It’s not all pretty in pink: To prevent breast cancer, let’s stop missing the forest for the trees

It’s October. While brightly coloured leaves and fall decor bespeckle our landscapes, we are also seeing a lot of pink. It’s Breast Cancer Awareness Month and messages to think pink and run for the cure, fundraising by Walkers for Knockers and even pink stickers on fruit are omnipresent.

But it’s not all pretty in pink as we continue to miss the forest for the trees.

It is widely reported that one in eight women in Canada will be diagnosed with breast cancer in their lifetime; 270 men are diagnosed each year. But while survival rates are improving, the likelihood of getting breast cancer in the first place has increased.

In the 1970s, the age-standardized incidence rate of breast cancer per 100,000 women was about 80. Rates significantly increased in the 1980s and for the past 30 years have hovered at around 130 per 100,000. Disturbingly, there also has been a considerable increase in the incidence of breast cancer among women between 20 and 29 years old. When more young people are getting a disease for which age is a key risk factor, it should be grabbing our attention and raising concern.

So, what is driving this trend? Research suggests environmental factors are present in 70 to 90 per cent of cases, adding to the mounting evidence between hazardous substances in our environments and the burden of disease. Increases in the incidence of breast cancer parallel increases in toxic chemical production. The Silent Spring Institute reports toxic chemicals lurking in the air we breathe, the food we eat, the water we drink and the products we use have been linked with breast cancer; 216 chemicals that cause mammary tumours have been identified. Yet, women continue to face these exposures in the air, in food and at work.

Our environment includes our neighborhoods and workplaces; our bathrooms, bedrooms and kitchens; what we put on our bodies and what we eat and cook with. Crops are sprayed with pesticides; phthalates hide in makeup, hairspray and perfume; plastic food containers leach a wide range of toxic chemicals; and non-stick cookware is coated in plastic.

It’s very easy to trivialize these exposures, but they can lead to health harms that only manifest themselves years or decades later. Cancers are multifactorial in cause and environmental exposures can be an important trigger. Two women who were interviewed as part of a research project illustrate this point (names have been changed as part of confidentiality agreements).

As a Black woman, she faced a potentially worse outcome.

Trisha discovered a lump in her breast in her late 30s. Her unexpected breast cancer diagnosis at a young age also led to the discovery that as a Black woman, she faced a potentially worse outcome. Canada doesn’t routinely track data on racialization and breast cancer, but U.S. research is connecting the dots between historical and social factors that contribute to disparities for Black women.

Margot lived and worked under the shadow of the Ambassador Bridge at Canada’s busiest border crossing where thousands of diesel transport trucks cross every day. She exercised, ate well and did not have the genetic or family history risk factors. She connects long-term, heavy air pollution exposure to her surprising breast cancer diagnosis.

Despite these important environmental links, only two to five per cent of cancer research funding in Canada goes toward prevention. It is time for a transformation agenda that adopts primary prevention – stopping breast cancer before it starts – and meaningfully includes the environmental risks for breast cancer.

Health-care professionals and environmental advocates have been important voices supporting Canadian Environmental Protection Act (CEPA) reform, including establishing the legal right to a healthy environment, and the creation of a national strategy to address environmental racism. Critical connections between human health and the environment are being solidified.

Medical and environmental health communities have a continuing role in advocacy. They can ensure regulators consider available information regarding vulnerable populations and their environments and their cumulative effects when conducting and interpreting the results of certain risk assessments under the Canadian Environmental Protection Act registry. Determining exposure and what constitutes a safe exposure can be highly problematic. Health care and environmental expertise are valuable to the process.

This October, let’s create an agenda of transformation for breast cancer, whereby our right to a healthy environment as well as highlighting the role of governments in preventing environmental exposures linked to breast cancer are given equal energy to the messages encouraging lifestyle changes. Otherwise, the risk of continuing to miss the forest for the trees means a future where preventable breast cancers are still accepted as normal.