2013 Annual Meeting

2013 BCERP Annual Meeting – Dawn Anderson, WBCC Executive Director, BCERP Community Partner

The annual scientific meeting of the Breast Cancer and the Environment Research Program (BCERP) was held November 6 -8 in Madison. BCERP is a national research project that includes epidemiologic and biologic studies investigating the influence of extended environmental exposures on breast cancer risk. These “environmental exposures” include chemical, dietary, and psychosocial stresses.  Researchers are targeting multiple “windows of susceptibility” over a woman’s lifespan during which she may be particularly vulnerable to these exposures.  Each research site also includes the participation of Community Partners, who are responsible for helping translate research findings into language that can be easily understood by the lay public, and can be disseminated as public health messages. Wisconsin Breast Cancer Coalition is represented by Executive Director Dawn Anderson and Board Director, Kris Miller, as a Community Partner in BCERP funded research being conducted at UW-Madison

The three day conference began with the business meeting of the scientists and Community Partners. The business meeting is an important time for the partnership to share recent progress in research and dissemination projects. Les Reinlib, PhD, of the National Institute of Environmental Health Sciences (NIEHS) reported that to date, BCERP had resulted in nine biological outputs, six public health interventions, twenty subsequent research projects and numerous dissemination activities.

Recent successful outcomes include improved water treatment methods in Cincinnati and Northern Kentucky as a result of research that identified high concentrations of PFOA in participants in a BCERP study following a cohort of young girls.

The week of the conference, new research by BCERP researcher Dr. Frank Biro, was published in Pediatrics, journal of the American Academy of Pediatrics, showing that obesity is the largest predictor of earlier onset puberty in girls, a phenomenon that is affecting white girls much sooner than previously reported and which is widely regarded as a risk factor for development of breast cancer later in life.

The public meetings on Thursday and Friday began with a keynote address by Ken Olden, PhD, Director of the EPA’s National Center for Environmental Assessment and former Director of the NIEHS. As background to understanding much of the research being done in BCERP, Dr. Olden reminded the audience that it is important to remember that breast cancer is a complex interaction of genes, the environment and behavior. As pointed out:  “Genetics loads the gun; environment pulls the trigger”.    In other words, you may have a predisposition for a disease and be fine if the “trigger” isn’t pulled. The trigger will likely be a combination of exposures and will likely be different for every person.  The importance of understanding this interaction between personal genetics and one’s environment was echoed by Dr. Linda Birnbaum, Director of NIEHS, later in the conference. “You can’t change your genes but you can change your environment.”

Two reports in the past two years have focused on the importance of prevention. The Institute of Medicine (IOM) report was commissioned by Susan G Komen for the Cure ™. The committee conducted a thorough analysis of existing scientific literature related to breast cancer and the environment. (“Breast Cancer and the Environment: A Life Course Approach”.) Based on that information they made recommendations for future research and presented some actions individuals could take to reduce their risk of breast cancer.

The Report by The Interagency Breast Cancer and the Environmental Research Coordinating Committee (IBCERCC  – or as we say “EYE – BEE – CERK) was a congressionally mandated report which also described the state of the science related to the environment and breast cancer and also identified key research questions and knowledge gaps. The IBCERCC committee’s report (“Prioritizing Prevention”) also undertook developing a strategy for accelerating research across disciplines and agencies, determining how to increase public participation in decisions about research and the best way to disseminate information on research progress.

As Dr. Birnbaum stated, the signature of the IBCERCC report is its repetition of “Prevention, Prevention, Prevention.”

However, only about 10-11% of NIH research for breast cancer is for environmentally or behaviorally related studies.

Dr. Olden, in his address, stated the need to make this kind of research (prevention) a priority for funders. We need to advise policy makers of their choices regarding chemical regulation, policy addressing environmental exposures, and the health consequences of their choices.

Dr. Birnbaum also touched on this the next day in a session on the future of breast cancer prevention.  Why don’t we know more? Primarily, because we haven’t been looking at the right environmental exposures at the correct life stage. This is a challenge and an opportunity, to determine lifelong individual susceptibility to environmental exposures by looking at all stages of life.

While prevention is the ultimate goal, it is a challenge to be heard over the much more common public messages regarding early detection and treatment.  Marion Kavanaugh-Lynch, MD, of the California Breast Cancer Research Program pointed out how hard it is to PROVE prevention. A woman may get a mammogram, be diagnosed, undergo treatment and have a positive outcome. She will say “that mammogram saved my life.” And, as Kami Silk, PhD, (Michigan State University) discovered in her work, risk reduction/prevention is not covered nearly as much as treatment in the media. People remember messages about early detection more than risk reduction/prevention.  From the standpoint of not just making prevention research a priority for funders and researchers,  but also engaging the public in risk reduction behaviors, it is much more difficult to persuade them to action, because there is no way to know you have definitively prevented a disease. Consequently, the definitive “saved my life” messages are the ones that get the most attention – from the public and likely, from researchers and funders.

From the researchers, the most active outcomes are around puberty, obesity and the effects of high fat diets. Early onset puberty has been considered a risk factor – but what factors can be considered as causes? One is obesity as noted in the previously cited article by Dr. Frank Biro.  Dr. Biro discussed the “Perils of Puberty” as a time of rapid expansion of stem cells and growth hormones. Introduction of environmental exposures that have the ability to disrupt the normal patterns of growth is akin to throwing a monkey wrench in the works.

Richard Schwartz, PhD, (Michigan State University) reiterated that puberty is a time of high sensitivity to environmental exposures. He discussed his research into the effects of a high fat diet (HFD) on the development of mammary tumors in mice during puberty. Pointing out that more people eat high fat diets than are obese, he used mice that are not induced to obesity and designed a study whereby mice were fed either a HFD or LFD starting at puberty. The mice were then treated with a tumor inducing carcinogen, DMBA. Mice on HFD had a shorter period of time between the exposure to the carcinogen and the development of tumors (decreased latency) and had an increased number of early lesions. It was also noted that changes began appearing in the mammary tissue even before tumors were observed. These changes have been shown to enhance tumor progression. Interestingly, Dr. Schwartz observed that switching from a HFD to a LFD in adulthood did not convey any protection. The negative effects of the pubertal HFD last well into adulthood. His take home message was to follow the Precautionary Principle – avoid a high fat diet in puberty. It can do no harm and may be beneficial.

So what’s next for this type of research? The NIEHS grants that fund the program will expire in 2015. Researchers and Community Partners are already beginning the discussion of how to continue the collaborative, transdisciplinary nature of BCERP going forward. The final session of the conference focused on “The Final Frontier” – the future of breast cancer prevention and treatment.  In the realm of advocacy, it is vital that consumers take the lead and work in their own states to address regulation of chemicals, however Dr. Lynch pointed out that we aren’t going to be able to do this “one chemical at a time.” She spoke passionately about civil action, and about our right to live in a healthy environment without being exposed to harmful elements.  Marc Hurlbert, PhD of the Avon Foundation, added that maybe breast cancer advocates need to re-ignite their fire – that perhaps we’d gotten too tame.

For me, the lesson from BCERP is that there is a role for everyone in discovering how to prevent breast cancer. This cannot and should not be left to funders and researchers alone. There are very important roles for advocates and policy makers as we go forward. Not all of the questions are answered yet by any means, but it is clear that protecting children – before they reach puberty – from certain environmental exposures can only be beneficial in disease reduction and general overall health as they become adults. We have a responsibility to make that happen.