Tuesday, March 26, 2013

Day 1,006: Why We Will Never Prevent Breast Cancer

I am tired of all of the articles about breast cancer prevention, even the ones that I think are right on the mark. I have a very specific reason for being tired of it: I was a young nursing mother, a manically-active size 2 who didn't drink, when I was diagnosed with a rare and aggressive form of breast cancer. So I understand that being overweight and inactive and never having children and drinking a lot increase the risk of contracting breast cancer, but none of those things applied to me. There are plenty of women who are overweight and inactive who are diagnosed with breast cancer, and plenty of women who are overweight and inactive who never get cancer at all. These are excellent, common sense risk reduction (NOT prevention) techniques: staying fit, eating healthy foods, not drinking or smoking.

But the thing is, those are risk reduction activities for just about everything bad that can happen to you.

Breast cancer is different. Breasts are like sponges, soaking up everything in the environment.

And breast cancer--yes, even triple negative breast cancer--is caused by shifts in hormones. That is simply not true for many other cancers and diseases.

It is a known fact that women are at an increased risk of developing breast cancer in the years directly following pregnancy and lactation. Now, we don't expect women to stop having babies due to the increased risk of breast cancer, do we? We don't terrify them, make them feel guilty for getting pregnant, and judge them on this basis. It is actually a risk factor to NOT have children, or to have children later in life (damned if you do, damned if you don't). And of course most women have babies and nurse them and do not get diagnosed with breast cancer in the subsequent years.

But I did.

I fully believe that pregnancy, nursing, and the wild hormonal fluctuations they entailed FOR ME (not for everyone), including my wildly over-producing milk supply that never regulated in the seven months I fed Lenny breast milk (I would produce 12 ounces when she only ate 3, and no, it never normalized. I had near-perfect supply and demand with Augie, so I know the difference) contributed to my breast cancer.

And I wouldn't change a thing. That is an unavoidable risk, and one worth taking. These kids are damn cute, and I love them, and I'm glad I had them, obviously.

I'm even glad I had Augie, who was conceived after I took one round of Clomid, because I never again ovulated after my first pregnancy. My hormones were completely off-kilter, and I knew something was wrong before I even knew that I wasn't ovulating. I only took that ovulation-inducing drug for one cycle, and I saw the perfect egg that became my son, and I don't regret it. But I do believe that it probably advanced the cancer that was already there to ingest those hormones. In May 2010, when Augie was 11 months old, I was diagnosed with breast cancer, and told that I had had it for probably 3 or 4 years--matching up exactly with my exploding post-pregnancy hormones after Lenny's birth.

I have talked to many women, especially triple negative women, who got pregnant for the first time after stopping birth control pills. Oral contraceptives increase the risk of breast cancer, especially triple negative breast cancer, especially if they are taken for long periods of time. We know that breasts are sensitive to hormone changes in youth (which is why hormones in meat and milk are problematic, and can lead to early puberty in girls), which can help explain why going on the pill at a young age can increase the risk. Here is a link to one study, on this issue. There are dozens more, but I hesitate to link to the sites that list them, because they are almost all pro-life, anti-abortion sites that seek to demonize women who use birth control and the policies that support that usage. I am in the unfortunate situation of killing the message because I don't want to pay the messenger.

I am not making this up. I am not a conspiracy theorist, and I am not hiding some conservative Rush-Limbaugh agenda. The World Health Organization has listed estrogen-progesterone oral contraceptives as a Class One carcinogen, on the same level as hormone replacement therapy for menopause. WHO gives a very interesting disclaimer, saying that oral contraceptives are known to help prevent cancer in the ovary and endometrium.

Why the need for this disclaimer, which, by its very nature, implies that WHO knows exactly what kind of cancer the pill causes: breast cancer?

I am sick of articles about prevention that focus on my need, and every woman's need, to become a health guru who lives in isolation and works out constantly and wears a hazmat suit to go out into the polluted environment and doesn't eat food she doesn't grow herself, when those articles fail to mention the fact that SIMPLY NOT INGESTING HUGE QUANTITIES OF ARTIFICIAL HORMONES CAN DO A LOT TO HELP REDUCE BREAST CANCER RISK.

These articles barely give a nod to the pill. How can they? Are we prepared as a society to accept what this means? Are we prepared to admit that the sexual revolution never happened, that the pill didn't lead to sexual freedom and emancipation? Are we prepared to force men to think about birth control on par with women, to stop saying that the pill liberated us? Are we prepared for the potential for extra babies to be born, for married couples to give up on that supposed "spontaneity" that the pill offers, for more men to get vasectomies?

I'm afraid to say that we are not. I for one, however, do not need to ingest carcinogens to be liberated. When we think we are being liberal, and we offer teenagers birth control, why is the focus on the pill, which has such harsh side effects that 60% of women and girls stop taking it during the first year? Why is the focus on a form of birth control that ONLY prevents pregnancy, and does nothing to prevent STDs? We continue to pass out the pill on college campuses like it is a placebo, like it is candy. Shit, we passed legislation making it illegal to process credit card applications on college campuses, and no one ever got uncontrollably sick or had strokes or gained weight from a goddamn credit card. We have stopped doing this to women who are in menopause. We need to stop doing this to girls and young women who simply want to prevent pregnancy.

I do not regret going on the pill at age 18, when the entire medical establishment told me that the only harm it would cause would be the potential for blood clots in heavy smokers. I do regret staying on it when my long-term boyfriend and I broke up when I was 24, because I did not use the pill for birth control purposes for years--I made everyone wrap it up, until it was clear that Gabe and I were in this for the long haul. I stayed on the pill because my cycles were regulated and I had less monthly illness and anemia, and because I had no reason not to--I had no idea that it was linked to breast cancer, and triple negative breast cancer didn't really exist yet as a concept.

But now we know, and we have other options--condoms, of course, but also non-hormonal implants like Essure--and we still ignore the entire connection. So we will continue to have women with 17% body fat who could kick your ass in a marathon contracting breast cancer at young ages. And other women will berate women like me for trying to take options away from them. I have been unfriended on Facebook for talking about this. People have said that I am an anti-feminist, and that I am trying to stop women from having control over their sexuality.

Me. The one who kicked a guy out of my apartment and told him to go fuck someone else because he wouldn't wear a condom. The one who is sick of hearing talk of consent because it seems to me to be the world's easiest concept, even for a teenager (my first time, the guy asked me the teenage version of the consent question: "REALLY?!")Me, the girl who sat on the senior class council in high school and suggested that we leave as our class gift, not a plaque or a statue, but a condom machine. I even went to an elderly male dean to make my case over the issue, devoid of any embarrassment or concern over what he thought of me.

I am sure that there are various factors that led to my being diagnosed with triple negative breast cancer at age 34, including many that I could not have avoided no matter what I did (such as having a CT scan of my head at age 6 to diagnose epilepsy; radiation to the chest and head at a young age is a major risk factor for later breast cancer). I am not trying to demonize the pill or make women who take it feel guilty or afraid. I simply believe that we are owed real information. I believe that the pill should continue to be offered as an option, as long as the risks are understood. I believe that there are cases (probably far fewer than we are led to think) when the pill can offer medical help to women who have various hormone imbalances or other ailments. (I still cannot get over the fact that my doctors considered putting me on the pill when I was 12 because I was severely anemic due to my heavy periods. They ultimately decided not to, because the pill would have counteracted my anti-convulsants. So, I took some iron supplements for a few months AND WAS JUST FINE). I also do not believe that if women stop taking the pill, no one will get breast cancer. Clearly, that is not how breast cancer works. But it would help to reduce risk, and some cancers would indeed be prevented--we know that is true about hormone replacement therapy, so there is no reason to believe it wouldn't be true about this. Plus, not taking the pill is a decision that is damn easier to control than when you get your first period or whatever the FDA approves for the food that is offered at your grocery store. I simply believe that we should acknowledge what the medical community already knows, and stop making women feel guilty for every few pounds they put on or every few days when they couldn't get to the gym while we continue to ignore another major issue because it does not behoove us as a society to mention it.

It is especially mystifying from a policy perspective. We have a liberal President who was able to include coverage of birth control PILLS under landmark health legislation. On the other hand, the non-hormonal alternatives such as Essure remain prohibitively expensive for many, and condoms are not covered. So we have legislated a carcinogen as the most economic choice for pregnancy prevention. This just makes it harder for women to reduce their breast cancer risk, especially for lower-income women. Lower income women are already at higher risk in relation to the other known lifestyle risk factors for breast cancer, as quality food is harder to buy in many poor neighborhoods, and it is often unsafe to exercise outside, too costly to join a gym, or too difficult to fit exercise into a schedule that includes multiple minimum wage jobs.

The fact is, we do not tell boys or men that they need to ingest artificial hormones in order to be sexually active. And when we do develop drugs like Cialis and Viagra (always covered by insurance, of course), we storm the prime time commercial spots with information about the potential risks of those medications. When we decide to be progressive in talking to our boys about sex, we talk about asking permission and wearing a condom and being respectful. There is an underground reality of boys and men taking testosterone supplements or steroids in order to perform better in athletics or improve muscle mass, but we not only do not condone such behavior, WE HAVE MADE IT ILLEGAL. We shun those who do such things, and then we continue pumping our girls, mothers and friends full of stuff that might harm them and call it a travesty if anyone questions the practice.

The pill is the breast cancer elephant in the room. We are collectively uninterested in removing the elephant, so I guess we are going to have to keep cleaning up its shit. I just don't think that breast cancer survivors, who are the objects of such harsh judgment by many who look at us disdainfully as they attempt to ascertain exactly how we gave this disease to ourselves, should be the ones left holding the shovel.

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