Rethinking Breast Cancer In The Age of Ecology
By Joseph B. Mitchell, MD
Dr. Mitchell has practiced medicine for more than twenty years.
Cancer, we are told, is essentially a cellular disease, a disease resulting from the activities of a relatively small number of grossly distorted abnormal cells that emerged in the body as a consequence of a dramatic transformation of some otherwise healthy normal cells through a process known as mutation. And because of this mutation, these abnormal cells begin to proliferate rapidly, until eventually a tumor is formed from which cells can spread out into adjacent tissues, or even further into more distant parts of the body.
But unfortunately, despite the extraordinary emphasis placed on the cell as the single most important concern of cancer research, what we have learned over the past hundred years about cancer is remarkably unbalanced and incomplete, while our attempts to prevent cancer or respond effectively should it occur have proven far less successful than might have been expected, considering the vast expenditure of time, effort and money devoted to this task.
The reason for the failure to achieve those anticipated results so many had hoped for, particularly since war had been declared on cancer in the early 1970s during the presidency of Richard Nixon, is because in emphasizing the cell to the exclusion of everything else, more and more issues began to be left out, ignored and dismissed by medical research as being irrelevant, and therefore unworthy of any serious scientific concern.
Increasingly, cancer began to be decontextualized, that is, taken out of context and reduced to a narrowly defined entity having the quality of a scientific abstraction; a reified entity seemingly with its own independent existence, totally unrelated to life as most people knew it. Until finally, all that remained were the molecules, those molecules the scientists had decided were all that really mattered.
And now, with the incidence of cancer rising steadily, and modern medicine unable to account for this increase, or provide truly effective treatment, the question confronting us is: what options do we have, and what can be done?
Continuing to search deeper and deeper within the shadow realms of the cell and beyond will not yield us the answers we need. Some other way has to be found. What we need today is a new paradigm, a new conceptual framework that allows us to see cancer from an entirely different perspective.
We need to rethink cancer from the perspective of modern ecology. Because ecology is concerned with context, and it is context that has to be reestablished again, so that we can begin to recognize cancer clearly for exactly what it is, and come to understand the meaning and significance of this disease in recognizably human terms.
Ecology is that scientific discipline which studies how living systems sustain themselves and are able to survive by functioning in an integrated coordinated manner as an organismic whole. If that coordination and integration of the cells making up a complex multicellular organism such as the human body are lost, ecology tells us that those cells can be expected to become seriously distorted both in their structure and in their function, for they are no longer active within the organism as members of an integrated, coordinated community of cells, but instead have acquired more and more autonomy for themselves of an increasingly pathological kind, and are beginning to function on their own, outside the normal control mechanisms of the body.
Mature and fully differentiated cells of a complex multicellular organism can only remain healthy and function normally if that organism remains fully integrated and coordinated, and is capable of sustaining itself as an organismic whole. However, should integration and coordination fail, cells become vulnerable to losing their identity within the organism, eventually functioning at a more primitive level of unhealthy independence, competing with the organism, and beginning to pose a very serious threat to it. Precisely as cancer cells do when they emerge in the body, and start to function as rogue cells to the detriment of the body and its very existence.
Seen from this perspective, cancer can be defined as an ecological failure taking place within the body, a body that is no longer adequately integrated or coordinated, and can not sustain its physical integrity as an organismic whole. Because those processes responsible for sustaining the body as a fully intact community of cells have failed, and cells emerged that are beginning to function independently, cells extremely dangerous to the body, so distorted and dysfunctional have they become.
The great advantage of applying ecological principles to the study of cancer is that it allows us to begin to shift our attention away from the cancer cell as the primary focus of our concern, and start to consider the context out of which cancer arises, and the factors operating within that context which contribute to the failure of organismic integration and coordination leading to the appearance of those pathologically independent abnormal cells so characteristic of this disease.
At the same time, using this ecological approach makes it possible to shift our attention from battling the cancer cell and trying to destroy what has become viewed as such a dreaded enemy, and instead begin to think about all that can be done to restore what has been lost; that is, the ability of the body to function as an organismic whole, and sustain itself as a community of cells, with each cell in perfect harmony and balance with one another.
Quite simply, ecology permits us to move away from the search for triumph and cure towards a clearer understanding of health, healing and recovery.
And so, using this ecological approach, let us consider the problem of breast cancer in the modern world, and explore why it is that the single most important risk factor with respect to whether or not a woman can expect to develop breast cancer during her lifetime is rarely if ever mentioned, namely the ominous fact of living in the United States, or some other country similar to our own.
From an ecological perspective, what is it about living in the United States that so damages and interferes with the integrated organismic functioning of the bodies of so many women that developing breast cancer becomes more and more likely, as the incidence of this disease continues to rise?
Scientists and cancer researchers believe that the health of the body is influenced from only a very few recognizable sources. The activities of genes, accidents, malnutrition, and as a consequence of chance encounters with various toxic substances or pathogenic microorganisms. Everything else is thought to be of absolutely no significance.
The principal argument supporting this belief is based on the idea that no interface has ever been identified between the realm of the organic and the realm of the nonorganic, or between the realms of the physical and nonphysical which could possibly account for and explain the influences of those factors claimed to be able to affect the human body in such a way as to make people sick. And thus, the context out of which illness emerges, the historical, cultural and social context, and the context of community and family, and the more personal context of identity and sense of self, feelings and emotions, and values and beliefs, although perhaps of some interest to historians or psychologists and sociologists, can nonetheless be safely ignored. For we are assured, they add nothing to our understanding of the great issues of health and disease, or help us in our ongoing war against cancer.
But is this really true?
After all, ecology does tell us that the study of the context of a disease is as important as the study of the disease itself, and because the United States consistently has the highest rate of breast cancer in the world, studying the broader context out of which this specific form of cancer arises seems vital.
In order to deepen our understanding of breast cancer and begin to see the meaning and significance of this disease in more recognizably human terms, it is necessary to realize that in addition to the United States, there are a number of other countries with very high rates of breast cancer as well; countries such as New Zealand and Australia, Israel, Argentina and Canada, and the countries of northern, western and central Europe. Most of these countries have rates of breast cancer of around 80 cases per 100,000 population, while the United States, with the highest rate of breast cancer, has approximately 92 cases per 100,000.
Epidemiologic studies indicate that breast cancer is observed far more frequently in those countries which are economically advanced, are committed to science and technology, are sustained by an ethic of individualism, self reliance and personal independence, and view themselves as being affluent if not rich. Countries described as being western, sharing the values and beliefs of the west, particularly the United States.
However, these same studies also demonstrate that breast cancer is found far less frequently in those countries described as being less developed; countries more traditional in nature where economic, scientific and technological issues are much less important, the society is sustained by an ethic of community, cooperation and sharing, while personal autonomy and independence are of comparatively little significance. Countries in which people are more open and able to make contact and communicate with each other in a way not observed in the west, and where the role and function of women are not only more clearly defined, but more highly esteemed as well. With the result that women living in these societies have a strong sense of themselves as women, and a clearer and more sustaining, though perhaps narrower, personal identity.
Countries such as Vietnam, Laos, China, Gambia and Haiti, all of which have rates of breast cancer ranging from 6 cases per 100,000 to 20 or so, dramatically less than the United Sates.
Why is this so? Why should breast cancer be so much more common in developed countries than in those which are not? Is there something about economically advanced countries that predisposes women living in them to develop breast cancer?
Why is it that the United States, together with Holland, has the highest rate of breast cancer in the world, while Haiti and Gambia have the lowest? Is it merely a matter of exposure to certain toxic substances found in the environment, such as agricultural chemicals, or radiation, or does it have to do with diet, lifestyle or stress? Something must account for this extraordinary disparity between the incidence of breast cancer in developed and less developed societies, and we would do well to try to find out exactly what it might be.
The mutation theory of cancer, which is the prevailing theory at the present time, accounts for this difference in the rates of breast cancer as being the result of exposure to something capable of damaging a healthy cell in the body and fundamentally altering the genetic functioning of that cell, causing it to proliferate rapidly and perhaps spread into adjacent tissues or beyond, in what might be described as a mutagenic or carcinogenic event.
On the other hand, what might be called the ecological theory of cancer accounts for this difference between the rates of breast cancer in developed and less developed societies on the basis of a failure of biological organization in women living within these highly developed societies, such that their bodies are no longer capable of functioning as an integrated, organismic whole. As a consequence, certain of the cells of the body, because they are now beginning to function outside the larger community of cells that comprises the body, eventually start to acquire more and more independence for themselves, independence of a very pathological kind, until these rogue cells take on all the characteristics of those distorted abnormal cells defined as being cancerous in nature.
And all of this which is occurring within the bodies of these women is in fact a mirror image of what is taking place within the society itself, where the very same processes of fragmentation, failure of community and loss of effective communication are creating an extremely pathological social context in which people struggle to live their lives, with very damaging effects upon their health.
An unhealthy society results in a weakening and loss of health for those people living in it, making them sick in specifically recognizable ways, depending on just how distorted and dysfunctional that society has become.
Context, we have learned, is of vital importance in ecology, and therefore should be of equal importance when trying to understand the meaning and significance of breast cancer in those societies described as being highly developed. And thus, it is entirely reasonable to suggest that breast cancer is primarily a social disease, not a cellular disease, best understood in ecological terms as a failure of integrated organismic functioning. A failure simultaneously of both the body and the society.
Exposure to various toxic substances within the environment, in the air, water, land or food chain, may indeed play a role in causing breast cancer. But the effect of these exposures is of far less importance than the simple fact of living in an economically advanced society where, by virtue of how that society is structured and how it functions, and the values and beliefs which sustain it, people are increasingly being forced to live in opposition to their human nature and deny the reality of what it means to be fully and completely human.
Something has gone wrong in western societies, seriously wrong, for too many people are becoming sick with cancer, especially breast cancer, and we are beginning to see why.
To make all of this a little clearer, perhaps it might be well were we to look at two specific countries in some detail, one with an extremely high rate of breast cancer, and the other with a very low incidence of this disease, the countries of New Zealand and Vietnam. So as to determine whether or not the idea that breast cancer is essentially a social disease best understood in ecological terms, instead of being primarily a cellular disease best understood as the result of some toxic exposure, could possibly be true.
New Zealand, an island nation to the east of Australia in the far reaches of the south Pacific, although a prosperous westernized country with a well established economic base and able to take advantage of the latest advances in modern science and technology, nevertheless is better known as being a relatively pristine country, with very little environmental pollution of any appreciable kind. But yet, New Zealand has one of the highest rates of breast cancer in the world, at around 80 cases per 100,000, as well as very high rates of prostate cancer, melanoma, and also asthma, even though the air in this country is quite probably among the cleanest to be found anywhere.
Vietnam, a country in south east Asia near Laos, Cambodia and Thailand, in dramatic contrast to New Zealand, has one of the lowest rates of breast cancer in the world, with approximately 17 cases of breast cancer per 100,000, half the world average of 34, and more than five times lower than the United States.
What makes Vietnam so interesting is that although Vietnam has such a low incidence of breast cancer, it is one of the most heavily contaminated countries in the world, its environment polluted with Dioxin, as a result of the use of Agent Orange, a defoliant chemical employed by the Americans in their war in Vietnam during the 1960s and 1970s.
Dioxin is an extremely toxic substance, known to cause birth defects, and was recently officially designated by the EPA, the Environmental Protection Agency, as a carcinogen, capable of causing cancer as well. Because of the widespread presence of Dioxin in Vietnam, this country has an especially high rate of fetal abnormalities and spontaneous abortions, indicating that Dioxin is biologically active within the population and has real toxic effects. But there is no corresponding increase in the rate of breast cancer, or any other form of cancer. Something is keeping the rate of breast cancer in Vietnam remarkably low.
Just as something is also keeping the rate of breast cancer in nearby Thailand very low, where despite the extensive use of agricultural chemicals to make this country the leading exporter of rice in the region, the incidence of breast cancer in Thailand is even lower than that of Vietnam, at around 15 cases per 100,000, six times lower than the United States with its rate of 92.
Unlike New Zealand, which is a country dominated by an ethic of self reliance, independence and personal responsibility, and where issues of community, cooperation and sharing have been largely ignored and all but forgotten, Vietnam is a deeply traditional society with a history going back at least a thousand years, and how this society is structured and how it functions would have to be considered the opposite of New Zealand.
In Vietnam, people live within a sustaining network of extensive personal relations, where family, neighborhood and local circumstances are of great importance, cooperation, sharing and mutual dependence are recognized as being of critical concern, and the entire society in some very real way functions as an integrated organismic community, strengthened by widely accepted values and beliefs. As a result, people living in this community based society do not feel themselves so alienated, alone or left out as do so many people living in the United States and other westernized countries of the world.
Together with Vietnam, where the rate of breast cancer is so low, there are three additional countries in Asia with similarly low rates of breast cancer: Japan, China, and South Korea.
Japan, the second largest economy in the world, which obtains one third of its electricity from nuclear power, and is one of the leaders in science and technology, despite its widespread environmental contamination, has a rate of breast cancer considerably lower than that of the United States at around 31 cases per 100,000.
China, the fastest growing economy in the world, with the dubious distinction of having fifteen out of the eighteen most environmentally unhealthy cities known, would have to be considered in a very serious crisis with regard to its entire environment, a crisis of a severity and scale rarely if ever seen before. Yet China has the same rate of breast cancer as does Vietnam, at 17, as well as the second lowest rate of prostate cancer in the world.
And then there is South Korea, the eighth largest economy in the world, with all the usual environmental problems of such a highly developed, technologically evolved society. But yet, South Korea has absolutely the lowest rate of breast cancer of any industrialized country, a rate of only 12 cases per 100,000, and with the exception of just four other countries, has the lowest rate of breast cancer of any society in the entire world, rich or poor, developed or undeveloped, modern or traditional.
If, as it is repeatedly claimed, exposure to toxic substances of environmental origin is the principal cause of breast cancer, what accounts for the dramatically low rates of this disease observed in those countries of Asia where the environmental contamination is so great and the resultant exposure is so real; while in countries like New Zealand, where there is so little environmental pollution, yet the rate of breast cancer is so high?
The answer to this question is really quite simple.
Women living in highly developed, westernized societies around the world are being diagnosed with breast cancer at ever increasing rates because the societies in which they live no longer function as life enhancing and life sustaining communities. And as a consequence, the health of these women is being compromised, making the possibility of becoming seriously sick far more likely.
Community can be considered a uniquely successful strategy for assuring the survival of living creatures, whereby individuals work together to create and sustain that community, at the very same time the community functions to strengthen and sustain each and every member of that community within a social environment of mutuality, interdependence and openness; such that the healthier the community is, the healthier its members become, because both the community and its members are able to function together as a single integrated, coordinated organismic whole.
Without community there is only chaos, and for this reason community is absolutely essential to life, and can be viewed as being the most important organizing principle of all living systems at all levels of their many diverse manifestations; whether at the level of cells like bacteria or fungi, or at the level of more complex multicellular organisms such as elephants and whales and humans.
There is no mystery associated with this worldwide rise in the incidence of breast cancer. Ecology makes it perfectly apparent that studying the context of a disease is as important as studying the disease itself. And when we do this in regard to breast cancer, it becomes obvious that how a society is structured and how that society actually functions is of much more significance than any other risk factor, thereby offering us a great opportunity to finally see this disease clearly for exactly what it is.
To define breast cancer as being primarily a social disease would permit us to reflect upon other more thoughtful approaches to this disease, rather than simply waging war on cancer and trying to gain victory over it, and instead start to emphasize those changes we can make both in our own lives and in society as a whole that conceivably could facilitate health and healing, thus making hope of ultimate recovery the basis for a reasonable and realistic expectation of success.
For far too long, too much has been left out of the way we think about cancer, and now is the time to begin to put it back.