Copyright © National Academy of Sciences. All rights reserved. Breast Cancer and the Environment: A Life Course Approach Breast Cancer and the Environment A Life Course Approach Committee on Breast Cancer and the Environment: The Scientific Evidence, Research Methodology, and Future Directions Board on Health Care Services Board on Health Sciences Policy Breast Cancer and the Environment: A Life Course Approach THE NATIONAL ACADEMIES PRESS 500 Fifth Street, N.W. Washington, DC 20001 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. This study was supported by a contract between the National Academy of Sciences and Susan G. Komen for the Cure ® . Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project. International Standard Book Number 0-309-XXXXX-X (Book) International Standard Book Number 0-309- XXXXX -X (PDF) Library of Congress Control Number: 00 XXXXXX Additional copies of this report are available from the National Academies Press, 500 Fifth Street, N.W., Lockbox 285, Washington, DC 20055; (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area); Internet, http://www.nap.edu. For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu. Copyright 2012 by the National Academy of Sciences. All rights reserved. Printed in the United States of America Cover credit: Illustration by Diana Ong/Getty Images. The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin. Suggested citation: IOM (Institute of Medicine). 2012. Breast cancer and the environment: A life course approach. Washington, DC: The National Academies Press. Copyright © National Academy of Sciences. All rights reserved. Breast Cancer and the Environment: A Life Course Approach Breast Cancer and the Environment: A Life Course Approach The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Charles M. Vest is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Charles M. Vest are chair and vice chair, respectively, of the National Research Council. www.national-academies.org Breast Cancer and the Environment: A Life Course Approach v COMMITTEE ON BREAST CANCER AND THE ENVIRONMENT: THE SCIENTIFIC EVIDENCE, RESEARCH METHODOLOGY, AND FUTURE DIRECTIONS IRVA HERTZ-PICCIOTTO (Chair), Professor and Chief, Division of Environmental and Occupational Health, University of California, Davis LUCILE ADAMS-CAMPBELL, Professor of Oncology, Associate Director, Minority Health and Health Disparities Research, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center PEGGY DEVINE, Founder and President, Cancer Information and Support Network DAVID EATON, Associate Vice Provost for Research, and Professor and Director, Center for Ecogenetics and Environmental Health, University of Washington S. KATHARINE HAMMOND, Professor, Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley KATHY J. HELZLSOUER, Director, The Prevention and Research Center, Mercy Medical Center ROBERT A. HIATT, Professor and Chair, Department of Epidemiology and Biostatistics, and Director, Population Sciences, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco CHANITA HUGHES HALBERT, Associate Professor, Department of Psychiatry, University of Pennsylvania, and Director, Center for Community-Based Research and Health Disparities DAVID J. HUNTER, Dean for Academic Affairs and Vincent L. Gregory Professor in Cancer Prevention, Harvard School of Public Health BARNETT KRAMER, Editor-in-Chief, Journal of the National Cancer Institute, and Editor-in-Chief, National Cancer Institute Physician Data Query (PDQ) Screening and Prevention Editorial Board BRYAN M. LANGHOLZ, Professor, Division of Biostatistics, Department of Preventive Medicine, University of Southern California (resigned July 2011) PEGGY REYNOLDS, Senior Research Scientist, Cancer Prevention Institute of California JOYCE S. TSUJI, Principal Scientist, Center for Toxicology and Mechanistic Biology, Exponent CHERYL LYN WALKER, Welch Professor and Director, Institute of Biosciences and Technology, Texas A&M Health Science Center LAUREN ZEISE, Chief, Reproductive and Cancer Hazard Assessment Branch, Office of Environmental Health Hazard Assessment, California Environmental Protection Agency Study Staff LOIS JOELLENBECK, Study Director JANE DURCH, Senior Program Officer SHARYL NASS, Senior Program Officer NIHARIKA SATHE, Research Assistant (from November 2010) CASSANDRA CACACE, Research Assistant (until December 2010) ASHLEY M C WILLIAMS, Senior Program Assistant (until December 2010) PATRICK BURKE, Financial Associate ROGER HERDMAN, Director, Board on Health Care Services ANDREW POPE, Director, Board on Health Sciences Policy Commissioned Paper Authors REBECCA SMITH-BINDMAN, University of California, San Francisco, School of Medicine LINDA DIX-COOPER, University of California, Berkeley Copyright © National Academy of Sciences. All rights reserved. Breast Cancer and the Environment: A Life Course Approach vi Copyright © National Academy of Sciences. All rights reserved. Breast Cancer and the Environment: A Life Course Approach vii Reviewers This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report: Mary Helen Barcellos-Hoff, NYU Langone Medical Center Julia G. Brody, Silent Spring Institute Diana Chingos, USC Norris Comprehensive Cancer Center Kathryn Guyton, U.S. Environmental Protection Agency Leena Hilakivi-Clarke, Georgetown Lombardi Comprehensive Cancer Center William A. Knaus, The University of Virginia Health Sciences Center Ruth M Parker, Emory University School of Medicine Lorenz Rhomberg, Gradient Stephen H. Safe, Texas A & M University Michael Thun, American Cancer Society David M. Umbach, National Institute of Environmental Health Sciences, National Institutes of Health Sandy Walsh, California Breast Cancer Organizations Noel S. Weiss, University of Washington Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations, nor did they see the final draft of the report before its release. The review of this report was overseen by David G. Hoel, Medical University of South Carolina, and David A. Savitz, Brown University. Appointed by the National Research Council, they were responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution. Copyright © National Academy of Sciences. All rights reserved. Breast Cancer and the Environment: A Life Course Approach viii Breast Cancer and the Environment: A Life Course Approach ix Acknowledgments The committee is grateful for the contribution of participants at its three public meetings. The presentations and discussions at these meeting were valuable in informing the committee about relevant research findings, issues of interest in the research community, the perspectives of advocacy organizations, and the concerns of individuals with breast cancer and their families. The agendas for these meetings appear in Appendix A. The committee was also ably assisted by Linda Dix-Cooper from the University of California, Berkeley, and Dr. Rebecca Smith-Bindman from the University of California, San Francisco, from whom the committee commissioned papers. The study was conducted with the generous support of Susan G. Komen for the Cure ® . The Institute of Medicine staff worked closely with Dr. Amelie Ramirez, who is a member of the Susan G. Komen for the Cure Scientific Advisory Board and Director of the Institute for Health Promotion Research at the University of Texas Health Science Center at San Antonio. Dr. Ramirez was helpful and supportive as the committee’s point of contact with the Scientific Advisory Board, which originally requested this study. In addition, Kendall Bergman graciously assisted the staff in the administrative coordination with Komen for the Cure. The committee and project staff appreciate the work of copy editor Laura Penny and gratefully acknowledge valuable assistance within the National Academies from Laura Harbold DeStefano, Greta Gorman, Diedtra Henderson, Jillian Laffrey, William McLeod, Janice Mehler, Abbey Meltzer, Michael Park, Christine Stencel, Vilija Teel, and Lauren Tobias. [...]... integrative approach to breast cancer research may accelerate progress in understanding the role that environmental factors may have in breast cancer CHALLENGES IN STUDYING BREAST CANCER AND THE ENVIRONMENT Trying to determine which environmental exposures may influence rates of breast cancer poses substantial challenges The biology of breast development and the origins and progression of breast cancer are not... Breast Cancer and the Environment: A Life Course Approach SUMMARY S-3 BOX S-1 Study Charge In response to a request from Susan G Komen for the Cure®, the Institute of Medicine will assemble a committee to: 1 Review the evidentiary standards for identifying and measuring cancer risk factors; 2 Review and assess the strength of the science base regarding the relationship between breast cancer and the. .. Cancer and the Environment: A Life Course Approach S-2 BREAST CANCER AND THE ENVIRONMENT developing effective preventive interventions, developing better approaches to modeling breast cancer risks, and improving communication about breast cancer risks to health care providers, policy makers, and the public Breast cancer has long been the most common invasive non-cutaneous cancer among women in the United... of the study task, the committee focused on areas that it considered to be the most significant and the most pertinent to its charge In particular, the study focused primarily on breast cancer in women and on the initial occurrence of a tumor, not recurrence The committee took into account the changes in the breast over a woman’s life and the potential for the timing of exposures to influence risks they... cardiovascular disease, diabetes, other cancers Breast Cancer and the Environment: A Life Course Approach S-10 BREAST CANCER AND THE ENVIRONMENT Limit or eliminate Varies by workplace, chemical consumer, and environmental exposure to chemicals that are plausible contributors to breast cancer risk while considering risks of substitutese If at high risk for breast cancer, consider use of chemoprevention... literature, the committee will seek input from stakeholders, in part by organizing and conducting a public workshop to examine issues related to the current status of evidentiary standards and the science base, research methods, and promising areas of research The workshop will focus on the challenges involved in the design, conduct, and interpretation of research on breast cancer and the environment The committee... Sciences All rights reserved Breast Cancer and the Environment: A Life Course Approach S-4 BREAST CANCER AND THE ENVIRONMENT human data, was the basis for noting that some factors may present a hazard, and thus potentially contribute to breast cancer risk, alone or in combination with other factors, depending on the nature of an exposure (e.g., amount, timing) A hazard has the potential to cause an adverse... critical events in the origins of breast cancer can occur very early in life; the variety of pathways through which breast cancer risks may be shaped; the likely contribution to breast cancer of some fundamental biologic processes; and the potential significance of the timing and combinations of environmental exposures in determining their effect on risks for different types of breast cancer This growing... functions to maintain the structural and functional integrity of the breast tissues through regulatory and homeostatic mechanisms PREPUBLICATION COPY: UNCORRECTED PROOFS Copyright © National Academy of Sciences All rights reserved Breast Cancer and the Environment: A Life Course Approach S-8 BREAST CANCER AND THE ENVIRONMENT OPPORTUNITIES FOR EVIDENCE-BASED ACTION TO REDUCE RISK OF BREAST CANCER On average,... Board requested that the Institute of Medicine (IOM) review the current evidence on environmental risk factors for breast cancer, consider gene environment interactions in breast cancer, explore evidence-based actions that might reduce the risk of breast cancer, and recommend research in these areas The Statement of Task for the study appears in Box S-1 The committee interpreted environment broadly, . rights reserved. Breast Cancer and the Environment: A Life Course Approach Breast Cancer and the Environment: A Life Course Approach The National Academy. Sciences. All rights reserved. Breast Cancer and the Environment: A Life Course Approach Breast Cancer and the Environment A Life Course Approach