Mar 1 2009

Overlooking Evidence

Media ignore environmental connections to breast cancer

Photo Credit: Flickr Creative Commons/TipsTimes

Photo Credit: Flickr Creative Commons/TipsTimes

Breast cancer is now epidemic, affecting one in eight women, according to the American Cancer Society and others. The leading cause of death in women in their late 30s to early 50s, it’s estimated to have killed 40,000 people in 2008.

Known risk factors for breast cancer—such as age, genetics, reproductive history and alcohol consumption—account for only half the cases. (Genetics, the culprit du jour in the media, accounts for just 5 to 10 percent of all cases.) What about the other 50 percent?

A growing body of private, university and government environmental health research on animals and human populations is implicating the chemicals and radiation to which women are unwittingly exposed every day. The suspects include scores of toxic and hormone-disrupting substances that are listed as known, probable or possible carcinogens—and thousands of others that (in the U.S., at least) remain untested for their safety. Among others, they include pesticides, plastics, consumer-product additives and industrial byproducts.

Moreover, science is finding the causes of breast (and other) cancers are complex and multi-factored, and the timing and pattern of chemical exposure are proving as important as dose. While these findings, focused on causes and prevention, are relatively new and few compared with much better-funded work on detection and treatment, they merit further research and a place in the headlines.

Unfortunately, Extra! has found, the major media have downplayed and frequently overlooked this evidence.

Tracking the coverage

To track the extent of coverage of environmental factors in breast cancer causation, Extra! used the Nexis database to examine a sample of the largest, most influential news outlets—those with big enough budgets to do regular science, health and environmental reporting. We studied four newspapers (USA Today, the New York Times, Los Angeles Times and Washington Post), three newsweeklies (Newsweek, Time and U.S. News & World Report) and four TV networks (ABC, CBS, NBC and CNN) from 2002 through 2008, reviewing coverage of environmental factors in breast cancer during an annual event, National Breast Cancer Awareness Month—October—in each of the seven years. Since its inception in 1985, this pageant of pink has brought special prominence to the disease. While the month has been criticized by some as an exercise in corporate self-promotion, it does provide a predictable news hook and an ideal time to draw on recent findings to add cause and prevention to the standard mix of items on cancer rates and risks, detection and treatment.

Extra! also looked for coverage of two major scientific metastudies that aggregated numerous peer-reviewed scientific studies on the environment/breast cancer connection:

State of the Evidence: The Connection Between Breast Cancer and the Environment, a summary and explanation of external scientific research plus policy and research recommendations. First released in 2002 and updated in 2003, 2004, 2006 and 2008 to include new research findings, the latest edition synthesizes the results of more than 400 studies, runs 147 pages long with 667 references, and was vetted by five independent experts. It is published by the Breast Cancer Fund, a national nonprofit focused on environmental and other preventable causes of the disease, and Breast Cancer Action, a membership organization that “challenges assumptions and inspires change to end the breast cancer epidemic.”

A veritable catalog of environmental villains, the ’08 edition explains that the latest data “show that we need to begin to think of breast cancer causation as a . . . web of often interconnected factors, each exerting direct and interactive effects on cellular processes on mammary tissue,” and points to growing evidence that “exposure of fetuses, young children and adolescents to radiation and environmental chemicals [notably the pesticide DDT] puts them at considerably higher risk for breast cancer in later life.” Though disturbing, the report’s underlying message is hopeful: “By decreasing exposures to carcinogens . . . we may continue to lower breast cancer levels—and actually prevent the devastating disease—in the future.”

Environmental Pollutants and Breast Cancer: Epidemiological Studies, a review of hundreds of existing studies and databases that identified some 216 chemicals that induce mammary tumors in animals. Compiled by researchers at the Silent Spring Institute, a nonprofit scientific research institute that studies links between the environment and women’s health, and three other institutions, including Harvard Medical School, the report was published in May 2007 as a special supplement in Cancer, the journal of the venerable American Cancer Society.

Stating that “laboratory research provides evidence that environmental pollutants may contribute to breast cancer risk by damaging DNA, promoting tumor growth or increasing susceptibility by altering mammary gland development,” the report cautions: “These compounds are widely detected in human tissues and in environments, such as homes, where women spend time.”

Among other things, the paper found that the relative risks associated with PAHs (largely from car exhaust) and PCBs were “comparable in magnitude” to many breast cancer risk factors that have received more attention, such as age at first full-term pregnancy and inactivity. The good news: “If these mechanisms similarly affect humans, reducing or eliminating chemical exposures could have substantial public health benefits.”

The coverage: nearly nil

At no time since the State of the Evidence report began publication in 2002 did any of the major media examined cover or even refer to it. Similarly, none covered the Cancer special report with the notable exception of the Los Angeles Times, which published a thorough, nuanced, straightforward front-page article of nearly 1,500 words by award-winning environmental reporter Marla Cone (“Common Chemicals Are Linked to Breast Cancer,” 5/14/07).

However, the Times seemed to back off Cone’s story a week later, publishing “A Closer Look: Chemicals and Breast Cancer” (5/21/07), a special report by Mary Beckman in the Health section that appeared intended not so much to debunk Cone’s article as to reassure a frightened public. Subheaded “Suspects, but not all perps; a report has linked chemicals to tumors in animals. But the risks to women are less clear,” it stated that the report’s findings do “not mean women should stop cooking with canola or cower indoors for fear of getting breast cancer, experts say.”

Stories about or even mentioning breast cancer’s environmental connections during Breast Cancer Awareness Month were extremely few. Over the seven Octobers examined, only four articles (Washington Post, 10/23/02, 10/9/07; L.A. Times, 10/9/02 and 10/6/03), an isolated photo and caption (L.A. Times, 10/24/02) and portions of three TV news segments (ABC’s Good Morning America, 10/27/08; CBS’s Early Show, 10/4/06; NBC’s Today, 10/6/05) considered those connections, including the disease’s cause and prevention. There were three brief items (CNN, 10/18/04; L.A. Times, 10/19/04; NBC, 10/24/04) about the federal Sister Study, which is looking at the environmental and genetic factors in the sisters of women with breast cancer; CNN also made passing mentions in four segments over the seven years, USA Today made two and NBC one (most of these pieces were about topics other than breast cancer).

Though substantial and informative, both Post pieces and one of the L.A. Times’ had a note of blaming the victim. The Post’s 2002 article on exceptionally high breast cancer rates in wealthy Marin County, California, noted that “experts say women here are most likely vulnerable because of something in the county’s lifestyle, rather than in its water,” assigning the cluster most likely to “demographics.”

The Post’s 2007 article reported on findings that childhood exposure to DDT was associated with a fivefold increase in breast cancer risk in adulthood—but “balanced” this possibly lifesaving news with concerns that further restrictions on the pesticide may hobble the fight against malaria. (See Extra!, 9-10/07.)

One L.A. Times story (10/6/03) on California’s search for the causes of breast and other cancers through “biomonitoring”—measuring toxins in the human body—gave credence to the risks posed by chemicals such as flame retardants in breast milk, but devoted about a third of the 2,000-plus-word piece to concerns that the findings might scare moms away from breastfeeding their infants.

ABC, to its credit, had a long segment on breast doctor Susan Love’s “Army of Women” campaign to recruit women for human trials to look at breast cancer’s causes—including environmental ones. CBS and NBC’s segments—mainly on other aspects of the disease—inquired about environmental connections, but in both cases the physicians the networks chose to interview downplayed them.

Notably absent was any coverage in the New York Times or any of the newsweeklies. Time did have a lengthy cover story on breast cancer’s increase in developing nations (10/15/07)—but when it suggested that adoption of “U.S. and European lifestyles” may be behind it, the magazine pointed the finger only at things like diet and “reproductive habits,” sidestepping the issue of American-style increases in pollution and chemical use.

Perhaps the New York Times’ lack of coverage shouldn’t be surprising, considering the historical skepticism of Times science reporter Gina Kolata. In a 1998 article in the Nation (7/6/98), environmental journalist Mark Dowie took a critical look at the Times’ science reporting, singling out Kolata’s many years of work on controversial topics connecting the environment and health, including breast cancer. As he told the journal Wild Duck Review (4/99), her environmental reporting has taken “a hard, pro-technology, pro-corporate line,” noting that Kolata “took a strong position that breast cancer has no environmental etiology at all.”

In a companion video for her article headlined “Environment and Cancer: The Links Are Elusive” (12/13/05), Kolata stated, “There are people who say that there may be cancers caused by things in the environment, but it’s a very small percentage of them, and the importance of them in the public’s mind has been exaggerated.” She later added, “One answer people don’t want to hear is it’s random bad luck.”

The dearth of media coverage was particularly perplexing in October 2008, when the major media missed a perfect news peg: On October 8, George W. Bush signed the Breast Cancer and Environmental Research Act, under which Congress funded the establishment of multidisciplinary research centers to study the potential links between the environment and breast cancer.

However, the influential outlets did make time and space for such news as an item on breast cancer survivors getting beauty make-overs (NBC Today, 10/15/08) and an explanation (NBC Today, 10/13/08) of how “you can shop for a cure. When you buy everything from pink jump ropes to golf clubs, you can stay fit while fighting breast cancer all at the same time.”

Same old story

Evolving research discoveries may make theories about breast and other cancers more robust over time, but the dearth of coverage of breast cancer’s environmental links seems to have changed little since before 2001. That year, Brown University sociologist Phil Brown and colleagues published their study Print Media Coverage of Environmental Causation of Breast Cancer. The researchers looked at 40 years (1961-2001) of coverage of breast cancer in two major papers, the three major newsweeklies, four popular science magazines and eight women’s magazines, and found that only 12 percent of science magazines, 10 percent of women’s magazines, 5 percent of newspapers and less than 5 percent of newsweeklies ever mentioned possible environmental causation, focusing mostly on an individual’s personal responsibility for avoiding the disease.

When it comes to breast cancer, why is it so hard to get the most influential media to pay attention to the possibility that, in addition to better-understood risks, unnatural substances entering women’s bodies might also be a factor?

“It wasn’t for lack of trying,” said Shannon Coughlin, communications director for the Breast Cancer Fund. According to Coughlin, major mainstream reporters seem to hold environmental health science findings to an especially high standard of proof. “Chemical regulation goes by the idea that a chemical is innocent until proven guilty, which places a terrible burden on us to prove harm,” she said.

Environmental health research is less certain by definition, added Julia Brody, executive director of the Silent Spring Institute and lead author of the Cancer report: “The standard breast cancer risks [e.g., reproductive history and diet] are things we can ask people about,” whereas “people don’t know what’s in their drinking water and in their air.”

Thus journalists “say there’s no smoking gun,” Jeanne Rizzo, the Breast Cancer Fund’s executive director, told Extra!. “If there’s no sensational, direct cause and effect, they’re not interested.”

She added: “We need to change the conversation to see the interconnectedness of things. The media need to be willing to go out on a limb and talk about complicated [causality].”

Silent Spring’s Brody noted that even her institute’s hometown paper, the Boston Globe, passed on the Environmental Pollutants story: “They said, ‘There’s no proof.’ We say, ‘We don’t think we’ll find proof; we think we need to act on the weight of the evidence as it evolves.’ . . . We waited too long on tobacco smoke, we waited too long on lead.”

Rizzo pointed to the Women’s Health Initiative study, which found a direct connection between artificial hormone replacement therapy (HRT) and breast cancer (Extra!, 9-10/02). “We should have learned from HRT that when you remove an endocrine-disrupting chemical from women, we get less breast cancer,” she said. “We need to extrapolate from that—what other exposures are similar that we should study? It’s not rocket science.” She added that because that health study was government-issued, “the media jumped all over it.”

Consider the source

Indeed, science news—and spokespeople—with the imprimatur of large, establishmentarian organizations are taken more seriously, said retired journalist Arlie Schardt, founder of Environmental Media Services, a nonprofit communications organization that until 2005 helped lesser-known scientists gain media coverage. Schardt explained that for efficiency’s sake, reporters tend to turn for sources to “the usual suspects,” who reflect “traditional viewpoints,” particularly when seeking feedback and “balance” on the validity of emerging science.

This fallback position may be due to the general “lack of knowledge” of environmental health science on the part of reporters and editors, according to former L.A. Times reporter Marla Cone, who is now editor-in-chief of Environmental Health News. She noted that breast cancer is typically the beat of medical reporters, who tend to interview physicians—and neither these reporters nor their sources are “accustomed to looking at this type of data.”

Schardt, a former Newsweek editor and later Al Gore’s press secretary, has found that scientists tend to be very cautious when pressed by reporters to make “definitive claims” about research findings. Not wanting to seem like advocates, they “cloak their quotes with a lot of qualifications,” reinforcing the uncertainty or controversy of newer scientific ideas in the resulting news stories.

Rizzo noted, “Reporters sometimes imply to us that our science isn’t valid because we have a perspective. But so does the American Cancer Society.”

Then there is what Brody calls “the connection between this field of science and the consumer economy.” Magazines, TV and newspapers all depend on advertising from companies that “produce the compounds targeted in our studies,” she pointed out.

Schardt puts it more bluntly: “Scientists are always attacked by industries with a stake” in the science. In his experience, “They’ll pull out all the stops to discredit the source.” That makes journalists more likely to shy away.

And there is something at stake: corporate power. Breast cancer activists not only want more research dollars devoted to environmental causes, they endorse strengthening consumer protection laws to ensure the safety of the chemicals in question, as is now taking place in Europe under the 2007 REACH (Registration, Evaluation, Authorization and Restriction of Chemicals) legislation.

Or as Cone, who observes that possible environmental angles are typically left out of reporting on the many other forms of cancer, puts it: “There is such a wealth of data on chemical exposures and their relationship to disease. . . . It should be brought up in every story.”

Miranda C. Spencer is a freelance journalist, editor and media critic based in Philadelphia. A longtime contributor to Extra!, she blogs on women, media and the environment for WIMN’s Voices.