TIME

BRCA Gene Can Be A Cancer Triple Whammy, Study Finds

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Ingram Publishing—Getty Images/Vetta

BRCA already boosts risks of breast and ovarian cancer, and now there’s evidence that it may contribute to lung tumors too

In research published in Nature Genetics, scientists report that a version of the BRCA2 gene, which, when mutated, can increase the risk of developing breast and ovarian cancers, also raises the risk of lung cancer.

Led by Dr. Christopher Amos, professor of community and family medicine at Geisel School of Medicine at Dartmouth College, the study included genetic data from 75,750 lung cancer patients and controls. Those with a relatively rare version of BRCA2 found in about 2% of the population, had a 26% increased risk of developing breast cancer, but an 85% higher chance of getting any type of lung cancer, and a 2.5-fold increased risk of developing an aggressive, hard-to-treat lung cancer known as squamous cell carcinoma. The lung cancer risk, says Amos, appears to an independent effect of BRCA on lung tissue, apart from its influence on the breast.

MORE: Lessons From the Woman Who Discovered the BRCA Cancer Gene

“We didn’t see an association to lung cancer with other BRCA2 variants, only this particular one,” says Amos. “What we found is a new effect of BRCA2 on lung cancer.”

Current tests for the BRCA 1 or 2 mutations, which account for about 5% of breast cancer cases in the U.S., already include this variant, so most women will know from their results whether they are at higher risk of developing lung cancer, much in the same way that BRCA mutations confer a higher risk of ovarian cancer.

MORE: The Angelina Effect

For now, however, there aren’t any effective treatments for squamous cell lung cancer. Smokers with the variant have twice the risk of getting lung cancer than those with the BRCA2 version who don’t smoke, so kicking the habit is one way to lower risk. But there are promising studies involving a class of drugs called PARP inhibitors, which is currently being studied to treat BRCA-related breast cancers. These drugs work by preventing tumor cells from repairing damage to their DNA, and given the newly discovered connection between BRCA2 and lung cancers, they might also be effective in treating squamous lung tumors. “It raises the question about how we can do a better job of allocating people to screening, and if [this variant] should become part of a panel for screening,” says Amos. Because squamous cell cancers are so hard to treat, such early detection of potential tumors might become a life-saver.

TIME beauty

Scout Willis: Topless Instagram Photos Are a Feminist Issue

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Scout Willis attends the Nylon Magazine May young Hollywood issue party at Tropicana Bar at The Hollywood Rooselvelt Hotel on May 8, 2014 in Hollywood, California. Tibrina Hobson—Getty Images

The famous daughter explains why she walked the streets of New York semi-nude last week to protest Instagram's discrimination against women's nipples

More than a few people noticed when Scout Willis walked around New York topless last week. But the 22-year-old daughter of Demi Moore and Bruce Willis says she wasn’t just trying to get attention — her public display was in protest of Instagram’s Terms of Use, which forbids users from posting nude or partially nude images. Willis took to XOJane on Monday to defend her shirtlessness, saying that women should be allowed to show their nipples on social media as a matter of female empowerment and gender equality.

The drama began two weeks ago when Willis said her Instagram account was deactivated because she posted a photo of herself in a sheer shirt and another photo of a sweatshirt featuring a picture of two friends topless. (You can’t see her faces in the photo.) She made a new account, but Instagram quickly took issue with one of her photos. She tweeted Instagram‘s fairly long response to her in which the company noted that while they “love that people use Instagram to express themselves artistically,” they must remain conscious of their global audience’s sensitivities when it comes to nudity.

So last Tuesday she took to the streets of New York — where female toplessness is legal — as a demonstration, tweeting photos of herself as she went: “Legal in NYC but not on @instagram” and “What @instagram won’t let you see #FreeTheNipple” she tweeted. Willis has continued since to post photos in which her nipples are visible to her Twitter account.

Willis is far from the first woman to be booted from social media for showing areola: the Facebook-owned site has previously asked mothers to take down pictures of them nursing their children and breast cancer survivors to take down their post-surgery photos, according to People. And earlier this year, Rihanna deleted her notoriously racy Instagram after the app mistakenly flagged the account.

Instagram’s policy, Willis argues, discriminates against women and reinforces sexist societal norms. She wrote in XOJane:

In the 1930s, men’s nipples were just as provocative, shameful and taboo as women’s are now, and men were protesting in much the same way. In 1930, four men went topless to Coney Island and were arrested. In 1935, a flash mob of topless men descended upon Atlantic City, 42 of whom were arrested. Men fought and they were heard, changing not only laws but social consciousness. And by 1936, men’s bare chests were accepted as the norm.

So why is it that 80 years later women can’t seem to achieve the same for their chests? Why can’t a mother proudly breastfeed her child in public without feeling sexualized? why is a 17-year-old girl being asked to leave her own prom because a group of fathers find her too provocative?…I am not trying to argue for mandatory toplessness, or even bralessness. What I am arguing for is a woman’s right to choose how she represents her body —and to make that choice based on personal desire and not a fear of how people will react to her or how society will judge her. No woman should be made to feel ashamed of her body.

Willis equates the nipple issue with body shaming and slut shaming in another part of the essay.

 

TIME Cancer

Drug Found to Preserve Fertility Among Young Women on Chemo

Goserelin protected ovaries from chemotherapy damage in a recent trial

A common drug may be a more cost-effective way for young breast cancer patients to preserve their fertility during chemotherapy than freezing their ovaries.

The drug goserelin is often used as a hormonal therapy for breast and prostate cancer. It has also been used to control the timing of ovulation. Now, researchers have discovered that the drug may actually protect the ovaries from chemotherapy damage. In a recent clinical trial women who received monthly doses of goserelin were more likely to give birth compared to women who did not receive the drug during treatment.

For young, premenopausal woman, the possibility that cancer treatment could leave them infertile is devastating. But researchers showed that only 8% of the women on goserelin had ovarian failure compared to the 22% of women who did not receive the drug. Exactly how the drug protects the ovaries is unknown.

Currently, young women who want to ensure their ability to have kids after cancer may opt for egg freezing for the future in vitro fertilization (IVF) treatments. However, the cost for egg freezing and IVF are in the thousands of dollars, and women must sometimes start their chemotherapy immediately, before egg freezing can be done.

The researchers, who presented their findings at the annual meeting of the American Society of Clinical Oncology, recommend women beginning chemotherapy consider goserelin as an option. Further research is still needed to confirm their findings.

Goserelin is sold by AstraZeneca as Zoladex, and global sales of the drug were around $1 billion in 2013, the New York Times reports. Goserelin has been shown to cause side effects like temporary menopausal symptoms including hot flashes.

TIME Cancer

Lessons From the Woman Who Discovered the BRCA Cancer Gene

Mary Claire King presents at World Science Festival 2014 in New York City Courtesy of the World Science Festival

The legendary researcher on work-life balance, the importance of trusting hunches, and her stunning scientific discovery

Sometimes the most stunning advances in science are based on a hunch that a dedicated investigator just can’t shake.

That was the case with Mary-Claire King, professor of genome sciences and of medicine at University of Washington. King discovered the region on the genome that eventually became known as BRCA1, the first gene linked to a higher than average chance of developing breast cancer and ovarian cancer. While it seems obvious now that genes can be tied to cancer, at the time King conducted her studies, the idea was too radical to have many supporters.

MORE: Angelina Jolie’s Double Mastectomy: What We Know About BRCA Mutations and Breast Cancer

But King was used to being unusual. As a graduate student at the University of California Berkeley, where she first studied mathematics and then switched to genetics, she petitioned the university protesting the U.S.’s invasion of Cambodia during the Vietnam War. When the National Guard removed demonstrating students, King dropped out and helped consumer rights advocate Ralph Nader to study how pesticides affected farm workers.

She returned to Berkeley and contributed to groundbreaking genetic work that showed humans and chimps shared 99% of the same DNA.

Today, BRCA1 and the related BRCA2 are responsible for about 5% of breast cancer cases in the U.S., or up to 25% of inherited breast cancer, and screening for changes in the genes can help steer women toward potentially lifesaving treatments. The Supreme Court recently ruled that BRCA1 and BRCA2 are not patentable, since they are products of nature, a decision that King supports so that more companies can now devise tests for the cancer-causing mutation.

We spoke with King when she was in New York for the World Science Festival. Here’s what we learned:

On how she discovered BRCA1, and the importance of believing in your gut instincts:

“If we cast our minds back to the 1970s, when my work [on BRCA] began, the mainstream theory was that breast cancer was viral. And some cancers are, so it wasn’t a crazy theory.

My thinking—and, believe me, this was not a theory in the field but just a notion I had—was that there was good evidence that there were some families in which breast cancer was especially common. There was no evidence of a smoking gun. That opened the possibility that there was something else. That went side by side in my mind with the logical way of thinking about cancer, that all cancer is genetic in the sense that it’s a consequence of changes in DNA. That also was not mainstream thinking at the time. But that was the basis of my own thinking, and I’m a stubborn person, so it allowed me to keep pushing my little idea in a very quiet way.”

MORE: 4 Ways The Supreme Court Gene Patent Decision Will Change Medicine

On seeing her little idea become a big one:

“I was absolutely convinced that cancer had to be genetic. I did not see any other way the relationship between a tumor and host could possibly persist. But I honestly didn’t appreciate at all how important and directly useful the inherited component would be. The idea that oncologists and medical geneticists would take that information and systematically be able to put into place screening programs that enable women to learn that they had mutations, and do something about it to save their lives, wasn’t the way I thought. If somebody had said that this was possible, I would have said, ‘Golly, maybe it was.’ But nobody said that to me.”

 

On whether every woman 30-plus should have a BRCA1 and BRCA2 screening:

“I am increasingly convinced that it is both feasible and a good idea to offer a blood test, a sequencing test for BRCA1 and BRCA2 and some of their sister genes for every woman after about age 30. Once a young woman reaches 30 or so, if she has a mutation in one of the genes, she should know about it. … These mutations are inherited from fathers half the time, and from mothers half the time. Because families in America are so small, we did a study that showed that in exactly half of women who had BRCA1 or BRCA2 mutations, there was no family history that would have led them or anyone in their family to think they carried the mutation. All of these women inherited the mutation from their father, and their fathers either didn’t have sisters or had sister who didn’t inherit the mutation.

Sequencing is now cheap, prices are coming down and the quality is going up. So there’s no reason not to do this. The point is to have a process that is benign enough to the individual—a blood draw—and inexpensive enough to identify people who are really at high genetic risk and then move them into very good screening programs to enable them to make a plan about preventive surgery or other options.”

On how being a woman in science has changed, and remained the same:

“I always assumed I would be an assistant to someone else, because there have always been women in those roles. I always assumed I would work for someone else. And I assumed implicitly that ‘someone else’ would be a man. There are obviously many more women in the field now. Acceptance in principle of women in the field is completely different and that’s absolutely fabulous; it’s just splendid.

The thing that hasn’t changed is the number of hours in a day. The coincidence of one’s child-bearing years with exactly the time one needs to build a career—that’s challenging. Science is also a very demanding child—you can’t just walk away from either. That hasn’t changed. It’s not realistic to say one can drop out of science and drop back in.

Really good child care is incredibly important. Creating a context in which young women scientists have child care they can rely on, and can afford, and that’s close enough to where they work, is enormously difficult, and institutions are working on it. One thing I try to do is run a family-friendly lab. I think it’s the responsibility of those of us whose children are now grown to remember what it was like, and to run family-friendly labs. When women in my lab get pregnant, we know they simply will not be there for a while. But you need the infrastructure in place so their experiments won’t rot when they’re not there, and so they can come back when they are ready.”

On being a mother and being a scientist:

“You never get over the guilt. My daughter would come into the lab when she was six or seven, and she had an area in my office with books, picture books and toys. She made posters that went on the door to my office. One was the First Mommy to Walk on Land. Another was the Sister of the First Mommy to Walk on Land. And there was the Brother of the First Mommy to Walk on Land. When I asked her why she was making the posters, she said, ‘They are to keep people happy while they have to wait for you.’

You have to have an environment in which it’s clear that having children is a part of life, and welcomed. You have to recognize that a scientific career can be very long, and you need to go into the business of being there for your child when you have a child. It’s possible. It’s not possible to do and get enough sleep, but it’s possible to do.”

MONEY Health Care

The Poor are More Likely to Die of Cancer

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People from wealthy areas are more likely to be diagnosed with breast cancer than people from less wealthy areas. Mark Kostich—Getty Images/Vetta

Your financial status affects your risk of the disease more than you might think.

A new study from Cancer, the peer-reviewed journal of the American Cancer Society, finds that cancer afflicts wealthy and poor areas at about the same rate. But the study also found that they suffer from different kinds of cancer—and the cancers that strike the poor are more often deadly.

The study looked at the incidence rates of 39 kinds of cancer in different census tracts. Researchers found that poorer areas have higher rates of lung, colorectal, cervical, oral and liver cancer, while wealthier areas have higher rates of breast, prostate, thyroid and skin cancer. The 14 cancers associated with poverty have a mortality rate of 107.7 per 100,000, while the 18 cancers associated with wealth have a mortality rate of 68.9.

“The cancers more associated with poverty have lower incidence and higher mortality, and those associated with wealth have higher incidence and lower mortality,” researcher Francis Boscoe said in a statement. “When it comes to cancer, the poor are more likely to die of the disease while the affluent are more likely to die with the disease.”

Why the difference? The researchers aren’t sure, but they did find that the kinds of cancers that are more prevalent in poorer communities are associated with “behavioral risk factors,” like smoking, drinking, drug use and poor diet. Furthermore, wealthier areas report higher rates of cancers with few symptoms, like skin, thyroid and prostate cancer. These cancers often require advanced medical technology to detect. Since wealthier areas offer better access to healthcare, the scientists suspect that those people are more likely to be diagnosed with earlier stage cancers, but they plan to do more research.

TIME Cancer

Some Chemotherapy Is More Toxic Than Others

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Chemotherapy is a necessary evil for most breast cancer patients, but some are worse than others when it comes to side effects

Researchers at the University of Texas MD Anderson Cancer Center compared six breast cancer chemotherapy regimens to determine which caused more toxic side effects by requiring the patients to be hospitalized for infections, fever, dehydration or low blood counts.

In order, from the regimen that caused the most hospitalizations among 12,894 patients who were treated for early stage breast cancer, to the one that caused the fewest, the chemotherapies were:

  • Docetaxel and cyclophosphamide cycled every three weeks (TC)
  • Doxorubicin and cyclophosphamide cycled every three weeks (AC)
  • Docetaxel, doxorubicin and cyclophosphamide cycled every three weeks (TAC)
  • Doxorubicin and cyclophosphamide cycled every three weeks, followed or preceded by docetaxel cycled every three weeks (AC+T)
  • Doxorubicin and cyclophosphamide cycled every two weeks, followed or preceded by paclitaxel cycled every two weeks (ddAC+P)
  • Doxorubicin and cyclophosphamide cycled every three weeks followed or preceded by weekly paclitaxel (AC+wP)

The treatments are interchangeable, says the study’s lead author, Dr. Carlos Barcenas, from the department of Breast Medical Oncology at MD Anderson, so knowing which ones are associated with more toxicity may help some patients and doctors to choose more tolerable therapies. Other factors may also play a role; the TC regimen, for example, is linked to the most hospitalizations but that’s because it involves more intensive doses of chemotherapy in half the time – 12 weeks – of all of the other options, which are spread out over 24 weeks. For women who prefer to have their chemotherapy finished sooner, the higher risk of side effects may be worth the time savings.

Women with heart disease also have to use the TC regimen, since the others include a drug that is toxic to the heart.

The results, published in the Journal of Clinical Oncology, should help patients to be more informed about their chemotherapy options, says Barcenas, and prompt more research into ways that the right treatments can be matched to the right patients.

TIME Breast Cancer

70% of Mastectomies Aren’t Necessary. Here’s Why Women Have Them Anyway

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Science says the treatment doesn’t lower risk of recurrence, but here’s why rates of the procedures continue to climb

In a new study published in JAMA Surgery, researchers say that 70% of women with breast cancer in one breast who decide to remove the other breast do so unnecessarily. In fact, only 10% of women diagnosed with breast cancer should consider such prophylactic mastectomy, say experts.

But that hasn’t kept rates of mastectomies from climbing. In the 1990s, about 1% of women diagnosed with breast cancer in one breast opted to have the other one removed; that percentage has jumped to 20% in recent years.

MORE: Angelina Jolie’s Double Mastectomy: It’s Not the Only Option

This increase is despite the fact that studies don’t show that removing an unaffected breast can lower a woman’s risk of recurrence or increase her chances of surviving the disease. That doesn’t change the fact that there are other reasons—perfectly understandable and deeply human ones—that may be guiding women’s choices. We spoke with leading experts and identified these four.

1. A fear of doing nothing

“Fear is absolutely driving the decision,” says Dr. Isabelle Bedrosian of the University of Texas MD Anderson Cancer Center. “I definitely understand that fear; we often hear, ‘I don’t want to deal with this ever again.’” And that’s reasonable, especially for women who go through the rigors of chemotherapy, and who are worried about surviving their disease so they can be there for their children and their families.

That fear, however, can overshadow reason. Bedrosian was not involved in the current study, but published a trial in 2010 in which she and her colleagues found that only a small and specific group of women diagnosed with breast cancer—those under age 50, with early stage disease that was negative for estrogen receptors—may benefit from having both breasts removed. These women enjoyed a nearly 5% improved chance of survival five years after diagnosis than those who did not have the unaffected breast removed. But as the current study found, this represented less than 10% of women with breast cancer.

MORE: The Angelina Effect

Studies also show that the chances of breast cancer recurring in the opposite breast are very, very small. In fact, breast cancer patients are more likely to develop recurrent tumors in other parts of the body—the liver, lungs, or the brain—than they are their other breast. Still, says Hawley, “There are probably other things caught up in the variable of worry, from not wanting to think about [cancer] anymore, to not wanting to regret anything in the future if something did happen.”

VIDEO: MRI: A New Tool to Detect Recurrent Breast Cancer

2. Early detection means too much information

Technology may also play a role in driving up rates of just-in-case surgery. More women are getting an MRI of the breast, both as a way to screen for breast cancer and to give doctors a better picture of the tumors. These images are refined enough to pick up the tiniest of lesions, including those that may not need treatment. But it’s hard for women to do nothing at all after learning they have a growth in their breast, even if they might be benign and not require treatment. In such moments, it’s likely that every instinct tells women to do something. “The feeling is to do everything possible, and doing everything possible means more surgery,” says Hawley.

3. The pink ribbon brigade

Breast cancer advocacy is a model of how to mobilize and educate the public about a disease. Rates of screening have gone up while death rates have come down (although it is still the leading cancer killer among U.S. women). The awareness about the disease and the push for better treatments, however, have magnified the obligation and responsibility behind every choice, from screening to diagnosis and treatment. And that’s especially true about the decision surrounding prophylactic surgery. “There is a hyper awareness surrounding prophylactic mastectomy, and many women are choosing it without a clear understanding of why,” says Bedrosian.

Coverage of celebrities’ decisions to proactively remove their breasts may also heighten the urgency of taking aggressive action for many women. “I don’t know of anyone publicly who has said they were diagnosed with breast cancer recently and chose to have lumpectomy with radiation,” says Hawley. (Good Morning American anchor Amy Robach, who does not carry the BRCA breast cancer genes which put women at higher risk of recurrence, still decided to have a double mastectomy.) “There is a feeling that doing everything you can is a way to take control. And just doing a lumpectomy and radiation may not be taking as much control as choosing a double mastectomy.”

MORE: Study: Double Mastectomy May Not Improve Survival

4. Not enough accurate information about options

Bedrosian admits that part of the reason women are choosing to proactively remove their breasts, even when they may not need to, has to do with the fact that doctors don’t have the best tools for helping patients make this decision. For the 10% of women at high risk of having recurrent breast cancer, the decision isn’t as challenging. But for the remaining 90%, many of whom may not have a genetic risk but have distant relatives with the disease, the decision becomes harder. “Communication is important to make sure that patients are informed about the medical facts,” says Bedrosian. “It’s important to make sure that our patients are making informed choices and not simply fear-driven choices.”

In the end, it’s a very personal—and complicated—decision, in which each of these factors, and many others, may take on varying degrees of importance.

TIME Cancer

17 Everyday Chemicals Could Be Linked to Breast Cancer

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Scientists who looked at data linking mammary tumors in animals to vehicle exhaust, paint removers, disinfectants and other common items, and compared it to more limited data for humans, say there's cause for concern

New research sheds light on possible nongenetic causes of breast cancer: everyday chemicals.

Scientists at the nonprofit Silent Spring Institute and the Harvard School of Public Health did a deep dive on epidemiological data, looking at chemicals linked to mammary tumors in animals and then comparing their findings against existing data for humans, which is far more limited. The study authors, who published their research in the peer-reviewed journal Environmental Health Perspectives, identified 17 groups of chemicals they say are cause for concern.

These everyday chemicals include those found in vehicle exhaust, flame retardants (which are commonly used on furniture, rugs and mattresses), stain-resistant textiles (like the kind used to upholster furniture), paint removers and disinfection byproducts in drinking water. The study also identified chemicals formed by combustion (benzene and butadiene), which humans are exposed to from gasoline, lawn equipment, tobacco smoke, and charred or burned food.

More research is needed before a conclusive cause-and-effect link can be established between these chemicals and breast cancer, but the authors urge men and women to take care in the meantime. In addition to standard breast-cancer prevention — maintaining a healthy weight, moderating alcohol consumption and not smoking — the study authors offer seven tips women and men should follow to minimize the risk of exposure to those substances:

1) Reduce your exposure to fumes from gasoline and to exhaust from diesel or other fuel combustion. That means: don’t idle your car, and if possible, use electric, not gas-powered, lawnmowers, leaf blowers and weed whackers.

2) Use a fan when you cook, and avoid eating burned or charred food.

3) Don’t buy furniture with polyurethane foam — or ask for foam not treated with flame retardants.

4) Avoid stain-resistant rugs, furniture and fabrics.

5) Find a dry cleaner who doesn’t use solvents; ask for “wet cleaning.”

6) Purify your drinking water with a solid carbon-block filter.

7) Keep your house clean to avoid bringing in outside chemicals. Remove your shoes at the door, vacuum with a HEPA filter, and clean with wet rags and mops.

TIME health

This One Graphic Will Change the Way You Look at Breast Cancer Screening

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Nurse with patient having a mammogram. bojan fatur—Getty Images

Here are the real numbers on mammograms and how to read them.

If you’re a woman in your 40s or 50s, you’ve almost certainly been told that you should have a mammogram. Many women are pressured to do so by their doctors. This has a long tradition. In the dark ages of male chauvinism, the American Cancer Society wrote, “If you haven’t had a mammogram, you need more than your breasts examined.”

Although that message wouldn’t go down well today, the underlying paternalistic attitude towards women hasn’t changed much. Information about the actual benefits and harms of screening has been held back for years. Pink ribbons and teddy bears, rather than hard facts, dominate the discourse.

Why is that? It’s not because the information is hazy. No other cancer screening has been studied so extensively. The fact box below outlines benefits and harms. It is based on half a million women in North America and Europe who participated in randomized clinical trials, half of whom attended screening and half of whom did not. The fact box shows what happened to them 10 years later:

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First, look at the benefit. Out of every thousand women aged 50 and older, five without screening died from breast cancer, compared to four in the screening group. This is an absolute reduction of 1 in 1,000. In fact, it might even be an optimistic estimate because the Canadian follow-up study of women for 25 years after these trials found no reduction at all. But the exact number is not my point here. What I want to explain is how women are being misled.

Trick #1: State that screening reduces breast cancer mortality by 20% or more, because it sounds more impressive than explaining that the absolute risk reduction is 1 in 1,000.

This trick has been used for years in pamphlets. You might think, well, it’s not much, but at least one life is saved. But even that is not true. The number of deaths from all cancers, breast cancer included, is the same in both groups, as seen in line two of the fact box. And that leads us to trick #2:

Trick #2: Don’t mention that mammography screening doesn’t reduce the chance of dying from cancer. Talk only about the reduction in dying from breast cancer.

Often, and particularly if a person had multiple cancers, the exact cause of death is unclear. For this reason, total cancer mortality is the more reliable information when you look at it in terms of the larger goal: saving lives. In plain words, there is no evidence to date that routine mammography screening saves lives.

Now let’s look at the harms.

Trick #3: Don’t tell women about unnecessary surgery, biopsies and other harms from overtreatment. If you are asked, play these down.

The first way a mammogram can harm women is if it comes back with a false positive, leading to invasive and unnecessary biopsies. This isn’t the rare fluke most people seem to think it is. This happens to about a hundred out of every thousand women who participated in screening. Legions of women have suffered from this procedure and the related anxieties. After false alarms, many worried for months, developing sleeping problems and affecting relationships with family and friends.

Second, not all breast cancers are life-threatening. Women who have a nonprogressive or slowly growing form that they would never have noticed during their lifetime often undergo lumpectomy, mastectomy, toxic chemotherapy or other interventions that have no benefit for them and that are often accompanied with damaging side-effects. This happened to about five women out of a thousand who participated in screening.

There’s one final trick I would like to share with you.

Trick #4: Tell women about increased survival. For instance, “If you participate in screening and breast cancer is detected, your survival rate is 98%.” Don’t mention mortality.

Susan G. Komen uses this trick, as do many health brochures. How can 1 in 1,000 be the same as 98%? Good question. Five-year survival rates are measured from the time that cancer is diagnosed. What this means is that early diagnoses only seem to increase the rate of survival; it doesn’t mean that 98% were cured, or even lived longer than they would have without an early diagnosis from a mammogram. What’s more, screening also detects nonprogressive cancers, which further inflate short-term survival rates without having any effect on longevity. For those reasons, survival rates are often criticized as misleading when it comes to the benefits of screening. What you really need to know is the mortality rate. Again, look at the fact box, which uses neither 5-year-survival rates nor other misleading statistics such as relative risk reductions.

Do men fare any better with screening for prostate cancer? In a 2007 advertisement campaign, former New York City major Rudi Giuliani explained, “I had prostate cancer five, six years ago. My chance of surviving prostate cancer—and thank God, I was cured of it—in the United States? Eighty-two percent. My chance of surviving prostate cancer in England? Only 44% under socialized medicine.” By now you will recognize that Giuliani fell prey to trick #4. In reality, despite the impressive difference in survival rates, the percentage of men who died of prostate cancer was virtually the same in the U.S. and the U.K. Most importantly, randomized clinical studies with hundreds of thousands of men have shown no proof at all that early detection with prostate-specific antigen (PSA) tests saves lives; it reduced neither deaths from prostate cancer nor total mortality. What PSA testing is good at is detecting more nonprogressive cancers than breast cancer screening. The subsequent (unnecessary) surgery or radiation has harmed many men, causing incontinence and impotence. What men should know: getting prostate cancer is not a death sentence. Almost every man lucky enough to live a long life will eventually get it. But only about 3% of American men die from it.

Thanks to these tricks, quite a few doctors (perhaps yours?) are inadequately informed as well. But again, why is the misinformation so widely spread? Like those who refused to peer through Galileo’s telescope for fear of what they would see, many who have financial or personal stakes in screening and cancer treatment—from medical businesses to patient advocacy groups sponsored by the industry—close their eyes to the scientific evidence and cling to a one-sided view.

Mass screening is not the key to saving lives from cancer; the effective means are better therapy and healthier lifestyles. About half of all cancers in the U.S. are due to behavior: 20-30% to smoking; 10-20% to obesity and its causes, such as lack of exercise; and about 10% and 3% to alcohol in men and women, respectively. With respect to breast cancer, less alcohol and a less sedentary lifestyle with more physical activity, such as 30 minutes of walking a day, can help.

Until five years ago, cancer screening brochures from organizations in Germany (where I live) used all four of the above tricks to advocate screening. That is no longer so. All misleading statistics have been axed, and for the first time harms are explained, including how often they occur. However, none of the organizations have yet dared to publish a fact box, which would make the evidence crystal clear to everyone. Then, every woman could finally make an informed decision on her own.

Gerd Gigerenzer is the author of Risk Savvy: How to Make Good Decisions. He is currently the director of the Max Planck Institute for Human Development in Berlin, Germany, and lectures around the world on the importance of proper risk education from everyone from school-age children to prominent doctors, bankers, and politicians.

TIME health

Angelina Jolie To Have More Cancer Prevention Surgery

The actress made headlines around the world last year after she announced she'd had a preventative double mastectomy in a New York Times op-ed

Less than a year after penning a revealing op-ed in the New York Times about her decision to undergo a preventative double mastectomy, Angelina Jolie has revealed that she plans to have more cancer-prevention surgery.

Last May, Jolie wrote that she’d tested positive for the breast-cancer-related BRCA1 gene, meaning she had a horrifying 87 percent chance of developing the disease. “Once I knew that this was my reality, I decided to be proactive and to minimize the risk as much I could,” Jolie wrote. “I made a decision to have a preventive double mastectomy.” Doctors said the surgery reduced her risk of developing breast cancer to just 5 percent.

But carrying the BRCA1 gene also means that Jolie’s risk of developing ovarian cancer—the disease which took her mother’s life at the age of 56—is at 50 percent and the Oscar-winning actress has confirmed that she’s planning on undergoing more surgery to lower her cancer risk. “There’s still another surgery to have, which I haven’t [had] yet,” she told Entertainment Weekly, for this week’s cover story. “I’ll get advice from all these wonderful people who I’ve been talking to, to get through that next stage.”

In her Times op-ed, Jolie also wrote about her decision to make her health issues public, writing, “I choose not to keep my story private because there are many women who do not know that they might be living under the shadow of cancer. It is my hope that they, too, will be able to get gene tested, and that if they have a high risk they, too, will know that they have strong options.”

[EW]

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