158 THE CHINA STUDYprostate, and one digestive cancer, large bowel-the second leading
cause of cancer death, behind lung cancer.BREAST CANCER
It was spring almost ten years ago. I was in my office at Cornell when I
was told that a woman with a question regarding breast cancer was on
the phone.
"I have a strong history of breast cancer in my family," the woman,
Betty, said. "My mother and grandmother both died from the disease,
and my forty-five-year-old sister was recently diagnosed with it. Given
this family problem, I can't help but be afraid for my nine-year-old
daughter. She's going to start menstruating soon and I worry about her
risks of getting breast cancer." Her fear was evident in her voice. "I've
seen a lot of research showing that family history is important, and I'm
afraid that it's inevitable that my daughter will get breast cancer. One of
the options I've been thinking about is a mastectomy for my daughter,
to remove both breasts. Do you have any advice?"
This woman was in an exceptionally difficult position. Does she let
her daughter grow up into a deathtrap, or grow up without breasts? Al-
though extreme, this question represents a variety of similar questions
faced every day by thousands of women around the world.
These questions were especially encouraged by the early reports on
the discovery of the breast cancer gene, BRCA-l. Headline articles in the
New York Times and other newspapers and magazines trumpeted this
discovery as an enormous advance. The hoopla surrounding BRCA-I,
which now also includes BRCA-2, reinforced the idea that breast cancer
was due to genetic misfortune. This caused great fear among people
with a family history of breast cancer. It also generated excitement
among scientists and pharmaceutical companies. The possibility was
high that new technologies would be able to assess overall breast cancer
risk in women by doing genetic testing; they hoped they might be able
to manipulate this new gene in a way that would prevent or treat breast
cancer. Journalists busily started translating selective bits of this infor-
mation for the public, relying heavily on the genetic fatalistic attitude.
No doubt this contributed to the concern of mothers like Betty.
"Well, let me first tell you that I am not a physician," I said. "I can't
help you with diagnosis or treatment advice. That's for your physician
to do. I can speak about the current research in a more general way,
however, if that is of any help to you."