September 2006 Forum Summary
Cancer and Environment Forums

At the suggestion of the staff of Senator Carl L. Marcellino (District 5, representing parts of Nassau and Suffolk Counties on Long Island, New York), the Fall Regional Cancer and Environment Forum took place at the beautiful Planting Fields Arboretum State Historic Park, in Oyster Bay. Approximately 65 activists, cooperative extension educators, state and local health and environment agency staff people, and other community members participated in this program held on September 28, 2006. The day opened with the recognition of Senator Marcellino's support for the BCERF program.

In organizing these programs, BCERF tries to highlight some issues of particular interest to the region where the event is taking place, such as research addressing a local study population, or local policies relating to risk reduction. In addition, we always highlight a current BCERF project, so that new as well as veteran participants of the BCERF Forums can learn about or stay current with what we do.

Shift Work, Light at Night, and Breast Cancer on Long Island.

Dr. Erin O'Leary presented her recently published research, Shift Work, Light at Night, and Breast Cancer on Long Island [American Journal of Epidemiology 164 (4), 358-366]. This study, part of the Long Island Breast Cancer Study Project, helps examine the hypothesized relationship between breast cancer risk and circadian rhythm disruption. This hypothesis, as stated in the published paper:

...involves the hormone melatonin, which is secreted by the pineal gland and follows a circadian rhythm according to the light:dark cycle in most people; melatonin levels are low during the day and peak at night ... Exposure to artificial lighting during the night could suppress the normal nocturnal rise in melatonin, which could in turn increase circulating estrogen levels or inhibit tumor anti-proliferative mechanisms and possibly increase breast cancer risk.

Dr. O'Leary described the study population and methods. The 576 women with breast cancer (cases) and 585 population-based controls were interviewed about their exposure histories; in this case, meaning their employment history specifically with regard to night shift work, and their light at night at home. This study generated mixed evidence for the hypothesis, Dr. O'Leary explained. While many other studies have reported an elevation in breast cancer risk with night shift work, this one did not. (In fact, Dr. O'Leary's group found overnight shift workers to be at lower risk than women never working shifts.) They did, however, find an increased risk in women who frequently turned on lights during sleep hours. This could indicate some support for the hypothesis, or it could be the result of "response bias," or, different recall between cases and controls. Because of the inconsistency of research results to date on this topic, Dr. O'Leary and her co-authors recommend future studies with improved methods for measurement of shift work, nighttime light exposure, melatonin levels, and any genetic variations which might affect an individual's response to these exposures.

The Coram, Mt. Sinai, Port Jefferson Station Follow-Up Investigation Report

A team of four New York State Department of Health (NYS DOH) staff members presented the results of this study, which is part of the New York State Cancer Surveillance Improvement Initiative. The study addressed seven contiguous ZIP code areas within Long Island's north shore, which were identified as having a higher than expected incidence of breast cancer in the time period 1993 to 1997. The four presenters - Maria J. Schymura, Director, New York State Cancer Registry; Don Miles, ATSDR/Long Island Section, Bureau of Environmental Exposure Investigation; Kenneth G. Bogdan, Bureau of Toxic Substance Assessment; and Gena Gallinger, Cancer Mapping Coordinator - gave background and overviews of the major parts of the study.

It is important to keep in mind that this investigation was designed to be able to generate hypotheses - an important step toward being able to identify the causes of the breast cancer rates in this region. This broad-based population-level study was focused on identifying any unusual environmental or other factors that might explain the locally elevated breast cancer incidence, and which might call for further study.

The NYS DOH presenters provided information on the main elements of the investigation:

Epidemiologic Evaluation. In this part of the investigation, epidemiologists analyzed breast cancer data, known breast cancer risk factors and additional information about women living in the study area. They concluded that the higher than expected breast cancer rate in this area does not stand out as significantly different from the rest of NYS when statistics accounted for income and education (commonly accepted surrogates for some known risk factors, such as delayed childbearing, but may also include environmental factors). This part of the study also analyzed the length of residence in the study area for those diagnosed with breast cancer. They concluded that, "an appreciable proportion of women with breast cancer in the area may be recent arrivals," which makes the environmental exposures of this subset of women in the study area less relevant.
Environmental Exposure Evaluation. This part of the investigation focused on what contaminants and levels of contaminants might be different or unusual in the study area compared to the rest of NYS or the county. NYS DOH researchers examined multiple databases for information on: air quality; in-home radon; pesticide use; hazardous waste sites; industrial sites; public and private drinking water; electromagnetic fields; as well as incidents such as spills, waste water discharges and fish advisories. Any unusual findings - such as several elevated air contaminants and four particular pesticides of concern - were recommended for the final phase of the investigation, the Integration Evaluation (see below). However, for the majority of environmental exposures investigated, the study area showed similar or lower levels.

Note: additional information on all aspects of this study, including the expansive number of environmental exposures considered, the methods for the toxicological evaluation, and details on conclusions can be accessed at: http://www.health.state.ny.us/environmental/investigations/cmp/ or call (800) 458-1158, ext. 27530

Toxicological Evaluation. NYS DOH researchers developed a classification scheme for the potential of 167 substances to increase breast cancer risk. In this system, used for the first time in this project, substances are classified by a weight-of-evidence approach into one of four groups (one with three sub-classifications), spanning from "known risk factor for human breast cancer" to "unlikely to be a risk factor for human breast cancer." This process resulted in the following category assignments:
Integration Evaluation. Information gathered and reviewed from the above three efforts was then used to evaluate the breast cancer (and other health) risks of any elevated contaminants in the study area. Researchers considered: confidence in the environmental data to estimate exposure, classification of the contaminant as a risk factor for human breast cancer, and the likelihood that the estimated level of exposure could cause breast cancer or other health effects. Thirty-one contaminants were evaluated (27 air contaminants and 4 drinking water contaminants). Researchers concluded that none of the contaminants or their mixtures are likely to be related to elevated breast cancer rates in the study area. (Much more information about the methods and results of the Integration Evaluation are available in the NYS DOH's Final Integration Report, available through the web site or telephone number in the box.)

NYS DOH recommends continued surveillance of the study area, consistent with other statewide activities, including updating ZIP code-level cancer data, identifying and classifying potential environmental exposures, and providing public health education relating to cancer and other health conditions and environmental exposures. The four NYS DOH representatives took questions during their session and were generous to volunteer to continue discussion into lunch.

Turf Pesticides: Applicator Pilot Study and the Cancer Risk Database. After lunch, Dr. Heather Clark, Research Associate at BCERF, presented on Turf Pesticides: Applicator Pilot Study and the Cancer Risk Database. (Please see the article on this project in this issue.)

Suffolk County's Pesticide Phase-Out Legislation: Panel Discussion

A panel of three discussed various aspects of Suffolk County's Pesticide Phase-Out Legislation. All are members of the county's Pesticide Community Advisory Committee (CAC) (see box below), appointed to oversee and carry out the legislation.

Amy Juchatz is chair of the Pesticide CAC and works for the Suffolk County Department of Health Services as a Health Program Analyst.
Joyce Rodler is an integrated pest management specialist with Cornell Cooperative Extension (CCE) of Suffolk County
Dr. Tamson Yeh is an integrated pest management and turf specialist, also with CCE of Suffolk County.

Suffolk County Code Chapter 380 "…the purpose of this law is to phase out the use of pesticides by the County for many pest control purposes and to adopt a pest control policy that substantially relies on non-chemical pest control strategies…"

"…A Suffolk County Advisory Committee (CAC) is hereby created to oversee the implementation of this law by the County Department of Health Services…" forum participants

Amy Juchatz discussed the workings of the CAC, which, aside from her and the CCE representatives, is composed of designees from Vector Control, the Commissioner of Parks, the cancer advocacy community, and the medical community. With miles of public beaches, 37,000 acres of parkland, three County golf courses and ownership or leases of over 300 buildings, the legislation's mandate is enormous. Because non-chemical pest control strategies are largely dependent on prevention, The CAC developed a comprehensive Integrated Pest Management Program focused on improving education, sanitation, maintenance, and repair efforts throughout County-owned buildings and properties. The committee also deals with yearly re-evaluations of exemptions, which include situations such as public health emergencies, low-toxicity pesticides used for the control of vectors capable of transmitting diseases, or County-owned property leased to another party.

Suffolk County CCE is a critical partner in carrying out this legislation, through its Pest Management Program. CCE is not a regulatory agency, but an educational resource, and much of what the CCE panel members, Joyce Rodler and Dr. Tamson Yeh, emphasized were the many ways in which education and community involvement are the keys to successful pesticide phase out. Joyce discussed the "Clean Up, Close Up, Common Sense," program she facilitates, which reaches County employees at all levels and the "Live Bug Show," which gets the message across that "all bugs are not bad," - a key concept with regard to pest management. She described methods and tools for effective communication between all those involved with non-chemical pest control, such as the Pest Communication Log Book, for establishing pest control related interaction between employees, clients, and management in a public building. With ten thousand employees and 1.3 million residents working, doing business, learning or playing in county properties nearly every day, there is a lot of communication needing to happen. With her very creative delivery, Dr. Yeh reiterated many of the basic tenets of integrated pest management (IPM) and the common sense - and creativity - they require on the part of everyone involved.

September 2006 Forum Summary Cancer and Environment Forums

September 2006 Forum Summary
Cancer and Environment Forums