Life's Delicate Balance
Causes and Prevention of Breast Cancer
by Janette D. Sherman, M.D.

Excerpts from Chapter 11
GENETIC CONNECTION 
The biology, economic and social ramifications

"We are so curiously made that one atom put in the wrong place in our original structure will often make us unhappy for life."  
-- William Godwin (1756-1836)

What can women expect from genetic research - the topic talked about on every media outlet?  An article in the  Journal of the American Medical Association discusses gene tests and cancer, diagnosis, measurement of tumor progression, therapy and drugs.   At no place in this article on the "cancer revolution" is primary prevention .  What can we expect?  Little, unless we demand specific action.
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If we are to stop the chemical-cancer link, the type and frequency of gene mutations and body burden of carcinogenic chemicals must be documented.  This carcinogen-specific research deserves at least as much effort and financial support as personal gene identification.  Given the potential for profit from patented gene-testing, and the threat to the status quo if the chemical pollution - cancer link becomes documented, it is unlikely that the needed research will be undertaken unless there is concerted pressure to do so. 

How do cancer mutations come about?  Through interference and damage by chemicals and/or various forms of radiation.  Some mutations are random and a part of the normal evolutionary process which allow new genetic traits to emerge.  The amazing creatures of the Galapagos are examples of what happens when genetic changes occur on an isolated island.

Much of the cancer epidemic of today is a result of increasing exposure to chemical and radiation factors.  Although many of us have genetic susceptibility to one illness or another, a second triggering factor from the environment is needed to make the abnormality or disease manifest.  Allergies come to mind: the susceptible individual can be symptom-free in the absence of the offending agent, be it ragweed, penicillin, or a cat. Unfortunately, throughout our common evolutionary history, we have not developed mechanisms to respond to many novel, man-made, insults.  
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Women are already having "prophylactic mastectomies" on the basis of a positive breast cancer gene test.  What body part will we next be willing to excise, based upon genetic findings?  Now that the nuclear genie is out, how can anyone claim that prophylactic mastectomies prevention?  Isn't primary prevention preferable?  That is to stop chemical pollution, stop nuclear bomb testing, close nuclear power plants,  and clean up and control wastes.

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UNCERTAINTIES OF GENETIC TESTINGƒ

The announcement of BRCA1 brings questions galore:

• What if a woman finds she carries the BRCA1 gene? Can she lessen her chance of developing breast cancer by any means?

• If the woman elects to have a bilateral "prophylactic mastectomy", who will pay the cost?

• For concerned women, would any of the following be useful: Eliminate use of pesticides?  Eat a vegetarian diet?  Avoid use of birth control pills and post-menopausal hormones?  Move away from the vicinity of an incinerator or nuclear reactor?  Close the incinerator and nuclear reactor?  Don't build an incinerator in the first place?  Don't renew the license of a reactor?

• What of the 95 percent, estimated at 172,000 other women without a genetic predisposition?

• There has to be a cause of this epidemic, and if 95 percent is not genetic, it must be some other factor we share.  What is that factor?

• Is there a the link between BRCA1, breast cancer, genital cancer, even prostatic cancer, which is also on the rise?

• If BRCA1 testing is approved, will tests be paid for by insurance companies?  By the Federal Government?

• Will the charge for genetic testing be based upon actual cost of development, or will a profit margin be factored in?

• If neither the insurance industry nor the government agrees to pay for such tests, will it mean that poor women and women without insurance will not be afforded the tests?

Until these concerns are answered, we must not allow technology to overwhelm valid scientific, social, ethical and moral issues.  Remembering the words of Martin Luther King, Jr., we may substitute the word genes for the word missiles, but the message remains the same:

 "Our scientific power has outrun our spiritual power. We have guided missiles and misguided men."   --from Strength to Love

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