The National Cancer Institute has released some eye-opening new figures revealing that not only is the United States not winning the war on breast cancer, but the enemy has been gaining on us over the past 15 years. That has prompted environmental health advocates to demand more and better research into the possible role of pollutants, radiation and other environmental factors in driving the dreaded disease.
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.
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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.”
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