The not so rosy side of breast cancer pink ribbons

National Breast Cancer Awareness month celebrates its 26th anniversary this year, and pink seems to be everywhere. Even football players are wearing pink. Have you ever wondered how this campaign began and what impact it is actually having on the prevention of breast cancer? Personally, I didn't give it much thought, that is until I was diagnosed with breast cancer. Before then, I rather naively assumed that anything pink was linked to a benevolent organization that was supporting the critical research needed to prevent the disease. That's why it came as a total surprise to realize that when it comes to the pink movement it seems there's a whole lot of gray.

Before I get to the gray, here's a brief history of the pink. Back in 1985, National Breast Cancer Awareness Month (NBCAM) was organized through the sponsorship of Astra Zeneca, a pharmaceutical company, the American Academy of Family Physicians, a medical society, and CancerCare, Inc., a non-profit. More on this later, suffice to say for now that their purpose in forming NBCAM was to "promote breast cancer awareness, share information on the disease and provide greater access to screening services." NBCAM's initial week long event spawned what is now an internationally recognized month devoted to breast cancer awareness.

On to the story of how breast cancer awareness became wrapped up in a pink ribbon. In the early 1990's, activist Charlotte Haley was inspired by the yellow ribbons tied on trees to honor American soldiers. She decided to make peach ribbons in her home and distribute them in an effort to raise public awareness about the National Cancer Institute's small percentage (5%) of their then $1.8 billion budget going towards cancer prevention.  Her efforts caught the attention of Estee Lauder and Self Magazine executives. They contacted Charlotte about joining her efforts.  She refused saying they were "too commercial". The attorneys at Self Magazine suggested that the color of the ribbon be changed in order for Self to use the concept. That's when the pink ribbon began to be associated with breast cancer, and shortly after Avon began their breast cancer cause related marketing campaign. 

Now, there is absolutely nothing wrong with pink ribbons, or raising money for cancer research, or providing greater access to mammography for the under or uninsured. When done altruistically, these are extraordinary  things. What is disconcerting is when pink ribbons are used to boost a company's profits or image under the guise of philanthropy. Unfortunately, it seems that breast cancer has become big business. It's because of those seeking to profit from breast cancer that some critics of NBCAM are now referring to it as "BCAM SCAM", or Breast Cancer Industry Awareness Month.  But how is it that such a noble and worthy cause has come to be viewed by some as a scam? To answer this question, a little research, along with some open minded consideration, is required.

When it comes to the public's health, the primary goals of health officials are prevention, intervention and eradication of disease, with prevention being preferable to intervention (McKenzie). For example, "immunizing to prevent a disease is preferable to taking an antibiotic to cure one" (McKenzie). Case in point, the human papillomavirus (HPV) vaccine and cervical cancer. Yet, when we look at the pink ribbon message, it focuses not on prevention, but detection and cure. Wait a minute. If prevention is preferable, why is the push for detection and cure? Because the detection and treatment of breast cancer has become a multi-billion dollar industry. Simply stated, prevention just isn't as profitable.

Skeptical? Perhaps a closer look at NBCAM might provide additional insight. Their organization was formed by Imperial Chemical Industries, the creator of Tamoxifen, a breast cancer treatment drug. In the 90's, Imperial Chemical Industries spun off Zeneca Group. Then Zeneca merged with Astra and became Astra Zeneca, which formed a non profit arm that is known today as AstraZeneca Healthcare Foundation, one of the largest financial contributors to NBCAM.  Astra Zeneca also created and markets Arimidex, another breast cancer treatment drug. CancerCares was also involved in the formation of NBCAM. A look at their donors reveals several pharmaceutical companies as well. So, what message would you want to spread if you were a drug manufacturer financially invested in breast cancer treatment medications? Probably not prevention. Might this explain NBCAM's focus on awareness and detection? To be clear, I'm in no way suggesting that awareness, screening and early detection of breast cancer is negative. The point is non-profit organizations accepting donations from companies that stand to gain from their philanthropy seems to represent a conflict of interest.

The pink campaign isn't only effected by conflicts of interest. There are also the companies that profit from linking their products to the breast cancer cause. At first glance this may seem altruistic, but sometimes things aren't always as transparent as they seem. For example, 12 years ago Yoplait began a pink ribbon campaign called Save Lids to Save Lives. A portion of the proceeds from the sale of their yogurt are donated for breast cancer research. The conflict resulted from their yogurt being made with milk from cows that were given a synthetic growth hormone, called rBGH. This chemical has been linked to breast cancer and is banned from use in many countries. You can read more about the topic here, and Oregon Physicians for Social Responsibility has an interesting video discussing rBGH and milk found here or click on the Videos tab in this blog.

The term "pinkwasher" has been used to describe a company "that purports to care about breast cancer by promoting a pink-ribboned product, but manufactures products that are linked to the disease" (Breast Cancer Action). When you consider that Yoplait was both contributing to and profiting from breast cancer, one could say they were successful at "pinkwashing." Thankfully, because of pressure brought about by health activist groups, like Breast Cancer Action and their "Put a Lid on It" campaign, as well as concerned consumers, to their credit as of 2008 Yoplait has stopped using rBGH milk in their yogurt.

The above is just one example of pink ribbon profiteering. Breast Cancer Action has some great information on their Think Before You Pink site to help guide consumers when purchasing "pink" products. They suggest asking the following questions:

1. How much money from your purchase actually goes toward breast cancer?
2. What is the maximum amount that will be donated? Sometimes contributions are capped at a certain amount. 
3. How are the funds being raised? 
4. To what breast cancer organization does the money go, and what types of programs does it support?
5. What is the company doing to assure that its products are not actually contributing to the breast cancer epidemic? 

You can find a more detailed discussion of these points here.

In a recent post I mentioned my support of the Love/Army of Women, a non-profit foundation dedicated to stopping breast cancer before it starts.  At first inspection I felt this group represented something that I feel is of critical importance - the need for more research into the prevention of breast cancer. However, after closer scrutiny I realized that this group is funded through a grant from Avon. This cosmetics company uses a number of chemicals in their products that have been linked to cancer through standard laboratory feeding tests done on mice and rats by the National Toxicology Program. Their study results have been published and accepted by the International Agency for Research on Cancer. A perfect example of the importance of the need to "think before I pink."

A final thought. On my last visit to the doctor she mentioned that Tamoxifen is now being recommended as a breast cancer prevention treatment for women who are considered to be at high risk for developing the disease. I was hoping that more breast cancer prevention research would be focused on how to reduce our exposure to cancer causing agents, such as the above-mentioned chemicals. Sadly, this doesn't appear to be a research priority, but it's not that surprising.  All things considered, I suppose drugs would be the first line of defense offered for prevention, if the pharmaceutical and chemical companies are underwriting a great deal of the research being conducted in the area of cancer prevention. Evidently there isn't anything completely transparent when it comes to this issue. One thing is for certain, pink looked a whole lot rosier before I took off my rose-colored glasses.

Sources
McKenzie, J., et.al., An Introduction to Community Health, 5th Ed., Jones & Bartlett, MA, 2005
http://www.nbcam.org/newsroom_nbcam_facts.cfm
http://bcaction.org/index.php?page=newsletter-88d
http://www.safe2use.com/drsherman/life/15.htm
http://www.cancercare.org/about_us/
http://www.cancercare.org/about_us/annual_reports/2009/donors.php
http://globalrace.info-komen.org/site/PageNavigator/hq_gr_learn_FAQ_2010
http://en.wikipedia.org/wiki/Imperial_Chemical_Industries#History
http://www.cancer.gov/cancertopics/factsheet/Risk/HPV
http://www.ajcn.org/cgi/content/full/86/3/878S
Lancet - Circulating concentrations of insulin like growth factor 1 and risk of breast cancer -  http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2897%2910384-1/abstract
Potential public health impacts of the use of recombinant bovine somatotropin in dairy production - http://www.consumersunion.org/food/bgh-codex.htm
Breast Cancer Action - http://thinkbeforeyoupink.org/?page_id=10
http://ntp.niehs.nih.gov/

Don't put a milk moustache on breast cancer

Milk is a healthy beverage right? We've been told to "drink your milk" since we were old enough to hold the sippy cup. A quick look at the GotMilk website here will show you that they are even touting milk as a way to help PMS (Pre-Menstrual Syndrome). They go so far as to call milk, "The perfect comfort food." If you're of a certain age you may remember when milk was delivered by the milkman to the front door of your house and it actually was healthy.  However, things have changed a lot since then and not all milk is created equal.

It all started back in the early 1980's with research for a drug that would increase the production of milk in cows. Monsanto Company eventually received Food and Drug Administration (FDA) approval for their drug Posilac. It's what is known as a genetically engineered hormone called recombinant bovine growth hormone, or rBGH. In 2008, Eli Lilly acquired the Posilac branch of Monsanto's business. Eli Lilly also manufactures breast cancer treatment drugs. So, what's the big deal? Well, the plot thickens.

There are potential health issues associated with the use of rBGH. To underscore this point, several countries including Australia, New Zealand, Canada, Japan, and the European Union recognize rBGH as a big enough health threat that they have banned it and any products containing it. Animal and food safety activists in the US have been voicing their concerns for years as well.  Thankfully, some grocery stores, dairies and companies that utlize milk in their products are no longer using rBGH milk. You can view a list here compiled by Food and Water Watch.org.

So, just what are these potential health issues? Well, one concern is that the hormone causes mastitis in the udders of cows. The mastitis then requires antibiotics - strong antibiotics.  In some cases, antibiotics are regularly used to prevent mastitis before it even occurs. The prolific use of antibiotics is thought to be one cause of the increasing numbers of antibiotic resistant strains of bacteria we're seeing. That by itself is bad enough. However, the story doesn't end here. 

The presence of rBGH in the cow's blood stimulates production of another hormone that is normally present in cow's milk, called Insulin-Like Growth Factor-1 (IGF-1).  A side effect of the use of rBGH is that it causes IGF-1 levels to rise significantly above normal. According to one study, rBGH caused the normal levels of  IGF-1 in cow's milk to increase by "sixfold", and recent information released by Eli Lilly to the European Community Committee for Veterinary Medicinal Products admitted increases of ten times the normal IGF-1. 

Why is this a problem? When we drink milk containing normal levels of IGF-1, the hormone usually binds with proteins whose job is to keep the biological activity of IGF-1 in check. However, when levels of IGF-1 are significantly increased, as they are in rBGH cow's milk, it's thought that this leads to unbound IGF-1 circulating in the body.  It's a known fact that IGF-1 causes cells to divide and that unregulated cell division leads to cancer. The concern many experts have is that rBGH, and the resulting increased levels of unbound IGF-1 in our circulation, are contributing factors to the increases seen in a variety of cancers, including breast, colon, lung and prostate.

So, that's the connection. A drug company that offers breast cancer treatment drugs is also responsible for a drug that may cause breast cancer. I find this appalling! Like me, you might be wondering where the FDA is in this story. If you'd like, you can read an updated 2009 statement from them here, and get their side of the story. It's difficult for me to understand how other countries can see the wisdom in banning the use of this drug, but the US cannot. Having said that, the cynic in me can recall many similar situations where a big industry with deep pockets was able to fly under the radar for years.

If you're feeling moved to activism, Breast Cancer Action has composed a petition to Eli Lilly requesting that they stop making rBGH. You can link to it here. It really is an inexcusable conflict of interest when a company sells a drug that ultimately may contribute to breast cancer and also sells drugs for breast cancer treatments.

The good news is that there is a movement for labeling non rBGH cow's milk and other dairy products so that consumers can identify and choose products that don't use this growth hormone. The bigger picture is that this fight isn't just about dairy products. It's about all foods that are being genetically modified or altered. Don't you think we should have a right to know what we're eating? That healthy milk delivered by the milkman is still available today.  It's just our responsibility to make sure that we can choose for ourselves which milk we deem healthiest.


Sources
http://documents.foodandwaterwatch.org/rBGH_Health.pdf
http://www.preventcancer.com/consumers/general/milk.htm
http://www.gotmilk.com/#/benefits/pms/info/
http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=5149628
http://www.fda.gov/AnimalVeterinary/SafetyHealth/ProductSafetyInformation/ucm130321.htm
http://www.preventcancer.com/consumers/general/documents/consumer2_001.pdf
http://www.medical-hypotheses.com/article/S0306-9877%2805%2900354-3/abstract
Image from -http://www.thedailygreen.com/cm/thedailygreen/images/milk-organic-FD-lg.jpg