Speaking Out!

To the Point - Guest Column

By Verna Hunt

Women and girls of all ages in today’s culture are stamped with the colour pink as the fantasy for the fairy princess lives they are lead to believe they should yearn for. It is like a plastic film that society puts over us at birth. Onward from birth they are made to think that nothing other than a fantasy life should ever happen to them. Never get old. Never get sick. Never be sad or mad or frightened. Women should be perfect—in pink. This is not reality. As a result women often feel that they are not “good enough” in the inevitable imperfect lives they lead, and their breasts are no exception.

Another unreality propagated by campaigns such as “the pink” is that there is a cure for every disease and that it can be discovered if the medical scientists just have enough money to discover this magic bullet cure.

Our culture does not teach coping strategies for tragedies such as someone near and dear to us or even ourselves developing a disease such as breast cancer. So, in an effort to turn our understandable emotional strife into something constructive, crusades such as the Pink Ribbon Campaign have evolved. Often they end up as a business enterprise unto themselves more interested in keeping the organization going than looking at how to serve humanity.

But what is the point of it all? Is the point to find the cure for breast cancer, or is the point to find the cause for lack of breast health? The Pink Ribbon Campaign is a distraction from what is really going on with breast health. All of the pink sound bites urge us to pitch in and find the cure like there is a missing link of knowledge, a holy grail, the one thing that will solve it all. Our society tries to commodify everything as if we all have the exact same disease. It is like assuming that we all wear the same size and style of shoes.

Another part of the pitch is that mammograms prevent breast cancer. They do not (See Mammography screening: Weighing the pros and cons). Mammograms detect structural masses that could be cancerous and this can only be confirmed with a biopsy examined by a pathologist. The key initial question should be: why and how do masses or tumours form in the first place and what can be monitored to discern if tissue is showing signs of building masses? Certainly the Pink Ribbon Campaign has raised awareness that there is something very significant going on when one in four women living around the Great Lakes of central eastern North America will have breast cancer in their lifetimes.

Cancer and our environment

The general scientific thought has been that breast cancer occurred in those with a genetic predisposition. While this is a factor, when we look at the world statistics available, the evidence  points to industrialized areas such as the Great Lakes of North America having one of the highest incidences. Why might that be so? The short answer is environmental pollution and the inability to neutralize its dangerous effects. For more information on this please read Living Downstream by Sandra Steingraber, and watch the film by the same name.

We need to look at the many factors  that contribute to  cancer because we live in a multifactorial environment.

The human body has abnormal or cancer cells in it all of the time but our immune system, largely via the white blood cells, spots the out-of-the-ordinary cells and kills them off (apoptosis). The immune system also cleans up dead abnormal cells, viruses, bacteria, pollution, old hormones all of the time, 24/7. The microcirculation via  lymph vessels then drains this lymph fluid and delivers the debris to our filters or “emunctories,” primarily the liver and kidneys although other organs have filtering functions as well.

Our filters break down the debris that the immune system has delivered but these organs can get clogged up just like the vacuum cleaner filter when you forget to clean it out. With clogging, the normal excretion via urine, stool, breath, skin and menses is incomplete and even the excretion routes can get clogged up. Constipation is an example of this and is more common than anyone wants to admit.

The miracle of the immune system is that each person develops an individualized non-specific immunity by six or seven years old and then a specific immunity largely complete by the age of puberty. That is, the immune system normally develops our defence system unless it is interfered with and interrupted from maturing. Interrupters could include but are not limited to adverse drug reactions, pollutants and pesticides such as xeno-estrogens (chemicals that mimic estrogen and attach to estrogen receptor sites causing abnormal reactions), lack of normal nutrients from empty processed foods and hormonal imbalances created through such things as prolonged stress.

Reducing the toxic load

Throughout recorded history every indigenous culture that existed for any length of time developed some sort of cyclical cleansing or detoxification method. They used what was available: fermented foods, herbs, water, sun, breath/air, saunas, bathing in hot springs and so on. Even in the animal kingdom you will see dogs for example eat fresh grass that contains chlorophyll and trace minerals to assist in the cleansing process. It is instinctual to clean our filters. The most obvious one in the human body is to exchange the normal 70% of body weight that is water.

We now live in a time of the greatest load of physical and non-physical toxins in recorded history. Chemically there are things going into the human body that were never made to be there such as petrochemical derivatives and asbestos. When the immune system and the filters do not know what to do with something, it can get parked in tissues. Over time, this load causes irritation and can lead to a dysfunction in the cells, resulting often in swelling and inflammation. Eventually these changes cause cellular mutations and can lead to cancer cells.

In addition to the physical toxic load, the non-physical load is mounting in terms of noise pollution, over-information from cyber space and on and on. We have to sort out all of these stimuli as well as sorting out the chemical soup toxifying our bodies. There is just too much sorting to do for all of our physical, emotional, cognitive and, some would say, energetic bodies. The filters are getting more and more clogged and our bodies are carrying around a load of rubble and debris that impair our immune resilience.

Women have a greater quantity of hormones to sort out and thus their load of sorting is larger, compounded by multiple roles as wage earner, child bearer and mother, food procurer and preparer, health care provider and decision maker, housekeeper and property organizer, and ringmaster of the modern family. Many of us are familiar with this chaos. Doing everything all of the time so that we experience everything except silence, stillness and relaxation. It is as if we are always breathing in and never breathing out. We need to exhale.

Research has shown that women who have breastfed have a lower incidence of breast cancer. While not all women choose to breastfeed, breasts need not become a parking lot for metabolic debris. We can avoid toxins to some degree through lifestyle choices such as: eating adequate fibre, healthy oils, additive free and non-overly processed foods, four or more cups of steamed or raw vegetables daily, seasonal fresh local raw fruit, drinking adequate amounts of clean water; adequate rest and relaxation; time in nature; enjoyable exercise and body movement; nurturing companionship and development of self-worth. Admittedly, these options are not readily available to all women.

Specific breast health therapy could include hands-on therapeutic breast massage techniques which are done by trained licensed professionals, usually a registered massage therapist. These specialized massage techniques assist in normalizing breast tissue function throughout a woman’s life, particularly pre and post breast feeding. The massage stimulates the lymph system in the breast to aid in drainage of any stored debris, and can aid in decreasing fibrocystic milk duct tissues and gently release adhesions.

Because of the compounding effects of environmental toxins in our bodies we need to cleanse now more than ever. However, it is not simple because of the complexity of toxins like toluenes, heavy metals, polyvinyl chlorides and dioxin all mixing together like soup and creating new reactions that we have no way as yet to measure. How can we safely get the body to excrete these “super toxins”?

Ideally detoxification, or cleansing, must be individualized to each person’s needs by a qualified health care professional, guided by a woman’s personal assessment of her means. In the case of breast health this professional would monitor breast health proactively in concert with the overall health picture of the individual. Tests using blood, hair, breath, heat (digital infra-red thermography), saliva, stool, etc. can indicate changes long before a pathological disease or even pronounced dysfunction is present. Results are correlated with a thorough consultation and physical examination, looking at findings that consider causation of symptoms and also determine how to improve total function on all levels. 

Although there are many licensed professionals trained and available to do this, such as naturopathic doctors, holistic medical doctors, etc., the cost for this out-of-pocket care is high for many. Our culture does not encourage people to invest in their health, but rather to pay vast quantities of  money to the disease care industry once people have a disease that is “treated” and “managed” with a patented prescription drug.

Being proactive

Proactive cyclical methods of cleaning our natural filters can be done safely at home to begin the necessary process of detoxification. Lifestyle choices that are affordable might include: eating only vegetable broth soup for a day, taking regular saunas, walking in a forest reserve, taking a one-to-seven-day break from cyber space including news, Internet, television and radio. Taking a pause from just being too busy and over stimulated. Although these efforts seem trivial, research has shown that something as accessible as a 30-minute walk in a forest can positively impact the immune system for up to one month after taking the walk.

Controversy abounds about breast self-examination [see Network article, Breasts Self-examination] but if you can wash your face every day and know if there is a new pimple just by touching, then saying “Hello girls” to your breasts as you shower or bathe will reveal changes. This friendly familiarity by touch will help you know if the breast texture pattern changes without terrifying yourself by looking for “the lump.”  Teaching girls at a young age what normal breasts look like will help pubescent girls to have normal acceptance and appreciation of their breasts. To educate girls using non-sexual pictures of breasts, check out the 007 Breasts website. 

Other proactive breast care choices include: avoiding body care products with harmful chemicals like those found in some deodorants and clothes detergents and fabric softeners that are potentially carcinogenic; and not wearing restrictive and in particular underwire bras that impede normal blood and lymph flow causing congestion of toxins.

So when you see the Pink Ribbon Campaign imploring you to walk for “the cure” I would offer you an alternative focus and direct you to the Pink and Green Ribbon Campaign, which focuses on the connection between breast health and the environment and what you can do to be proactive about your breast health [additional resources listed below].

Dr. Verna Hunt, B.Sc., D.C., N.D. has been practising as a chiropractic and naturopathic doctor, for over 30 years.  She owns and operates The Centre for Health and Well Being in Toronto established in 2005. She acts as a medical advisor to colleagues and companies, which service holistic health care. Dr. Hunt writes, speaks and teaches presenting through her organization Being Well Communications. She is a long time member and promoter of CWHN. Contact her through verna@healthandwellbeing.info or 416-604-8240.

Additional resources on breast cancer prevention:

Women, plastics and breast cancer section of CWHN website

CWHN – Get the Word Out! About breast cancer prevention

Breast Cancer Action Montreal (BCAM) 

Breast Cancer Fund in the United States 

Spring Talks Sex blog by Lyba Spring

At the end of 2012, when a 23-year-old woman in India was viciously attacked and later died of her injuries, it touched off a movement which will hopefully have a profound effect on their culture. Not surprisingly, there is no such movement in the Congo where rape continues to be used against both men and women as a weapon of war. During the last American presidential election, the absurd and enraging remarks about rape and pregnancy got a lot of press as well as more activity from women’s organizations in a long time. In a Toronto neighbourhood last summer, people came together after a series of sexual assaults, resulting in well-attended and well-publicized demonstrations.

And yet, despite decades of feminism and talk of “rape culture” we do not seem to have affected a fundamental shift in thinking in Canada.

Working in middle school and high school classrooms for three decades, I dedicated considerable time to issues of gender equality, including developing an education module on sexual assault specifically in a dating situation. 

Years ago, I was in a class of Grade 8 students, 13-year-olds. We were working through the first part of an exercise on sexual assault. I was asking them to respond to a list of statements. It was interesting that they often gave the thumbs up to what they thought was the “correct” answer. For example, “no always means no” almost universally got a yes. Then, I would explore why some girls and women may say no at first, but then seem to accept the advance. They understood that some girls and women don’t like to be considered “easy”; that they worry about their reputations. They also understood that the tone of voice or body language could lend their “no” a certain ambiguity, resulting in miscommunication, especially if alcohol was involved. 

Next statement: “a person never loses the right to say no.” One boy stood alone in his refusal to accept that notion. I asked the class under what circumstances someone might want to stop the action and the student responses included: experiencing pain if it was the first time, a change of mind, worries about STIs, etc. But this one male student steadfastly insisted that once you started you had to finish. I said, “what if you’re with a girl, you’re on top and you see that she’s in pain?”

“Turn her face away,” he said. 

I later found out from his teacher that he had trouble with female authority figures, which made sense in terms of his misogyny and lack of empathy; but it also made me fearful about his potential future behaviour.

It is an understatement to say that parents are raising children in a culture steeped in contradictory images of what it means to be a man, what it means to be a woman. What’s a parent to do?

One day when my children were young, I heard my young son and daughter fooling around in the living room. My daughter sounded unhappy about what was going on. I peeped in. My son had pinned her down and she was struggling to get up. I said to my daughter, “say, ‘get off me’ like you mean it”; and to my son, “and then you have to listen.”

Of course, using this kind of teachable moment can only happen in a context with all other things being equal. Statistically, a child who has been sexually abused is more likely to be sexually assaulted, especially in the absence of good therapy. The egregious ongoing assaults and murders of Aboriginal women are in a category by themselves based in the profoundly racist history of our relationship with First Nations people.

We live in a society that deems us responsible for our choices in health, including sexual health, without taking into consideration the factors over which we have no control, like abuse, poverty and racism. Yet, the potential for dealing with sexism remains the purview of the parent through education. What is taught—or not taught—in the home can have a profound effect on children’s ability to work through the issues despite the media barrage of sexist images, including pervasive violent sexual images.

After the 23-year-old Indian woman died of her injuries recently, men in India laid their bodies down in the street and called for a fundamental shift in culture. Our White Ribbon Campaign has made some significant inroads; and yet, the scourge of sexual assault remains statistically high. In 2011 more than 21,800 sexual assaults were reported in Canada. We know this represents only one in ten of the actual assaults, which are most commonly committed by someone we know.

Of the many challenges facing our quest for equality, this one runs deep.

Talk to me: springtalks1@gmail.com

To the Point - Guest column

By Cornelia J. Baines 

Since the late 1980s people have argued heatedly about the usefulness of mammography screening, especially in women aged 40 to 49. This unceasing controversy continues. Burgeoning new research in the first decade of 2000 clearly revealed that therapy was outweighing the impact of mammography in terms of mortality reduction. But the defence of screening persists. In September 2012, the Journal of Medical Screening (JMS) issued a supplement reporting that, based on European data, screening benefits were unquestionable. I document the flaws underlying this conclusion, but these flaws are more easily understood when framed by the controversy’s history. So I outline events up to 2000 and then critique the JMS message.

Since 2000, many downsides of screening have been widely reported. Twenty-one hundred (2,100) women aged 40 to 49 must be screened every two years for 11 years to avoid one breast cancer death. Of these, 700 women endure false-positive screens leading to unnecessary diagnostic work-up and anxiety, and ten to 15 will be over-diagnosed and receive unnecessary breast cancer treatment. (Having breast cancer, I am appalled that anyone might undergo unnecessary therapy.)  Importantly, contrary to expectations, screening has not reduced subsequent incidence of advanced cancers, a prerequisite for successful screening.

The good news is that even in jurisdictions without screening programs, breast cancer death rates have declined to the same extent as observed in screened populations, with declines even in women in their 30s to whom screening is not offered. The message is clear: breast cancer treatment has radically improved over the last few decades leaving little opportunity for screening to help. And downsides to screening are incontrovertible.

Why the continuing defence of screening? Let’s look at the history.

In the beginning, that is, in the last half of the 20^th century, randomized controlled trials evaluated breast cancer screening. Women in a specific age group were either randomized to mammography or to be “controls” with no mammography. Of all the trials, two received much attention.

Trial A used signed informed consent for both groups. Trial B assumed consent with attendance for screening but controls were “un-informed.” 

Trial A randomized individuals. Trial B randomized clusters of women.

Trial A compared mammography to no intervention in women aged 40 to 49 and mammography plus clinical breast examination to clinical breast examination alone in women aged 50 to 59. Trial B compared mammography to no intervention.

In Trial A, 100% of participants complied at first screen. Not so for Trial B.

Trial A annually collected detailed demographic and medical information from both groups, for the trial’s duration. Trial B recorded only age at entry.

Trial A offered four to five rounds of screening. Trial B only two to four.

Trial A used two-view mammography; Trial B used single-view.

Trial A screened women every 12 months; Trial B every 24 to 33 months.

Trial A at first screen had smaller cancers and a higher cancer detection rate compared to Trial B.

Trial A over time published consistent numbers regarding trial outcomes such as cancers and deaths; only in 2011 did Trial B finalize its numbers.

Trial A audited mammography externally based on a randomized stratified sample. Trial B described no audit.

Trial A externally audited all tissue biopsies. Trial B did not.

Trial A externally reviewed causes of deaths for confirmed or probable breast cancer cases. Trial B reported their procedure 26 years after first publication.

Now it came to pass that Trial B reported that mammography hugely reduced breast cancer deaths in women aged 40 to 74 and the world rejoiced. Paradoxically, Trial B also revealed a 26% excess of breast cancer deaths in screened women aged 40 to 49; that was ignored. Trial A reported no screening benefit for women aged 50 to 59 and the world was sore aggrieved. Excess breast cancer deaths in screened women aged 40 to 49 (as in Trial B) was loudly condemned. Trial A (The Canadian National Breast Screening Study) was found to be flawed, while Trial B (The Swedish Two-County Trial) was praised and magnified. Forth went Two-County prophet Tabár with Mammography Education Incorporated  proclaiming “mammography saves lives” for nigh unto 30 years. Revered he preached in upscale hotels at touristic destinations for substantial fees, and new disciples spread his gospel. Corporations like GE Healthcare and Siemens (that make mammography units) gave their benediction, donating vast sums to the American College of Radiology to promulgate the prophet’s message. And so great was women’s fear of breast cancer, they too became converts steadfastly believing in screening mammography. Others following the new gospel were surgeons and pathologists, for lo their work-load increased! 

Evidence from all the trials comparing mammography to no mammography reveals a 15% reduction in breast cancer mortality for women aged 50 to 69. But North American women aged 40 to 49 insisted that they too be screened. Radiologists even persuaded the U.S. Senate that these women deserved no less, in spite of unbiased, expert opinion to the contrary. Those not endorsing screening for women under 50 included the Canadian Task Force on Periodic Health Examination, the Canadian Workshop Group (Canadian Cancer Society, Department of National Health and Welfare and the National Cancer Institute of Canada), the U.S. Preventive Services Task Force, the American College of Physicians, the U.K. Forrest Report, the International Union Against Cancer, the European Group for Breast Cancer Screening, the New Zealand Cancer Society, the British Medical Association, and national policies in Finland, Denmark and Holland. Such dissent was heresy. The public agreed the best available version of the truth came only from radiologists and their acolytes.

Despite the wave of more recent research showing fewer benefits than previously thought from screening, not surprisingly, screening advocates are strenuously defending themselves, most recently in a supplement to the Journal of Medical Screening (JMS), describing findings from the Euroscreen Working Group (ESWG). Where controversy prevails, the messengers as well as the message require scrutiny. JMS has a low impact factor of only 1.69, compared to the Journal of the National Cancer Institute (13.757), Annals of Internal Medicine (16.7), New England Journal of Medicine (51), Lancet (33.797) and BMJ (14.093). What could explain the choice of a low impact journal?

The JMS’ pro-screening message was praised in AuntMinnieMobile, an online entity offering "news, educational links, … and information for radiologists, technologists, administrators and medical imaging professionals.” AuntMinnieMobile is sponsored "in part" by Phillips Health Care, manufacturers of imaging systems. 

“The researchers found that mammography had a mortality reduction of 48% among women who were screened. What's more, the study found that the number of women whose lives were saved outnumbered by two to one the number who were ‘over-diagnosed,’ or who had cancers detected that might never cause symptoms or threaten their lives”  (Letter from the Editor, 13/09/12).

With these results, the editor declared, the breast screening controversy was finally over! 

However, according to objective expert panels, breast cancer screening does not remotely achieve a 48% mortality reduction and the number of over-diagnosed women vastly exceeds breast cancer deaths avoided. Why the huge divergence between ESWG findings and panels like the Canadian Task Force? Simply put, screen advocates dominate both ESWG and JMS; objective panels include a range of expertise and minimal opportunity for conflict of interest.

Scrutiny of JMS is revealing.

• The JMS editor (ND) has for decades co-authored articles with Tabár (Two-County Trial).
• SD, a JMS editorial board member co-authored many papers with Tabár, was ESWG Coordinator, and the supplement’s Guest Editor and Review Co-ordinator, authoring two of eight articles.
• SM, a JMS board and ESWG member authored three articles.
• Board member AKH wrote the editorial.
• ESWG member (MB) acted as a Review Co-ordinator and authored four articles.

The overlapping roles are clear.

Turning finally and briefly to the JMS message, what are the flaws? 

• Omitted from the text are studies demonstrating that breast cancer mortality has declined in the absence of screening, even in the too-young-to-be-screened.
• Over-diagnosis is a much larger problem than claimed in JMS. A recent report in the high impact New England Journal of Medicine shows that more than a million U.S. women have been over-diagnosed in the last 30 years because of screening.
• Totally overlooked is the 20% increased risk of mastectomy for screen-detected cancers.
• Screening benefits are inflated. Long recognized as biased and inappropriate for evaluating screening, case-control studies that falsely inflate benefit are included in the ESWG analysis.
• Incidence-based-mortality (IBM) partitions mortality by screening and further inflates benefit. “One must be cautious in interpreting the results (based on IBM), since factors like lead-time bias can influence these analyses, whereas they generally will not influence overall death certificate mortality.”  
• Lead-time (earlier detection extending survival time backwards) and over-diagnosis both spuriously enhance benefit.
• The JMS reports a 48% breast cancer mortality reduction in women attending screening, comparing attenders at lower risk of death (healthy screenee effect) inappropriately with non-attenders, at higher risk of death. A valid comparison requires two similar populations, one offered screening and the other not, each including attenders and non-attenders.
• The potential for conflict of interest is evident.

Women have a choice: they can rejoice in the message they want to hear or they can consider whether the message is serving interests other than their own.

Cornelia Baines, MD, MSc, FACE, was co-principle investigator and deputy director of the Canadian National Breast Screening Study, a major trial of breast screening that enlisted 90,000 women across Canada in the 80s. She has closely followed screening outcomes research since then. Baines has also been involved in research respecting silicone breast implants and multiple chemical sensitivity. She is Professor Emerita at the Dalla Lana School of Public Health in Toronto.

Spring Talks Sex blog by Lyba Spring

After my first baby (18-hour labour plus episiotomy without anesthetic) I thought I would never let anyone near me again—not even myself. The thought of peeing or having a bowel movement was inconceivable. And yet, we continue to pee, shit and have sex. How do we get back to that beautiful place?

Every woman, every delivery and every baby is different, as is a woman’s relationship status at delivery. What follows are some general remarks about sex after baby.

No matter how “easy” or difficult the delivery, every woman has to heal after childbirth. With a Caesarean section, clearly the healing period is longer: it is major surgery. Immediately, the baby’s needs are paramount. Anyone who has heard a newborn cry can attest to that. If there is a partner on the scene, hopefully they get it. You are sore. You are tired. If you are breastfeeding, your vagina (when it heals) tends to be dry. Your libido has been tamped down by all of the above.

You may not feel particularly gorgeous. Some women spend their pregnancies feeling undesirable, others highly sexual. If you are breastfeeding, you may feel closer to other mammals than any human except your baby. You probably feel “touched out” and want to get some of your body integrity back.

That said, if you have a partner and you want them to stay in your life while you go through this incredible adjustment, it means sharing tenderness. Everybody gets some.

Hopefully, you were still engaged in some way with your partner right up to the birth, whether with loving words, sweet kisses, warm embraces or other sexual activity. Some pregnant women prefer fingers or oral sex to other vaginal activity, especially close to the birth. For others, all physical contact may have come to a full stop long before.

For these women, the road back to feeling sexual may take longer. It starts with reminding yourself why you wanted to have a baby with this person in the first place (if, indeed this was a wanted pregnancy). You will need to re-establish some physical contact with your partner as a basis for future sexual intimacy.

When you first start feeling like some kind of lovemaking might be a real possibility, you have to progress very slowly. If you want to give your partner some pleasure, now is a good time to revisit your sexual repertoire. Use your hand, your breasts, your mouth—or whatever else feels good—to make your partner feel good. If the day comes when you want your genitals touched, touch yourself first. See how it feels. Take it slowly. Can you put in a finger without cringing? Is the lube handy? 

If you want to let your partner touch you, show them the way you did at the beginning of the relationship and say clearly, “this feels good, this not so much—oooh, that feels wonderful.” And just like having anal sex for the first time, you need to start small if anything is going to enter your vagina.

Some people are okay having sex with the baby in the room (some even have sex with the baby in the bed); but others find it easier to concentrate on their pleasure and their partner without having to worry about the baby waking up. So even though the baby may not be on a fixed schedule, try to find the most likely time to be alone. You may need to make a date and have someone take care of the baby while you and your partner rediscover each other.

If you are fully breastfeeding, you may not ovulate for several months. If you are not breastfeeding, you can get pregnant in six to seven weeks. That means finding a way to avoid a second pregnancy too soon after the first if you have a male partner.

One of these blogs, I’ll talk about birth control methods. In the meantime, let me know what other sexual health issues you would like me to write about. E-mail: springtalks1@gmail.com