June 1, 2005

Resource Paper

Community-Initiated Breast Cancer and Environment Studies and the Precautionary Principle (PDF)
Environmental Health Perspectives Volume 113, Number 8, August 2005.               
Julia Green Brody, Joel Tickner, and Ruthann A. Rudel.

Call Notes
Community-Initiated Breast Cancer and Environment Studies, and the Precautionary Principle

Moderator: Jeanette Swafford
Speakers: Julia Brody, Ph.D., and Ruthann Rudel, M.S.

WELCOME :

Jeanette Swafford, Collaborative on Health and the Environment:
Welcome to the call, this is Jeanette Swafford. I’m the Director of Health Initiatives at the Collaborative on Health and the Environment and the Coordinator of this group. Let me review how the call will run today. We’ll begin with a brief overview of who is on the line and then we will hear an update on the recent National Breast Cancer Coalition conference. Then we’ll move into our main discussion on Community-Initiated Breast Cancer and Environment Studies and the Precautionary Principle.

Our speakers today are Julia Brody, Executive Director of the Silent Spring Institute and Ruthann Rudel, Senior Scientist and Environmental Toxicologist at the Silent Spring Institute. (Joel Tickner, Assistant Professor, University of Mass, Lowell was not able to join us today.) The presentation will be about 10 minutes and then we’ll have a 30-minute question and answer session.

Since several of you are new to CHE calls, I’d like to extend a special welcome. I’d also like to review CHE call etiquette. I’d like to ask everyone to mute your line – by pressing 6 now. Please use this mute function and do not put us on hold. In the future we will be shifting to a system where the operator can eliminate any extraneous noise, but for this call, we don’t have that feature and we’ll need everyone to cooperate. The mute is on a toggle – so simply press 6 again to open up your line.

Two things to remember:
1. Please identify yourself when you speak.
2. This is a diverse group. We encourage the sharing the ideas and conversations, but please respect the views that are presented even if you don’t agree with them. The culture of civility is very important to us here at CHE.

The article that we’ll be discussing today is posted online at www.healthandenvironment.org.

Let me briefly summarize who is on the line today. We have representatives from regional breast cancer coalitions, like the Great Neck Breast Cancer Coalition, and Huntington Breast Cancer Coalition and the New York State Breast Cancer Network, the Breast Cancer Coalitions in Canada and Massachusetts and Minnesota as well as multiple groups in California.

We have authors, film makers, national cancer activists, scientists, community based advocates, health professionals and national cancer organizations, as well as those who are working in the areas of sustainability and the precautionary principle. I refer you to the RSVP list for a closer read if you’d like more details. We are among a very educated and interesting group for today’s discussion. I want to thank everyone for joining us.

So, let’s move to our updates. We have 10 minutes. I’ve asked Nancy Evans who is a consultant to the Breast Cancer Fund to give us a brief backgrounder on the National Breast Cancer Coalition. Then we’ll hear from Marian Feinberg and others who attended the event. We’re especially interested in how environmental issues were framed and any ideas or opportunities that this group might be interested in. Nancy, I’m turning it over to you now.


UPDATES:

Nancy Evans, Consultant to the Breast Cancer Fund:
Hi everyone. Thank you Jeanette. The National Breast Cancer Coalition was founded in 1991. Its primary focus was to increase visibility of the breast cancer epidemic and to increase federal research funding for breast cancer. They’ve been highly successful in doing that. The funding has jumped from $90 million annually in 1991 to over $800 million in 2003. However, NBCC has been extremely cautious and largely silent on the issue of environmental links to breast cancer. Instead the focus has been on research related to diagnosis and treatment of breast cancer and on access to care.

As part of the national action plan on breast cancer, during the 1990s, the etiology working group held several workshops on environmental factors and breast cancer but for the most part, none of the recommendations from the gatherings were ever implemented. NBCC defined an environmental exposure as any factor that is not an inherited genetic characteristic, so this means diet, exercise and lifestyle and personal risk factors. They are apparently open to supporting research on environmental links to breast cancer, but are unwilling to advocate for policy changes based on existing evidence using the precautionary principle. Typically NBCC does not collaborate with other breast cancer or environmental health organizations on campaigns or initiatives that originate outside of NBCC. I think that I’ll stop there.

Jeanette Swafford:
Thank you Nancy. I also want to note that Nancy wrote a great backgrounder that elaborates more on what she’s said. If you’re interested you can access that on the CHE website: www.healthandenvironment.org under working groups and cancer resources.

So let me turn this over to Marian now. Please tell us what you recognized at the conference on the environmental side.

Marian Feinberg, For A Better Bronx:
Hi Everyone. I started off, until I got a note from Nancy, with high expectations because in New York the breast cancer network, we actually lobbied on behalf of a precautionary bill and body burden bill. So I thought that this was going to be more of the same which it turned out not to be. The people in New York that I went with from SHARE, the breast cancer peer support organization here were pumping it up saying that they’re now looking at the environment in a much more serious way than before. This has been a long effort. That idea was reinforced by people from the Massachusetts Breast Cancer Coalition and others.

There was a panel. There was number of workshops. Ken Olden from NIEHS was on one of the panels. Kirsten Moysich from Buffalo reported on some research which seemed to her to be a disappointment. It came out negative for effects on PCBs and PBDs except for persons with a specific vulnerability gene. She did say that people need to study the environmental effects with the same rigor and same repetition as they do with, say, dietary issues and not just throw the issue away after one negative study. Ken Olden really talked about things. He mentioned the sister study. Does everyone know what the sister study is?

Jeanette Swafford:
Why don’t you say a very brief word about it.

Marian Feinberg:
I should do that. Great. My sister is participating in it. It is a national study looking at a pool of sisters of women with breast cancer, so this presumably would be a high-risk group compared to the general population. It is an extensive study looking at their environmental exposures both as children and as adults. The study includes everything from questionnaires about their childhood, to taking dust samples from their current houses. Then following that cohort of women to see who comes out with breast cancer in that group and seeing if there is a difference in their exposure levels from the negative group. I hope that I explained it OK.

To get back to Ken Olden, he talked about the fact that we can’t look at these chemicals one at a time. He talked about environmental susceptibility genes. They’re on the road to identifying them. And he talked more about the interactions between genes and environment and a discussion of agents that interact with environmental susceptibility genes. He pushed the whole idea of a center on toxicogenomics and technology that can help us look at classes of chemicals and how they affect biological systems, and how they interact with each other.

Jeanette Swafford:
Marian, can you summarize any opportunities that you saw?

Marian Feinberg:
Um, I think when I came back and started discussing this with my co-worker… Part of our discussion was that a lot of this runs counter to looking at things with the precautionary principle point of view. How are we going to merge these things? I mean, people were talking about it more than they have been before, but the primary focus of the National Breast Cancer Coalition, as posted on the CHE website, was to fund more multi-center research and, as Nancy said, not an effort to advocate for interventions that would actually deal with exposures that people currently have and to try to act on the information that we already have.

Deb Forter, Massachusetts Breast Cancer Coalition:
This is Deb Forter. I was also at the National Breast Cancer Coalition conference. I’m from the Mass Breast Cancer Coalition. I also served on the board until recently with them. Actually our organization stepped off the board because they weren’t willing to move more quickly on the environmental aspect as we perceive it. I think simplistically they have a very strong allegiance to evidence-based science. That’s how they see it. It is incongruous with the precautionary principle. At the talk that Ken Olden gave Sue Love was also on that panel. She did make a point of saying that if something is proven to be toxic we shouldn’t be exposed to it. So I kinda held onto that as a bright light. Mostly they are just very entrenched and, as Nancy Evans said, they are not receptive to collaborating with others. That’s my short take.

Marian Feinberg:
I’d like to add one more thing that Susan Love said. People are looking at levels of chemicals in blood and not in the breast themselves. When people did a small study looking at fluid in the breast ducts they found much higher concentrations of certain chemicals. The ducts actually concentrate certain chemicals and not other materials. We should be looking directly at the breast which I thought was worth listening to.

Jeanette Swafford:
Thank you Marian and Deb. There was another comment I heard.

Leo Petrilli, Windsor, Canada:
Hi, It’s Leo Petrilli from Windsor.

Jeanette Swafford:
Hi Leo. We have time for a very brief comment. Please go ahead.

Leo Petrilli:
I live in a border community. NAFTA traffic, truck traffic is huge in my city. The diesel that is coming from those trucks is very detrimental to our health. We have huge cancer in our city. I think that it is worth discussing since truck traffic is a very big issue in Detroit and Windsor.

Jeanette Swafford:
Thank you Leo. Diesel is big issue for many communities.

Let’s move on today but I think that we should revisit this issue in case we do find a way to help NBCC revisit the science, or perhaps another opportunity will emerge.

I’d like to add a note from Theo Colborn. She wasn’t able to join us today because she is participating in activities around the UN World Environment Day. As you may know, there is a team at The Endocrine Disruption Exchange that is working on a spreadsheet that summarizes the science of the fetal origins of cancer. They have an Excel spreadsheet and a Word bibliography that is available to those who are interested. If you would like a copy, please email me and I’ll pass on the request. She is particularly interested in any citations that they may have missed. We’ll talk about this project in greater detail on another call. So again, email me if you’d like a see a copy and comment. Understandably, she wasn’t comfortable putting it out on the listserv.

Devra Davis, University of Pittsburgh Cancer Institute:
This is Devra Davis and I want to try to relate to the past two comments. In fact, Susan Love personally has been very outspoken about the fact that while we lack definitive epidemiological proof we should not be exposing people to things that look like hazards, experimentally, in vivo or in vitro. I think that it might be worthwhile for someone from CHE to make direct contact with her. I wrote an article with her ten years ago on a different topic. I don’t know if anyone on this call is in more direct contact with her. Considering the endocrine disruptor issue, one of the things that we have to be aware of is that the recent studies are dazzling and very depressing in that they clearly imply that early life exposures dictate what all is ever going to happen. We want to be careful that while acknowledging that that this is very important, not let people have no hope whatsoever about what this means for their lives.

Jeanette Swafford:
Thank you Devra. Is there anyone on the call who would like to work with me to help organize a response to Susan Love or to the National Breast Cancer Coalition?

Nancy Evans:
Jeanette, I would be very interested in working with you on this. I also have to say that it is very interesting that Susan Love spoke out about looking at the breast itself when she opposed, actually led the opposition, to our biomonitoring bill in California.

Deb Forter:
I’d also like to join the effort Jeanette.

Marian Feinberg:
I have a few more comments to make.

Jeanette Swafford:
I’m sorry to interrupt Marian, but we are tight on time. Please feel free to email them to the group though. Would anyone else like to join this effort?

Karen Joy Miller, Huntington Breast Cancer Coalition:
This is Karen. I’d like to work on this too Jeanette.

Joan Reinhardt Reiss, Breast Cancer Fund:
So would I. This is Joan Reinhardt Reiss.

Mandy Hawes, CalCOSH:
This is Mandy. I want to be included as well.

Laura Weinberg, Great Neck Breast Cancer Coalition:
Me too. This is Laura Weinberg.

Jeanette Swafford:
OK, I have Nancy, Devra, Marian, Karen, Joan, Mandy, Laura. If others would like to join please email me and we’ll connect offline.


MAIN PRESENTATION:

So, it’s time to move into our main discussion now. Unfortunately Joel Tickner will not be able to join us today, but we do have Julia Brody and Ruthann Rudel, two of the authors of the paper Community-Initiated Breast Cancer and Environment Studies and the Precautionary Principle which was published in the March 2005 issue of Environmental Health Perspectives.

The breast cancer communities have some of the most organized, developed, innovative activists of any health arena. They have continually pushed for more funding, more research, more studies – and not just about treatment options but about prevention and the etiology of this disease. Activists have played a major role in developing research. I’m referring specifically to the Long Island Breast Cancer Study Project and the Cape Cod Breast Cancer and the Environment Study. There was a “tension in the relationship between activist goals and scientific methodology” as noted in the article. We are very pleased to have leaders in this field on the call today to talk about how the precautionary principle can and should be brought into this scientific discussion. Julia, I’ll turn it over to you. You have 10 minutes.

Julia Brody, Silent Spring Institute:
Thank you very much. It is a pleasure to be on this call and to have a chance to talk about this paper. I’m very eager to hear from others on the call who have experience with some of these studies. I’m going to talk a bit about the historical context and the basic components of the breast cancer and the environment studies and why they’re relevant to the precautionary principle. Then Ruthann will talk in more detail about the exposure studies.

As you were saying the breast cancer activist movement arose in the early 1990s and one of the central elements was the frustration that traditional science wasn’t asking questions about environmental factors that could lead to prevention. The Long Island Breast Cancer Study and the founding of Silent Spring Institute and the beginning of the Cape Cod Breast Cancer and the Environment Study were all a direct result of that. More recently the NIEHS breast cancer and the environment research centers are a new development in this history.

At the beginning of the Long Island and Cape Cod studies there were two groups of chemicals that had entered the market after World War II during the period when breast cancer incidence was rising that people were focusing on. One was chemicals that cause mammary tumors in animals and the other was chemicals that mimic estrogen which is an established breast cancer risk factor. Devra Davis was writing about the estrogen mimic and Mary Wolf was writing about the mammary carcinogens. The hypothesis about these chemicals is very compelling, but the tools to investigate them are weak. To make a link between pollutants and breast cancer we have to be able to measure the relevant exposures. When you think about the tools that are available for doing that, especially looking back, understanding that hormones and the reproductive history effects breast cancer, and with a job matrix, it was observed that nuns had higher breast cancer risks. And then the effects of reproductive history and other established risk factors were elaborated through interview studies which had self-reported exposures like: How old were you when your first kid was born?

The understanding that exogenous hormones affect breast cancer comes from clinical trials like tamoxifen and hormone replacement therapies. So when you look back over these tools they really are not available for tracking environmental pollutants and there have not been any occupational cancer studies. The self-report is not as useful for things like “what did you breathe?” The clinical trials for pollutants we would consider unethical and this has come up recently in relation to pesticides. So, there is a mismatch between the public health questions that activists want to answer and the scientific tools that are available. This is the kind of situation where the precautionary principle comes into play and provides guidance about how to develop evidence and how to integrate evidence from multiple sources. I think that it is interesting in the discussion about the National Breast Cancer Coalition and especially Deb Forter’s comment. It really crystallized this question of what is proof and when will we act on the evidence that we have. What are reasonable expectations based on the evidence that we will be able to use as a basis for action.

Joel Tickner has been talking about and thinking about this question for a while and we’re pleased at his invitation to work together to play out the example of the breast cancer study as a model for these issues. The Long Island and Cape Cod studies actually began at about the same time. The Long Island study began as a case control study and later developed a geographic information system (GIS) which is a computer mapping database. The exposure measures in the Long Island case control study used biomarkers of banned organochlorines and PAHs measured in blood near the time of the breast cancer diagnosis. They found no association between breast cancer and organochlorines. They observed a 50% higher breast cancer risk with a higher PAH damage to DNA but they did not see dose response relationship and they did not see a relationship between a PAH marker and two of the known sources of PAH, smoking and grilled foods.

The Cape Cod study started with GIS using the scoping tool to understand patterns of disease and environmental factors and then used the GIS to assess historical exposure to pesticides and to drinking water in the case control study. We saw no overall association between our GIS and pesticide exposure markers and breast cancer risk. We did see some weak, statistically unstable association with particular types of use and a particular time period. One example is one association between living near the cranberry bogs during the years when the organochlorines were being used and breast cancer risk. This was also found by Ann Aschengrau in an earlier study so its got a little more legs to it with the two different findings.

In our paper we talk about the problems in interpreting negative studies, like those of the case control studies which have negative elements and weak elements and maybe some elements to be perceived in the future, and questions about when to invest in this kind of large epidemiological study. I think that the most important part of the Cape Cod study both scientifically and in terms of public health was the two exposure studies. One, an assessment of estrogenic activity and specific endocrine disruptors in ground water and drinking water where we did document drinking water that was impacted by septic systems as a potential root of exposure to endocrine disruptors. Our second exposure study was our household exposure study of 89 endocrine disruptors in air, dust, and urine in 120 homes. This is Ruthann’s work and she is going to talk about it a bit more.

So these exposure studies have some features that you’d like to see in precautionary research. One, we took on a large number of chemicals in real world mixtures. Second, by describing exposure we provide information about the plausibility of a health affect and its preventability. So we have lab-based information that there is a plausible biological connection between chemicals and cancer. That matters if people are exposed. So, from a precautionary point of view that is kind of the next thing that you want to know.

We also see these as tool-building studies which is consistent with the precautionary principle because the precautionary principle sees research and public policy as an ongoing iterative process and you’re not necessarily looking for that one big study that changes it all and provides what maybe NBCC was thinking of classically as proof. Rather thinking of evidence as accrued rather than new studies that come online. There is a need for ongoing research development.

We’ve seen some applications of this work in a public health context which we’re very pleased to see. It is one of our goals. Right now our work is focused on reporting results to individuals on their own homes and identifying sources which has precautionary implications and testing methods for reducing exposure. Ruthann is going to come back to this in a moment. I also want to say that the NIEHS centers represent a new element in precautionary research because they’ve taken on what precautionary principle folks call an upstream health outcome. They are looking at effects on puberty in girls and age of menarchy and perhaps development of the breast in adolescents are themselves related to breast cancer risk. So this is taking the health question upstream which is something that precautionary principle advocates for as well. Before I close I just want to say thank you, thank you to the breast cancer activists. The research that I just told you about, not a single one of these studies would have happened without the activists work and we are just enormously indebted and grateful to them.

Jeanette Swafford:
Thank you Julia. Ruthann, you have three minutes.

Ruthann Rudel, Silent Spring Institute:
Hi, this is Ruthann. I’m going to give an overview of the household exposure study that we did. We wanted to understand how women are exposed and we wanted to look at as many chemicals as we could. We started off with a list of chemicals that are known to cause mammary tumors in animals and chemicals that have been identified as endocrine disruptors. Then we prioritized chemicals based on what could be analyzed in analytical methods and essentially prioritized so we could get the most bang for the buck.

Ultimately we looked for 89 different chemicals that were either mammary carcinogens or endocrine disruptors. We looked at indoor air and house dust in 120 homes. In air we detected 52 of the chemicals. In dust we detected 66 of the chemicals. We were able to develop good information on mixtures of chemicals and mixtures of endocrine disruptors that women are typically exposed to indoors. As an example, the average number of the chemicals per home in air was 19. Twenty-six of these chemicals were found per home in dust. Again, that is just the ones that we measured. There were many pesticides, 23 different pesticides in air samples and 27 different pesticides in dust samples, including 10 that have been banned, some banned for many, many years.

Our measures were the first measures indoors for over 30 of the chemicals that we looked at. They had never been measured before. Many of the chemicals that we detected, including many that had never been detected before, were found in 100% of the homes. This includes phthalates, bisphenols and some other very prevalent endocrine disruptors. I think that we can safely assume that they are in every indoor environment.

DDT, which was banned in 1962 was detected in 65% of the homes. Related to that, there were 15 chemicals that were present at some level above the EPA guidelines. Only 39 of the chemicals even had EPA guidelines. Twenty-eight of them didn’t have any kind of health-base guidelines. We found 15 chemicals at some level above the EPA guidelines and with two or three exceptions, they have all been banned. Some of them have been banned for many years. That’s a message that supports precautionary principle because we can’t wait until we have distributed the chemicals widely in the environment before we decide whether they are safe or not and then ban them. Just by banning them, they don’t just disappear. They stick around.

We are committed to trying to do research and getting it into the peer reviewed literature so it can be used by other scientists to build on and used in regulatory proceedings. We’re also wanting to see the application of this work in precautionary policies and in campaigns. We’ve seen some of that and we want to see more. As an example of how this has been used, the PBDE levels that we detected in house dust studies was the first concentration reported indoors in the U.S. and it did show 10 times higher levels in U.S. dust than in European dust which parallels that usage of those compounds are much higher in the U.S. than in Europe, and that the breast milk levels are much higher in the U.S. than in Europe.

Phthalates which have been getting a lot of attention and probably will be getting a lot more attention given the paper that came out last week from Shanna Swan that showed affects on reproductive system development in baby boys. We had some of the first indoor measurements of phthalates and finding them in 100% of the homes and finding air as a potentially important route of exposure.

Then the Clean Production Action study which came out recently looking at dust levels of contaminants in seven states really relied almost exclusively on the analytical methods that we developed. They were able to go to the laboratory and spend $10-$20,000 to support their campaign. The reason that they were able to do that is that we spent several hundred thousand dollars developing the methods that were used. They were available and the laboratory was able to analyze the dust samples.

Jeanette Swafford:
Ruthann, could you wrap up so we have time for some questions please.

Ruthann Rudel:
Yup, that was kind of the end. We want to see more synergy with the activist campaigns and hear what kind of scientific research will help their work.


QUESTION AND ANSWER:

Jeanette Swafford:
Great, thank you both. Let’s open this up for a discussion. Please identify yourself and remember to mute and unmute by pressing 6.

Karen Miller, Huntington Breast Cancer Coalition:
This is Karen Miller with both a statement and a question to this illustrious panel. One of the things that I’ve heard repeated a lot that intrigues me, and that I’d like to use in my activist language, is the word “development of tools”. In other words, pushing for the precautionary principle, but actually pushing for increased development of these tools that can measure, and getting out to the public and not only educating the government for increased funding, you know, people who might give more money towards that project, but also educating the voting population as to where their dollars might go and how effective that could be in giving them answers as to why their family members may be coming down with diseases such as breast cancer. I keep hearing the word “tools” and it was a buzz word for me. I like that word and that was my statement.

Laura Weinberg, Great Neck Breast Cancer:
Hi, this is Laura Weinberg from Great Neck Breast Cancer. I also wanted to add to Karen’s statement that after reading your paper on Community-Initiated Breast Cancer and Environmental studies. I also saw that throughout the paper the issue of unresolved weaknesses in exposure assessment methodology, which is what Karen was saying,and I would like to know, what can we do as a group to help move this process and how close are we to doing it?

Julia Brody:
We do see that as a core problem. I think that the breast cancer advocacy community can be powerful on this issue. The Massachusetts Breast Cancer Coalition really is responsible for our being able to conduct the household exposure study. It wouldn’t normally be considered part of a breast cancer study. If we sent a proposal for the household exposure study to the National Cancer Institute we would get back a note saying that this was not a cancer study. In fact, we actually did that (laugh). So, to redefine these exposure studies as cancer studies is a first step (her emphasis). To take the step of saying, do a health study. We need to understand the exposures so we’re going to consider these exposure studies to be health studies.

Joan Reinhardt Reiss, Breast Cancer Fund:
This is Joan Reinhardt Reiss. One of the things that stood out for me, this is obviously coming from the Breast Cancer Fund perspective, and as many of you know we have a bill in the legislature that just passed out of one house on biomonitoring so we’re very excited about that. So, I think that the biomonitoring piece, and I don’t put this out as a simple issue, really starts telling us what’s inside individuals as opposed to what’s outside in the environment. I realize that this is a very expensive way to go but maybe what we need are some judicious choices about what to look for inside and match that with the wonderful exposure work done by Silent Spring on the outside. I’d appreciate any comments on that.

Ruthann Rudel:
We’re very supportive of biomonitoring and in our study, I didn’t mention this, but we did collect urine samples and analyze them. We couldn’t analyze them for as many chemicals. The tests didn’t exist, or they weren’t available. So, I support what Julie said. We need more development and application of exposure inside and outside. It’s good to know what’s in our bodies because it is closer to making links to health effects. One of things that we’ve been wanting, is what is the main source. Personally, I like pairing up the inside environment with outside environment measurements or other tools or information so that we can understand more about where they may be coming from and how to reduce the exposures whether it is in the same study, or in different studies. The key is not to leave that behind because if we’re looking at precaution, then we need to look at preventability. We need to reduce in order to reduce the body burden.

Jeanne Rizzo, Breast Cancer Fund:
Hi, This is Jeanne Rizzo. I’m just wondering if an effort on our part to talk to the NHANES people about having household exposure along with the rest of the whole NHANES program would make some sense.

Ruthann Rudel:
That is an interesting idea and any support that you can give to the environmental health section of the CDC, they need.

Jeanne Rizzo:
Well I know that the CDC has agreed to provide to California in kind services in the event that our biomonitoring bill fully passes and gets signed by the governor. The CDC will provide testing of the biospecimens in support of this program. So I’m just thinking that if we could try to incorporate both sides of this in all of our efforts. That whatever we’re advocating for, we add the other component whichever one maybe wasn’t the primary one for our efforts but we work towards that so the language of biomonitoring and exposure are put together in terms of cancer research.

Julia Brody and Ruthann Rudel:
I think that that is a very good idea.

Devra Davis:
This is Devra Davis. Ruthann, you did brilliant work several years ago and I have to admit, I haven’t looked to see if you’ve published it. You were cross-indexing all the known and suspected carcinogens and mammary carcinogens. MaryWolf of course did some of this work as well. My only concern here is that by the conversation focusing on human evidence, and human proof, and human exposure I think that we don’t want to admit or in any sense imply that experimental findings are not relevant. I wonder what progress you’ve made Ruthann, or others on the call, in looking at what we know are mammary carcinogens experimentally in vivo, in vitro and arguing that that should be evidence per se that we should we want to keep these things out of our bodies. I’m concerned and I believe that one of the reasons that Susan Love was opposing the bill was that by focusing what is inside the body, you are by implication, allowing it to get there rather than keeping it out.

Ruthann Rudel:
Say that again Devra. I’m sorry. Just say the last part.

Devra Davis:
OK, the last part… The last part was that some people are opposed to biomonitoring because it appears passively to accept the invasion in our bodies by chemicals and I know that nobody on this call agrees with that but rather than turning us into lab rats, my question is really oriented towards making better use of experimental data where we have it. I know that Ruthann was starting a large project before your first child was born so it’s been a while, right? What has happened (laughter)?

Ruthann Rudel:
I’m glad that you mentioned that. I’m VERY supportive of expanding the role and frankly, the funding for toxicology, and the experimental work being done in toxicology as part of what activists try to get funded. In our review article that was published six years ago, we tried to really emphasize the experimental. Over half the paper is on experimental, both endocrine disruptors and mammary carcinogens and we’re expanding that now for a project for the Komen Foundation which is also going to result in publication. And another part of that which is turning out to be very interesting is looking at how the mammary carcinogen endpoints from the cancer bioessays is used, or for the most part, not used in any kind of risk assessment or application of the bioessays.

Carol Becker, American Cancer Society:
Hi Jeanette, I have a comment. This is Carol Becker with the American Cancer Society in New York City. About a year and a half ago there was a full page ad in the New York Times. It was run by BodyBurden.org and it highlighted a test that Mt. Sinai developed that can measure toxins in the body. So the gist of the ad is that people are walking around with anywhere from 60-100 different chemicals in their body. It’s a very expensive test incidentally, but I’m wondering how people, or I’m wondering how a test like that can be useful in the research that you’re doing.

Julia Brody:
That’s a very interesting project. It is in some ways a precursor to the California body burden biomonitoring legislation so as Ruthann said, we do think that this is a good step from a public health standpoint and it would begin to create data that could then be used in health studies.

Ruthann Rudel:
I think that the other way that these measurements can be used, um. I think that there is a voice out there that says you can’t take these measurements, especially in breast milk because we don’t know how to interpret them. We don’t know what they mean. I think that the response to that, the answer, is that it puts pressure on us to find out what they mean. Investing in more of the experimental studies like Devra said, some more tox studies and some more epi studies and also figuring out how to reduce those exposures by finding what the main sources are.

Jeanne Rizzo:
This is Jeanne again. That study was Mt. Sinai, Commonweal, the Environmental Working Group and the woman in the ad was the founder of the Breast Cancer Fund. What that has done is catapulted the dialogue. As activists, part of what that study has done when we do biomonitoring of activists and luminaries is that it brings home to the policy makers, to the public, and to the researchers and to the funders of research that this is an important component and one kind of research that we need to take a look at. If we are walking around with these chemicals, then we ought to be doing something about it. It actually helped us get the precautionary principle ordinance and just yesterday a precautionary principle purchasing ordinance passed through yet another committee in the city of San Francisco. So when you talk about tools, this has an implication that goes far beyond just the science.

Karen Miller:
This is Karen Miller. Jeanne, Deb, Joan, in New York, the New York State Breast Cancer Network has just gotten bills launched that include biomonitoring and health tracking. So maybe through email we should do an East coast/West coast language push on looking at inside-the-body, outside-the-body and looking at in vivo/in vitro as Devra Davis said and develop a common language because it was launched on April 12th so we’re following Deb, Jeanne and Joan, your lead. I know that the biomonitoring and health tracking bill which has both Republican and Democratic backing was actually put forward in 2001 so it has had three years of floating out and about. So I think that we should connect with each other together after this call, via email.

Jeanette Swafford:
This will be our last question.

Margaret Roberts:
Hello, this is Margaret Roberts. I’d like to make a statement for the record. I’m with Capital Region Action Against Breast Cancer and not the New York State Breast Cancer Network. I have worked with Karen Miller and Laura Weinberg to help promote the new public health and environmental policy initiative bill that Karen just spoke about and she mentioned that there is a safe and sustainable procurement act and an environmental health tracking system act but together with that, and I think that this is important for activists, we should be promoting health studies. We should also be promoting public policy that is using the precautionary principle and as part of this package of bills, we also have the public health protection act which essentially says that decision-making by state and local agencies in New York state reflect the precautionary approach. So, together with the more science-oriented bills we also have introduced the public health protection act and I think that the two must work together advancing public policy based on the precautionary principle as well as advancing scientific studies that can further the field.

Janice Barlow:
This is Janice Barlow. Can I offer a resource?

Jeanette Swafford:
Yes, go ahead. Briefly.

Janice Barlow:
This is Janice Barlow. I’m with the Marin Breast Cancer Watch and last October we did an all-day community forum on critical issues in biomonitoring that had representatives from the CDC. We had panels that talked about where we are with the art and science of biomonitoring, as well as some of the ethical issues around testing people and communities. That was a whole panel. The different ways that biomonitoring can be used whether it is for public surveillance, research or advocacy and how communities should be involved in biomonitoring processes. In our organization, one of our beliefs is that communities need to really understand biomonitoring and the issues related to it, especially what it can tell you and what it can’t tell you. This is a good summary of the state of the art, as of last October. I’d be happy to send out copies. We have conference proceeding and a DVD.

Jeanette Swafford:
Thank you Janice. We’ll be distributing a contact list with details for everyone so you’ll be able to make the East/West connections, as well as the biomonitoring resources. Thank you for that. Notes will be distributed from this call. Our next call will be Sept. 13th at 9:00am Pacific/12 noon Eastern. Please mark your calendar. I’d like to thank everyone for joining us. This has been an especially interesting conversation. A special thank you to Julia Brody and Ruthann Rudel.


ADDITIONAL COMMENTS:

Neil Gendel, Healthy Children Organizing Project:
The Healthy Children Organizing Project's mission is to protect fetuses and young, low-income children from exposures to environmental contaminants in San Francisco. We know that indoor air and dust is much more hazardous for small children than adults, and their body burden is often greater than their parents. We began as a lead poisoning prevention project in 1990, expanded to include preventing asthma triggers in the home as much as possible in 1996, and then expanded to include all toxic hazards in the home [and public facilities where small children learn and play]. Much of our focus is on helping low income parents of color have "healthy homes' now--by legislation and education. With that in mind, the call brought to mind several things:

1. Ruthann's research findings will be helpful in my local efforts. We are linking these studies on what is in the home with low income parents who can do simple things to protect themselves and their children from toxic exposures. We work with community-based organizations providing family and children's services, and we are trying to get the local public health department to join in this effort--with the help of some CHE members and others. Any information we can use on this issue, especially in everyday language, will be greatly appreciated.

2. HUD provides yearly funding for "healthy homes" projects to reduce exposures to lead poisoning and asthma triggers. It has provided some research funding. I don't know if research or cleanup funding would be available for breast cancer triggers also, but it might be worth seeing if there is a link that HUD/Congress et al will accept.

3. More of a question: are these studies on the links between toxic chemicals in the environment and breast cancer already joined with current children's environmental health studies and work, e.g. the good work that Elise Miller is doing with the help of many CHE members? If not, can/should the two groups' work be linked together as the struggle goes forward to gain mainstream acceptance for funding and everything else that is needed to prevent the diseases and disabilities caused by all these toxic chemicals. Maybe the link is already there and I just don't know about it?


CALL PARTICIPANTS:

Liz Armstrong
Breast Cancer Prevention Coalition
Box 430
Erin, Ontario N0B1T0
519-833-7202
liz@ican.net

Lisa Bailey, M.D.
American Cancer Society
California Division
1807 Casterline Road
Oakland, CA 94602
510-883-1095
baileylisa@msn.com

Allison Barlow
Consultant
Beldon Fund
99 Madison Avenue
New York, NY 10016
212-616-5612
akbarlow@earthlink.net

Janice Barlow
Executive Director
Marin Breast Cancer Watch
26 Bellam Blvd, Suite 260
San Rafael, CA 94901
415-256-9011 ext.101
janiceb@breastcancerwatch.org

Carol Becker, CSW
Director Patient & Family Services
American Cancer Society
Brooklyn Regional Office
31 Washington Street
Brooklyn, NY 11201
718-237-7851 ext. 9131
carol.becker@cancer.org

Julia G. Brody, Ph.D.
Executive Director
Silent Spring Institute
29 Crafts Street
Newton, MA 02458
617-332-4288 ext. 23
brody@silentspring.org

Phil Brown, Ph.D.
Professor of Sociology and Environmental Studies
Brown University
Box 1916
Providence, RI 02912
401-863-2633
phil_brown@brown.edu

Lynn Carroll, Ph.D.
Database Manager
TEDX, Inc.
211 Grand Ave., Suite V
Paonia, CO 81428
970-527-4082
tedx@tds.net

Guy Dauncey
The Solutions Project
395 Conway Road
Victoria, BC
V9E 2B9 Canada
250-881-1304
guydauncey@earthfuture.com

Devra Lee Davis, Ph.D., M.P.H.
Director
Center for Environmental Oncology,
University of Pittsburgh Cancer Institute
5150 Center Avenue, Suite 500
Pittsburgh, PA 15232
202-544-7731
devradavis@comcast.net

Nancy Evans
Health Science Writer/Editor/Consultant
The Breast Cancer Fund
4194 Cesar Chavez
San Francisco, CA 94131
415-285-7267
Nancywrite@aol.com

Marian Feinberg
For A Better Bronx
3980 Hillman Av. 2D
Bronx, NY 10463
718-884-2462
marian.fabb@earthlink.net

Deborah Forter
Executive Director
Massachusetts Breast Cancer Coalition
1419 Hancock Street, Ste. 202
Quincy, MA 02169
617-376-6222
dforter@mbcc.org

Neil Gendel
Project Director
Healthy Children Organizing Project Consumer Action
717 Market Street, Suite 310
San Francisco, CA 94103
415-777-9648
neil.gendel@consumer-action.org

Robert Gould, M.D.
President
San Francisco Bay Area Physicians for Social Responsibility
311 Douglass Street
San Francisco, CA 94114
408-972-7299
rmgould1@yahoo.com

Jamie Harvie
Institute for a Sustainable Future
32 E. 1st Street, Suite 206
Duluth, MN 55802
218-525-7806 ext. 2
harvie@isfusa.org

Amanda Hawes, JD
Cal-COSH
152 N. Third St
San Jose, CA 95112
408-189-1776
ahawes@alexanderlaw.com

Steve Heilig, M.P.H.
Director of Public Health & Education
San Francisco Medical Society
1409 Sutter Street
San Francisco, CA 94109-5417
415-561-0850 ext. 270
heilig@sfms.org

Genevieve Howe, MPH, MA
Researcher
Environmental Health Initiative
University of Mass., Lowell
Lowell Center for Sustainable Production
617-983-3925
genhowe@earthlink.net

Karen Folger Jacobs, Ph.D.
Breast Cancerland
2600 Tenth Street
Berkeley, CA 94710
kfjacobs@berkeley.edu

Molly Jacobs, M.P.H.
Project Manager
Environmental Health Initiative
University of Mass., Lowell
Lowell Center for Sustainable Production
mjacobs@envhealth.net

Thom Jones
Cancer Champions
958 Pine Avenue
Pittsburgh, PA 15234
412-885-6488
tjones@on-target.net

Tess Karwoski, R.N., B.S.N.
University of Michigan
2454 Adare
Ann Arbor, MI 48104
734-668-7197
tessmec@voyager.net

Sharon Kaufman
Beldon Fund
99 Madison Avenue
New York, NY 10016
212-616-5612

Lisa Ledwidge, MSES, MPA
Editor, Science for Democratic Action
Institute for Energy and Environmental Research
6935 Laurel Avenue, Suite 201
Takoma Park, MD 20912
301-270-5500
ieer@ieer.org

Karen Joy Miller
President
Huntington Breast Cancer Action Coalition
5 Broadview Drive
Huntington, NY 11743
631-547-1518
516-547-1518
friends@hbcac.org
mam18@aol.com

Anita Nager
Director of Programs
Beldon Fund
99 Madison Avenue
New York, NY 10016
212-616-5612
anita@beldon.org

Frieda Nixdorf
Administrative Specialist
Collaborative on Health and the Environment
P.O. Box 316
Bolinas, CA 94924
415-868-0970
info@healthandenvironment.org

Terry Nordbrock, MLS
Founding Member
Families Against Cancer and Toxics
P.O. Box 41285
Tucson, AZ 85717-1285
info@familiesagainstcancer.org

Leo Petrilli
306 Partington Ave Apt 105
Windsor, Ontario N9B 2B5
Canada
519-253-4223
leovan7052@yahoo.ca

Joan Reinhardt Reiss
Public Policy Consultant
The Breast Cancer Fund
1388 Sutter Street, Suite 400
San Francisco, CA 94109
415-346-8223
reissjm@aol.com

Joan M. Ripple
President
Council on Wireless Technology Impacts
Marin Precautionary Principle Working Group
113 Ensenada Drive
Novato, CA 94949
415-883-6791
Purrycomo@jps.net

Jeanne Rizzo, R.N.
Executive Director
The Breast Cancer Fund
1388 Sutter Street, Suite 400
San Francisco, CA 94115
415-346-8223 ext. 26
jeanne@breastcancerfund.org

Margaret Roberts
Capital Region Action Against Breast Cancer (CRAAB!)
125 Wolf Road, Suite 124
Albany, NY 12205
518-482-1314 Home office
518-435-1055 CRAAB office
PenPalette@aol.com

Ruthann Rudel, M.S.
Senior Scientist
Environmental Toxicologist
Silent Spring Institute
29 Crafts Street
Newton, MA 02458
617-332-4288 x14
rudel@silentspring.org

Ted Schettler, M.D., M.P.H.
Science Director
Science and Environmental
Health Network
84 Water Street
Newburyport, MA 01950
978-462-4092
tschettler@igc.org

Lisa Starr, M.S.N. C.N.P.
Breast Program Coordinator
SMDC Health System
400 East Third St.
Duluth, MN 55805
218-786-3847
lstarr@SMDC.org.

Sandra Steingraber, Ph.D.
Distinguished Visiting Scholar
Ithaca College, Division of Interdisciplinary Studies
Program on Breast Cancer and Environmental Risk Factors
14 Bradley Street
Trumansburg, NY 14886
ssteingraber@ithaca.edu

Kim Storm, M.S.Ed.
Health and Wellness Program Director
YWCA Breast Cancer Awareness Program
202 West Second Street
Duluth, MN 55802
218-722-7425
wellness@ywcaduluth.org

Jeanette Swafford, M.H.Ed.
Director of Health Initiatives
Collaborative on Health and the Environment
P.O. Box 316
Bolinas, CA 94924
415-868-0970
info@healthandenvironment.org

Robert Tufel, M.S.W., M.P.H.
Executive Director
National Brain Tumor Foundation
22 Battery Street, Suite 612
San Francisco, CA 94111-5520
415-834-9970
tufel@braintumor.org

Lisa Wanzor
Associate Director
Breast Cancer Action
55 New Montgomery Street, Suite 323
San Francisco, CA 94105
415-243-9301 ext. 18
lwanzor@bcaction.org

Laura Weinberg
Great Neck Breast Cancer Coalition
lpw513@aol.com