Report identifies gaps in breast cancer research

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Study promotes shifting focus to environmental factors and prevention

A new interagency report recommends investing in breast cancer research that focuses on environmental factors and prevention as much as diagnosis and cures.

The report, “Breast Cancer and the Environment: Prioritizing Prevention,” was released Tuesday by federal health officials and follows a legislative mandate from the Breast Cancer and Environmental Research Act of 2008.

Congress required the creation of the interagency committee as part of the legislation and the committee, in turn, was to make recommendations that address gaps in current breast cancer research.

The committee’s work reviewing the scientific literature began in September 2010, according to committee chairwoman Michele Forman, a renowned expert in nutritional and perinatal epidemiology and professor at the University of Texas.

Because the committee represented the scientific community, federal agencies and advocates equally, the group’s work over the past two years stayed focused on finding the best prevention strategies, Forman said.

“The research has to make prevention a priority,” Forman said. “We can no longer ignore this.”

Breast cancer is the most common cancer in women and, after lung cancer, the second leading cause of cancer death in women in the U.S. More women die worldwide from breast cancer than any other cancer.

While men can get breast cancer, only about 2,200 men were expected to be diagnosed with invasive breast cancer in the U.S. in 2012, compared to 227,000 women. Another 63,000 women were expected to be diagnosed with non-invasive breast cancer in the U.S. in 2012.

Genetics can play a role in breast cancer risk, but most breast cancers occur in people with no family history. In other words, research on environmental factors has wide potential to decrease the cancer burden, the committee found.

In the report, the committee defined four kinds of environmental exposure worthy of further research. They recommended research into lifestyle and behavioral factors; chemical substances; other physical, non-chemical exposures, such as radiation; and social and cultural influences.

In addition, the committee noted that women were the most vulnerable to environmental exposure during fetal development, puberty and pregnancy and made research recommendations accordingly. The committee also noted that research needs to determine why African-American women are more likely than Hispanic and non-Hispanic white women to be diagnosed with more aggressive tumors.

A lot of money, by both government and non-government agencies, has been dedicated to research in diagnosing and curing breast cancer, the committee found. Very little has been spent on research to prevent breast cancer from occurring in the first place.

In addition to many recommendations on how research into prevention can be accelerated, the committee recommended collecting and monitoring surveillance data.

Environmental exposures can be monitored with the same kind of data public health officials gather to monitor communicable diseases.

“We need the monitoring and surveillance system set up so the public can get the information — that’s an important part of the puzzle,” Forman said.

This is the third such report from a distinguished panel of cancer experts calling attention to cancer prevention and the unrealized potential to decrease cancer deaths and suffering and, by extension, health care costs, according to Julia Brody, of the Silent Spring Institute.

In December 2011, the Institute of Medicine produced a similar report, which was commissioned by the Susan G. Komen Foundation. The President’s Cancer Panel of 2009-10 also produced a report on the National Cancer Program, as required by the National Cancer Act of 1971. The panel’s report concluded that “the burden of cancer from environmental factors was underestimated and there were many actions industry, regulators, the public, and others could take to mitigate cancer risk from these environmental sources.”

Building consensus around cancer prevention has been difficult, Brody said.

“It’s difficult because you don’t know whether your sister, or your neighbor, or you, didn’t get cancer because we reduced exposures,” she said.

Once the gap is closed and science knows more on how to prevent environmental exposures, Brody said there was potential to reduce the risk not only for breast cancer but also for other kinds of cancers, as well as problems with fertility and child development.

“Many of the breast cancer risk factors are implicated in other types of cancers, particularly those linked to hormone disruption, such as prostate and testicular cancers,” Brody said.

In one of several community assessments conducted by the United Way of Denton County, local officials found cancer edged out heart disease as the leading cause of death for Denton County residents.

PEGGY HEINKEL-WOLFE can be reached at 940-566-6881. Her e-mail address is pheinkel-wolfe@dentonrc.com.

 

RECOMMENDATIONS FOR RESEARCH

A new report from the Interagency Breast Cancer and Environmental Research Coordinating Committee says coordinating research and communicating its findings could prevent new cases of breast cancer. Below are the committee’s recommendations:

* Prioritize prevention — to date, most research has been focused on diagnosing and curing.

* Transform how research is conducted with a cross-disciplinary approach on compelling scientific themes.

* Intensify the study of chemical and physical factors to reduce knowledge gaps between what is known and not known.

* Plan strategically across federal agencies — coordination and collaboration can accelerate the pace of research.

* Engage public stakeholders at every stage from research planning through disseminating findings.

* Train cross-disciplinary researchers.

* Translate and communicate science to society.

SOURCE: Breast Cancer and the Environment: Prioritizing Prevention


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