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Vol. 13 Issue 3, Summer 2008

Spring 2008 Regional Cancer and Environment Forum in Rochester
The Ribbon 

• New approaches to understanding and decreasing exposures to endocrine-disrupting chemicals
• The prevention of weight gain as a strategy to decrease breast cancer risk
• The Rochester Healthy Home

The Breast Cancer Coalition of Rochester hosted a very full house on May 29, 2008 when BCERF brought its twice-yearly Forum there. The 70 participants (the maximum number we could accommodate) heard and participated in four presentations by BCERF and University of Rochester faculty.

Prevention of Weight Gain as a Strategy to Decrease Breast Cancer Risk

Dr. Barbour Warren, Research Associate with BCERF, shared the scientific rationale for, and the design of, the BCERF project on obesity and breast cancer risk. Key characteristics of the project include:
• its preventive medicine approach (eliminating disease to decrease both mortality and morbidity),
• addressing breast cancer risk by preventing weight gain and physical inactivity,
• environmental change linked to eating and activity, and
• participants making daily, small, manageable changes.

Dr. Warren described why weight gain and obesity are good targets for a breast cancer risk reduction program for a wide range of reasons, including the extent of breast cancer risk associated with obesity, that the size of risk increases with weight gain and body mass index, and that they are relatively easily modified risk factors. Likewise, physical activity is an appropriate intervention due to its relationship with breast cancer risk, the fact that further decrease in risk is found with successively increased activity, and this risk factor’s modifiability. Epidemiologists see risk reduction effects of physical activity beyond those linked to weight loss.

Dr. Warren gave a fascinating review of how contemporary western women’s typical pattern of “calories in” versus “calories out” is in stark contrast to how we evolved in humankind’s historical environment, resulting in a mismatch of genes and environment. Our ability to efficiently store energy results in a susceptibility to obesity when our calorie intake is high and physical activity is low. Features of our contemporary environment that promote this level of caloric intake include soft drink consumption, meals eaten out, portion size, and advertising. Further, little physical work is required of most people and one-third of Americans report no physical activity.

The BCERF intervention that Dr. Warren described focuses on efforts to address these features of a community environment in a way that can be locally executed and sustained. Intervention sites have included a hospital, a school system, a government office building, and a nursing home. Goals have included specific increases in walking steps, and particular healthy eating choices, three days per week. The project is closely documenting its success in meeting these goals and making adjustments to address barriers. For more information, see http://envirocancer.cornell.edu/BCEResearch/obesity.cfm

The Estrogen Connection: Estrogenic Chemicals in Plastics, Personal Care Products and Electronics

This talk by Dr. Suzanne Snedeker, BCERF’s Associate Director for Translational Research, provided an overview of the background science and the risk reduction strategies that comprise BCERF’s Estrogen Connection Project. The Project “provides target audiences with tailored resources that suggest ways to decrease exposure to environmental estrogens found in everyday products that they may use, and ways to keep these chemicals out of our common environment.” The current focuses, as reflected in the new BCERF videos, are estrogenic chemicals found in cosmetics and other personal care products, certain plastics, and electronics. An important current dissemination strategy is reaching high school and college students through electronic means such as YouTube and Facebook, two popular web sites, the first for video hosting and the second for social networking.

Dr. Snedeker reviewed the basic background science supporting the Estrogen Connection approach. She discussed the relationship between levels of circulating estrogens and breast cancer risk, evidence of outside estrogenic agents, such as pharmaceuticals, playing a role in breast cancer risk, and the increasing evidence that widespread low-level exposures to the many estrogenic chemicals in our environments may contribute to risk. The ongoing work of Dr. Andreas Kortenkamp, a BCERF Forum speaker in September 2007, is contributing extensively to our understanding of this mixture effect. He and his colleagues are demonstrating additive estrogenic effects of combination exposures and environmental estrogens working together with the body’s own estrogen to increase breast cancer risk.

Dr. Snedeker then gave specifics about those environmental estrogens that are the current focus of the project, including bisphenol-A (BPA), ultra-violet screens and photostabilizers, nonylphenol, and certain heavy metals known as metalloestrogens, such as cadmium, nickel, and lead. For each chemical/metal, Dr. Snedeker explained where it is found, how we might be exposed to it, and ways to reduce exposure. For example, BPA is found in No. 7 polycarbonate plastics, in epoxy resins lining metal food cans, and in dental sealants. BPA leaches from plastic bottles with wear and tear, harsh detergents, and especially heat. Therefore she recommends hand washing these bottles, not leaving them in heat, never using worn or scratched bottles, and to consider using stainless steel or glass instead. Because of the transfer of BPA from can linings to food, Dr. Snedeker recommends minimizing use of canned foods with BPA epoxy liners. For information on these environmental estrogens and ways to reduce exposure, see: http://envirocancer.cornell.edu/research/endocrine/videos/summary.cfm

Heather Stone, MPH, joined BCERF in July as a program manager for the Estrogen Connection Project. She is developing, disseminating, and evaluating programming to support the Estrogen Connection videos for two target audiences, college students and community cancer groups. Heather is a new arrival from San Francisco, CA, where she recently completed her MPH in Maternal and Child Health at UC Berkeley. While in graduate school she worked on projects related to community nutrition and reproductive health. She also enjoyed volunteering in school gardens and evaluating new school lunch programs. Women's health has been a life-long focus and she is excited to be working with BCERF on the Estrogen Connection Project.

Obesity, Phthalates, and Reflections on the Big Picture (originally titled Phthalates, Obesity, and Insulin Resistance: First Looks)

Dr. Richard Stahlhut, an Environmental Health Post-doctoral Fellow at the University of Rochester, is lead author on a paper published last year in Environmental Health Perspectives entitled, “Concentrations of Urinary Phthalate Metabolites are Associated with Increased Waist Circumference and Insulin Resistance in Adult U.S. Males” (Volume 115, Number 6, June 2007). We invited him to speak on this paper and the science and epidemiology in which to situate its findings. His introduction complemented Dr. Warren’s talk, in that he provided further environmental and evolutionary context to help in understanding the obesity epidemic.

The background of the paper includes previous findings showing exposure to phthalates impairing rodent testicular function and being linked with anti-androgenic effects in humans, including decreased testosterone levels. Low testosterone in adult human males is associated with increased prevalence of obesity, insulin resistance, and diabetes.

The objective of Dr. Stalhut and his colleagues in their study was to investigate phthalate exposure and its associations with abdominal obesity and insulin resistance.

Phthalates are commonly used in plastics as softeners, in cosmetics and other personal care products, paints and wood finishers, toys, and many other common products.

US Federal lawmakers recently agreed to a ban against their use in toys and other baby products as part of a consumer product safety reform bill, following in the footsteps of California, Washington, and Vermont, as well as the European Union and several other countries. The US ban is effective February 10, 2009; toys containing phthalates will still be on the shelves in stores for some time. Children’s products, though, comprise less than five percent of the use of US-manufactured phthalates.

Stahlhut’s study was cross-sectional and involved US adult males in the National Health and Nutrition Examination Survey (NHANES) 1999–2002. Dr. Stahlhut and his colleagues modeled six phthalate metabolites with prevalent exposure and known or suspected anti-androgenic activity as predictors of waist circumference and insulin resistance, adjusting for age, race/ethnicity, fat and calorie intake, physical activity, and tobacco smoke exposure in one model. They adjusted additionally for renal and hepatic function in a second model. Results showed several of the metabolites associated with increased waist circumference and insulin resistance. Adjusting for liver function attenuated but did not eliminate most of these correlations. The conclusion to the paper states, “if confirmed by longitudinal studies, our findings would suggest that exposure to these phthalates may contribute to the population burden of obesity, insulin resistance, and related clinical disorders.”

Dr. Stahlhut also included in his presentation a lively discussion of our distinctive point in history in which we are exposed to chemicals for “years to decades before understanding and action.” He explained, “we do not yet have adequate scientific methods or even awareness to assess complex mixture effects” and that “by the time a threat is understood scientifically,” entrenched forces are at play to keep a chemical in commerce. He encouraged participants to take personal and political action to decrease exposures, but also to know that we can’t “be perfect,” nor do it all ourselves.

The Rochester Healthy Home: A Model for Integrated Toxics Education

Dr. Katrina Korfmacher is Research Assistant Professor and Community Outreach Coordinator in the Environmental Health Sciences Center (EHSC) of the University of Rochester. As Community Outreach Coordinator, she provides a link between environmental health research and the information needs of the community, with her primary focus being environmental health and justice issues of the communities in and around Rochester. She spoke about the Rochester Healthy Home – a partnership between the University of Rochester and community groups, and one of her projects related to childhood lead poisoning prevention and healthy homes – and hosted a special group tour of the facility following the Forum.

Dr. Korfmacher discussed the history of this project, beginning with the history of lead exposure and efforts to pass the local lead law in Rochester. A “Lead Lab” piloted a hands-on approach, and this type of education proved to be promising with other housing-based environmental health threats, such as mold, pests, carbon monoxide, asbestos, tobacco smoke, and toxic chemicals.

The core partners who were to establish the Rochester Healthy Home came together to discuss an integrated approach for older low-income urban homes and created their “Principles for Collaboration” in 2004. These partners included the University of Rochester EHSC, South West Area Neighborhood, Rochester Fatherhood Resource Initiative, Action for a Better Community, and Regional Community Asthma Network.

The approach of the Rochester Healthy Home includes providing: free tours in a home-like setting tailored to diverse audiences; information on health risks, home-based hazards, low cost solutions, and resources to support action; and follow up with individuals and groups. Inside the Healthy Home visitors find displays addressing chemical poisoning, lead poisoning, asthma, indoor air quality, and the solutions and resources with which to decrease those risks, such as a model “asthma-safe bedroom.”

Property owners, contractors, community groups, agency staff, school children, medical students, and residents/tenants of urban housing visit the Healthy Home. In its first year, 740 visitors from 95 groups visited, 25 organizations joined the Advisory Council, and $150,000 was secured through four grants. Evaluation results show that participants contact resource agencies, make physical changes in their homes, talk to landlords of their rentals, change housecleaning habits, and teach others. Future plans to expand programming include: addressing nutrition, obesity prevention, and gardening; addressing energy efficiency and sustainability; and reaching home health care professionals.

Dr. Korfmacher described the Healthy Home as a model for low-income home education that is effective for multiple audiences, can serve as hub for community activities, and can build on existing policies and programs. Its potential sustainability and replicability offer promise for urban communities struggling with the variety of health hazards that are so often present in their housing environments.

About 25 Forum participants joined the special group tour of the Rochester Healthy Home following the program and commented enthusiastically about the value the tour added to the day. If you are interested in visiting or for more information, contact the Healthy Home at (585) 529-9957 or visit the web site.

http://www2.envmed.rochester.edu/envmed/ehsc/outreach/CommunityPartners/CommunityPartnersHH.html

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Last Update 09.09.08