 FORGET
THE San Andreas Fault. The news that Marin County, Calif., had seen a
skyrocketing increase in the incidence of breast cancer unleashed an
earthquake of concerns.
Breast cancer jumped by 72 percent among
Marin women ages 46 to 64 during the 1990s, according to a May report in
the journal Breast Cancer Research.
“These high rates
set off a mobilization of people from throughout the Bay Area to work
together on solving this medical crisis,” says Fern Orenstein, a board
member of Marin Breast Cancer Watch, a local nonprofit group that has
sponsored community forums attended by thousands of residents as well as
researchers.
“While most cancer
researchers discount the role of the environment, that’s about 95 percent
of what people in the community talk about,” says Orenstein. Local
concerns range from the possible roles of radioactive dumping and nuclear
submarines in the San Francisco Bay to hazardous chemicals in Richmond
Harbor to toxic fuel from jetliners and pesticides on suburban lawns.
Here, as in many
places, relatively little research has focused on possible environmental
links to the disease. But last week, California received nearly $1 million
from the federal Centers for Disease Control and Prevention to plan a
surveillance system to track chronic disease and its links to the
environment. It is one of 20 states beginning to do such tracking.
STATE OF THE SCIENCE
In August, two groups, The Breast Cancer Fund and Breast Cancer
Action, released “The State of the Evidence,” a report compiling results
from many studies that they say already show links between environmental
toxins and breast cancer. Among the findings: Common pollutants, such as
benzene, a compound found in car exhaust, are linked to breast tumors, and
people who move to industrialized counties suddenly face a higher breast
cancer risk within one generation.
But critics complain
that research institutions haven’t focused enough on this kind of
investigation.
Federal cancer
research spending has increased dramatically, from $90 million in 1990 to
$800 million in 2001, but less than 3 percent of those dollars have been
focused on finding environmental links to breast cancer, according to the
National Breast Cancer Coalition.
The American Cancer
Society, for example, downplays the possible connection. “Currently,
research does not show a clear link between breast cancer risk and
exposure to environmental pollutants,” the society says on its Web site.
While acknowledging that some studies have suggested links, the society
insists that these likely account for only “a small portion of breast
cancer cases.”
And some activists
fear the National Cancer Institute (NCI) is unlikely to invest
significantly in more environmental research since its expensive effort
with the Long Island Breast Cancer Study . By far the biggest investment
of its kind, costing $30 million over nine years, the project was a
multistudy attempt to investigate whether pollution was responsible for
high rates of the disease in several New York counties. The NCI concluded
earlier this year that pesticides such as DDT were not linked to breast
cancer on Long Island.
 But
Brenda Edwards, associate director for the NCI’s surveillance research
program in Bethesda, Md., dismisses such concerns: “NCI has and will
continue to fund research on the causes, diagnosis, detection, treatment,
survivorship and surveillance of cancer. This has included and will
continue to include investigations related to health-related environmental
factors,” she says.
The Long Island
study has been heavily criticized, however, for failing to look at more
relevant chemicals than long-banned compounds as well as at potential
radiation exposure.
“The Long Island
study results were confused, but the growing breast cancer numbers and the
Marin County data certainly should trigger very hard discussion of
[prevention-oriented research] at the highest levels,” says Dr. Phillip
Lee, a former assistant secretary for the U.S. Department of Health and
Human Services, now an emeritus professor of medicine at the University of
California, San Francisco.
The NCI’s latest
numbers, released this month, show that the agency had previously
underestimated the incidence of cancer in the United States. In the case
of breast cancer, new diagnoses have, in fact, been growing at a rate of
.6 percent per year nationwide.
QUESTIONS ON RISING RATE
Some activists expressed outrage at the new NCI numbers and said they were
a further argument for investigating as-yet unstudied environmental
factors.
“Every year, there’s
a press release about how we’re winning the war on cancer. We’ve been
warning for years that the emperor has no clothes. Now the emperor has
just stood up on stage naked and said, ‘Whoops!’” says Barbara Brenner,
director of Breast Cancer Action.
Adds Shelley Hearne,
director of the nonprofit advocacy group Trust for America’s Health: “The
discovery that several common forms of cancer are rising — not declining
or leveling off as previously thought — reveals serious shortcomings in
the way this country keeps track of cancer and other chronic diseases.”
"Something environmental has to be going on, since we haven’t had a steady
change in genes of such magnitude,” she says.
The NCI’s Edwards,
however, attributes the increase to better early-stage detection, and a
miscalculation caused by delays in hospitals’ reporting patient data. She
adds that breast cancer deaths will continue rising as the population
ages.
“If you look at what
we know today, the greatest risk is due to reproductive factors ... as
well as lifestyle factors like alcohol and smoking,” she says. “If [the
environmental component] is there, it’s very hard to measure, especially
exposure over time. It’s not that I want to discount the environment, it’s
just that it’s very difficult to study.”
Dale Sandler, deputy
chief of the epidemiology branch at the National Institute of
Environmental Health Sciences, thinks the increase in breast cancer, while
not drastic, deserves more study. “With correction for error and the now
statistically significant trend, it will be less easy to be complacent,”
Sandler says. The fact is, she admits, “we have very little information on
the potential role of environmental exposures in breast cancer risk, and
more research is needed.”
Francesca Lyman is an
environmental and travel journalist and author of “Inside the
Dzanga-Sangha Rain Forest” (Workman, 1998).
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