Heavy Silence

Why no one wants to talk about obesity and breast cancer

Every October, this country celebrates Breast Cancer Awareness Month. But what are we supposed to be made aware of? That the disease exists? That's hardly necessary. How about that it's the most prevalent female cancer? Most women know that, too. Perhaps women should be made aware of what is probably the single most important controllable risk factor for breast cancer.

No, it's not power lines or DDT or toxic waste dumps. It's obesity.

Federal government weight specialists define obesity for women as having a body mass index of 27.3 or higher. (Your BMI is your weight in kilograms divided by the square of your height in meters.) Many studies have found obesity increases the risk of breast cancer in older women. The National Cancer Institute's 1996 publication "Cancer Rates and Risk" states flatly, "Among postmenopausal women, breast cancer risk increases with weight and body mass."

Obesity greatly raises a woman's risk of getting breast cancer and, because fat obscures the tumor and delays detection, substantially increases the chance that the cancer will be fatal. As a risk factor for breast cancer, obesity is more significant than other risk factors such as an inherited genetic mutation or early puberty. But the connection between obesity and breast cancer is rarely discussed because feminists and fat acceptance activists, aided by sympathetic, intimidated, or clueless journalists, find it ideologically inconvenient.

The evidence is getting harder to ignore. Results from the Boston-based Nurses Health Study, reported last November in The Journal of the American Medical Association, indicate that postmenopausal women who have gained 44 pounds or more since age 18 are twice as likely to get breast cancer as women who have gained less than five pounds. And Harvard University endocrinologist JoAnn Manson, one of the study's lead researchers, says "There seems to be even a stronger association with greater degrees of obesity." Other studies have yielded similar results. The probable explanation, Manson says, is that after menopause fat becomes the primary source of estrogen in a woman's body, swamping outside sources (such as DDT) that environmentalists have tried to link to breast cancer.

A study by researchers at Yale University, reported last September in the American Journal of Epidemiology, found that obese women are more than three times as likely as thin women to have their breast tumors detected at a later, less treatable stage of the disease. The Yale study is the latest of several to report this association. Other studies suggest that severe obesity decreases breast cancer survival rates independent of when the tumor is detected, perhaps because it makes a woman much less likely to survive major surgery. Partly as a result of these tendencies, black women are considerably more likely than white women to die of breast cancer, even though they are significantly less likely to develop the disease in the first place (apparently for genetic reasons). One cause of this disparity may be that black women tend to see doctors less often, but another important factor is that they are about 50 percent more likely than white women to be obese.

Since over a third of American women are obese, obesity probably causes several thousand breast cancer deaths each year. There are also consistently significant links between obesity and other women's cancers, such as those of the uterus, cervix, and ovaries.

Yet the average American woman almost never hears warnings about obesity and cancer. Consider how the issue has been ignored by People, a magazine with some 3.5 million readers, about 65 percent of them women. Like most magazines with a substantial female readership, People has turned breast cancer into a cause célebrè, mentioning the subject in some 200 articles over the past two decades. None of these articles noted the link between obesity and breast cancer. Neither did a recent cover story ("Who Says Size Counts!") that celebrates female obesity.

This sort of silence has been the rule, not the exception. You just don't talk about the link between obesity and breast cancer in polite company. Activist groups object to the implication that women can do anything to reduce their risk of breast cancer. Francine Kritchek, co-chair of Long Island's influential One in Nine, says women are "are tired of being told" to "watch their diets." The National Alliance of Breast Cancer Organizations goes so far as to call the idea that there's any "known way to prevent breast cancer" a "myth."

Why the great silence? Every aspect of breast cancer, from funding to prevention to treatment, is dominated by feminist ideologues. In feminist parlance, to say that a woman has any control over contracting breast cancer–or even to say that she is genetically predisposed–is called "blaming the victim." This is the line pushed by America's top breast cancer activist, Dr. Susan Love. Citing Love, Toronto Sun reporter Marilyn Linton writes, "Beating ourselves up over what we might have eaten, taken and done or not done is of no help at all." (In pushing this line of thinking, feminists and fat-acceptance activists have been abetted by environmentalists who blame cancer on power lines, radar stations, fertilizers, pesticides, toxic waste dumps, and even air pollution–anything connected to industry. Says Samuel Epstein, a physician and environmental activist, "The cancer establishment remains myopically fixed on blame-the-victim theories," while ignoring "evidence of environmental contaminants.")

Just as the language of breast cancer has been shaped by feminists, so has the language of obesity. The titles of psychologist Suzie Orbach's best-selling books say it all: Fat Is a Feminist Issue and Fat Is a Feminist Issue II. "Fat," writes Orbach, is "rebellion against an imprisoning social role." It is "not about lack of self-control or lack of will power" but rather "a response to the inequality of the sexes." Women become fat because they think, "if I get bigger like a man then maybe I'll get taken [as] seriously as a man."

Orbach's thesis cannot explain why, according to 1994-95 government data, 54 percent of American women are healthily thin, while only 40 percent of American men are. But feminists applauded her books. Backlash author Susan Faludi says the first one, originally published in 1978, should "be read by every American woman." And Orbach has spawned a legion of imitators. Sharlene Hesse-Biber's 1997 book Am I Thin Enough Yet? blames women's eating problems on "capitalism and patriarchy." She explains that keeping women fixated on their weight is part of a conspiracy to divert money, time, and energy from more empowering activities.

Yet nobody spreads more diet disinformation than the women's magazines, with their silly "52 Tips to Lose Weight," "Ten Ways to Melt Off That Flab by Bikini Season," and my favorite, "The Last Diet You'll Ever Need," followed up two months later by another "Last Diet You'll Ever Need." The editors and writers for these magazines are almost all women. The largest diet centers, which produce results so dismal most refuse to release their data, are almost entirely staffed by women. Most of the worthless diet books are written by people with names like Susan Powter, Adele Puhn, and Debra Waterhouse. Today the best-selling nonsense diet book is The Zone–authored by a man, but edited and published by a woman, Judith Regan. If it's true that women are being victimized, they are also the prime victimizers.

The "blaming the victim" charge discourages journalists, scientists, and public health officials not only from discussing obesity and breast cancer but from advising women to lose weight for any reason. Doing so almost inevitably provokes the accusation that such advice promotes eating disorders, even though the most serious eating disorders generally result from underlying psychological problems. The National Association for the Advancement of Fat Acceptance claims eating disorders kill 150,000 women a year in the United States. The actual number, reports the National Institutes of Health, is about 150.

Through such tricks, the feminists and fat-acceptance advocates have convinced many of us that thinness kills, to the point where they finally prevailed upon Mattel to fatten up that longtime object of feminist wrath, the Barbie doll. Meanwhile, the number of American women who die of obesity-related breast cancer is probably more than 30 times the number who die as a result of eating disorders. Last year there were about 29,000 postmenopausal breast cancer deaths in the United States, and Zhiping Huang, who collaborated with JoAnn Manson on the Nurses' Health Study, estimates that 16 percent of them–more than 4,600–were caused by obesity. Overall, reports the Centers for Disease Control and Prevention, about 150,000 American women die prematurely each year from obesity-related causes such as heart disease, stroke, and diabetes.

It's true that we don't know what causes all breast cancers, or even most. But prudence, logic, and compassion dictate that women should be informed about the risk factors that have been identified–especially when, as in the case of excess weight, they can do something about them.

Michael Fumento ([e-mail]) is author of The Fat of the Land: The Obesity Epidemic and How Overweight Americans Can Help Themselves (Viking) and a resident fellow at the American Enterprise Institute in Washington, D.C.