The objective in primary prevention is to prevent the disease process from starting.'Primary prevention' is about eliminating the causes of a disease before it can affect people. It is historically based on common sense and recognition of the proven or suspected cause and effect of diseases. For example, the connection between poor standards of sanitation, drainage, water supply and ventilation, and diseases such as typhus, cholera and consumption, was recognised by the British Parliament's Select Committee on the Health of Towns in 1840.
(Gray & Fowler 1984)
A primary prevention approach to a multi-factorial disease (i.e. one believed to have resulted from the interaction of genetic factors with environmental factors) such as breast cancer would aim to reduce and eliminate, as far as possible, human exposures to all substances or agents that are known to be, or suspected of being, implicated in the disease process.
Barriers to a 'primary prevention' focusThere are a number of attitudes, mindsets and misconceptions standing in the way of a primary prevention focus on breast cancer. These include:
We have been conditioned over time to accept cancer as a fact of life (and death). Statistics tell us that breast cancer affects 1 in 9 women while cancers in general affect 1 in 3 of the population. These frequently reported figures influence the gradual acceptance of breast cancer as both a 'normal' disease and one that must inevitably affect some of us.
The acceptance of breast cancer as a disease we have to put up with is affirmed in a survey conducted by the charity Breast Cancer Care. Asked about the challenges for breast cancer over the next 30 years, the majority of the 80 breast cancer experts participating predicted that 30 years from now breast cancer will still be incurable but it will be a disease women live with, like diabetes or asthma, rather than die from, and that the biggest problem for the NHS will be the sheer number requiring care. ('Health Service Journal' July 2003)
When we think of breast cancer we think of it as unpreventable.Confusion
Jenni Murray (presenter) Woman's Hour BBC Radio 4 November 3 2000
The slogan 'early detection is the best prevention' has attained the status of a 'truth' in the public mind. In fact, early detection, by whatever means, is only detection. Equally persistent has been the promotion of regular mammograms as a 'preventive measure'. Mammography is a tool for detecting breast problems, not for preventing them.
Women have been sold the myth that the answer to breast cancer is early detection and treatment.
Dr Cathy Read 'Preventing Breast Cancer: the politics of an epidemic' Harper Collins UK 1995 p8
Fixation on treatment and control of the disease by medical science leaves primary prevention in an extremely marginal position on the national agenda.
The main error of the biomedical approach is the confusion between disease processes and disease origins. Instead of asking why an illness occurs, and trying to remove the conditions that lead to it, medical researchers try to understand the biological mechanisms through which the disease operates, so that they can interfere with them … These mechanisms, rather than the true origins, are seen as the causes of disease in current medical thinking and this confusion lies at the very centre of the conceptual problems of contemporary medicine.
Fritjof Capra 'The Turning Point – Science, Society and the Rising Culture' Simon & Schuster USA 1982 pp149-150
Vested interests and the status quo
A truth seldom aired is that there is no profit in prevention. The disease of cancer has spawned a major world industry and it is unlikely that such a massive and multi-faceted industry will welcome the prospect of its own demise in the shape of primary prevention.
A firm alliance between the established cancer institutions and the chemical, pharmaceutical and nuclear industries has formed the medical-industrial complex … At its best, this complex provides better diagnosis, new treatments and first rate health-care facilities. At its worst, the medical-industrial complex blocks an all-embracing programme for preventing cancer … What is stopping us [from getting serious about prevention] is the almost suffocating hold the medical industrial complex retains over cancer policy, and the hugely powerful chemical industry's interest in protecting its products.
Professor Ross Hume Hall 'The Medical- Industrial Complex' pp62-68 The Ecologist Vol 28 no2 1998
We generally trust advice when it comes to us from government, especially when it is reinforced by the media and cancer charities. Both Scottish and UK government's cancer plans target lifestyle factors (exercise, diet, alcohol consumption and smoking) as the key to cancer prevention. This narrow focus perpetuates ignorance that dietary and environmental contaminants are significant sources of human exposure to carcinogens which are impossible to avoid.
A narrow focus on lifestyle – like a narrow focus on genetic mechanisms – obscures cancer's environmental roots. It presumes that the ongoing contamination of our air, food, and water is an immutable fact of the human condition to which we must accommodate ourselves.The media is the main source of public information in today's world. It is an all-pervasive global force in society and is becoming an integral part of the public debate about breast cancer. However, the information industry – print and broadcast – is largely controlled by market forces and these exert strong influences on society, especially through advertising. This can compromise editorial decision-making or it can obscure core issues. For example, the survival of a women's magazine or a TV channel in a very competitive marketplace will depend upon revenue from advertisers selling products – often directed at women – that should arguably be part of the debate on causes of breast cancer. Therefore, it is impossible to get issues like 'primary prevention' taken up by mainstream media. One result, for example, is the widespread misconception that breast cancer is a largely inherited disease.
Dr Sandra Steingraber 'Living Downstream: An Ecologist Looks at Cancer and the Environment' Virago UK 1998 p262
Genetic screening for women with an inherited 'high risk' of contracting breast cancer still tends to dominate popular media reporting, with the effect that most women estimate the genetic cause of the disease to be far commoner than it is: around 5% of all breast cancers.
Laura Potts 'Stopping Breast Cancer Before it Starts' Health Matters July 2001
There is a widespread tendency (among scientists, industrialists and politicians) to claim the need for more research when challenged by prevention measures based on existing scientific knowledge. In the case of breast cancer prevention this delaying tactic devalues a half century of scientific endeavour, leaving policy makers forever in the grip of 'paralysis by analysis'.
'We need more study' is the grandfather of all arguments for taking no action.
P Infante & G Pohl 'Living in a chemical world: actions and reactions to industrial carcinogens' pp225-249 Teratogens, Carcinogens, Mutagens 8 1988
A myriad of scientific papers exist concerning adverse effects from exposure to radiation and from exposure to hundreds of chemicals. There is more than enough information to make informed decisions about exposures to these entities.
Dr Janette Sherman 'Life's Delicate Balance: A guide to causes and prevention of breast cancer' Taylor & Francis USA 2000 p235
The invisibility factor
Away from their source of production, there are no identifying clues, such as odour or colour, that might alert us to the many carcinogenic chemicals and sources of harmful radiation in our everyday environment. The invisibility of such health hazards makes it difficult not only to accept their existence but also their hazardous nature.
The reason people don't believe in radiation is, it's out of sight, out of mind.
Dr Alice Stewart 'The Woman Who Knew Too Much' Gayle Greene University of Michigan Press 1999 p213
Many harmful or suspect chemicals (in drinking water) can't be tasted or smelled even at dangerous levels.
Jeffrey Steingarten 'The Man Who Ate Everything' Headline USA 1998 pp61-62
Fear of cancer feeds our resistance both to learning and even thinking about the disease.
Nothing in life is to be feared. It is only to be understood.
Marie Curie, Polish Scientist, Received 2 Nobel prizes for her work with radioactive elements, 1867-1934
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