legislative process.

    The Environmental Justice Strategy Act will require the government to examine the links between racialization, socio-economic status and environmental risk, and develop Canada’s first national strategy on environmental racism and environmental justice.

    A 2020 report by the UN Special Rapporteur on Toxics and Human Rights pointed to “a pattern in Canada where marginalized groups, and Indigenous peoples in particular, find themselves on the wrong side of a toxic divide, subject to conditions that would not be acceptable elsewhere in Canada.”

    To read our full joint statement with the Canadian Coalition for Environmental and Climate Justice, click here.

    Bill C-230: An Act respecting the development of a national strategy to redress environmental racism
    A private member’s bill, Bill C-230, An Act respecting the development of a national strategy to redress environmental racism, has passed second reading and is now before the House of Commons Standing Committee on Environment and Sustainable Development for study. It would require the federal government to develop a national strategy to counter environmental racism by collecting information and data on race, socio-economic status and hazards, identifying the location of environmental hazards and develop measures to redress these situations.
    Breast Cancer Action Quebec submitted a brief to the committee strongly supporting the rapid adoption of Bill C-230 which you can read here.
    The House of Commons environment committee recently completed its review of the Bill. This marked a critical first step toward Canada acknowledging its shameful legacy of environmental racism and ensuring that all people in Canada benefit from environmental protection policies. Read our press release
    For more on Bill C-230:
    Canadian Coalition for Environmental and Climate Justice
    An important coalition, the Canadian Coalition for Environmental and Climate Justice, led by Dr. Ingrid Waldron at Dalhousie University has been created to support the fight against environmental racism and for environemental justice. Over sixty organizations across Canada, including BCAQ, are members.

  • Overdiagnosis

    Coming to Terms with the Overdiagnosis and Overtreatment of Breast Cancer

    Overdiagnosis and overtreatment are two concepts that are particularly difficult to understand when thinking about breast cancer. The dominant approach to “raising awareness” about breast cancer has been to say that “early detection saves lives.” The reality is more complex and in many cases, early detection can lead to overdiagnosis and overtreatment, particularly in cases of ductal carcinoma in situ (DCIS).

     

    What exactly is “overdiagnosis” of breast cancer?

    Overdiagnosis is the diagnosis of a tumor that would not have become clinically apparent in the absence of screening. Treatment of an overdiagnosed tumor cannot provide benefit, but it can lead to harm. Overdiagnosis and overtreatment are now widely acknowledged to be an important harm of medical practice, including cancer screening.[1] In the case of breast cancer, for example, DCIS was rarely diagnosed before screening was adopted.[2] Yet tens of thousands of women in North America diagnosed with DCIS will have aggressive locoregional treatment, often a lumpectomy or mastectomy followed by radiotherapy and sometimes hormonal therapy as well.

    There is as yet no sure estimate regarding the extent of overdiagnosis and overtreatment with estimates in the literature cover a frustratingly broad range.[3] There is, however, broad agreement that DCIS is particularly susceptible to overdiagnosis.

    The new paradigm of the complexity of cancers

    It is now understood that breast cancer is not one disease, but a range of diseases requiring different treatments.  Furthermore, tumors do not progress at a steady rate. Indolent tumors may stop growing, grow very slowly or even regress. All this is leading to a new paradigm of complexity regarding cancer and cancer treatment.

    Population-wide screening programs are based on the assumption that cancer has an orderly and gradual progression which will eventually become lethal if left untreated. But the simplistic dictum that early breast cancer detection saves lives is increasingly problematic as it causes harm to those women whose tumors would have remained harmless but are nonetheless subjected to unnecessary surgery, radiation, possibly chemotherapy and hormonal therapy. These women are then labeled for the rest of their lives as having had breast cancer with all the medical, financial and social consequences that this creates.

    In 2012, the U.S. National Cancer Institute organized a “brainstorming meeting” of a panel of cancer specialist and patient advocates to address the issue of cancer overdiagnosis. The Panel issued the following consensus regarding overdiagnosis and overtreatment:[4] It proposes that we must recognize that overdiagnosis occurs and is common and develop new terminology to replace the word “cancer” for the classification of low-risk lesions. It also suggests the creation of observational registries for low-risk lesions and the adaption of our detection methods to avoid identifying unimportant lesions. Finally, they suggest that we need new strategies on how to approach breast cancer progression and prevention.

    We at Breast Cancer Action Quebec understand deeply just how scary the words “breast cancer” are for any woman. But too many women are being unnecessarily treated for lesions that would never have caused problems.

    For women to better understand the issue of overtreatment, we need to change discussions of breast cancer from fear-mongering approaches of “one in nine” to an understanding that it is a complicated set of diseases requiring very different approaches, and in some cases, no intervention, but rather an attentive surveillance. We need a discussion on current screening programs, a reexamination of the treatment of DCIS and the development of less aggressive treatments, as well as the creation observational registries to study the evolution of these cases. We also clearly need better coordination of breast cancer research agendas so that fundamental research on tumor biology is made a priority.

    Individual women must be informed, prepared and encouraged to enter into these discussions with their doctors when the diagnosis of breast cancer is first raised. And finally, women in the women’s health movement must be included in these discussions to develop the tools necessary to bring about these changes.

    [1]Elmore, Joann G. et Ruth Etzioni (2015). Effect of Screening Mammography on Cancer Incidence and Mortality. Invited Commentary. JAMA Internal Medecine. Publié en ligne le 6 juillet 2015. Téléchargé de http://archinte.jamanetwork.com/le 7 juillet 2015.

    [2]Esserman, Laura, J. et colleagues (2014). Addressing overdiagnosis and overtreatment in cancer : a prescription for change. Lancet Oncology. May 2014. 15(6) : e234-242.

    [3]Elmore et Etzioni, op. cit.

    [4]Esserman et colleagues. op.cit.