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AGENDA
I) Presentation and Commentary: 2006 4th edition of State of the Evidence
II) Review of the CHE Breast Cancer Discussion Group Consensus Statement
I) Presentation and Commentary: 2006 4th edition of State of the Evidence
Welcome and Introduction: Nancy Evans, Health Science Consultant, Breast Cancer Fund, and Editor, 2006 4th edition of State of the Evidence.
1. Report Introduction: Jeanne Rizzo, Executive Director, Breast Cancer Fund
The 2006 State of the Evidence Report was jointly published by Breast Cancer Fund (http://www.breastcancerfund.org) as well as Breast Cancer Action (http://bcation.org), San Francisco-based breast caner organizations with a shared quest to explain the rising rates of breast cancer in the United States, and the elimination of environmental and other preventable causes of breast cancer.
The report has helped leverage for policy change discussions, points to the trend towards a precautionary approach to environmental hazards, and has given integrity to advocacy. The report includes recommendations for four priorities for advancing the national research agenda, including consideration of timing of exposure, multiple and low-dose study, chronic and accumulative effects, exposure to women at home and in the workplace, socioeconomic status, development of less invasive and more effective screening methods, etc.
The report also includes a 10-point plan for reducing risk and ending the breast cancer epidemic, the idea being that these measures also reduce the risk of other cancers, and include: a federal and state national health tracking program, public education, corporate accountability, greater funding transparency, etc. More than ten thousand copies of the report have been disbursed.
2. Report Overview: Nancy Evans, Editor, 2006 State of the Evidence
<u> Basic Statistics: </u>
* Breast cancer is the most common cancer among women in world, behind skin cancer.
* In 2005, 211,000 women in the U.S. and more than 1 million women worldwide were diagnosed with invasive breast cancer.
* Last year, more than 40,000 died from breast cancer in the U.S., and more than 410,000 worldwide.
* Since 1964, the lifetime risk of breast cancer has increased from 1/20, to 1/8, and in some parts of the world and the country, 1/7.
* Genetic predisposition accounts for less than 10% of all breast cancer cases. Environmental exposures, defined in the report as exposures beyond an individual’s control (i.e. pesticides, dioxin, second-hand tobacco smoke, diesel exhaust, etc.) may be attributed to an unexplained 50% of cases.
* Increasing incidence parallels the rise of synthetic chemicals since WWII – there are 100,000 chemicals in use today, and at least 148 of them have been found in human bodies.
* Studies of cord bloods of newborns have shown as many as 200 chemicals.
* Many exposures interact with each other and effects may be additive or synergist, and specific links are difficult to prove, especially since factors may interact over years, and exposures may have occurred before birth or during childhood.
* The newest research shows that timing of exposure matters.
The evidence in the report is prevented in 3 parts: 1) Environmental factors known to cause breast cancer (i.e. Ionizing radiation, PVC, etc.) 2) Probable links to breast cancer (i.e. DDT, dioxin, PAH’s, and 2nd hand smoke) 3) Possible links (i.e. herbicides like atrazine, sunscreens, phthalates, EMF, etc.)
More than 340 studies (46 new) were included in the report. Most are not startling – they confirm what we know from earlier research, that we are exposed to far too many chemicals known to cause cancer in lab animals and wildlife.
3. Ana Soto, MD, Tufts University School of Medicine
Dr. Soto commented on the importance of the SOE and summarized recent scientific links between exposure and breast cancer, emphasizing the newly realized importance of timing of exposure.
Exposure to estrogens is a main factor for breast cancer development. The exposure is not only important from puberty to menopause and beyond, but recent epidemiological studies show that exposure to estrogens is relevant even before birth. Studies investigating di-zygotic twins show an enhanced propensity to develop breast cancer when compared to a single fetus pregnancy.
Other experiments have tested exposure to estrogen mimics in fetal life. Dr. Soto and her team studied perinatal exposure of Bisphenol A (BPA). BPA can be found in metal sealants, polycarbonate plastics, and many other products, and according to a CDC study, significant levels of BPA were found in 95% of human urine in the United States. The doses used by Dr. Soto’s team were within the range found in humans, and the study resulted in: 1) An increased sensitivity of mammary gland to the female hormone, estradiol; 2) Increased number of terminal buds at puberty, resulting in an increased number of terminal ends later on, which are the sites where breast cancer arises both in humans and in mice; 3) Increased sensitivity to estrogens, leading to the over-expression of progesterone receptors, which may also contribute to breast cancer – progesterone induces lateral branching of mammary ducts, leading to increased ductal density of the gland, which is also a risk for breast cancer.
This study, conducted with a low dose exposure, shows increasing risk of fetal origins of breast cancer when exposed to phenoestrogens that needs to be addressed. It was an exposure using merely one chemical, at levels currently found in humans – in reality, humans are exposed to many chemicals, and information about how to measure exposure is important, but we also need to learn how to reduce exposures and educate people about them.
4. Devra Davis, Ph.D., MPH, Executive Director, Center for Environmental Oncology, University of Pittsburgh
Devra Davis praised the SOE, mentioning that there exists certain evidence about some exposures, and reason to be suspicious about others. We should not need proof to take action – the epidemiologic requirements are unattainable. She praised the report for explaining that the concern is not only for breast cancer, but also for many diseases and conditions, due to the fact that pollutants do not carry passports, and cause more than one problem. The challenge is to figure out how to make sense of an array of information. Researchers need to rethink the questions we have asked in the past, and pursue studies about chemical interactions and mixtures in the future. Please check out the University of Pittsburgh’s Center for Oncology website at www.environmentaloncology.org.
5. Richard Clapp, D.Sc., MPH, Professor, Department of Environmental Health, Boston University School of Public Health
Dr. Clapp reiterated the importance of the SOE, and the importance of Dr. Soto’s research on BPA. BPA, in addition to electromagnetic radiation (EMF), are going to be developing topics in the field of environmental and occupational causes of cancer. Dr. Clapp and others conducted a study in an IBM plant located in San Jose, CA. The study found high levels of BPA and EMF exposure in the female employees working in the cleaning rooms at the plant. The relationship between BPA and EMF is important to study, since the mixture of the two may affect the workers in other ways than single exposure of either would.
Dr. Clapp also commented that epidemiologic standards need to be rethought – unattainable standards for evidence currently draw attention away from prevention. The 10-point plan in the SOE Report can help set us in the right direction.
6. Discussion
Ted Schettler, MD, MPH, commented that another interaction briefly mentioned in the SOE - early life nutritional factors (maternal diet during pregnancy) and development - can influence tissue development as offspring grows up and possibly predispose the offspring to certain diseases, further complicating epidemiologic studies.
Devra Davis, Ph.D., MPH, added that the Center of Environmental Oncology is doing an investigation into the effects of Omega-3 fatty acids on mammographic density, but that surveys of nutrition are complicated, and they are moving towards the use of biological markers, rather than asking people through surveys. Dr. Davis also commented on the Pratt & Whitney workers in the brain cancer study that is not scheduled for completion until 2009, even though ended in 2001. It is a 12 million dollar study, and many are prospering from it, which shows some of the challenges we are up against in public health research.
Brenda Salgado, Program Manager for Breast Cancer Action, commented on the importance of pushing research to look at timing of exposure, cumulative exposure, mixtures, and early-life exposure. She also suggested that SOE might help move policy in a precautionary direction.
Mandy Hawes, Founder of CalCOSH, also took part in the IBM worker investigation. She commented that exposures in the workplace are routinely thousands of times higher than tolerated in the environment, and that the disparity is worldwide and long overdue to be corrected. In addition, mortality files that many corporations have on their employees need to be made accessible to employees.
Janet Sherman, MD, referring to the Pratt & Whitney issues, commented that there are two nuclear power plants in Connecticut, and that the site is also downwind from Indian Point and across the bay from the old Brook Haven site. On page 21 of the SOE, the report refers to gamma rays, but in reality the problem is not so much the much gamma rays, but the 200+ isotopes emitted during normal functioning of the nuclear power plant, and have been implicated strongly with cancer.
II. Review of the Breast Cancer Consensus Statement
Diana Zuckerman, Ph.D., asked about what efforts will be made for the report or the consensus statement to be distributed to federal policy makers, and how CHE Partners can be helpful. She also wondered about the purpose of the statement, and to whom it will be distributed.
Jeanne Rizzo offered to discuss the process further offline, since the process includes more than simply mailing to policy makers.
Guy Dauncey, from Concerned Citizen in Canada, wondered why there is no mention of ionizing radiation in the consensus statement, and suggested that the end of statement have a stronger approach to solutions like clean production, green chemistry, toxics use reduction, etc. He also suggested the statement have a Global versus American focus, especially due to the recent Strategic Approach for International Chemicals Management (SAICM) agreement that recently took place in Dubai.
Michael Lerner mentioned that if any CHE Partners would like to be part of the CHE Breast Cancer Sub-working group, email julia@healthandenvironment.org. He also commented that it might be possible to have a global version of the consensus statement, in addition to a national version, but that the intention of the breast cancer group was to craft a consensus statement that any reasonable cancer organization in U.S. can accept. The group attempted to keep the statement as focused on the science as possible, and as neutral as possible. By letting the science speak for itself, the idea was to make the focus on the fact that for the first time that we know of, a community of breast cancer groups has come together to state their concern about, not only other breast cancer groups, but all disease groups. The hope was that the statement could be emulated across various disease groups.
The group considered possible next steps to be: one, present the statement to as many breast cancer organizations as possible; two, present to other cancer organizations; and three, present to other organizations with a strong focus on health.
Nancy Evans added that the statement is not just about breast cancer, but also about our collective health and environmental damages that affect all disease groups.
Devra Davis asked for Janet Sherman’s comment, given that she has seen much iteration, and there was a brief period when she was a member of the executive advisory to the EPA on Toxic Substances.
Janet Sherman commented that she believes the situation is much worse now – that there is less federal government interest. The EPA has just disbanded the library system that many EPA employees and the public rely on. Janet hopes that grassroots organizing will make the difference.
Karen Miller, President of the Huntington Breast Cancer Action Coalition, commented that the timing of the statement seems right, and that we should move forward with it as soon as possible. In order to lie out a plan for delivery, she suggested we spend the rest of the call commenting on the substance so that we can at least agree on that.
Brenda Salgado commented that Breast Cancer Action was pleased with the document, and she is also interested to see how it can be used to get the word out to other folks.
Nancy Evans added that if folks would like to sign-on to the statement, email: Nancy@BreastCancerFund.org.
Unknown Speaker asked about Silent Spring Institute progress on the Komen Foundation report, and wondered whether the statement and report should come out at the same time.
Kathleen Attfield, from the Silent Spring Institute, answered that the report should be submitted soon, and hopefully published in June or July.
Jeanne Rizzo commented that the consensus statement should come out first, hopefully by April or May.
Theo Colborn, Ph.D., commented that Dr. Soto’s work has been extremely important, especially due to the nanogram levels her team studied.
Guy Dauncey asked specifically for the reasoning behind leaving ionizing radiation out of the statement.
Michael Lerner responded that there are many factors that affect health such as nutrition, income disparities, racial issues, stress, radiation, etc., and that the challenge always is what to include and what to leave out. The group created a paragraph to discuss some of these interactive factors, and that EMF and ionizing radiation should be part of that list, but that headlining all of these issues would make the document complex. The choice was made to keep the statement focused on chemical contaminants.
Guy Dauncey replied that he did not read the statement as specifically focused on chemicals, and that there is sound science behind the health effects of ionizing radiation. For instance, he cites one study showing that women living within 50 yards of a nuclear reactor have an increased breast cancer risk of 14% – 40% while the reactor is operating. Stress and racism are not scientifically sound, he adds. Leaving it out of the statement weakens the argument that nuclear radiation is important, at a time when it may be a mistake to do so.
Unknown Speaker added that nuclear isotopes are chemicals with a radioactive tag.
Dick Clapp agreed with Guy Dauncey, that nuclear power and radiation exposure is a timely issue, and is going to be another global issue.
Devra Davis added that some epidemiologists have published critiques about the relationship between breast cancer and proximity to power plants, stressing that the association is not wholly accepted in the scientific community.
Michael Lerner added that if Ted Schettler were on the call, he might bring to bear a set of issues such as income disparity, stress, nutrition, that are very real issues in the scientific literature. CHE has a strong commitment to looking carefully at the preponderance of the evidence, especially in areas where many have less expertise.
