Friday, December 10, 2010

The Politics of Breast Cancer

Elizabeth Edwards died this week at the age of 61.  She lost her fight against the ravages of breast cancer after too short a battle.

Many admired Elizabeth for her forthright and upfront campaign to beat this odious disease.   She lived a full life in her modest time with us, becoming a lawyer and raising four good children.  She also refused to become a victim, neither from the assault of disease nor the personal trials she faced.   She refused to allow cancer to define who she was.  She took on the insurance industry, as she became a voice for many whose opportunity for health care had been denied.  She was an advocate for the public option and testified frequently before Congress and advocacy groups from her think tank position at the Center for American Progress.  She understood that many foreclosures, long before the recent increases, were due to the expenses of uninsured families trying to pay for medical expenses.  She knew that over half of all bankruptcies were a direct result of medical bills owed by those who were not insured or had been under-insured.  She knew about the politics of breast cancer. 

Many in health care today support the public relations campaigns that have brought the treatments for breast cancer front and center into the public consciousness.  One cannot walk into a shopping mall without seeing multiple pink ribbons adorning products from sneakers to lingerie as corporate America jumps on the breast cancer awareness band wagon.  But, many wonder, has the incidence of breast cancer decreased with this awareness?

Have we increased the diagnoses without increasing the knowledge about causation?  Aside from testing for genetic pre-disposition and some familial tracking, we are not much further along in halting the incidence than we were a generation ago.  We do not understand why some young pre-menopausal women get the disease -- and may have a much more invasive condition than others.  In fact, some medications which were said to be helpful, such as hormone replacement therapy, subsequently were found to cause harm.   Screening mammograms were promoted, then demoted, first as an annual test, then decried as too costly.   Insurance companies tried to schedule mastectomies as outpatient procedures.  Only huge publicity against "drive thru" mastectomies cancelled these requirements.  (The reasoning, incredibly, by the companies was that these are not vital organ parts and therefore are expendable!) 

Elizabeth Edwards did not make it to the five year mark cancer free, so she could not be labeled a "survivor" according to the American Cancer Society guidelines, but she did teach survivors and others how to fight.  Generations ago, women did not mention that they had cancers.  It was a disease which was whispered about; patients often were not told of the finality of their diagnoses.  Elizabeth put this practice behind her and went public from the first day of her diagnosis. 

Only by bringing out the incidence and challenging the politics of breast cancer will women begin to address a cure.  The Race for the Cure has helped a lot of women -- but it should not be an end point.  Women should be racing to determine the causes and prevent the occurrence.  This was something which Elizabeth understood quite well.  Elizabeth would be the first to admit that she had an atypical course of diagnosis and treatment.  She had enough money to buy what ever health care she wished to obtain and treatment continued until just before her death.  She had standard and experimental treatments, but in the end, the disease -- as it often does -- won out.  During recent years Elizabeth was a strong advocate for dismissal of the use of pre-existing condition clauses in insurance contracts.  She stated many times that sick people need to get the care which is required by their illness, what ever it is.  She acknowledged that Americans have great care available for those who could afford it.  However, she noted, that while we spend more on healthcare than anywhere in the world, we are only 36th in longevity.  We have too much care that is ineffective and too many practices that are unhealthy.

Women must ask what toxins in our environment, food or water have increased the numbers of women -- and men -- getting breast cancer.  Incidence according to one study has increased from an average in the 1940s of 66 per 100,000 population to an average of 127 per 100,000 today.  Death rates of 25 to 24.7 per 100,000 have remained constant across this more than 60 year span.  There have been advances in care from the disfiguring radical mastectomies to more minimal surgeries today.  There are staging and hormonal testing for cell descriptions.  Radiation, chemotherapies and hormonal treatments have been greatly improved.  But, to my way of thinking, until women stop thinking that wearing pink ribbons will cure breast cancer, we will not be on the road to eradication of this disease.  Until women speak up and say, "find the cause and stop the increases in incidence," we will not see change.  We should do this to honor the life of Elizabeth Edwards and all who suffer today and have suffered in the past from this disease.

1 comment:

  1. Thanks Sharon, This is a very thoughful and thorough review of the issue. Marilyn

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