Inside Prevention

Study shows increase in metastatic breast cancer at first diagnosis for young women

A paper published yesterday in the Journal of the American Medical Association describes a small but statistically significant increase in the incidence of breast cancer with remote metastases (breast cancer that has spread to other parts of the body, including the bones, brain and lungs) at first diagnosis for women aged 25 to 39 years.

This statistical study examined the incidence of breast cancer in women in the U.S. from 1976 to 2009. The increase in remote metastases at first diagnosis was not seen in older women. There was also no increase in the incidence of local breast cancer (confined to the breast only) or regional breast cancer (cancer that has spread to adjacent organs like lymph nodes or the chest wall) diagnoses in younger women.

There's been a lot of commentary on this paper already, some of which has been potentially misleading. Our friends at the Young Survival Coalition have published an in-depth and thoughtful blog post on this paper that puts this new data into context.

There is a need for more research to confirm this finding—something the paper's authors agree needs to be done.

If this increase is confirmed, we need to find out how such an increase could occur within a single generation of women. In particular, we want to know what's causing metastatic breast cancer—including potential environmental exposures—among women of all ages.

U.S. report urges deeper look into breast cancer's environmental links (Center for Public Integrity, 2/12/2013)

More coverage of this week's major report release, this from the Center for Public Integrity:

Compiled by the congressionally mandated Interagency Breast Cancer and Environmental Research Coordinating Committee, the report notes that most cases of breast cancer “occur in people with no family history,” suggesting that “environmental factors — broadly defined — must play a major role in the etiology of the disease.”

Yet only a fraction of federal research funding has gone toward examining links between breast cancer and ubiquitous chemicals such as the plastic hardening agent bisphenol A; the herbicide atrazine; and dioxin, a byproduct of plastics manufacturing and burning, says the report, prepared for Health and Human Services Secretary Kathleen Sebelius and released today.

“Prevention needs to be as important as other investments that are made in screening, treatment and access to care,” Jeanne Rizzo, co-chair of the committee and president of the San Francisco-based Breast Cancer Fund, said in an interview. (Read complete article.)

Emphasizing breast cancer prevention (San Francisco Chronicle, 2/11/2013)

The San Francisco Chronicle weighed in on yesterday's game-changing report in an editorial that urges lawmakers to take action:

"So now it will be up to the Obama administration and Congress to act on this compelling case to prioritize prevention on a disease that is costing 40,000 lives and more than $17 billion a year...This report should give Washington the political will it needs to put the nation's health interest first."

The editorial echoes (and quotes) the voice of Breast Cancer Fund President and CEO Jeanne Rizzo:

"We are all exposed to a cocktail of carcinogens and endocrine disrupters every day that puts us at greater risk for breast cancer, and we need to prioritize and invest in identifying and preventing exposures to these chemicals."(Read complete article.)

Welcome to the breast cancer prevention era? (Huffington Post, 2/13/2013)

Read and share this new Huffington Post blog by Jeanne Rizzo, President and CEO of the Breast Cancer Fund, as well as co-chair of the federal advisory committee that yesterday released a report concluding that preventing environmental exposures is the most promising path to decrease incidence of the disease.

Is this indeed the start of a new era in breast cancer awareness, research and -- yes -- prevention? We hope so.

If you're under 50, you can't remember the dark days when the tobacco industry was winning the PR war, insisting that smoking wasn't linked to cancer. That all changed in 1964 when the Surgeon General's report on smoking and health created a seismic shift, alerting the nation to the health risks of tobacco and, notably, moving the focus from individual behavior to the public-health impacts of smoking. The report ushered in an anti-smoking era, complete with a national strategy that reshaped the research agenda and inspired policies and public education initiatives that greatly reduced smoking across the nation.

With the release of a groundbreaking federal report today, there's hope that we're entering a breast cancer prevention era -- one in which my young granddaughters won't remember a time when the chemical industry got away with its story that breast cancer isn't linked to chemical exposures, and when the only focus on prevention was on personal behavior. (Read complete article.)

Report faults priorities in studying breast cancer (New York Times, 2/12/2013)

The New York Times spoke with Breast Cancer Fund President and CEO Jeanne Rizzo about yesterday's groundbreaking report, "Breast Cancer and the Environment: Prioritizing Prevention." Jeanne served as co-chair of the federal advisory committee that produced the report.

Jeanne Rizzo, another member of the committee and a member of the Breast Cancer Fund, an advocacy group, said there was an urgent need to study and regulate chemical exposures and inform the public about potential risks. "We’re extending life with breast cancer, making it a chronic disease, but we’re not preventing it," she said.

"We have to look at early life exposures, in utero, childhood, puberty, pregnancy and lactation," Ms. Rizzo said. "Those are the periods when you get set up for breast cancer. How does a pregnant woman protect her child? How do we create policy so that she doesn't have to be a toxicologist when she goes shopping?" (Read complete article.)

We're making history today

"Evidence suggests that breast cancer can be prevented."

While these words might not seem revolutionary to those of us who have been working to prevent the disease for years, they will make big news today because of who is saying them: a federal committee of leading breast cancer experts, co-chaired by Breast Cancer Fund President and CEO Jeanne Rizzo. The committee’s report calls for a shift in the multi-billion dollar breast cancer research agenda toward prevention. That’s groundbreaking! 

This congressionally mandated Interagency Breast Cancer and Environmental Research Coordinating Committee concludes that preventing exposure to environmental risk factors is the most promising path to decrease incidence of the disease, and is the "key to reducing the burden" on individuals, families and society. 

Sound familiar? That’s because this report builds on work the Breast Cancer Fund has been doing for more than a decade. We were honored to be part of developing this important report, and will continue to work to bring about its vision of a sea change in the way our society views and understands breast cancer.

Read our press release, take action and stay tuned for more information about this paradigm-shifting report.

DES and breast cancer lawsuit settled

Big news yesterday out of Boston: Pharmaceutical giant Eli Lilly has settled a case brought against it by four sisters who developed breast cancer in their forties, decades after their mother took the synthetic estrogen DES (Diethylstilbesterol) during her pregnancies. A total of 51 women have filed lawsuits in Boston against more than a dozen companies that made or marketed DES, and this was the first case to go to trial. The settlement was announced Wednesday on the second day of testimony.

This is the latest chapter in the tragic legacy of DES. Between 1938 and 1971, doctors prescribed DES for millions of pregnant women to prevent miscarriages – without having been tested for its effect on fetuses. It is now clear that not only was DES ineffective for preventing miscarriages but it had devastating effects on those exposed in the womb. The drug was banned when daughters of women who took the drug were found to have higher rates of an extremely rare vaginal cancer when compared to the daughters of women who did not take the drug. Later, evidence emerged that DES exposure is also associated with an increased risk of breast cancer in the women who took it during the 1950s.

In a follow-up study of daughters who were exposed prenatally to DES, a nearly twofold increase in breast cancer risk was observed in women older than age 40. An even greater effect was found for women over the age of 50, although relatively few of the daughters had yet reached that age at the time of the study. Women exposed in utero who had the most severe abnormalities of their vaginal epithelial cells (an indicator of exposures to higher doses of DES) also had a higher risk for developing breast cancer. The evidence about the health consequences of DES was one of the first indicators that exposure to endocrine-disrupting compounds in the womb can increase risk for later life breast cancer.

The story of DES should serve as a cautionary tale. This tale underscores the need for chemicals testing protocols that consider the risks of exposures early in life. We need chemical testing that looks at the effects of chemicals across the lifespan and that measures early signs for concern – such as exposure-induced changes to how the mammary gland develops – if we are going to prevent such tragic events in the future. And this evidence needs to be folded into comprehensive chemicals policies that ensure these kinds of exposures do not occur as the result of prescribed pharmaceuticals or from inadvertent exposure to chemicals used for other purposes. 

Now undeniable: Breast cancer that comes with the job (Huffington Post, 11/26/2012)

Our own Jeanne Rizzo published her thoughts about the recent Canadian factory worker study on Huffington Post yesterday. Now we have evidence that women who are exposed to hormone-disrupting chemicals in food canning and plastics factories have a sharply higher risk of breast cancer—so what will we do about it? And who will act on behalf of these women?

Unfortunately for these women workers and for all of us (for we too are exposed to some of these chemicals on a daily basis), many industry and government leaders refuse to act based on biological plausibility. Instead, they prefer plausible deniability, saying we need more and more and more evidence—incontrovertible truth, in fact—before we take action. (Read complete article.)

Related articles

Can certain jobs cause breast cancer? A new study suggests yes (The Daily Beast, 11/21/2012)

Jeanne Rizzo: Now Undeniable: Breast Cancer That Comes With the Job

Study spotlights high breast cancer risk for plastics workers (Center for Public Integrity, 11/19/2012)

Can certain jobs cause breast cancer? A new study suggests yes (The Daily Beast, 11/21/2012)

Florence Williams, author of the acclaimed book, Breasts: A Natural and Unnatural History, spoke with Breast Cancer Fund President and CEO Jeanne Rizzo for a piece on The Daily Beast describing a new Canadian study.

The study authors found a higher risk of premenopausal breast cancer among women working in factories that make canned foods and plastic parts for automobiles:

Both the automotive and canning industries are known to use chemicals that affect hormone systems in lab animals, such as BPA, phthalates, and flame-retardants. Phthalates, which are used to make plastic malleable for molding car interiors, have been associated with lower sperm counts in men. BPA, used in the lining of food cans, has been banned from some products in Canada.

“The U.S. has not conducted this kind of workplace study,” said Jeanne Rizzo, president of the Breast Cancer Fund, a California-based nonprofit. “Federal agencies should immediately look into similar occupations in this country and take this seriously.” (Read complete article.)

Study spotlights high breast cancer risk for plastics workers (Center for Public Integrity, 11/19/2012)

Researchers have found a fivefold increase in breast cancer risk for pre-menopausal women who worked in factories that make food cans or plastic automotive parts, as compared to a control group from the same industrial community. In the course of their work, these women were likely exposed to carcinogens and hormone-disrupting chemicals like BPA, phthalates and flame retardants.

The study was published today in the journal Environmental Health; the Center for Public Integrity interviewed Breast Cancer Fund President and CEO Jeanne Rizzo for an in-depth story also out today: 

“These workplace chemicals are now present in our air, water, food and consumer products,” said one of the two principal investigators, James Brophy, an adjunct faculty member at the University of Windsor and a former occupational health clinic director. “If we fail to take heed then we are doing so at our own peril.”

Jeanne Rizzo, president of the Breast Cancer Fund, a San Francisco-based group that has pressed for more research into environmental causes of a disease that claimed nearly 40,000 lives in the United States last year, called the Windsor study “a very powerful piece of work. The piece that’s really been missing for female breast cancer is occupation.” (Read complete article.)

This is big news—and a call to action for industries and governments to do more to protect workers from toxic chemicals.