Collaborative on Health and the Environment, March 26, 2007


Elizabeth Edwards and Breast Cancer Prevention

[Rachel's introduction: Because of Elizabeth Edwards' breast cancer, "... A new story might be told. It is a story about the need to prevent breast cancer.... It is not an easy story to reduce to a sound bite. But here are the basics. There is an epidemic of breast cancer. The causes of the epidemic are clearly environmental. ..."]

By Michael Learner

During the past week, John and Elizabeth Edwards announced that Elizabeth's breast cancer has returned. The cancer is in her rib. It may be in her lungs.

My thoughts kept coming back to Elizabeth this week. I thought about what she and John have been through since the doctor gave them the news. I thought about the conversations they had before they told their staff of their decision and stepped into the sunlight to make their private grief public before a media-drenched world.

For the past twenty-two years, I have worked closely in the Commonweal Cancer Help Program with hundreds of mothers like Elizabeth Edwards who are facing metastatic breast cancer while their children are still young.

I know Elizabeth hopes for many years of life. I imagine she also decided that if she has less time, making John president would be the greatest gift she could give to the man she loves. I imagine she wants to go out fighting for the things she believes in and taking care of her family.

The one thing Elizabeth Edwards' new diagnosis -- and their shared decision to stay in the race -- makes almost certain is that breast cancer will be front and center in the presidential campaign. The predictable course of media coverage will be stories about her courage, about new treatments, about the need for more research, and about living with recurrent breast cancer as a chronic disease.

What interests me is the possibility a new story might be told. It is a story about the need to prevent breast cancer. It is a story that a number of us across America have been telling for some time. It is not an easy story to reduce to a sound bite. But here are the basics. There is an epidemic of breast cancer. The causes of the epidemic are 'clearly environmental. We do not know which environmental factors contribute how much to the epidemic.

More important, we may never know which environmental factors contribute how much to the breast cancer epidemic. Because breast cancer is a disease that is amplified in industrial civilizations by an infinitely complex interaction of many factors. Diet, exercise, and chemical exposures make some contribution. There are many other possible contributors.

If it were "just" a breast cancer epidemic that is amplified by industrial civilization, maybe we would throw up our hands and say: "This is a tragedy but it is too hard to deal with all the complexities to try to do something." But the breast cancer epidemic is not the only epidemic. And it is not separable from the other epidemics of our time. How many of our children struggle for breath? How many cannot read, or write, or pay attention to what is happening around them? How many are autistic? How many have birth defects that you can see? How many have birth defects that you cannot see at birth - defects of the heart, the immune system, or the mind? How many have childhood cancers?

How many young girls have premature puberty? How many develop endometriosis? How many young couples struggle with infertility? And, as we get older, how many of us develop cancers -- like Elizabeth Edwards -- in the prime of life? How many develop allergies, chemical sensitivities, or autoimmune diseases? How many develop early onset Parkinson's Disease, or ALS, or early onset Alzheimer's? And how many are subtly altered, in ways that do not manifest as frank disease, but shift the experience of what it is like to be human?

It may be too much to ask Elizabeth and John Edwards to talk about breast cancer prevention. It seems indecent to intrude on their private and public tragedy and to tell Elizabeth Edwards what her message about breast cancer should be. We cannot decently ask Elizabeth Edwards to make the link between preventing breast cancer and preventing many of the epidemic diseases of our time.

But it may be that some of the rest of us can say a word or two on the subject. Because -- after over twenty years of working with hundreds of young mothers with metastatic breast cancer -- there is only one thing I am sure of.

I know Elizabeth Edwards is strong enough to face life and death with metastatic breast cancer. But I also know, deep in her heart, Elizabeth Edwards absolutely does not want her two daughters, one adult and one eight years old, to face the same disease. She does not want her daughters, when they have young children, to face what she is facing now. She has lost one son already, claimed by a car accident at age 16 in 1996. She has no need, whether she is alive or dead, to lose another.

Elizabeth Edwards is now among the thousands of mothers with stage IV breast cancer who know in their bones what it means that their young children may lose their mother. But what is even harder for Elizabeth, and all those like her, is the thought that her daughters, who may lose their mother at an early age, might face the same disease when their children are young. It is this tragic lineage of preventable grief that stands at the heart of the breast cancer prevention movement.

That thought may lead Elizabeth Edwards where many of the courageous women with breast cancer I have known have been ineluctably led. They know how difficult a cure for breast cancer has proven to find. Billions of dollars and decades of research have not found one. They know what living with breast cancer is like. The surgeries, the chemotherapies, the radiation. They know about living from one check-up to the next with the ever-present fear of recurrence. And when recurrence comes, they know what it means for them and the ones they love.

Many of these courageous women have come to understand that the only sensible thing to do is to make the kind of investment in breast cancer prevention that we have made in breast cancer treatment research. And they understand that this investment in prevention should be not only investment in a research agenda but investment in public policies that protect public health as well.

These courageous women have come to understand that the breast cancer epidemic is essentially inseparable from the other epidemics of environmentally related disease in our time. And so they have decided to fight for a world where every major contributor to breast cancer and other chronic diseases is minimized.

That means a return to some basic public health values. It means clean air, clean water, and safe foods. It means schools where children eat nutritious meals and exercise vigorously every day. It means eating the foods our grandparents and their parents for thousands of generations before them ate. It means reducing the terrible gap between rich and poor which is the largest single contributor to the burden of all disease in this country and every other country. It means health care for all. And it means a systematic and thorough approach to reducing our body burdens of thousands of toxic chemicals and radiation exposures that were not in our grandparents' bodies and should not be in ours.

Politics completely aside, from a public health perspective John Edwards is talking about the real issues. He talks of universal health care. He talks of narrowing the gap between rich and poor. That yawning gap in the distribution of wealth is the single greatest cause of ill health. It is also the single thing we could most readily change with a simple vote in Congress and the stroke of a pen. Edwards talks of the need to spend at home the billions we are now spending in the Middle East. It is not a political statement to say that it is a good thing that at least one candidate is talking about the real issues in public health.

Will Elizabeth Edwards' new cancer diagnosis lead her to do the kind of thinking so many thousands of women across the country have done? Will it lead her to think about breast cancer prevention? Will she do the research and come to understand how complicated breast cancer prevention is? Will she go deep enough to recognize breast cancer as an ecological disease that is part of the whole fabric of ecological diseases we face today? Will she see the need to do what the Europeans are doing and what people are doing in states across the country -- to work for clean air, clean water, and safe foods, and to systematically reduce the thousands of untested toxic chemicals building up in our bodies? And if she makes the connection, will she discuss it with John Edwards? And if agrees, will Elizabeth and John Edwards be the ones who finally bring breast cancer prevention into the American mainstream?

I don't know the answer. I only know that if Elizabeth doesn't do it, we need to continue to do it. We need to tell the simple truth that breast cancer prevention is part and parcel of preventing most of the major diseases of our time. It is only complicated if we get caught up in the game of trying to figure out which specific stresses are responsible for what proportion of what disease. It is simple if we just say we need to make our country safer for our children and for all of us again. We know how to do that. It is common sense. That is our choice, and Elizabeth's choice.

Michael Lerner is president of Commonweal and a Co-Founding Partner of CHE, the Collaborative on Health and the Environment.