I’m tired of Breast Cancer Awareness Month. Forgive me, but as a researcher studying how we understand information on links between environmental and occupational exposures and breast cancer, I’ve grown weary of yet another October decorated in pink, promoting the same message of awareness. The message itself has become tired, and awareness-raising alone is an ineffective solution to the breast cancer epidemic.
Year after year, we miss opportunities for critical interventions in the primary prevention of breast cancer. For my dissertation research on awareness of environmental breast cancer risks, I interviewed women workers at the Ambassador Bridge, where there are high rates of breast cancer. Larissa* pointed out:
“I know it is out there. I know it happens. You see breast cancer awareness everywhere, but it’s pink. That’s what you see. You don’t see information on what we can do to prevent.”
Screening and early detection programmes are widely promoted, advocacy for treatments continues and survival of breast cancer for some groups of women has improved. These are crucial pieces for tackling breast cancers that develop. But comparatively little effort seems to go into primary prevention, which means stopping cancer before it starts.
The focus persists on advising women to exercise, eat well and limit alcohol intake. Messaging about the need for policy, regulation, legislation, strategies and programs that prioritize primary prevention from environmental exposures to breast carcinogens is inconspicuous.
Lifetime Risk Is 1 In 8
I recognize that Breast Cancer Awareness Month provides an opportunity for contribution, engagement and hope. And I understand why women and their allies support these initiatives. It offers a chance to feel some power over a disease that creates so much fear and suffering.
Nearly 630,000 women across the globe died from breast cancer last year. The overall global incidence of breast cancer continues to rise with marginal improvements in five-year survival rates. North American women face a one in eight-lifetime risk for breast cancer, with almost 525 new diagnoses of breast cancer each week in Canada. Fourteen Canadian women die each day from breast cancer. Incidence is rising in younger women, specifically in premenopausal women.
Only five to ten per cent of cases are related to genetics, with family history, lifestyle and behaviour factoring into overall incidence. Fewer than 50 per cent of breast cancers can be explained by known or suspected risk factors. Research suggests that environmental factors may contribute in 70 to 90 per cent of breast cancer cases.
When I interviewed Annie, she said:
“I am a big proponent of government taking care of us citizens. To me, that is what government is for. Regulation is important to me. I feel that that’s key.”
With Annie’s words and those of other women in mind, I recently wrote to governmental leaders, ministries, public health agencies and the Canadian Cancer Society. I conveyed my concerns about the focus on awareness that highlights lifestyle factors and omits exposures in our living and working environments. I suggested we need more action on primary prevention to limit or eliminate exposures to known and suspected breast carcinogens.
My letter also reflected Erin’s thoughts:
“I think that ensuring that people have the knowledge of what is really going on is a big issue. And then, with the knowledge, change policy or the way that things are being done, so that people are not at risk.”
Breast Cancer Awareness: Primary Prevention
To implement practical primary prevention activities, we need to draw on the science of the associations between breast cancer and risky exposures in our social environments. For example, when we know women are being exposed to identified breast carcinogens in their workplaces, why are we not reducing or eliminating these exposures to prevent breast cancer?
When we know that there are endocrine-disrupting chemicals in personal care products, and these are associated with an elevated risk for breast cancer, why are we not eliminating or replacing these substances?
When science tells us that women in areas with high volumes of air pollution, especially vehicle exhaust, are at a higher risk of developing premenopausal breast cancer, why are we not putting controls on pollutants or developing alternatives?
When we know there are disparities in breast cancer incidence and survival across groups of racialized women, why are we ignoring social determinants of health in our strategies to mitigate risk and prevent the disease?
Science provides evidence of exogenous exposures that contribute to the development of breast cancer. Many of these exposures are outside of the control of individual women; they are involuntary exposures not modifiable with lifestyle or behavioural changes. Instead, systemic changes — regulations, legislation, policies — with the protection of the public are fundamental to prevention. We need the political will and those with power to enact these critical changes.
Pink products and awareness-raising are not enough. At this time, when COVID-19, climate change and political turmoil dominate our thoughts, it is tiring even to begin to think of adding yet another struggle to the list. But to effect real change against the breast cancer epidemic, we need more powerful, structural strategies that prevent exposures to known and suspected breast carcinogens in the places we live and work.
*Pseudonyms are used to protect the identities of study participants.