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Vol. 13 Issue 4, Fall 2008
On Monday, November 3, 2008, BCERF returned to Long Island to host its Fall Regional Cancer and Environment Forum at Stony Brook University. Meeting in the beautiful Charles B. Wang Center, we offered a new program schedule, starting in the afternoon and including an evening program with dinner, to help accommodate high school students and their families. We particularly sought young women’s participation in our effort to share and hear reactions to our Estrogen Connection project. We thank Karen Miller of the Huntington Breast Cancer Action Coalition and Laura Weinberg of the Great Neck Breast Cancer Coalition for their enthusiasm and support in planning and publicizing this program.
Contaminants Emerging in Our Water: Don't We Have Enough to Worry About?
Dr. Henry J. Bokuniewicz, a professor of oceanography at the Marine Sciences Research Center in the School of Marine and Atmospheric Sciences at Stony Brook University also serves as Director of the University’s Long Island Groundwater Research Institute. We invited him to speak on reports of emerging contaminants, particularly pharmaceuticals, in water supplies. Dr. Bokuniewicz suggested a perspective that recognizes that there is “contamination all around us.” He cited the 2002 US Geological Survey (USGS) report on US streams containing pharmaceuticals and personal care products. Despite the term “emerging contaminants” becoming a recognized way of describing these contaminants, most of them are not new. “Emerging” refers rather to our increased ability to detect them, at more and more minute levels. We can detect parts per trillion or even quadrillion, and, Dr. Bokuniewicz explained, can distinguish compounds down to one electron in some cases. He also cited the “explosion of pharmaceuticals,” with prescription drug use going up and percentages seven times the rate of population growth. The Associated Press report this past year alerted the country to pharmaceuticals in the water supplies of major metropolitan areas (see also Ribbon article in the Volume 13, Number 2, Spring 2008 issue, “Following the News on Pharmaceuticals in Drinking Water,” or online at http://envirocancer.cornell.edu/Newsletter/articles/v13DrinkingWater.cfm).
Dr. Bokuniewicz used caffeine as a case study for some of the perspectives he wanted to share. The USGS found 100 parts per trillion of caffeine on average in their samples. Caffeine “comes right through” sewage treatment plants, which are not designed to remove this nor any of the other chemicals discussed. Dr. Bokuniewicz provided examples of local Long Island work exploring these issues, such as that of Bruce Brownawell and Mark Benotti, whose samples found levels of caffeine in treated water slightly lower but similar to those that the USGS found. Dr. Bokuniewicz provided very helpful technical information about the Long Island aquifers, which supply all of the public drinking water. Benotti analyzed samples from one of the main aquifers on Long Island and found some of the compounds at levels as high as 67 parts per trillion, but not in many samples. Dr. Bokuniewicz explained that this may “represent degradation”; that the chemicals “didn’t survive the 50-year trip through the aquifer.”
Dr. Bokuniewicz suggested a comparison of a therapeutic dose to these amounts found in water, but also pointed out that these are compounds that are designed to work at very low levels. He reviewed some of the data on changed sex in fish populations, but also commented that fish “change their sex easily.” Nevertheless, he said that the ecological impact is not to be dismissed lightly. Dr. Bokuniewicz’s perspective was that there is “little we can do about medications not absorbed by the waste stream,” but that we must make it a point to properly dispose of all expired and unused prescription and over-the-counter drugs by, for example, taking them to a local hazardous waste collection event, or if none exist, disposing of them in household trash rather than flushing or pouring down the drain. See the handout from the NYS Department of Environmental Conservation from which Dr. Bokuniewicz adapted his own handout at the Forum, available at http://www.dec.ny.gov/chemical/45083.html.
Children’s Environmental Health Centers of Excellence: Partnerships Making a Difference
This talk was given by two collaborators on a very exciting project. Stephen Boese, the Executive Director of the Learning Disabilities Association of New York State (LDANYS), and Karen Joy Miller, the President of Huntington Breast Cancer Action Coalition (HBCAC) and the founder of Prevention Is The Cure (PITC), described their respective organizations and their mission of working together.
Boese began by outlining HBCAC and LDANYS. HBCAC was founded over 20 years ago on Long Island to raise visibility of the breast cancer epidemic, provide forums to encourage open dialogue, and to create opportunities for transdisciplinary research. Their strong focus on prevention evolved into the PITC campaign. LDANYS is affiliated with LDA of America, a nationally recognized children’s environmental health initiative, and is a statewide not-for-profit membership association of parents, professionals, and service organizations. LDANYS is concerned with the increases in learning and developmental disabilities – one in six children is affected – and Boese says that “a modest investment in prevention can reap huge benefits for the state.” Both organizations are acutely interested in the growing body of research on exposure to environmental toxins during critical periods of development increasing the risk of both cancers and neurological problems.
Boese described his and Miller’s history of participating in a working group, organized by Dr. Philip Landrigan of the Mount Sinai School of Medicine, developing and promoting the concept of the Children’s Environmental Health Center of Excellence. The many objectives of the Centers include evaluating, diagnosing, and treating children with diseases of environmental origin, along with various community education, support, and outreach objectives. Boese and Miller working together on the Centers corresponds well with the joint mission of HBCAC and LDANYS: promoting preventive and precautionary ideals, providing science-based information in understandable formats to those with limited science background, promoting informed decision making, influencing policy that reduces exposure to environmental toxins, and promoting community wellness. Boese described progress made to date, including the development of advisory boards and ensuring a statewide commitment. He informed the group of the toll-free number available for speaking with an environmental health expert: 1-866-265-6201.
Karen Miller shared the wonderful educational materials that they are developing for the Center, which include a coloring book, brochure, reference cards, and a game addressing lead contamination, endocrine disruptors, air pollution, and pesticides (or L.E.A.P., resulting in the project slogan, “Look before you LEAP”). Through this game children might learn, for example, to avoid bus fumes and not to put plastic toys in their mouths. She solicited the group’s feedback on the resources, and explained the approach used for their content and features. Reference cards are packed with information on what to avoid and what to choose in order to reduce exposures in the home, community, and broader environment, and in one’s lifestyle and diet. Even so, she explained, it’s always a challenge to determine the simplest wording and most important information.
For more information, see their websites: www.ldanys.org and www.hbcac.org
Genetic variation, environmental factors, and breast cancer risk
Dr. Mia Gaudet, Assistant Attending Epidemiologist at Memorial Sloan-Kettering Cancer Center in New York, provided an extremely useful background talk focusing on genetics and environment in breast cancer risk. She has co-authored several papers in this area, including the paper that investigated the relationship of breast cancer risk to exposure to polyaromatic hydrocarbons (PAHs), using the Long Island Breast Cancer Study Project data. In this talk, she provided background statistics, an overview of breast cancer risk factors, an explanation of the interaction of non-genetic and genetic factors, and directions for future research. She very much shares BCERF’s enthusiasm, saying, “it is an exciting time for the translation of research for the public.”
Dr. Gaudet provided the US estimates for breast cancer incidence for 2008: 125 new cases per 100,000 women, totaling 178,000 cases. New York State has the 13th highest state rate in the nation at 131 cases per 100,000, or 13,800 new cases this year. She described how incidence rose in the 80s, leveled off a little in the 90s, and is decreasing in the 00s. The decrease is found in those over the age of 50, with the decline in the use of hormone replacement therapy (HRT) largely responsible. Women are at risk of breast cancer throughout adulthood: from age 25 to 55 risk increases sharply, then increase occurs at a slower rate, and by age 80 there is a decline in breast cancer incidence. Incidence in African American women is higher in younger women than it is in white women, and lower later. Mortality is higher in African American than in white women at every age group.
Dr. Gaudet defined the term risk factor, emphasizing that risk factors are based on studies of populations, and that it is impossible to give an individual woman her risk of breast cancer. Importantly, having any given risk factor does not guarantee breast cancer in an individual. Risk factors are based on estimates and provide a guide of who is at higher or lower risk. Breast cancer has no “smoking gun” like lung cancer, but rather has a myriad of factors. Most of these weakly increase risk, and a few known factors strongly increase risk. Family history is one of the strongest risk factors: two or more first-degree relatives having had breast cancer increases one’s risk four-fold; one first-degree relative increases risks two- to three-fold. Family history is an indicator of shared genetics and environment.
Dr. Gaudet provided a brief lesson in “Genetics 101” before moving on to explain what science has accomplished in breast cancer genetics. An important graphic in her presentation showed that “genetic factors vary by frequency of variation and magnitude of breast cancer risk.” Eight genes have been verified to increase breast cancer risk, and there likely are additional genetic variations related to risk. Early work in the field located the rare genetic mutations that cause a high risk of breast cancer, BRCA 1 and 2. Other known variations carry moderate risk and are somewhat rare, and now, Dr. Gaudet explained, “work is focused on the end of the curve that is common/low risk,” and on African American women.
Questions of the identification of genetically susceptible individuals are becoming more and more important. Private companies are offering expensive testing. Dr. Gaudet emphasized that there is no government oversight of these tests and that there is uncertainty and concern about this among physicians and scientists. She continued in her talk to state that, “genetic variation is only a small fraction of the story,” and that “your genetic variation and environment act in concert.” She described some of the gene-environment interaction research underway, posing questions such as these: “How does the known genetic variation related to breast cancer risk alter the effect of environmental factors?” “Are early interventions of the environment possible to lower risk of genetically susceptible women?” Dr. Gaudet also outlined important research questions that are not yet being addressed and urged women to consider joining breast cancer research studies, particularly those with biological sample collection.
The Estrogen Connection: Estrogenic Chemicals in Plastics, Personal Care Products, and Electronics
Dr. Suzanne Snedeker, BCERF’s Associate Director for Translational Research, provided an updated version of her “Estrogen Connection” talk that she gave at BCERF’s Spring Forum in Rochester (summary in Volume 13, Number 3, Summer 2008 issue of The Ribbon or online at http://envirocancer.cornell.edu/Newsletter/articles/v13Spring08.cfm). For this Forum, the talk bridged to an evening dinner program, to which younger women were especially invited to view and share their thoughts about the three videos produced as part of the Estrogen Connection project. The videos address environmental estrogens in everyday products including plastics, cosmetics, detergents, and electronics.
An update to the earlier version of the talk included the recent federal agency activities and controversies surrounding bisphenol-A (BPA), one of the chemicals of concern in the project, that can leach out of canned foods, polycarbonate bottles, and dental sealants. Dr. Snedeker summed up new developments this way: the National Toxicology Program (NTP) recently reviewed the developmental and reproductive effects of BPA and regards the concern for the mammary gland as “minimal.” Meanwhile, the Food and Drug Administration (FDA) had released a report stating that the levels of BPA in the US food supply are not of concern. However, there is a controversy ensuing as to whether members of the FDA panel have conflicts of interest that may not have allowed unbiased contribution to the FDA’s review. Dr. Snedeker also mentioned that a scientific peer review of FDA’s draft assessment of BPA has recently been released. They cite problems in the FDA report, calling for a reassessment. In addition, the FDA has recently requested more information on medical devices that may contain and leach BPA. (This talk was videotaped and will be featured on CornellCast in the near future. CornellCast – found at http://www.cornell.edu/video/ – hosts video and audio recordings of lectures, discussions, and performances featuring members of the Cornell community and guests.)
Following the lecture and over dinner, Heather Stone, Program Manager for the Estrogen Connection project, and Dr. Snedeker then provided an informal setting to view the videos and collect reactions and action strategy ideas from participants. They brought along many examples of products and labels to examine with regard to their possibilities for containing estrogenic chemicals and four handouts overviewing the basics on avoiding estrogenic chemicals in makeup, plastics, canned food, laundry detergent, and electronics. The high school student participants provided a wealth of valuable input on strategies for reaching their peers and practical approaches for reducing exposures among younger people. They provided many suggestions on the next step in the Estrogen Connection project: developing credit-card-sized market guides on ways to avoid environmental estrogens in cosmetics, as well as “DOs” and “DON’Ts” for choosing alternatives to avoid environmental estrogens in plastics, household detergents, and electronics.
Program on Breast Cancer and Environmental Risk Factors
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