I Wish I Were Far From the Madding Crowd

March 28, 2010

Risk factors for breast cancer – Missing one of the major ones?

Up to a third of breast cancers could be avoided (Yahoo! News)

http://news.yahoo.com/s/ap/20100325/ap_on_he_me/eu_med_avoiding_breast_cancer

European breast cancer conference in Barcelona. Carlo La Vecchia cited figures from the International Agency for Research on Cancer (website).  I couldn’t find the precise source for the figures, but perhaps they came from “Estimates of cancer incidence and mortality in Europe in 2008” (abstract only).

Conference website – http://www.ecco-org.eu/Conferences-and-Events/EBCC-7/page.aspx/840

Abstracts – http://www.ecco-org.eu/Conferences-and-Events/EBCC-7/Abstracts-online/page.aspx/2177

Or go directly to http://ex2.excerptamedica.com/ciw-10ebcc/

Type in “cancer” in the search field.  You should get 655 abstracts.

The focus of the conference was clearly on diagnosis and treatment with little to no discussion of environmental factors.  Certainly screening, diagnosis, and treatment are critical, but shouldn’t we try to prevent as much as we can?

More from the Yahoo story

Dr. Michelle Holmes of Harvard University, who has studied cancer and lifestyle factors, said people might wrongly think their chances of getting cancer depend more on their genes than their lifestyle.

“The genes have been there for thousands of years, but if cancer rates are changing in a lifetime, that doesn’t have much to do with genes,” she told The Associated Press in a phone interview from Cambridge, Mass.

Could perhaps increasing exposure to substances in the environment change rates in a lifetime?  That doesn’t have much to do with genes either.  Though if you’re being exposed to chemicals that interfered with how your genes were turned on and off before you were born, or are interfering with that now, perhaps it does.

Breast cancer is the most common cancer in women. In Europe, there were about 421,000 new cases and nearly 90,000 deaths in 2008, the latest available figures. The United States last year saw more than 190,000 new cases and 40,000 deaths.

Tara Beaumont, a clinical nurse specialist at Breast Cancer Care, a British charity, noted that three of the major risk factors for breast cancer — gender, age and family history — are clearly beyond anyone’s control.

What about environmental exposure to chemicals?

IARC, on its World Cancer Day page, notes that it has an active program in the identification of carcinogenic risks. The IARC Monographs identify environmental factors—including chemicals, complex mixtures, occupational exposures, physical and biological agents, and lifestyle factors—that can increase the risk of human cancer.

In other words, there are several other environmental factors besides lifestyle that have been identified.  See the articles below for examples of how environmental factors could be contributing to breast cancer.

While the advice to eat less and exercise more is good (in fact, given that no one really has much direct control over environmental exposures that advice is probably even more important), I find it disturbing that the major risk factors cited in news stories seem to be reduced to diet, lifestyle, gender, age, and family history (that is, genetics), leaving environment out of the picture.

Why is that?  Because it’s easier to blame cancer victims than to confront companies and industries that sell us products that release substances that can mess with our health and who continue to release carcinogens and endocrine disruptors into our air and water?  (I’ll refer you again to the TEDX site, “Prenatal Origins of Cancer” for more information on that.)

Another perspective

In a post “do patients need doctor navigators to use the internet?”, David Collins discusses a March 25 New England Journal of Medicine opinion piece titled “Untangling the Web — Patients, Doctors, and the Internet” in which the authors “expressed a lot of concerns about how the internet is putting patients in touch with a lot of questionable information about disease” and about how they thought that changes the doctor-patient relationship in an adverse way.  (While they do raise some good points about the quality of some of the information on the Internet, I tend to agree with Collins.)

The reason I’m citing that here is the following statement from his post:

When I joined cancer public health in the ’70s the medical community almost universally rejected the idea that food and nutrition had anything to do with the prevention of cancer. People who talked about a relation between nutrition and cancer were sneered at and called the “fruits and nuts” crowd. Thirty-five years later as I approached retirement I had to chuckle inwardly many times about the current enthusiasm for the view that diet and nutrition are key to the prevention of much cancer. These days ya gotta eat your greens and grains!

So even the experts can change their minds….

Finally, it seems that environmental factors only really get attention when there are clusters of rare cancers.

Democratic Senators Eye New EPA Role Investigating Local Cancer Clusters

Environmental Policy Alert – March 24, 2010

From InsideEPA.com’s Environmental NewsStand (pay-per-view news)

Note: The site has a one-time offer of three free articles or documents by creating a new account today.

Senate environment committee Chairwoman Barbara Boxer (D-CA) and Sen. Bill Nelson (D-FL) are working on legislation that would give EPA and the Department of Health & Human Services (HHS) a major new role helping local health agencies investigate and address cancer clusters and communicate risks to local residents.

Press release from Sen. Bill Nelson on legislation

Nelson plans to preview testimony he’s been invited to give at next Wednesday’s hearing (my blog post on the March 17 hearing), which aims to find ways to strengthen the federal government’s hand in investigating cancer clusters, like the Acreage.

Recent Acreage blog post on Nelson’s efforts

Right now the federal Environmental Protection Agency ( EPA ) and Department of Health and Human Services ( HHS ) usually don’t get involved absent a request from a state.
“This effort is aimed at finding ways to bring in more federal resources more rapidly to help protect people, especially little children,” said Nelson, who’s also expected on Friday to announce he’s partnering with U.S. Sen. Barbara Boxer on new legislation to do the same.
Sen. Nelson’s testimony at Senate committee hearing on EPA and children’s environmental health
Advertisements

Blog at WordPress.com.

%d bloggers like this: