By Nafis H
The month of October has been designated as National Breast Cancer Awareness Month. To celebrate such an occasion, hundreds of men and women will walk or run to raise money for more research, talk about their or their relatives’ harrowing brushes with this disease, share courageous stories of breast cancer survivors on social media, and maybe even resolve to live a healthier lifestyle like signing up for SoulCycle, or getting on a detox program followed by a juice cleanse.
The narrative that has been constructed around breast cancer is one of individualism, one where the disease “is a consequence of personal rather than societal failings”. The scientific evidence presented to uphold this narrative is one of reductionism and determinism – we are told that cancers are caused by aberrations in our DNA and these aberrations are mostly due to our “bad luck.” The treatments for this disease, arising from chemical agents used during World War I, increasingly rely upon targeted destructive measures upon one’s body, and are described using military vernacular such as “magic bullets” and “battlespace vision”. The prices of cancer treatments keep increasing at a faster rate in the US compared to any other country, without significantly increasing patient quality of life or overall survival.The scientists and physicians are complicit in this endeavor – the academic field is rife with fraud, irreproducible data, researchers raking in money and not disclosing financial ties with biotech startups, and physicians making recommendations to the FDA oncology advisory council without needing to disclose their relationship to companies that do not yet have a drug on the market.
The bourgeois government has encouraged public-private partnerships since the 1980s with the introduction of the Bayh-Dole Act, the FDA’s Critical Path Initiative in 2004, and more recently the Cancer Moonshot Initiative in 2016. Over the years, more and more money has been allocated to the National Institutes of Health (NIH) and the National Cancer Institute (NCI), especially following the publication of the human genome sequence, which is believed to hold the secrets to curing all diseases, not just breast cancer.
However, this privatization has worsened the situation. As evidence shows, privatization has provided perverse incentives for researchers, and ultimately, created the current chaos that reigns in cancer research today. The current state of research shows an ailing system with spawning of predatory journals, transparency issues in established medical journals, sham conferences, plethora of reproducibility issues in basic research, corruption among scientists and abuse of public funds for personal gains. This reflects the “quantity over quality” approach where scientific trainees (graduate students & postdoctoral scholars) are often exploited in a tight budget climate.
Not that more money had resulted in better research — when NIH’s budget doubled between 1997–2003, the growth was mainly observed in ancillary markets such as reagent companies, expansion of universities, and number of NIH contractors. Although there exists a host of scientific literature on the environmental causes of breast and other cancers, only 15% of NCI’s budget in 2008-09 was dedicated to studying such causes rather than focusing on individual genes. In the meantime, independent scientists are fighting uphill battles to get chemicals, such as Bisphenol A that have shown to cause breast cancer in laboratory rodents, off the market. The regulatory agencies and government policies favor the evidence presented by the manufacturing companies and ignore the myriads of evidence that independent scientists have provided. This has also allowed profiteering entities to continue exploiting vulnerable populations, while building social capital by sponsoring biomedical research.
The neoliberalization of cancer has also pushed for creating niche markets that are aided by non-profits. The mantra “early detection saves lives” has successfully brainwashed the public into believing that it actually prevents cancer deaths effectively — in one study, 68% women thought that mammography lowers their risk of getting breast cancer, 62% were convinced that screening decreased the rate of breast cancer by half, and 75% thought 10 years of screening would prevent 10 breast cancer deaths per 1000 women. Unfortunately, this mantra has allowed non-profits such as Susan Komen Foundation to balloon, with less and less of the raised money going to supporting actual research and more into maintaining the foundation itself.
The burdens of breast cancer, and the neoliberal approaches to fight it, falls disproportionately on people of color in the US – African-Americans have the highest mortality from breast and other cancers, and native Hawaiians have the highest mortality from breast cancer in the US across all ethnicities. These disparities were originally attributed to a lack of diagnosis and the cancer being at a more advanced stage at the time of diagnosis in these non-white populations.
However, adjustment for stage of cancer at diagnosis did not solve the discrepancies observed. Even as mammography screening for breast cancer became equivalent nationally among Black and white women of all ages, these disparities persisted. This has been supported by epidemiology studies that suggest that disparities in outcome by race/ethnicity have not improved over time. In fact, between 1975–2000, disparity in death rates from all cancers combined between Black and white, men and women, increased.
While much of the blame was put on the differences in biology between races/ethnicities (e.g. — Black women have a higher risk of developing a more aggressive form of breast cancer), it appeared that the racial gap in outcomes was prominent among breast cancers with good prognosis (hormone-receptor positive, multiple treatments available). This essentially led to the conclusion that “biological factors cannot explain all of the racial disparity in morbidity and mortality.”
While socioeconomic status (SES) has been put forward to explain such disparities, again it cannot be understood without a framework of historical racism in this country. In fact, as the prominent public health scholar David R. Williams states, “race is an antecedent to and determinant of SES.” The fact that non-white populations experience greater poverty just shows the success of discriminatory policies in the US. The 2010 U.S. Census found that Black populations are living in poorer quality housing, have higher exposures to toxins and pollutants in residential and occupational settings, and have less access to healthy food and quality healthcare — conditions that are cancer risk factors, or as more eloquently put by Dr. Samuel Brodar, NCI Director (1991), “poverty is a carcinogen.” Consider that Black women are 4–5x more likely to experience treatment delays and less likely to receive cancer-directed therapy for breast cancer, even when they have similar tumors to those in white women. Black and Hispanic women suffer more often from inadequate pain management; between 90–91, data from outpatient centers that treated predominantly minority patients show that these patients were 3x more likely to have inadequate pain management compared to patients seen elsewhere. When compared with the findings that patients across ethnicities, when treated equally regardless of SES, have equal outcomes, the rampant racism present in healthcare becomes very clear.
Cancer is a deadly disease – there is no doubt about it. Just as capitalism alienates the individual from the environment, reductionism alienates the disease from the body it manifests, essentially “other”-izing it and pitting the patient against their own body. This alienation promotes individualism through the language of “survivorship,” where the victim has beaten their own body into submission using “potent chemical weapons.” The “War on Cancer” is waged not in laboratories, but on the bodies of patients undergoing surgery, radiation treatment and chemotherapy. There is nothing to “win” here – one cannot fight their own physical manifestation of their existence and expect to achieve victory. But the popular narrative of “winning over cancer”, shaped by an imperialist, capitalist government, the pharmaceutical companies and neoliberal non-profits, distorts one’s perception of cancer treatment and their own body.
None of this is to say that we should give up on trying to prevent and/or treat cancer. In order to do so, however, we need to radically revise how we understand cancer and how we can best prevent it. Consider that the biggest curb in cancer mortality in the US was achieved by public health measures such as tobacco control – why isn’t there more money in prevention of other cancers through public health measures? Why aren’t we stemming the endless flow of chemicals and pesticides into our environment that have shown to cause breast and other cancers? Why are we so focused on studying the intrinsic factors that supposedly cause cancer when research shows 85% of cancer incidence risk can be explained by extrinsic factors?
Ultimately, all of this points to the fact that the “War on Cancer” cannot be won unless the racist and capitalist system is dismantled. Sociologist Catherin Bliss notes that “the relationship between scientific knowledge and state power has been dialectical” and public policies govern the course of scientific research. We cannot expect a capitalist government to instate policies that will hold corporations accountable for poisoning our environment, or to regulate drug prices to make treatment available for all and to end racism in healthcare. We cannot allow the pinkwashing of corporations, which burden vulnerable populations with both physical and financial toxicity. Awareness about breast cancer should be a priority; however, awareness will not achieve anything unless it is framed in the context of how capitalism propagates this terrifying disease.