Antiperspirants And Cancer
Dr. Ted S. Gansler, director of medical content for the American Cancer Society, who was interviewed for the report, had several complaints about its "sensational and misleading tone." He outlined his concerns in a recent letter to "Evening News" Executive Producer Jim Murphy. From his letter:
"The average viewer hearing the story would believe there might quite likely be a link between antiperspirants and breast cancer that is being covered up by the government, health experts, and the cosmetics industry. As a result, rather than dispel this common misconception, your report served to further the baseless and scary rumor, leaving women confused, concerned, and arguably, worse off than they would have been had they not watched the program."Upon receipt of Gansler's letter, Attkisson responded. From her letter:
"Your letter appears to once again repeat a widespread misconception in seeming to imply that a link between antiperspirants and breast cancer has been ruled out. The point made in our report is that no such link has been ruled out, a fact that surely antiperspirant-users deserve to know when making decisions about their product usage."
Below is the full text of Gansler and Attkisson's letters.
December 16, 2005
CBS Evening News
Dear Mr. Murphy,
I was happy to help when CBS News reporter Sharyl Atkisson requested an interview to help separate myth from fact regarding persistent rumors that antiperspirants might be linked to an increased risk of breast cancer.
After all, countless American women have long been scared into thinking this unproven claim might have some validity and ignore the real risks to their health. However, I expected more from your news organization than the sensational and misleading tone of the resulting report.
The average viewer hearing the story would believe there might quite likely be a link between antiperspirants and breast cancer that is being covered up by the government, health experts, and the cosmetics industry. As a result, rather than dispel this common misconception, your report served to further the baseless and scary rumor, leaving women confused, concerned, and arguably, worse off than they would have been had they not watched the program.
The report placed undue reliance on the claims of a single investigator who authored a single study, with no balance about the limitations about that study, while downplaying considerably stronger evidence that fails to show any increased risk of breast cancer from the products. Unmentioned was the fact that the study lacked even a control group, and that it has been criticized by epidemiologists as not relevant to the safety of these underarm hygiene practices. Also unmentioned was the fact that experts have described a probable reason for the study's finding: that young breast cancer patients may simply be more likely than older women to use these products and to shave their underarms. In addition, the report did not mention that the study failed to account for other, known risk factors for breast cancer (e.g.: delayed childbearing, alcohol use, hormone replacement therapy), a standard practice in epidemiologic investigations of potential risk factors. Adding to the confusion from your report was the impression it created that aluminum was the likely culprit in the claimed link. In fact, the study discussed in the report did not discriminate between antiperspirants, which often contain aluminum, and deodorants, which do not.
Particularly grievous was the report's creating the misperception that it is possible to prove something is completely safe. A reality of science is that one can detect a hazard, but it is impossible both in practice and in principal to establish the absence of a hazard. In this case, CBS used the absence of "proof" to insinuate a strong suspicion of risk, even quoting the Society statement that the link "cannot be ruled out" to infer that a link actually exists. In fact, our Web site says: "There is no good scientific evidence to support [the] claim" that antiperspirants increase the risk of breast cancer.
The comment that the Society is "funded in small part by antiperspirant makers" was clearly used to imply that donations from the industry colored our interpretation of the evidence. This is inaccurate and offensive. More than 90 percent of our income comes from regular Americans, many of whom have been touched by cancer. The mix of individuals and organizations that support the American Cancer Society does not stop us from often reporting evidence that may be detrimental to a specific interest. We are not beholden to any one of them, except to achieve our shared mission to beat cancer, as outlined by our volunteer board. We are the top source of credible, science-based information to help Americans avoid cancer and deal with it when it hits, a role we take very seriously and that is not for sale.
Breast cancer is a top health issue for many American women and its risks are quite well-known. CBS News has done a disservice by continuing to muddy the waters with unproven claims while ignoring the real risks to women's health. The news media can do better to help Americans understand the many claims they are bombarded with. In this case at least, you've let your viewers down.
I know the American Cancer Society has enjoyed a constructive working relationship with CBS news over the years. We would welcome the opportunity to discuss this issue in more detail and to find ways to help ensure our support can lead to productive and accurate reports about cancer and its many issues.
Ted S. Gansler, MD
Director, Medical Content
American Cancer Society
Dear Dr. Gansler:
This is in response to your December 16th letter.
Your letter appears to once again repeat a widespread misconception in seeming to imply that a link between antiperspirants and breast cancer has been ruled out. The point made in our report is that no such link has been ruled out, a fact that surely antiperspirant-users deserve to know when making decisions about their product usage.
You state that the American Cancer Society is "the top source of credible, science-based information." In that context, it is significant to note that your organization had formulated a definitive position on this issue, yet was not familiar with the latest research. When we first spoke on the phone, your organization mistakenly stated that the antiperspirant breast cancer link had been widely disproven and asked if there was "something new." I told your organization there were several recent studies, including the one by Dr. Kris McGrath. Your organization told me you were unfamiliar with such studies. Therefore, as you know, I provided Dr. McGrath's study to you for your review prior to our interview.
Likewise, the antiperspirant industry lobby—which asked us to interview you (the American Cancer Society)—had also formulated a definitive opinion on this issue without, apparently, giving serious consideration to the complete body of research on the subject. Like the American Cancer Society, the antiperspirant industry wishes to rely on the earlier study that found no proof of a link; while entirely discounting other science supporting the idea of a link. Here's what the director of Cosmetic Chemistry for the Cosmetic, Toiletry and Fragrance Association told me in explaining why the antiperspirant industry considers the earlier study (that found no link) "definitive."
CTFA: (Decisions must be made) based on sound science.
Sharyl: What does that mean?
CTFA: Sound science means well planned, executed, peer reviewed.
Sharyl: (McGrath's) study was all of that..
CTFA: I'm not familiar with details of McGrath.
The antiperspirant industry lobby, therefore, is unfamiliar with a study (McGrath's) that has been listed by the National Cancer Institute as one of two significant studies on this issue. Further, shortly after the study's publication, the FDA contacted Dr. McGrath in writing and requested a copy of the full paper. It would seem prudent for the antiperspirant industry and American Cancer Society to have been more familiar with emerging research on this topic since they are giving strong opinions about it.
You seem very uncomfortable with the idea of the public knowing that this particular risk has not been definitively laid to rest. The FDA does not share the American Cancer Society's view that the issue merits no further exploration. The FDA and others indicate this is—and deserves to be—an active area of research. For example:
The average viewer hearing our story would believe there could possibly be a link between antiperspirants and breast cancer. This is factually correct. We reported the opinions that a breast cancer risk is small or unlikely, but that it has not been definitively ruled out.
The idea of a cancer link might indeed be "scary" as your letter states, but it is certainly not "baseless." Just because people might find an idea scary doesn't mean the truth should be withheld from them.
Our report profiled a reputable investigator and his study. However, we did not "place undue reliance" on his claims. By way of background, our report also took into consideration other studies supportive of a potential link between antiperspirants and breast cancer (though not conclusive); as well as resources and sources who confirmed to us multiple times that the issue is very much indeed an open issue.
When given the opportunity, neither the FDA, nor your organization, nor the antiperspirant industry took serious issue with Dr. McGrath's study. You called McGrath's study "inconclusive." To the extent that his study does not prove a definitive link to breast cancer, that it merely furthers the questions, you are correct. We specifically stated in our story that his study was not definitive proof of a link. However, independent experts we spoke to do not agree with your analysis that the older study deserves great weight while Dr. McGrath's study should be discounted entirely.
All studies have limitations, including studies on both sides of this issue. While you now criticize Dr. McGrath's study as "just one study"; you selectively choose to rely on a different study that is also "just one study." Even in the study on which you rely, like all studies, there are discussions—including by the study authors—as to its limits and potential weaknesses. Dr. McGrath's study was limited in other ways, but answers some of the prior study's weaknesses. Dr. McGrath's study was reviewed by three Institutional Review Boards, including ones on which oncologists sat; and peer-reviewed and published in a cancer prevention journal. Further (perhaps the American Cancer Society is not familiar with these studies, either), other investigators are looking into the issue and have found evidence that they believe is supportive of a link (though not conclusive).
The conclusions of the study on which you appear to rely have been widely misrepresented. Many have claimed that study disproved a link when, in fact, it failed to establish a link but it did not disprove one. A good logician understands the significant difference. However, the misrepresentation may be why so many people have mistakenly thought the antiperspirant-breast cancer theory was a disproven "myth" rather than an unanswered question.
In our report, we reported that there are people who don't believe in a link; we reported that Dr. McGrath's study is not conclusive proof (just enough, in his opinion, to call for large-scale studies; and other medical authorities including FDA concur); we reported that rumors of a link had been circulated for years but dismissed by most, including at one time the FDA; we reported the National Cancer Institute and your organization would not encourage throwing out your antiperspirant in fear; we reported that your group thinks a risk, if any, would be very small. All of these things clearly and responsibly reported the state of affairs.
It is not "absence of proof" of safety that we used to raise a question, but absence of proof of safety along with concern by the FDA and some of its scientists; the statement by FDA that it hopes definitive studies are done "in the near future"; and Dr. McGrath's study and supportive studies.
As to funding, you are incorrect when you state that our comment that the American Cancer Society is "funded in small part by antiperspirant makers" was intended to color your interpretation of the evidence. Disclosing relevant funding behind groups advocating a position is critical, especially as more and more groups and non-profits receive funding from outside entities. I likewise queried Dr. McGrath about the source of funding for his study; he reported no outside funding.
As you may know, the American Cancer Society acknowledged to me receipt of money from the antiperspirant industry, and said it was a "small" amount, but would not say how much or what percentage or even provide a general range or estimate. As you may further know, your organization agreed to let me interview you only with the caveat that I was not to ask you about the funding, which I complied with. You should not be uncomfortable with the disclosure of your funding sources related to the issue on which you are giving an opinion.
One has to wonder why the American Cancer Society, given its mission, would choose to selectively rely on one study when the National Cancer Institute and FDA have not done the same; why your organization would formulate a position without being familiar with the latest relevant publications on the issue; why the American Cancer Society would go to such pains to dispel a potential link between antiperspirants and breast cancer when no such link has been definitively dispelled; and why your organization seems so uncomfortable with the public being told that it's an open question rather than a closed issue. Instead of being in tandem with the antiperspirant industry, one might have expected the American Cancer Society to support public dissemination of all information regarding potential cancer risks—especially in cases where the public can choose to take steps to reduce exposure that could add to risks.
Our report was neither sensational nor misleading. We believe we've done a service to our viewers in giving them truthful, honest information about widely-used products that they could not have easily found otherwise. Nobody knows the true risk of antiperspirants at this time. Many Americans will conclude a potential risk is small or non-existent and continue using their antiperspirants. Some may choose to rethink their product usage, as is their prerogative. The public has the right to know the full truth and make its own decisions.
Sharyl Attkisson, correspondent