Breast-Cancer Politics

By Christine Gorman

One thousand strong they marched on the Ellipse near the White House, mostly women but some men as well, wearing small pink ribbons and waving large angry signs. They came to Washington last week to deliver a message to the President and the nation: breast cancer will strike at least 1 of every 9 women, so put more money into stopping the epidemic. Organized by the National Breast Cancer Coalition, a grass-roots movement with 70,000 members, the rally produced a quick response. During a meeting between the group's leaders and Bill and Hillary Clinton, the President pledged to draw up a "national action plan" for preventing, diagnosing and treating the disease.

Following the successful strategy of the red-ribboned AIDS lobby, breast- cancer victims and their supporters have become a powerful political force over the past year. The National Cancer Institute plans to spend $263 million in 1994 combatting the disease, 34% more than in 1993. But while the government's commitment is growing, setting a rational breast-cancer policy is becoming problematic. Controversy rages over what is a reasonable amount of money to spend and how it should be spent.

Even as Clinton was meeting with protesters and proclaiming the next day (Oct. 19) to be National Mammography Day, a dispute was erupting over the government's attitude toward the X-ray tests that are the best means of detecting a breast cancer before it becomes incurable. NCI was considering making a new recommendation: women in their 40s should no longer be given routine mammograms unless there is some reason, like a family history of the disease, to suspect a higher-than-normal risk. While studies have proved the value of the test in women 50 and older, the available research suggests that mammograms in younger women do not spot tumors well enough to produce a significant drop in the breast-cancer death rate. Many women's groups reacted angrily, arguing that not enough research had been done to reach such a conclusion. Just when women are getting into the mammogram habit, complained NCI's critics, the government is sending out a confusing message about the test.

The demands of breast-cancer lobbyists are growing even though the disease receives more government funds than other forms of malignancy, including lung cancer, which kills more women each year. One justification is that while the causes of lung cancer (chiefly smoking) are well understood, the causes of breast cancer (diet, genetic makeup or exposure to pollutants?) are still mysterious. Even so, no one can guarantee that more money will bring a quicker cure. "People say that the money will save lives, but that's not necessarily true," says Ann Flood, a sociologist at Dartmouth Medical School. "It's not like we are close to brand-new information that would benefit from such funds."

Or maybe we are. Researchers report in the current Nature Genetics that they may have isolated a gene linked to hereditary forms of breast cancer. If confirmed, the results could help lead to a better understanding of the disease -- and more effective weapons against it.

With reporting by Janice M. Horowitz/New York