A Survivor & Provider on the Mammogram Recs

(Community Matters) Marjorie Gallece from the Breast Cancer Resource Center shares her perspective on the recommendations

First, please understand that the views I express here are mine and not that of any one organization. I belong to many.

The confusion and emotional spin from that task force report is causing a great deal of anxiety – mostly among survivors. I’m cringing at all the first person interviews and media coverage of breast cancer survivors and hope to explain why.

As survivors, we have a handle on the emotional and physical impact but our views are not always as well informed on the science of breast cancer.

I have a strong reaction when I see us being used in this way. It’s taken me several years to get a handle on that science and it’s been
changing.

Last night, I watched a segment on CNN with Carly Fiorina in California who is 8 months out of breast cancer treatment. She stated that she had her mammogram (that didn’t image the breast cancer) then found the lump a few weeks later. Her next statement was that “under these new guidelines, I would have had to wait 2 years for another mammogram!” Say what?! Once a lump is felt, women don’t even qualify for screening mammograms. We receive a diagnostic mammogram or MRI – a completely different
situation not affected by the guidelines. It’s not a part of basic population screening. I can only imagine what women who viewed that segment are now believing. CNN didn’t bother to correct this or fact check her statement.

Have we been oversold on the_impact_of screening mammography? Yes. It isn’t infallible but it’s all we’ve had – for far too long.
As a large population screening tool, it isn’t nearly as effective as everyone originally thought it could be. I think we can now imagine just how upset and betrayed our mothers felt when they learned about hormone replacement therapy (HRT). Between 1950 and 1990, the incidence of breast cancer increased by 53% in the United States. During this same period, despite  improvements in early detection, cancer treatments, and increased population based screening, breast cancer
mortality rose 4%. Since that time, treatment regimens have changed along with HRT recommendations.

Thousands of women are diagnosed with breast cancer every year who have no known risk factors other than being a woman and growing older. This is what underlies the efforts to shift the focus in the public health paradigm to involuntary environmental exposures to toxic chemicals, processes and products. In the meantime, with increased imaging, there is an entirely new group
of women with what has been termed “pre-cancers”. This makes up a rapidly expanding part of the breast cancer sisterhood.
I’m referring to women with DCIS and LCIS, or stage 0. Despite the large increase in this category, in theory, this massive
amount of earlier detection should be diminishing the number of women with invasive cancer. If we are actually diagnosing women with breast cancer earlier, that number should be declining proportionately, right?

Nope. Not even close.

In the meantime, more women with these “pre-cancers” are being channeled through surgeries and cancer treatment. The data has overwhelmingly indicated that only one in almost 2000 women might actually need it. This was known 10 years ago (!) and here it is again. This is a very bitter pill to swallow and the truth deflection games have begun once again. Last time, Congress intervened and lambasted the report and I believe many industries were behind that, fanning those flames.

So, while not abandoning mammography as a diagnostic tool, should we perhaps be placing more public health efforts to research this? In the meantime, here’s something promising in terms of better detection tools.

Last week, the Karmonos Cancer Center released this report:
http://www.karmanos.org/view_news.asp?id=658
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We can only hope that local imaging centers will be able to afford this kind of technology. It provides a shorter process with no breast compression. I bet this would cause a lower “call back” rate and fewer “no shows”. Wouldn’t it be great if CPRIT funded a large randomized comparison trial using this technology?

In the spin up last week, another report that appeared in Science (a journal) didn’t make the news. It should have because it impacts breast cancer. I’ve pasted it below.

*New Science for Chemicals Policy
**Megan R. Schwarzman * and Michael P. Wilson

*U.S. regulation of chemicals is in need of an overhaul, informed by
European legislation and guided by new thinking about risk.

“Over the last century, industrial chemicals have become ubiquitous in materials, products, and manufacturing processes used throughout society. In 2006, more than 34 million metric tons of chemical substances were produced in, or imported
into, the United States every day. ( 1). Over the next quarter-century, global chemical production is projected to double, rapidly outpacing the rate of population growth ( 2). These substances ultimately enter Earth’s environment; hundreds of chemicals are routinely detected in people and ecosystems worldwide ( 3, 4). Long-standing public policies governing chemical design,
production, and use need deep restructuring in light of new science on the health and environmental effects of anthropogenic chemicals. Such reforms are essential to safeguard ecosystem integrity, human , health, and economic sustainability.”

The end:

“New chemicals policies must confront multiple challenges: a backlog of unexamined chemicals; ineffective means of phasing out chemicals of concern; and the need for methods to apply emerging science on chemical hazards, such as EDCs, to inform precautionary decision-making. New approaches should enable action in the face of scientific uncertainty and should account for interrelated factors affecting human health and ecosystems. Well-intentioned environmental regulation has been plagued by the substitution of one hazard for another, such as the shifting of chemical risks from air to water, from the general population to workers, or from energy solutions to chemical hazards. No one policy can single-handedly prevent these missteps, but the next generation of environmental decision-making can better reflect interconnectedness in nature and society. ”

*****************************************************************

*NIEHS Director Birnbaum: “We jump from the proverbial fry pan into
the fire” when replacing chemicals *

Nov. 20, 2009
By Jane Kay, Environmental Health News

NIEHS Director Linda Birnbaum spoke at a scientific conference in Sausalito, Calif., sponsored by Breast Cancer & the Environment
Research Centers

Nearly a year ago, toxicologist Linda Birnbaum was named director of the National Institute of Environmental Health Sciences and the National Toxicology Program. She sat down with Environmental Health News journalist Jane Kay in San Francisco on Wednesday to answer questions about the environmental health risks we face today.

As head of the federal institute examining environmental health, Birnbaum and her staff are taking on many controversial topics,
including Bisphenol A and new flame retardants in consumer products. She explains how scientists are trying to figure out what role chemicals and contaminants may play in breast cancer and other diseases and health problems.

“I’m concerned about some of the plasticizers, including phthalates, and some of the flame retardants, especially the alternative ones,” she said. “In this country, we kind of jump from the proverbial fry pan into the fire without thinking about the alternative.”

Q: You say if you don’t ask the right questions in science, you are not going to find the answers. Your agency has just dedicated $30
million to study bisphenol A, the estrogenic chemical found in polycarbonate bottles and food can linings. What are some of the
questions we should be asking about bisphenol A and what are we doing to get the answers?

A: We’re emphasizing that we really need to look at the low-dose effects. We’re looking at many different targets – the mammary gland, the prostate and immune and cardiovascular systems.A: The $30 million program that we have on bisphenol A is looking at what can bisphenol A do, especially developmental exposures: At what doses do these effects occur and how serious are they? Some focus is on epidemiology but much of it is animal experimentation. We brought all of these investigators together in October to facilitate collaboration – sharing of samples, standards. We’re emphasizing that we really need to look at the low-dose effects. We’re looking at many different targets – the mammary gland, the prostate and immune and cardiovascular systems./
/Bisphenol A has often been called a weak estrogen. But it’s going to do some things that estrogen doesn’t do. So we have to look more broadly.

There are two recent human studies, one showing an effect on cardiovascular disease and one Kaiser Permanente study on workers in China (in polycarbonate-manufacturing plants) showing effects on male sexual function. Their occupational health standards are not as stringent as ours, and so there was a much higher exposure in that population. It’s kind of a new observation. The adult male effects are very interesting because we’ve seen similar effects in our animal studies. That strengthens my confidence in the new study. It needs to be repeated in another population, and we need a better understanding of how high the exposures really were in that population.

Q: Bisphenol A has attracted a lot of public and scientific attention. What other contaminants deserve that sort of attention?

A: I’m concerned about some of the plasticizers, including phthalates, and some of the flame retardants, especially the alternative ones.A: Anything where we have wide exposures in the population. Bisphenol A is not a persistent chemical. If it stopped being made, it would rapidly go away. Chemicals that are very persistent, we all need to look at because they are not going to go away. Sixty to 70 percent of the PCBs made are still out there. The levels are lower in our bodies than in our parents’ bodies, but PCBs are going to be around for a long time. In this country, we kind of jump from the proverbial fry pan into the fire without thinking about the alternative. *I’m concerned about some of the plasticizers, including phthalates, and some of the flame retardants, especially the alternative ones. They’ve now found chlorinated tris that was banned in babies’ pajamas 30 years ago in high levels in sediments. It’s a real concern. It’s used in carpet padding and cushion foam, and it’s being found in house dust. So people are being exposed. In this country, we kind of jump from the proverbial fry pan into the fire without thinking about the
alternative.

Q: The Food and Drug Administration has said it will announce a new policy statement on bisphenol A by the end of the month. What do you expect?

A: I don’t expect the FDA to come out and say the information is conclusive that bisphenol A is safe.A: I think the FDA is looking at
the newest science, and I think it is going to take some time for that to happen. I don’t expect the FDA to come out and say the information is conclusive that bisphenol A is safe. All the regulatory agencies are beginning to realize it’s important to update approaches and look at all of the available science. The guidelines from the past may not be addressing questions we’re asking today.

Q: Which exposures in everyday life do you consider the greatest risk factors for breast cancer?

A: I have concerns about early-life exposures, and how that may predispose for breast cancer later on.A: Some of our greatest risk
factors are obesity because of the excess estrogen associated with it. We know that women who are obese have a greater risk of breast cancer. If we’re talking about environmental chemicals, we know there are pharmaceutical exposures that may predispose women to breast cancer later on. We know hormone replacement therapy is associated with an increase in breast cancer. Since the report that it did cause breast cancer and many women have stopped taking hormone replacement therapy, we’ve seen a decrease in breast-cancer incidence, exactly what you’d predict for our understanding of how estrogens work. I have concerns
about early-life exposures, and how that may predispose for breast cancer later on. We know that exposing animals in utero, or during the infantile period, or puberty or pregnancy can alter the breast responsiveness and change what may happen later on.* *When you have cells rapidly dividing and differentiating, that is the time they are especially vulnerable to the effects of chemicals. If you expose an organ in utero or in the infantile period, it may never develop normally.

Q: What recent research funded by NIEHS shows the most promise for disease prevention in the near term?

A: Let’s identify the major sources of exposure, and work to control those.A: We have developed sensors to measure exposures. If we know what people are exposed to, then we can prevent the exposures. With bisphenol A, where is it all coming from? It’s not just baby bottles. It’s not just cans. How is it getting into us? Is it getting into our food, in our drinking water, in our house dust? Let’s identify the major sources of exposure, and work to control those. The very minor sources may not be an issue. NIEHS identified the BRCA1 and BRCA2 genes, which has furthered breast cancer research. There is also the “sister study” of 51,000 women followed for 10 years looking at nutrition, lifestyle, exposure to environmental chemicals and biological markers.

Q: What are we doing to answer the big questions: Are chemicals in the environment increasing breast cancer, reproductive diseases and neurodevelopmental/behavioral problems?

A: A study I’m trying to encourage is where you’d make a mix of what’s in the American population and expose animals to that mix.A: We’re addressing it at this point very much on a one-chemical-at-a-time basis. We need to begin to develop strategies to look more broadly because no one’s exposed to one chemical at a time. And we need a better understanding of whether the whole suite of chemicals in our bodies is associated with the problems. Nobody’s trying to look at the sum total. A study I’m trying to encourage is where you’d make a mix of what’s in the American population and expose animals to that mix. Maybe I would start in by looking at the high-end of the population. If we saw something in our animals, that would certainly be a concern. Now if we didn’t see anything, that doesn’t mean things aren’t happening. But I think it would be a study worth doing.

Q: Do you still have concerns about people’s exposures to the brominated flame retardants, PBDEs?

A: There is no convincing evidence that PDBEs are declining in people or wildlife in the United States. It’s too soon.A: Yes. There is no convincing evidence that PBDEs are declining in people or wildlife in the United States. It’s too soon.* *Manufacturers stopped production of penta and octa in 2004. The chemicals are still getting into the environment from existing products. Deca continues to be produced. Until recently, scientists didn’t measure deca in people. Deca rapidly metabolizes in people and wildlife but is very stable in the environment. PBDEs look as though they are on the decline in Europe where they were never used as widely as in North America. The European Union banned them in 2004. Germany banned them in the 1980s, and Sweden stopped use in the early 1990s. The peak levels in Swedish women occurred around 1997, and have since declined.

Q: Many experts talk about the “data gap” when it comes to our knowledge of the risks of chemicals. How substantial are these gaps
and how can we fill them? What new testing should be required?

A: If the levels where we see effects in the animals are similar, or within a factor of 10 or more than we see in people, then I think we
should be concerned.A: Some [gaps] we can fill by testing, and some by doing specific studies. We have to prioritize the data gaps of the greatest concern. As the first toxicologist heading NIEHS, I will bring in exposure science. Toxicology is a hybrid science that
examines the safety of different exposures using all the tools of molecular biology, analytical chemistry, biochemistry, physiology and pathology. Today’s toxicology is not our grandparents’ toxicology. It’s not the old-fashioned “dose ’em and count ’em.” I would like to see any study done on animals get a measure of the internal dose so we can compare the animal results to humans. We need to know if the levels in experimental animals that are associated with effects are similar to the levels that we’re finding in people. If the levels where we see effects in the animals are similar, or within a factor of 10 or more than we see in people, then I think we should be concerned. The standard tagline was “the dose makes the poison.” But it’s the dose and the timing that’s critical. Different things happen at different doses.

Q: You have said, “Animals may not be people. But people are animals.” Can you explain what you mean by that?

If we have chemicals that cause a multiplicity of effects in several species, why would we think that some people are not going to be
susceptible to the effects?A: Nature is inherently conservative. So many of the basic processes that govern development and physiology in fish, for example, are the same processes that occur in human beings. Some people are concerned whether rats or mice, or in some cases, cats or dogs or non-human primates, are good models for humans. If we have chemicals that cause a multiplicity of effects in several species, why would we think that some people are not going to be susceptible to the
effects?

For more information on Linda Birnbaum, go to
http://www.niehs.nih.gov/about/od/director/index.cfm
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out/\
<https://mail.bcrc.org/exchweb/bin/redir.asp?URL=http://www.niehs.nih.gov/ab
out/od/director/index.cfm>
od/director/index.cfm>

Jane Kay, who has been an environmental journalist for more than 20 years, can be reached at_JaneKayEnvironment
<mailto:janekayenvironment@…
<http://health.groups.yahoo.com/group/CapitalTexasTeamSurvivor/post?postID=Q
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46o9pdmU0GY34Hh6zA>  @gmail.com

Arlene Blum PhD
Arlene@…
<http://health.groups.yahoo.com/group/CapitalTexasTeamSurvivor/post?postID=1
A4HOngX6OF99wcDHUq6OOaaS3G7mQN4UUlaoHKRog80Rda1QsYroJ_HSGgcHhu6dqbZJuid-UBNe
c9IcEfn>  <mailto:Arlene@…
<http://health.groups.yahoo.com/group/CapitalTexasTeamSurvivor/post?postID=1
A4HOngX6OF99wcDHUq6OOaaS3G7mQN4UUlaoHKRog80Rda1QsYroJ_HSGgcHhu6dqbZJuid-UBNe
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Visiting Scholar, Chemistry
University of California, Berkeley
Executive Director, Green Science Policy Institute
Telephone: 510 644-3164 Mobile: 510 919-6363
Web: www <http://www.greensciencepolicy.org/
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The Green Science Policy Institute provides unbiased scientific information to government, industry, and non-governmental
organizations to facilitate more informed decision-making about chemicals used in consumer products in order to protect health and environment world-wide.

Marj

quoted with Marj’s permission