My Friend Melanie Has Breast CancerPrint
How it might have happened, and why we are looking in the wrong places to prevent similar cases
By Anna Blackmon Moore
To understand why, we have to go backward in time, back to Melanie’s formation not as Melanie but as an organism in her mother Sally’s womb. Back to organogenesis, the five-week span early in the first trimester when the force of Sally’s womanhood and the power of mitosis are forming Melanie’s organs. They are growing like a universe, her cells dividing, specks of kidneys churning to life, spindles of brain wrapping around themselves, grains of liver elongating into gall bladder and bile ducts. Magnified about 5,000 times, Melanie’s mammary gland looks like the shadow of a squishy, fat-fingered hand, dark and bulky, a spineless cactus with thick, flat leaves. Melanie the organism is at this point about two inches long. Ecologist Sandra Steingraber, who writes about the links between the environment and breast cancer, says she looks like a mature grove of trees bumping up from a sheath—the placenta, which pumps Sally’s oxygen, water, and antibodies into Melanie.
Pregnant Sally—nurturer to her core, artist and sculptor but also architect of healthy meals, of a spotless and organized home—ate her vegetables and meat and fruit and drank milk and took extremely good care of herself, and Melanie’s mammary glands grew from thick and leafy to thin and gangly, splitting into branches. Picture the branches growing backward from the nipple into Melanie’s body, filling two fat pads, tissue spreading to cover. This is the general design of the organ we call the breast.
When Melanie was born, in 1969, Sally was thrilled. Melanie was crying loudly. Sally and the nurses could see her newborn toes and fingers and also her newborn breasts and her vagina, which was red and enlarged—evidence at birth of an intense hormonal conversation that began with the hypothalamus and pituitary glands and extended to the gonads, which release sperm if you’re a boy and eggs if you’re a girl. Once the conversation reached Melanie’s ovaries, each one a centimeter long at birth, they produced estradiol, a powerful and persuasive form of estrogen that started the development of Melanie’s breasts. They won’t grow during infancy, but the conversation that will initiate puberty when she turns eight, nine, 10, or 11 starts at birth, and it is very loud. So loud that Melanie might have lactated in utero. So loud that her vagina swelled with the force of it.
Nine months passed, and the conversation stopped. This system of communication hibernated. You could almost hear the gentle click as it shut itself down, the rounds of sighs from Melanie’s ovaries, the clearing of pathways in her brain.
What I’ve just described is a period of rapid growth, a window that lasts from inception to a certain point in the life of an infant. Literal windows can open to good things: fresh air, views of oceans, blooming magnolia trees, breezy back yards, meadows in bloom. Through this metaphoric window in time, one we learn about only under a microscope, breast cells too small to comprehend divide and divide and divide. Their DNA replicates and replicates and replicates. But if something damages just one of the millions of cells in Melanie’s mammary gland, her DNA might not be able to repair the damage—to stop a bad cell from growing or force it to self-destruct. This damage, whatever it is, might remain in Melanie for a long, long time.
Sally and her family lived in Topeka, Kansas, a town on the edge of the high plains. (To respect their privacy, I’ve changed the names of the members of this family.) Say in 1968 she lived near a future Superfund site, like the canal in New York where Hooker Chemical (since purchased by Occidental Petroleum Corporation) dumped 21,000 tons of chemical waste in the 1940s, or like the now-vacant New Jersey land where Chemical Insecticide Corporation manufactured pesticides, herbicides, and fungicides for 16 years. Say Sally was pregnant with Melanie, walking through her neighborhood or cracking an egg for breakfast or sipping from a glass of ice water. Regardless of what Sally was doing—breathing, drinking, eating—chemical molecules might have entered Sally’s system, passed through the placenta to Melanie’s mammary gland, and adhered to a cell that would eventually become one of the hundreds of thousands to line the walls of her milk ducts. Perhaps a few dozen micrograms of mercury settled in. Or more likely a few thousand molecules of PCBs—polychlorinated biphenyls. Polychlorinated biphenyls. Do not dismiss the words because they are intimidating. Polychlorinated biphenyls are invisible, odorless chemical compounds that can perform all kinds of functions, from oiling transformers so that electricity can move efficiently from one circuit to another to cooling engines of all kinds to extending the life of a pesticide. They were additives in flame retardants and waterproof coatings as well—until 1979, when the U.S. Environmental Protection Agency banned their production.
But in 1968, when Sally was pregnant with Melanie, Monsanto, Westinghouse, and General Electric were producing and delivering and transmitting PCBs all over the world. If we all had our blood tested for PCBs right this second, we would find them there, in levels from low to high depending on where we have lived, worked, eaten, drunk, slept, and grown as human beings over the course of our lives. We would find them there because this is what chemicals do. If they don’t dissolve in water, they linger in our fat cells and contaminate our soil. Even after we find the political will to ban them, they keep invading. They multiply. They biomagnify up our food chain, their concentration increasing with every living thing that consumes them. They break into the conversations that create us with voices potent enough to change the conversation itself.
If Melanie was exposed during her first period of rapid growth (and she was, since exposure has long been the norm), her branches might not have grown into her fat pads as quickly as they were supposed to. So the window of time became longer, the growth period extended. PCBs, mercury, dioxin, atrazine, radium, tetrachloroethylene, benzene, formaldehyde, lead, phthalates, arsenic, cadmium, chromium, or any of 85,000 other chemicals in our marketplace, most of them untested and unstudied, would have had more time to lodge themselves onto or into Melanie’s fetal or infant cells. Exposure could also have sped up the growth of Melanie’s branches, a possibility that complicates things even further. You never really know how different bodies with different cells and different DNA will react. That’s how chemicals are. They enter our bodies and if they stay there, we just have to wait and see.
Take phthalates. These are plasticizers, chemicals that would have made Plastic Man even stretchier had he been a real person. But phthalates cannot bond with the plastic they are added to, so as you write with your plastic Bics or ride your Big Wheels or sip from Superman cups or carry out your recycling in a Rubbermaid bin, the phthalates might leach into your skin, the water in your cup, the air you breathe. Even the urine of infants tests positive for phthalates, and not only because of pacifier runoff. Phthalates might have been binding to the estrogen receptors in Melanie’s cells when she was just Melanie the organism, from the moment she was conceived, simply because there were shower curtains in Sally’s house, spackle on her ceiling, deodorant on her armpits.
You might be asking, Does breast cancer run in Melanie’s family? And why wouldn’t you ask such a thing? Even though you know about PCBs and phthalates, the question feels fair. After all, you go in for a mammogram, and the first thing the technician asks is whether you’ve noticed anything different about your breasts, but then she asks whether breast cancer runs in your family, or she mentions “the gene,” or she warns you about it. She’s not specific, and she’s speaking to you from the console of the mammogram machine behind a pane of plastic that’s clear as glass. You stand in your gown, staring at the highlights in the technician’s hair, wondering if she intended to make you panic.
The gene in question is actually two genes—BCRA1 and BCRA2—and we all have them. They exist in the DNA inside every one of our cells—and thank God they do, because these genes give orders. Loud, unambiguous orders to the nucleus of a cell to stop growing, usually when its wall touches the wall of another cell. And the nucleus often obeys, even if it’s the nucleus of a cancer cell. Sometimes BCRA1 and BCRA2 order a nucleus to kill itself, and it does. But if you have a mutation in BCRA1 or BCRA2, or both, your genes do not have the capacity to give these kinds of orders. They are left without a voice.
This voicelessness is what you can inherit. And if you do, if your cells can’t yell, if they don’t have the capacity to protect themselves, your risk of cancer goes up by a little. Or a lot.
But Melanie doesn’t have the mutation. We might hear a great deal about women who do, but most of us don’t. Melanie’s sister Sarah, two years older, doesn’t either, but she had a double mastectomy more than a year ago. She was diagnosed with DCIS—ductal carcinoma in situ, which means that cell clusters in at least three walls of Sarah’s milk ducts were thick enough to clog them up. In situ means these probably cancerous (precancerous) cells have not (yet) spread outside the ducts themselves. These clusters, though, would have turned into the same kind of cancer Melanie had—ductal cancer, with a tumor responsive and sensitive to estrogen. So now Melanie has a reconstructed left breast and is entirely without her ovaries, which were removed to keep her body from producing estrogen ever again. She has officially entered early menopause. Meanwhile, her sister Sarah has reconstructed breasts—and she doesn’t have the mutation either. It accounts for 10 percent of breast cancer cases per year, maybe fewer. Ninety percent of breast cancer diagnoses do not result from absences in BCRA1 and BCRA2. But government funders and research organizations give studies relevant to this mutation hundreds of millions more dollars per year than they give studies on environmental, chemical causes of breast cancer. Follow the money. Its path will lead you to study after study on the treatment of cancer, to study after study on the biology of cancer. But only infrequently to possible causes of cancer.
Don’t misunderstand. Ten percent is as important as 90 percent. Ten percent is an estimated 23,000 women if you’re talking about the year 2013, and those 23,000 women who do have the mutation are just as important as the 209,000 women diagnosed with breast cancer who do not. But given the proliferation of toxic chemicals in our postindustrial world and the frequency of cancer diagnoses in developed countries, isn’t it time we turned to our air? Our water? Isn’t it time to confront the questions with answers that feel too grave to process? Consider this one: why is Komen for the Cure funding so much research on biology and treatment rather than on prevention? Well, biology is interesting. Just ask Susan Love, who in the latest edition of Susan Love’s Breast Book wonders whether the hundreds of millions of dollars activists have raised over the past few decades has enabled scientists to zoom in not on what might cause cancer but on what might fascinate them. And what fascinates a lot of scientists, evidently, is biology.
Our medical community might also be reluctant to change its focus because carcinogens are so difficult to isolate. Even after people die of cancer, even after relatives and friends and communities might have offered convincing proof that their water or air or soil contained chemicals that caused the cancer, very few of those chemicals are pronounced actual carcinogens. Wicked chemical corporations and noble scientists—those with the money and backing and power to invest in cancer research—go into great detail about how hard it is to pin those carcinogens down. How many PCBs were you exposed to? One hundred nanograms? One thousand? And what about your age? You think you got cancer from breathing formaldehyde that leached from the walls of that FEMA trailer you lived in for more than a year, but if you’re over 70, you’re more likely than most to get cancer anyway. One in 25 women over 70 is diagnosed with breast cancer every year. And we need to account for age as a risk factor if we’re going to take the time and money or expect the U.S. government to actually ban a chemical, change a common practice, generate a credible study. You think you and your deceased daughter got cancer from the trichloroethylene in the aquifer that supplied your drinking water over the course of 10 years? Well, if you’re anything like a lot of Americans, you barely exercise at all, and that factor increases your risk for getting cancer. We have to account for that. And are you obese? Because your risk goes up for all kinds of reasons if you’re obese, and we have to account for that. Do you live in a rural or urban area? How old were you when you started menstruating? Ever been exposed to car exhaust? Because free radicals in car exhaust increase our risk for cancer. So does the solvent in your nail polish remover. And haven’t you as a citizen of this toxic world been exposed to thousands of other chemicals, too? By the time you’re 70? By the time you’re 10? (And you don’t drive a car? Who do you think you are, anyway?) We have to account for that.
And besides, any one of us might be afraid, deterred, intimidated, conducted into apathy by all the connotations in prevention. In the context of the environmental causes of breast cancer, prevention implies political action. Here we don’t mean eat your fruits and vegetables, don’t smoke, don’t drink alcohol, take your vitamin D. Prevention here implicates enormous and ominous forces at work, entities full of people who have discovered or created many of those 85,000 chemicals and allowed them to be used in everything from the production of paper to the growing of corn to the packaging of bubble wrap to the formulation of eye shadow to the composition of red dye in the cheapest of ballpoint pens. Prevention in this context might mean we have to shut down all the factories in the world. Deactivate all our power plants and forge a community that will remake the way we produce, the way we consume, and the way we live.
But instead, we search for answers and solutions in the wrong places. Should we decide to raid those factories and shut them down and turn off our power plants and remake everything to at least slow the rate of global warming, or should we decide to build a machine that sucks minute amounts of carbon from the atmosphere and inefficiently shoots it deep into the ground? Take world hunger. More than three million children die every year because of hunger or diseases resulting from hunger. Read this sentence one more time. More than three million children die every year because of hunger or diseases resulting from hunger. So let’s drop food from airplanes with packaging in English that their parents cannot read. Or let’s just let them die. That’s life. And chemicals are a part of our everyday lives, whether we live with the threat of extinction, the effects of drought, or the ache of starvation. It’s unfair, but things survive, things perish. That’s just how it is.
It’s not as if organizations such as Komen for the Cure or the American Cancer Society dislike those 90 percent. Their funding practices are nothing personal. And of course scientists can get funding for biology and treatment when they’re working within a medical and scientific community that emphasizes biology and treatment. But how could any scientist or representative of the American Cancer Society, or anyone, disabuse us of the notion that chemicals cause cancer? Is there anything more obvious?
A volcano erupts, spewing ash, lava, and gases into the air—along with dioxins, a group of carcinogenic organic pollutants that are perfectly natural. Lots of chemicals are. Natural does not mean safe or noncarcinogenic. Burning trash is natural, isn’t it? We’ve been burning trash, presumably, since we discovered fire. But when we burn trash, we release dioxins into the air; when we bleach paper or incinerate plastic, we release dioxins into the air. We don’t mean to.
But when we spray Agent Orange, which was made and supplied mostly by Monsanto and Dow and contained the most potent and officially carcinogenic dioxin of all, TCDD, on five million acres of jungle and woods and crops, we mean to. We spray it on purpose. When we use it to deforest acres of the Amazon rainforest, we mean to. We spray it on purpose. This kind of destruction is what chemical companies beget. They create substances that enter our bodies and stay not only there but also in our soil and in our water and in the people of our world for generations.
When she was 12, Melanie’s sister Sarah was not in Vietnam or Brazil. She was living in Topeka, in Sally’s house, going to McClure Elementary School. Let’s say she was eating a hamburger Sally had made for her. The cow from which the meat was ground could well have been raised on her grandfather’s nearby farm, where it ate grass.
But what if that grass was laced with dioxins, which drifted invisibly through the air, expelled from the smokestack of a power plant? When Sarah ate that hamburger, those dioxins were more toxic—more concentrated—than they were when the cows ate that contaminated grass, because the most lethal chemicals biomagnify up the food chain. Their power and toxicity rise with each living thing that consumes them. When Sarah’s babies nursed, they consumed dioxins or PCBs or phthalates at much higher levels than when those chemicals first entered Sarah’s system. With every swallow of milk, her nursing infants ingested dense concentrations of chemicals that are with them still.
But perhaps the cows that Sally used to make hamburgers were dioxin free. (They weren’t—no way—but let’s just say they were.) Sarah and Melanie could have been working on their grandfather’s farm. Say they escaped from an afternoon of fence repair by walking down rows of corn, corn planted in soil saturated not by water but by atrazine, an herbicide that cheaply and effectively kills grassy weeds. Atrazine is neither classified as a carcinogen, nor banned in herbicides. Atrazine is a chemical that the EPA regulates because it has caused tremendous, perilous damage to the mammary glands of lab rats in study after study after study. Atrazine is an endocrine disruptor: it attacks our gonads and interrupts those conversations of creation, the ones that start or stop puberty, start or stop menopause, start or stop our growth from girls to adolescents to women.
Melanie is 11, with breast buds we can just barely see through her shirt. She has started thelarche—the process of breast development and the marker of the onset of puberty. The window has reopened; the conversation has begun again after being dormant for about 10 years. The inside of each breast—going backward from the nipple—now looks like a tree with thin branches, but each branch has a bulb on the end. These bulbs are called terminal endbuds even though they aren’t terminal at all. On slides magnified 5,000 times, TEBs look like tiny teardrops on the ends of thin, spindly pieces of string. These buds reach out and spread into the stroma—the gelatinous universe that contains all the ducts and cells within our breasts—and fill the fat pads. Buds reach for one another but never meet, like lovers not meant to be. Before the buds ever have the chance to touch, they change and form more branches. Sarah is 13, and her breasts, on the outside, are fuller than Melanie’s; on the inside, they have more buds and more branches. Sarah still hasn’t started menarche—menstruation—but her hormonal conversation has been flowing for about two years.
All four of their breasts are growing and changing and reaching out in patterns that doctors and scientists try to understand and trace. Researchers do know that the distance between endbuds is extremely important. They know that too much or too little space between those buds at various points after thelarche has begun means something is interrupting the conversation. But we cannot hear this interruption, no matter how loud or aggressive, nor can we see or feel it—unless 10, 20, 30, 40, 50, 60 years later, the interruption manifests as a malignant tumor in Melanie’s left breast, or a cluster of precancerous cells in Sarah’s right.
Sarah and Melanie aren’t idiots: it’s not as if they picked up a bottle of Aatrex and poured it into their mouths. If workers sprayed at all on that farm, they probably followed the directions, so atrazine did not enter their bloodstreams through the cells in their mouths, nor did it enter through the skin of their bare feet as they walked. Sarah and Melanie probably drank atrazine in their water. They still do. It has been used as an herbicide so widely for so long that atrazine has washed its way into all our water sources. So the EPA decided on a maximum contaminant level for atrazine in our water—a perfectly harmless level that all our water sources consistently exceed, month after month. The European Union effectively banned atrazine in 2003, as must have seemed warranted for an endocrine disruptor that causes mammary tumors in rat after rat after rat and turns male frogs into females. Our government officials must be overwhelmed by how much work they—rather than Syngenta—would be required to do, all the money they—rather than Syngenta—would have to spend not only to phase out atrazine, but also to remove it from our water.
Not that anyone goes so far very often, since the process of cleaning up Superfund sites or decontaminating an aquifer is tremendously expensive! It can take years and years! It’s not as if Syngenta or Monsanto or Dow or Westinghouse or Bayer or DuPont or our government has the money or manpower to invest in such exercises. I mean really—you expect them to stop everything, to change their mission, just to prevent cancer?
Perhaps they haven’t noticed that the prevalence of their chemicals in our physical world makes girls develop breasts earlier than they used to. And if you haven’t noticed, then you must not be paying attention, because girls start thelarche and therefore puberty one to two years earlier than they did 40 years ago. Early puberty has become the norm, like chemical exposure. That window of rapid growth through which we viewed Melanie and Sarah is now open one to two years longer than it used to be. Millions and billions of toxic molecules have more time to enter girls’ bodies and adhere to the walls of their cells—or break the walls outright and connect to the hormone receptors inside. Tumors start not in the ducts and not in the lobules at the end of the ducts, but in the cells that line them.
Our breasts live on the outside of our skeletons beneath soft skin, unprotected by bone and vastly misunderstood. They are erotic symbols of life in every culture but also organs—clinical, bloody blobs of gray and green and blue and brown. Throughout our lives they reinvent and realign themselves, changing their purpose, rethinking, revising.
I remember when I got breasts. Thirty-two years ago. Fifth grade. They seemed big to me, but my friends called mine mosquito bites. Theirs were bigger, fuller, in need of elasticized support. But by the time I was in junior high, my breasts were bigger than theirs. Boys called me Boom-Boom and wrote me dirty notes that made me feel desirable and gross at the same time. None of my friends were getting notes like that—notes indicating that they were being watched, studied, fantasized about, and talked about. My breasts became bewildering sources of shame and vanity. I could find no poise between these extremes and still can’t. Women who are comfortable with their breasts and secure in their own bodies make me aware of my own lack of confidence. I tend to resent them.
I’m sorry. It’s hard to be vigilant all the time, to repel the attitudes and habits of thought that divide us. But if we are not vigilant, we will destroy ourselves. To be honest, I am afraid that we already have, that my sarcasm and anger are just defense mechanisms. And this is what defense mechanisms do: they grow and shrink and grow and shrink, but overall they get weaker and weaker.
Anna Blackmon Moore has been published in Shenandoah, Black Warrior Review, Brain Child, and other magazines. She thanks Commonweal for helping to educate her about breast cancer and the environment.