My 15-year-old daughter’s tone was even. “Mom, could you check this?”
She guided my fingers to a spot on her neck. I felt a lump about the size of a pea.
“Is that anything I should worry about?” she asked.
My voice was as uninflected as hers. “It’s nothing, sweetheart. Probably an infected lymph node.”
I knew this was true, and later her doctor would confirm it. But for one horrifying moment, fingers on her neck, I found myself staring into an abyss.
Anna’s studied casualness spoke more eloquently of her fear than tears and trembling would have. She’d discovered the lump a couple of days earlier. She didn’t have to tell me how she’d lain in bed for long hours touching the lump, palpating it, willing it to disappear. I knew. I had done the same thing four years earlier with a lump in my breast–a lump that did turn out to be cancer.
In the years since my diagnosis, I’ve learned a fair amount about breast cancer, but almost nothing that will protect Anna. I buy her vitamins. I suggest a low-fat diet, though the connection between fat consumption and breast cancer is unclear. I could recommend that she get mammograms in her 20s or 30s, but researchers question their effectiveness for younger women, and some say mammograms themselves might cause cancer. Some women with cancer in their families are having healthy breasts cut off or taking tamoxifen, a dangerous drug that helps prevent recurrence in women who have already had breast cancer. These are not options I would suggest to my daughter.
One in three Americans will get cancer; one in four will die of it. One American woman in eight will get breast cancer if she lives to old age. Something terrible is happening. Yet most cancer patients don’t demand to know why cancer rates are soaring. Many turn inward, struggling to understand why they gave themselves cancer. And a huge industry is spewing out self-help books, relaxation tapes, and workshops to encourage them.
There’s a certain kind of story we hear over and over: Someone with terminal cancer changes her diet, learns to meditate, leaves her stressful job, communes with the ghost of her dead mother, and–miraculously–recovers.
There’s nothing wrong with such scenarios if they give patients hope. Certainly, miraculous remissions do occur.
But these stories can drive a patient to despair if her illness progresses despite all efforts. When my friend Molly learned that her breast cancer had metastasized to her breastbone, she fought guilt as well as sorrow. “People who get cured convince themselves that it’s all the things they did. But if it is, what about those of us who don’t get cured?”
I think the reason that many women with breast cancer are eventually able to go beyond this kind of reasoning is that they are veterans of the feminist movement, knowledgeable about organizing. In 1991, for example, attorney Fran Visco and Dr. Susan Love founded the National Breast Cancer Coalition, an umbrella for advocacy groups around the country that rapidly netted over $300 million in new funds for breast cancer research.
The backlash came equally fast. Many prominent scientists decried earmarking research funds for particular diseases. Important discoveries are most likely to be made, they said, when researchers pursue not directed goals but the straight pathways of pure science. There is some truth to this. But it is equally true that top researchers go where the funding is. And their presence increases the likelihood of significant discoveries.
The critics’ arguments are specious on a deeper level, according to Elisabeth A. Lloyd, associate professor of philosophy at the University of California at Berkeley. Researchers speak as if sickness was caused only by the “overrunning of the body by a sick cell, by mutation in the DNA, or a virus,” she says. This simplistic picture ignores the myriad interactions between the cell and its environment. Scientists must turn their attention to these mechanisms–including the role of toxins in food, air, soil, and water.
Many cancer patients are excited by the endless media stories about current research: treatments that enhance the protective abilities of white blood cells; monoclonal antibodies that carry chemotherapy directly to the cancer; bio-engineered cells that teach cancerous cells how to behave. They give us hope for our lives and those of our children and a vision of a time when the treatments we’ve endured–surgery, chemotherapy, radiation–will be as obsolete as leeches and bloodletting.
But Nancy Evans of San Francisco’s Breast Cancer Action is skeptical. “The mythical hope for a cure has been just around the corner for 20 years,” she says. “I don’t believe we’ll have a cure in my lifetime. We have to take a public health approach to the problem, and a key aspect of public health is prevention.”
So far the response to disquieting studies about environmental toxins has been to insist that nothing can be declared a danger until the exact mechanism by which it creates cancer is understood. Yet Devra Lee Davis of the Department of Health and Human Services points out that we still don’t know exactly why smoking causes cancer. “When does scientific theory become fact?” she asks. “The answer is political and social.”
Juliet Wittman is the author of “Breast Cancer Journal: A Century of Petals,” a finalist for the National Book Award.
