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Selective Science and Breast Cancer


Last month, my local paper ran a front-page article highlighting the abnormally high rates of breast cancer in the San Francisco Bay Area. For obvious reasons, interest runs high in getting to the bottom of this medical mystery. Since breast cancer has multiple predisposing factors, any ultimate explanation would necessarily be complex.

The article therefore could provide no firm explanation for why rates are higher here, only a sketch of the main threads of ongoing research. Genetic and environmental factors, some of which are clear triggers for breast cancer, are mentioned in broad terms. The pesticide DDT, however, is suggested as a possible culprit: don’t get me started.

It was careful to specify only certain lifestyle factors so that the reader would be excused for assuming they are limited to diet, exercise, and alcohol use.  Aside from a brief reference to delayed and total lack of childbearing, a concerned reader would have no inkling how pertinent this and other reproductive factors can be, as I have previously discussed in these pages and elsewhere.

There is also no reference to birth control pills, an officially recognized but deeply downplayed risk factor, or to induced abortion. The authorities have deemed it fit to ignore the strong evidence about these contested factors.

Instead, readers come away assuming diligent scientists are on the case, leaving no stone unturned: who would dare stymie legitimate avenues of inquiry or conceal plausible risk factors from public view?

A new California law, which will go into effect in April 2013, might bolster the impression that our medical and political leaders are doing everything they possibly can. The law will make it mandatory for doctors to explain to patients, should their mammograms indicate high breast density, that breast density is associated with an elevated risk of breast cancer. 

Informing women and the public about legitimate risk factors seems essential, although whether or not this particular mechanism is ideal is another question. Improvements in cancer treatment – a real marvel of medical science – have not eliminated one of the present limitations of mammography as a diagnostic tool: it generates an awful lot of false positives. Translation: diagnoses of breast cancer when in reality none exists.  

According to a recent report in the British Medical Journal, more than 70,000 American women were erroneously diagnosed in 2008.  That is almost a third of all legitimate breast cancer cases among women over 40, and about half of all cases overall. By some estimates, the harm women endure from the unnecessary, ensuing procedures outweighs the benefits stemming from accurate detection.

This story in the L.A. Times makes a germane observation: the relationship between breast density and cancer had been suspected for decades, before gaining widespread acceptance by the medical community. It was not routinely conveyed to women in part because it was supposed it would “serve little purpose… since it’s largely determined by factors outside of their control (such as heredity, age and ethnicity).”

But apparently it is perfectly acceptable to deny and downplay physiologically credible reproductive risk factors falling under one’s control. This is hard to reconcile with the zealous and otherwise well-intentioned search for cures and answers.

It is also deeply at odds with the Left’s own self-understanding as unwavering champions of science. “Science,” writes Yuval Levin, “is constantly on the lips of Democratic politicians” – and as the popular narrative goes, something the Left heroically defends like a “vulnerable and precious inheritance being pillaged by Neanderthals.”

My own local State Senator, Joe Simitian (D), advanced this breast density legislation, but given the status of, say, Planned Parenthood within his party and district, I can’t quite imagine him summoning the bravery to propose that, by law, anyone considering an abortion be informed that it is associated with subsequent development of breast cancer. I guess science qua science isn’t really always to be extolled. 

Granted, he may not be adequately apprised of the relevant evidence; not everyone is. But a critical mass of the prevailing power structure is comprised of politicians who ignore the science and scientists who bow to the politics.

The most important quality any scientist must possess, as this ongoing travesty should make plain, is not intelligence – indispensible as that it is – but honesty. Without the honesty to abide by science’s own framework, you only look the part of the scientist while really playing the role of manipulator.  It takes great chutzpah to do this while maligning political opponents as enemies of science.

At the end of the day, authorities who choose to look the other way on abortion as a risk factor are not so different from, say, doctors all those years ago who failed to acknowledge that hand-washing could be protective, even well after sufficient evidence had been accumulated.  

In drawing this parallel, bioethicist Fr. Tad Pacholczyk recounts what happened in the 1840s. A pioneering doctor in Vienna began requiring hand-washing between visits to women and prior to delivering their babies; consequently the mortality rate from childbed fever plummeted dramatically.  Nonetheless, this man of science faced severe resistance, endured professional ridicule, and eventually got fired.

The achievements of science are too numerous to count. So too, it sometimes seems, are its promises and politicized claims.  The Catholic Church makes a distinctive yet rather bold claim of its own: to be the servant of “mankind, of every condition, in every weakness and need,” as Paul VI put it to close Vatican II.

I’m not sure what non-Catholics make of this grand claim. But theology aside, when it comes to grappling with this medical affliction with the clues science has provided, a question emerges: is tolerance or intolerance of neglecting certain risk factors, in all honesty, more indicative of an abiding love for humanity?

 

Matthew Hanley

Matthew Hanley’s new book, Determining Death by Neurological Criteria: Current Practice and Ethics, is a joint publication of the National Catholic Bioethics Center and Catholic University of America Press.



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