Not Just a Pretty Face

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Cover Courtesy New Society Publishers
The Ugly Side of the Beauty Industry

Lead in lipstick? 1,4 dioxane in baby soap? Coal tar in shampoo? How is this possible? Simple. The $35 billion cosmetics industry is so powerful that they’ve kept themselves unregulated for decades. Not one cosmetic product has to be approved by the US Food and Drug Administration before hitting the market. Not Just a Pretty Face(New Society Publishers, 2007) author, Stacy Malkan, delves deeply into the dark side of the beauty industry, and looks to hopeful solutions for a healthier future. This scathing investigation peels away less-than-lovely layers to expose an industry in dire need of an extreme makeover. 

Pinkwashing: a term used to describe the activities of companies and groups that position themselves as leaders in the struggle to eradicate breast cancer while engaging in practices that may be contributing to rising rates of the disease.  

The bald woman in the pink T-shirt looks wistfully off into the distance in the ad in Yoga Journal. She is standing in a sea of pink hats and hopeful faces. We can live without our hair, the caption says. We can  live without our breasts. We cannot live without our hope for a cure. I feel the anguish of this woman, recalling images that will never leave me: my grandmother doubled over on the chair with blood leaking from the bandage where her breast used to be; my terror when I first brushed across the lump in my own breast. I want to hug this bald woman in the ad and cry with her. But I also want to shout: We should not have to live without our hair! We should not have to live without our breasts! Why is this happening? 

In just my lifetime, the risk of getting breast cancer for women living in the United States increased dramatically. More American women have died of breast cancer in the last 20 years than the number of Americans killed in World War I,World War II, the Korean War and the Vietnam War combined. Once a disease almost exclusive to postmenopausal women, breast cancer now strikes women in their 20s and 30s—especially young African-American women — and it is the second leading cause of death (after heart disease) in American women ages 25–54. What’s going on?

More than half of all breast cancer cases can’t be explained by any of the known risk factors, such as genetics, diet or reproductive history. Growing evidence indicates that the explanation lies in the environment around us: in the carcinogens and hormone-disrupting chemicals women are routinely exposed to throughout our lives. The patterns of breast cancer indicate the importance of environmental factors. Breast cancer rates are much higher in industrialized countries, such as North America and northern Europe, than in developing countries. People who move to industrialized countries from countries with lower breast cancer rates soon develop the higher rates of their new country.

The increase in breast cancer also parallels the proliferation of man-made chemicals since World War II. Many of these chemicals persist in the environment, accumulate in body fat and can remain in breast tissue for decades. Some have been shown to induce mammary tumors in animals, while others disrupt the delicate hormonal balance in the body. “Compelling scientific evidence points to some of the 100,000 synthetic chemicals in use today as contributing to the development of breast cancer, either by altering hormone function or gene expression,” according to State of the Evidence 2006: What Is the Connection between the  Environment and Breast Cancer?, a report that summarizes more than 350 studies on the environmental links to breast cancer. The report, published by the Breast Cancer Fund and Breast Cancer Action and peerreviewed by leading scientists, also identifies radiation exposure, such as nuclear radiation and X-rays, as the “longest-established environmental cause of breast cancer.”

Among chemicals of concern, suspicion focuses on substances that act like estrogen in the body. There is broad agreement in the scientific community that higher exposure to estrogens over a woman’s lifetime leads to a higher risk of developing breast cancer. For example, girls who menstruate before age 12 are 50% more likely to develop breast cancer than girls who menstruate after age 16, in part because of the increased lifetime exposure to estrogen. Early breast development is also clearly associated with an increased breast cancer risk. Both these phenomena—earlier onset menarche and earlier breast development — are occurring with disturbing regularity in US girls, and even more dramatically in African-American girls, according to a 2007 report by biologist Sandra Steingraber, PhD, distinguished visiting scholar at Ithaca College in New York. Several factors may hasten the onset of puberty in girls, including low birth weight and premature birth, obesity and environmental exposures to endocrine-disrupting chemicals, Dr. Steingraber reported.

The evidence suggests that the metaphor of the reproductive system as a “biological clock” — a fixed entity insensitive to environmental input—is misleading. “Puberty is less like a clock and more like a musical performance, with our bodies as the keyboards and the environment (both internal and external) as the hands of the pianist,” Dr. Steingraber said. “Our bodies are the mediums for a much larger message; as we change that message, we change ourselves.”

Another disturbing trend that has researchers looking to environmental explanations is the rising incidence of breast cancer in young African-American women. Compared with women of their grandmothers’ generation, African-American women have a 41 percent greater rate of invasive breast cancer and White women have a 21 percent greater rate, according to a 2006 analysis by researchers at the University of Pittsburgh Cancer Institute Center for Environmental Oncology and the Graduate School of Public Health.7 African-American women under 40 have a higher incidence of breast cancer than White women in this age group, and they are more likely to die of the disease at any age. The known risk factors can’t explain the ethnic variations, the researchers said.

But the researchers point to something they believe may explain the difference: hormone-containing personal care products. “We hypothesize that the use of estrogen and other hormone-containing personal care products in young African-American women accounts, in part, for their increased risk of breast cancer prior to menopause, by subjecting breast buds to elevated estrogen exposure during critical windows of vulnerability in utero and in early life,” the researchers wrote in the scientific journal Medical Hypotheses. 

The paper notes that African-American females are more likely than whites to experience early sexual maturity, and they are also more likely to use hormone-containing personal care products, such as hair pomades and conditioners with placental extracts. “Some of these compounds are widely used in the African-American community throughout life, starting at very young ages,” said senior investigator Devra Davis, PhD, director of the UPCI Center for Environmental Oncology. The paper cites several reports linking hormone-containing personal care products to premature sexual development. In one case, Black toddlers began to develop breasts and pubic hair when their parents applied hair pomades to their scalps. “When they stopped using these products, the breasts went away,” Dr. Davis said. “Now anything that can make breasts grow in an infant has got to be problematic.”

More research is needed to verify or refute a link between personal care products and breast cancer, although the paper notes that research is hampered by the lack of publicly available information about hormone-mimicking compounds in personal care products. The researchers called on cosmetics companies to disclose their use of hormonally active ingredients so research can move forward. But, said Dr. Devra Davis, “We don’t just want to study the problem, we want to make the problem go away.” She believes there is enough evidence to justify removing questionable compounds now. “As scientists, we’ll never know enough. It’s inherent in science that there is uncertainty. But just because something is complicated doesn’t mean we can’t understand it,” Dr. Davis said. “It comes down to, how much proof do we need? If we insist that the only proof we’ll accept is dead bodies and sick people, than we are dooming our kids to getting sick before we can take action to protect them.” Dr. Davis said she is particularly concerned about products containing placenta, parabens preservatives, phthalates, formaldehyde preservatives and heavy metals as well as products marketed to young children that are contaminated with carcinogenic impurities. Her advice to women is “simpler is better” — use fewer products, choose products with fewer synthetic or unknown ingredients, and avoid hormonally active ingredients when possible.

The news about environmental links to breast cancer is, ultimately, hopeful news: it means we can take collective action to reduce risk. “We can’t change our parents, but we can change our environment. We can change, for God’s sake, the ingredients in nail polish,” said Dr. Sandra Steingraber. The State of the Evidence 2006 report called for new government policies that require companies to phase out harmful chemicals and favor safer alternatives, and new research agendas that focus on the preventable causes of breast cancer. “We need to eliminate, as much as possible, human exposures to all substances or agents known or suspected of contributing to the disease process,” said Jeanne Rizzo, RN, executive director of the Breast Cancer Fund. What it’s really going to take to reduce breast cancer, she said, is “a revolution in thinking on the parts of government and the private sector.”

Pink It Up 

What we find in the mainstream culture instead is a revolution in shopping. We can “shower for the cure” with pink ribbon gel, dust our cheeks with “Hint of a Cure” blush and “Kiss Good Bye to Breast Cancer” with Avon lipstick. We can “test drive a BMW for the cure,” buy an iPod “Case for a Cause” and “save lids to save lives” with Yoplait yogurt — though you’d have to eat three yogurts a day for four months to raise $36 for the cause, points out the nonprofit group Breast Cancer Action on their “Think Before You Pink” website. The site urges consumers to ask critical questions about pink-ribbon products and promotions, such as: How much money goes to the cause? What is it supporting? What is the company doing to ensure its products don’t contribute to breast cancer?   

Some pink-ribbon promoters would rather not confront such questions. For instance, the cosmetics companies’ high-profile efforts to raise money for the cause include Revlon’s 5K Run/Walk and the Estée Lauder Companies’ Annual Breast Cancer Awareness Campaign — billed as “the Power of a Pink Promise.” Yet both companies were singled out in the 2005 Skin Deep report, which included a list of “Top 20 Brands of Concern” based on toxicity. Revlon’s Ultima II and the Estée Lauder brand were 8 and 9 on the list, respectively. Both companies make products that contain suspected carcinogens and hormone-disrupting chemicals, as does Avon, which claims to be the largest corporate supporter of the breast cancer cause in the US. Through their trade association, the Cosmetic, Toiletry, and Fragrance Association, the companies opposed a California bill that would require cosmetics companies to disclose their use of chemicals linked to cancer or birth defects. And none of the three companies has signed the Compact for Safe Cosmetics, a pledge to remove hazardous chemicals and replace them with safer alternatives.

All of this outrages Jeanne Rizzo of the Breast Cancer Fund. “If they’re concerned about the cause and prevention side of the disease — and I don’t know how they could not be — Estée Lauder, Revlon and Avon ought to be in the leadership on this issue, not having to be pushed on it,” Rizzo said. “When new knowledge comes to you that your product contains problematic ingredients, if you were authentic in your support for breast cancer, you would be vigilant in addressing that.” Instead, the pink-ribbon cosmetics companies defend their use of hazardous chemicals (“it’s just a little bit”) and fight to keep their industry unregulated. “It points out a lack of sincerity about the issue. They chose breast cancer because it’s women and that’s their market.”

It’s not that having an iconic symbol for a disease is a bad idea, Rizzo points out. For many women, wearing the pink ribbon and participating in community events is important and validating. But the pink ribbon, with its carefully contrived message about “awareness” and “hoping for the cure,” also serves to distract from a deeper public discussion about preventable causes of breast cancer. “It is the very blandness of breast cancer, at least in mainstream perceptions, that makes it an attractive object of corporate charity and a way for companies to brand themselves friends of the middle-aged female market,” wrote author Barbara Ehrenreich. Companies want to support breast cancer because “breast cancer is safe,” said Carol Cone, who helped kick off “cause marketing” in the 1980s with research showing that, given the same cost and quality, more than half of consumers would switch from a particular brand to one associated with a good cause. With breast cancer “there was no concern that you might actually turn off your audience because of the lifestyle or sexual connotations that AIDS has,” Amy Langer, director of the National Alliance of Breast Cancer Organizations, told the New York Times in 1996. “That gives corporations a certain freedom and a certain relief in supporting the cause.”  Or, as National Women’s Health Network director Cindy Pearson put it: “Breast cancer provides a way of doing something for women, without being feminist.”

And there’s the rub. With its focus on moving products, the pink ribbon excludes all notions of feminism, activism, corporate accountability or changing the status quo. Instead, the public conversation — and much of the research — narrows in on a set of topics that don’t rain on the corporate cash parade. We hear a lot of hype about pharmaceutical solutions for breast cancer, but not much about prevention strategies such as cleaning up carcinogens in the environment. We hear that fewer women are dying of breast cancer, but there’s little discussion about how many more women are getting the disease. We’re told to take personal responsibility and make good lifestyle choices, such as eating right and exercising. But there’s barely a whisper about industry’s responsibility to reduce pollution and use precaution. Tugging the ends of the pink ribbon, one starts to unravel some reasons why.

Raining Ribbons

The pink ribbon was originally neither pink nor was it intended to be used as a marketing tool. It was a peach ribbon developed in the early 1990s by Charlotte Haley, who watched her daughter, sister and grandmother suffer breast cancer. Angry and determined to start a grassroots movement, Charlotte sat down at her dining room table and crafted thousands of peach ribbons by hand. She bundled them into sets of five, each with a card that read: “The National Cancer Institute annual budget is $1.8 billion; only 5 percent goes for cancer prevention. Help us wake up our legislators and America by wearing this ribbon.” She distributed the bundles at her local supermarket and wrote to Dear Abby and other prominent women to call attention to the campaign.

At that time, breast cancer was just starting to come out of the closet, and a couple of major corporations had big plans. Estée Lauder and Self  magazine teamed up to create the second annual Breast Cancer Awareness Month issue, and they envisioned a breast cancer ribbon displayed on cosmetics counters from coast to coast. But somebody already had a breast cancer ribbon, they were told. So they called up Charlotte Haley offering to partner with her and take her peach ribbon national. “She wanted nothing to do with us. Said we were too commercial,” Self magazine editor Alexandra Penney explained to MAMM magazine. For Charlotte, the ribbon was a tool to inspire women to become politically active, not to sell products. But her vision was not to be realized. Estée Lauder and Self  really wanted that ribbon. Their lawyers advised them to choose another color. Pink, a life-affirming color known for its calming, quieting, stress-reducing effects, was the color chosen. “In focus groups and studies, pink came out as something that was warm, happy, pleasant and playful, which is everything that breast cancer is not for women who are living with the disease,” commented Brenda Salgado of Breast Cancer Action. “So that’s where the pink ribbon was born. And Charlotte Haley’s peach ribbon just kind of disappeared, inundated under pink ribbons ever after.” 

Cancer, Inc.

Unraveling the ribbon further, one finds even more disturbing contents inside the pink package. “They make the chemicals, they run the treatment centers, and they’re still looking for ‘the cure’ — no wonder they won’t tell you about breast cancer prevention,” begins the expose by Sharon Batt and Liza Gross in Sierra magazine. It’s the most straightforward way to put it.

The co-founder and major sponsor of Breast Cancer Awareness Month is AstraZeneca (formerly known as Zeneca), a British-based multinational giant that manufactures the cancer drug tamoxifen, the most widely prescribed breast cancer drug. Until 2000, the company was also a leading manufacturer of agricultural chemicals, including the carcinogenic pesticide acetochlor. When Zeneca created National Breast Cancer Awareness Month in 1985, it was owned by Imperial Chemical Industries, a multibillion- dollar producer of pesticides, paper and plastics. The company was named in a 1990 lawsuit by the federal government for allegedly dumping DDT and PCBs into the Los Angeles and Long Beach harbors. After buying up cancer clinics around the country, Zeneca merged with the Swedish pharmaceutical company Astra in 1999 to form AstraZeneca, the world’s third largest drug company.

“This is a conflict of interest unparalleled in the history of American medicine,” said Dr. Samuel Epstein, a professor of occupational and environmental medicine at the University of Illinois School of Public Health. “You’ve got a company that’s a spin-off of one of the world’s biggest manufacturers of carcinogenic chemicals, they’ve got control of breast cancer treatment, they’ve got control of the chemoprevention [studies], and now they have control of cancer treatment in eleven centers—which are clearly going to be prescribing the drugs they manufacture.”

They’ve also got control over the public message of National Breast Cancer Awareness Month, which focuses on early detection — in other words, find out if you’ve already got the disease. “The awareness is about getting your mammograms and getting pills,” said Brenda Salgado. “It focuses all our attention on ‘early detection’ and ‘cure,’ which is important for women who currently have cancer, but it keeps us from the equally important effort of preventing women from getting the disease in the first place. It also avoids the critical questions the breast cancer epidemic raises. What is the connection between environmental toxins and breast cancer? And why has the incidence of breast cancer risen, despite the ‘war on cancer’ and all the money spent on research?”

The nation’s largest breast cancer charities fall in line with similar messages about early detection and cure, and divert public attention away from prevention strategies in ways that are sometimes not so subtle.    The American Cancer Society (ACS), for instance, is frequently quoted in the press urging cautious interpretation of evidence linking chemicals to disease. As one example: a July 2005 New York Times story entitled “Should You Worry About the Chemicals in Your Makeup?” quoted Dr. Michael Thun, head of epidemiology at ACS, questioning the science on phthalates. “There are real uncertainties about animal studies,” Thun said. However, expert panels at the US National Toxicology Program have said the animal studies on phthalates are likely to predict human reproductive health effects.

ACS also dismissed a report by the California EPA, based on an exhaustive analysis of two decades of research, that second-hand smoke is linked to premenopausal breast cancer. According to Jeanne Rizzo of the Breast Cancer Fund, this is an indication of an institutionalized culture of resistance. “Not only is the American Cancer Society not taking leadership, there’s a resistance,” she said. “They are willing to look at alcohol, obesity, diet and genetics. But are they willing to look at what’s making girls go into puberty earlier? Are they willing to look at the links between chemicals and cancer? Their focus is on cure. There’s a normalization of cancer in that model when you don’t look at causes of cancer. It’s like saying you’re going to get it — but we’ll cure it.” 

According to State of the Evidence, synthetic chemicals that can mimic estrogen or disrupt hormones in the body include: 

• Bisphenol A — a component of polycarbonate plastic (#7), used in baby bottles and water coolers 

• Parabens — used as preservatives in a range of cosmetics

• Phthalates — used in personal care products and vinyl plastic

• Placental extract — used in hair products marketed primarily to African- American women

The vast majority of chemicals have not been tested for hormone-disrupting effects or their potential to cause breast tumors. 

Reducing Carcinogens

In May 2007, the Silent Spring Institute and Susan B. Komen for the Cure released the most comprehensive scientific review of mammary carcinogens to date. The report identified 216 chemicals that cause breast cancer in animals, including industrial solvents, pesticides, dyes, cosmetics ingredients, hormones and pharmaceuticals.  

“Overall, exposure to mammary gland carcinogens is widespread,” the researchers wrote in a special supplement to the journal Cancer. “These compounds are widely detected in human tissues and in environments, such as homes, where women spend time.” 

Some of the most widespread mammary carcinogens include:  

• 1,4-dioxane — found in detergents, shampoos, soaps 

• 1,3-butadiene — common air pollutant; found in vehicle exhaust 

• Perfluorooctanoic acid — used in manufacture of Teflon 

• Vinyl chloride — used to make PVC/vinyl plastic 

• PAHs — from diesel and gasoline exhaust 

• PCBs — electrical transformers; banned but still in environment 

• Atrazine — a herbicide widely used in the US, but banned in Europe 

Because breast cancer is so common and the exposure to the chemicals so widespread, “the public health impacts of reducing exposures would be profound even if the true relative risks are modest,” the researchers wrote. “If even a small percentage is due to preventable environmental factors, modifying these factors would spare thousands of women.” 

The Good News

After a decades-long increase, breast cancer rates in the US have been falling  in recent years. An analysis of statistics by researchers at the University of Texas  M.D. Anderson Cancer Center found that the most common form of breast cancer, estrogen positive tumors, declined a startling 15% in women ages  50–69 between 2002 and 2003 — the first significant drop in breast cancer rates in a quarter century. The researchers believe the reason is that millions of women abandoned hormone replacement therapy after a large federally funded study reported that women who regularly took the menopause drug Prempro (a combination of estrogen and progestins) were more likely to develop heart problems and breast cancer. Soon after the findings emerged, many women stopped using the hormones and breast cancer rates began falling, the statistics show. The findings raise the question: could reducing exposure to other sources of external synthetic estrogens further reduce breast cancer rates? 

Reprinted with permission from Not Just a Pretty Face by Stacy Malkan and published by New Society Publishers, 2007.

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