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Breast Cancer Research Neglects Environmental Links

New America Media, News analysis, Joan Reinhardt Reiss Posted: Nov 22, 2009

This week, a federal task force issued new guidelines on mammograms, which reversed 25 years of screening protocol and sparked a storm of controversy. Instead of annual mammograms beginning at age 40, a woman need only initiate mammography at age 50. The task force also recommended biennial screening for women between the ages of 50 and 74. Adding to the confusion, the American Cancer Society (ACS) and the American College of Radiology stated their intent to follow the original guidelines of annual mammograms for women over 40.

For a number of years, some medical experts have questioned the efficacy of regular screening for breast and prostate cancers. In October, a paper in the Journal of the American Medical Association (JAMA) created a stir around the benefits of breast cancer screening and the concurrent false positive tests that often occur. The recent JAMA report showed that improvements in screening mammography produced a 40 percent increase in diagnosis and a corresponding decline in late-stage breast cancer was expected. However, only a 10 percent decline in late-stage breast cancer resulted. Lead author of the JAMA article, Laura Esserman, M.D., professor of surgery and radiology at UC San Francisco stated, There is a lot of uncertainty in medicine. But we shouldnt let that lead to more intervention. Less screening isnt necessarily a bad thing. Theres a moral to this story---detection is not prevention.

The dispute over screening guidelines obscures the elephant in the room: environmental causes of cancer. In the past two decades, scientists have demonstrated that most breast cancer is linked to environmental toxicants. These carcinogens represent all involuntary exposures to pesticides, chemicals, cleaning agents, radiation, and second-hand tobacco smoke. Two major pathways for these toxicants involve hormonal disruption and damage to our DNA.

Based on research over the last 20 years, the ACS seems to deny the relationship between environmental factors and breast cancer. Recently, the ACS released a statement regarding environmental factors and breast cancer. However, aside from tobacco and smoking hazards, the language is confusing and in spite of overwhelming evidence, the ACS requires more study.

The New York Times recently published a mammoth article with a focus on breast and prostate cancer prevention. Major attention was placed on the lack of interest of pharmaceutical companies to develop medications that lower cancer risk. Physicians claimed that even when these drugs are prescribed, patients have no interest. Once again the established link between environmental factors and these cancers was not mentioned.

An excellent living laboratory for studying the impact of environmental factors is identical, female twins. Almost a decade ago, Scandinavian scientists conducted a major study on that population where one twin was diagnosed with breast cancer and the other was free of the disease. In this ground-breaking work, environmental factors were determined to be responsible for at least 70 percent of the breast cancer in the diseased twin.

The Breast Cancer Fund (BCF), which advocates for the elimination of environmental causes of the disease through changes in state and national policy, was anxious to track funding available for research on environmental factors and breast cancer. BCF looked at external grants from the National Cancer Institute, a major funding source, to cancer researchers. In 2002-2003, NCI awarded $981,522,098 to non-NCI scientists for breast cancer research. Each project was carefully analyzed by the BCF to determine subject, allocation and relevance to environmental factors. Of almost $1 billion in grant awards, only 11 percent was allocated to research involving breast cancer and environmental toxicants. Once again, the majority of funds spent by NCI focused on genetics and molecular biology. This appears disproportionate considering the impact of environmental exposures on the disease.

The highest incidence of breast cancer is seen in white women followed by African Americans, Latinas, and Asians. However, as women of color immigrate to western industrialized countries with high concentrations of environmental toxicants, breast cancer incidence rates increase for these ethnic groups and mimic that of white women. Workplace exposures could be one reason.

Dr. Joe LaDou, of UCSF, a consultant to the World Health Organization, has studied work-related illnesses in many countries. He stated, Womens jobs are mistakenly considered to be safer than mens. For that reason, very few occupational health studies have focused on women workers.

In a number of occupations where wages are low, African Americans and Latinos bear a disproportionate burden of toxic exposures. Men are often assigned to strenuous jobs while the women tend to dominate in the field of residential and commercial cleaning with high exposure to toxic chemicals. In the San Francisco Bay Area, Womens Action to Gain Economic Security (W.A.G.E.S) is addressing that problem. It has helped its mostly Latina member form cleaning cooperatives, where women learn to utilize safe, non-toxic cleaning products.

Farmworkers, another Latino-dominant sector, are often exposed to carcinogenic pesticides. Research has proven a direct link between the pesticides chlordane and malathion and breast cancer in Latinas. These carcinogens accumulate in the female body and can be passed on to children.

Environmental factors in cancer are also found where people live. Housing in or adjacent to industrial areas places low-income individuals in harms way. The 100-mile stretch between Baton Rouge and New Orleans has been dubbed Cancer Alley due to the seven oil refineries and 175 heavy industry plants. Area residents are primarily black and Latino. Not surprising is the fact that these toxic exposures are linked to high rates of cancers, brain tumors, and other respiratory diseases. Paper plants pollute the water with dioxin,which even in the smallest amounts is a major carcinogen.

New studies known as biomonitoring are underway to measure the accumulation of chemicals in people. Scientists hope that in the future biomonitoring will demonstrate the linkage between chemicals and disease.

Meanwhile, our chemical regulatory system is completely broken. There are over 80,000 synthetic chemicals registered for use in the United States and just 7 percent have any toxicological screening data. The European Union moved ahead of the United States in chemical regulation with the 2007 passage of a new law on chemicals called REACH--Registration, Evaluation, Authorization and Restriction of Chemicals. Although individual states have enacted some measures of control more work is needed on behalf of all the generations to come.

Joan Reinhardt Reiss M.S., a former public policy advocate for the Breast Cancer Fund, has been a public interest advocate specializing in environmental and health issues. She lives in San Francisco, and her commentaries are heard on the KQED radio Perspective series.

Related Articles:

Black Activists Blast Breast Cancer Guidelines

Five Years is a Lifetime to Wait for Affordable Health Care

Latinos Face Cancer Scourge

A Doctors Word--Tips to Escape the Smoking Trap

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