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For too long now breast cancer research has been dominated by the elusive search for the cure," says Andrea Martin, founder and executive director of the Breast Cancer Fund, a San Francisco-based group that has launched a major campaign to draw attention to the links between the environment and breast cancer. Citing the fact that only 5 to 10 percent of breast cancer cases are genetically caused and that the number of women with breast cancer nearly doubled between 1970 and 1990, the fund has teamed up with the Susan G. Komen Breast Cancer Foundation to urge the public to agitate for more research into environmental causes of the disease. Last October the two groups rallied 70 individuals and organizations (including local breast cancer groups, the Coalition of Labor Union Women, and the YWCA) to sign a letter to President Clinton. The letter called for increased funding for research examining environmental links; monitoring by the Centers for Disease Control (CDC) of what chemicals are in our bodies and in what amounts; full funding for the Environmental Protection Agency's (EPA) program to screen for environmental toxins; and a cross-agency committee to oversee government funding for environmental health research.

The following is excerpted from the Breast Cancer Fund's publication Examining the Environmental Links to Breast Cancer.
Since 1971, the year President Richard Nixon declared a "war on cancer," more than $35 billion has been committed to research. Yet we still cannot pinpoint with certainty the causes behind the vast majority of breast cancer cases, nor have treatment options changed or improved much over the years. Women still must choose from surgery, radiation, and/or chemotherapy. In addition, some in the medical establishment have misleadingly focused on mammography as a prevention measure, with the assumption that early detection can prevent serious illness. Mammography, however, is not prevention. It can only detect cancer that already exists and may have been present for eight to ten years. It fails to detect breast cancer 20 percent of the time in women over 50, and as much as 40 percent of the time in younger women.

Hundreds of scientific studies of laboratory animals and wildlife have drawn links between exposure to toxic chemicals and cancer. Emerging science suggests that synthetic chemicals in the environment pose a risk to the human reproductive system, the endocrine system, and to human growth and development both in utero and after birth.

A rapidly evolving field of research involves the study of "endocrine disrupters" or "hormone mimickers"--synthetic chemicals found in pesticides like DDT, some fuels, plastics, detergents, and pharmaceutical drugs. We know that estrogen binds with receptors in mammary glands, signaling cells to grow. In 1993, scientists at Cornell University cautioned that growing evidence seemed to indicate that exposure to estrogen-mimicking chemicals, called xenoestrogens, can cause cells to rapidly grow out of control and form tumors. It has been postulated that xenoestrogens may be responsible for increasing a woman's chances of getting breast cancer. Researchers at Tufts University Medical School have demonstrated that xenoestrogens make human breast cancer cells grow in the laboratory, just as natural estrogen does.

There are also studies that show drastic changes in development, particularly in the reproductive system, when laboratory mice are exposed to estrogen mimickers during critical windows of vulnerability in utero. When cells are rapidly developing and proliferating, there can be a key period of vulnerability during which damaging or altering cell development can lead to cancer. Other windows of vulnerability include puberty and a woman's first pregnancy.

Studies tracking patterns of breast cancer development in humans also strongly suggest the influence of environmental factors. In Asia, women are four to seven times less likely to develop breast cancer than women in the U.S. Yet when Asian women migrate to the U.S., their risk of breast cancer rises over a two-generation span. Women who live in the U.S. for a decade or more have an 80 percent higher risk of developing breast cancer than more recent immigrants, and those whose grandparents were born in the U.S. have a 60 percent greater risk than women whose grandparents were born overseas.

Estrogen mimickers may be either beneficial or detrimental. Estrogen-mimicking compounds found in foods such as broccoli, soy products, and cauliflower may act as "good" estrogens, providing some protection against the effects of estradiol, the chief "bad" estrogen, made naturally by our bodies. Critics of the "xenoestrogen theory" argue that these beneficial compounds found in foods can balance possible hazards posed by human-made chemicals. Other scientists point out that the human body has been fine-tuned to handle plant estrogens through thousands of years of evolution, while human-made estrogen mimickers have been in the environment only since the 1940s. Since we do not yet understand how women's natural estrogen affects breast cancer, it is difficult to predict how estrogen mimickers might behave, even at low doses.

Studies have identified the presence of more than 200 foreign chemicals in women's breast milk, including significant levels of dioxin, a carcinogen that has been shown to disrupt children's hormone systems. Within six months of being breast-fed, a baby in the U.S. or Europe receives the maximum recommended lifetime dose of dioxin.

Chemicals that are persistent in the environment accumulate in body fat and are carried by women in their breast tissue. Thus far, human data about the link between these chemicals and breast cancer are inconclusive. For example, some studies have shown that women with breast cancer have the same or lower levels of pesticide residue in their system than women without the disease.

However, other studies, by U.S. and Canadian scientists, have found that women with higher levels of organochlorines in their blood have four to ten times the risk of breast cancer than those with lower levels. [Organochlorines are hydrocarbon-based chemicals containing chlorines like DDT. Many of these compounds break down very slowly in the environment and can be stored in the fat of animals, fish, and humans.] These seemingly inconsistent results point to the need for long-term prospective studies on this issue.

There are only two recognized causes of breast cancer: exposure to ionizing radiation and inherited genetic defects in breast cells. Other factors, though they have not been shown to cause the disease, are associated with higher risk: beginning menstruation before age 12, onset of menopause after age 55, bearing children late in life or not at all, not breast-feeding, and prolonged use of estrogen after menopause.

More research is needed to examine why the established risk factors increase a woman's vulnerability. However, additional and different research is needed to determine which of the thousands of chemicals in the environment cause the disease, and how. Most important, we must conduct long-term prospective studies that measure exposures to chemicals during critical windows of breast development.

For many years the focus of the National Cancer Institute (NCI), the largest single government funding source for cancer investigations, has been on earlier detection with mammography, improved radiation and chemotherapy, and improved surgical techniques designed to help women survive the disease and live longer. Much research continues to be focused on the role of inherited gene defects. Currently, there is no breast cancer prevention research strategy at the NCI except for chemo-prevention through the use of raloxifene and tamoxifen in high-risk, healthy women.

The federal government has funded one multimillion-dollar, multiyear environmental research study, the Long Island Breast Cancer Study Project, to determine whether environmental contaminants increase breast cancer risk. But overall, funding for environmental research represents only a tiny fraction of the government's budget for disease research. Of the National Institutes of Health's $15.7 billion budget last year, just $382 million, or 2.4 percent, went to the National Institute of Environmental Health Sciences, the primary agency conducting research on environmental health. Similarly, the CDC's National Center for Environmental Health received just $172 million for 1999.

Over the years, a growing movement has emerged calling for prevention-based research.

Breast cancer advocates and researchers have identified three important types of research currently underfunded by the federal government: testing and screening of industrial chemicals and pesticides for their toxicity and hormone-mimicking effects; measuring the levels of these chemicals in our bodies--a process known as "bio-monitoring"; and learning how girls and women are exposed to these chemicals, so we can study health effects and ultimately reduce health risks. In 1996, an advisory committee of scientists and experts established by the EPA recommended the creation of a program to test the toxicity and hormonal effects of 9,000 chemicals, as required under the Food Quality Protection Act. However, this program has been grossly underfunded. Development of the tests alone will cost $50 million over a period of several years. The program's proposed 2000 budget is only $12 million. Further, as currently devised, the tests do not screen for toxicity during the prenatal and early development period when chemicals have been known to have different and often more harmful effects. To fully understand the impact of environmental contaminants on humans, the EPA's data on the toxicity of these chemicals must be completed and complemented by an ongoing systematic program of bio-monitoring data to identify what chemicals exist in our bodies and at what levels.

Unfortunately, the CDC's National Environmental Health Laboratory, the agency that spearheads bio-monitoring research, is also severely underfunded. The Breast Cancer Fund is calling for more broad-based testing as well as testing on breast milk, a fluid that absorbs chemicals differently, and, in some cases, at higher and potentially more dangerous levels. Not only do women have the right to know what chemicals are in their breasts and breast milk, but investing in this kind of research is also a critical step to developing public policies and prevention strategies that will effectively address the breast cancer epidemic and other serious illnesses.

Yet research into the environmental causes of breast cancer remains a low priority among leading cancer organizations and government agencies. Advocates have attributed this lack of commitment, in part, to pressure from industry. Pharmaceutical companies, in particular, have a vested interest in keeping breast cancer research focused on drug therapies and away from environmental pollution. Breast Cancer Awareness Month was initiated by the pharmaceutical giant Zeneca, the maker of tamoxifen. [Activists often note Zeneca's link to Imperial Chemical Industries (ICI), the maker of pesticides, plastics, pharmaceuticals, and paper. Zeneca was a spin-off company of ICI, which was sued in 1990 by state and federal agencies for dumping DDT and PCBs in California harbors.] In 1999, Zeneca merged with the Swedish pharmaceutical company Astra to become the world's third-largest drug concern. AstraZeneca continues to be the primary sponsor of Breast Cancer Awareness Month.

If exposure to chemicals in the environment was shown to be associated with only 10 to 20 percent of breast cancer cases, and the U.S. acted to reduce or eliminate these hazardous chemicals, we would be able to prevent between 9,000 and 36,000 women from contracting the disease each year.



Copyright Ms. Magazine 2009