Identifying Gaps in Breast Cancer Research California Breast Cancer Research Program Special Research Initiatives Identifying gaps in breast cancer research: Addressing disparities and the roles of the physical and social environment Editors Julia G. Brody, PhD Executive Director Silent Spring Institute Marion (Mhel) H.E. Kavanaugh-Lynch, MD, MPH Director California Breast Cancer Research Program Olufunmilayo I (Funmi) Olopade, MD Walter L. Palmer Distinguished Service Professor of Medicine University of Chicago Medical Center Susan Matsuko Shinagawa Breast Cancer and Chronic Pain Survivor/Advocate, Intercultural Cancer Council; Asian and Pacific Islander National Cancer Survivors Network Sandra Steingraber, PhD Author and Distinguished Visiting Scholar Ithaca College David R. Williams, PhD Department of Society, Human Development and Health Harvard School of Public Health Front Matter DRAFT 8/11/07 Page 1 California Breast Cancer Research Program Table of Contents Preface Introduction Section I: Exposures from the Physical Environment and Breast Cancer Overarching Issues A. Secondhand Smoke B. Environmental Chemicals/Pollutants 1. Air Pollutants, Fuels and Additives 2. Persistent Organic Pollutants 3. Polybrominated Flame Retardants 4. Pesticides 5. Solvents and industrial chemicals 6. Water Contaminants 7. Hormones in Food 8. Metals 9. Exposures from Polyvinyl Chloride 10.Bisphenol A C. Compounds in Personal Care Products D. Pharmaceuticals E. Infectious agents F. Ionizing Radiation G. Electric and Magnetic Fields H. Light at night I. Vitamin D/Sunlight Section II: Disparities in Breast Cancer: Domains of Individual-level Social Inequality A. Race/Ethnicity B. Sexual Minority Women C. Disability Status D. Culture E. Health Insurance Section III: Neighborhood Context and Breast Cancer Front Matter DRAFT 8/11/07 Page 2 Identifying Gaps in Breast Cancer Research Acknowledgements The California Breast Cancer Research Program would like to acknowledge the assistance from the following individuals who participated in the development of these chapters. Any inaccuracies, however, are solely the responsibility of CBCRP. Please feel free to send comments about any chapter to [email protected]. Deborah Bowen, PhD, Professor, Social Behavioral Sciences, Boston University Judy Bradford, PhD, Director, Community Health Research, Virginia Commonwealth University Linda Burhansstipanov, MSPH, DrPH, Grants Director, Native American Cancer Research Christina A. Clark, PhD, Research Scientist, Northern California Cancer Center Lisa Clarke, MS, Research Associate, Northern California Cancer Center Richard W. Clapp, DSc, MPH, Professor, School of Public Health, Boston University Melissa B. Davis, PhD, Postdoctoral Fellow/Scholar, Center for Interdisciplinary Health Disparities Research, University of Chicago Suzanne E. Fenton, PhD, Research Biologist, Reproductive Toxicology Division, U.S. Environmental Protection Agency, Maria Feychting, PhD, Professor, Institute of Environmental Medicine, Karolinska Institute Scarlett Lin Gomez, PhD, Research Scientist, Northern California Cancer Center Robert B. Gunier, MPH, Research Associate, Northern California Cancer Center Dawn Hershman, MD, Assistant Professor of Medicine, Columbia University Chanita Hughes Halbert, PhD, Associate Professor University of Pennsylvania Susan E. Hurley, MPH, Research Associate, Northern California Cancer Center Esther M. John, PhD, Research Scientist, Northern California Cancer Center Lovell Jones, PhD, Director, M. D. Anderson’s Center for Research on Minority Health Sue Joslyn, PhD, Professor of Epidemiology, Associate Dean of Graduate Academic Affairs, University of Northern Iowa Marjorie Kagawa-Singer, PhD, RN, MN, MA, Professor, School of Public Health and School of Asian American Studies, University of California, Los Angeles Judith Salmon Kaur, MD, Medical Director, Professor of Oncology, Native American Programs, Mayo Comprehensive Cancer Center Steve Kaye, PhD, Associate Professor, University of California, San Francisco Charles Land, PhD, Senior Investigator, National Cancer Institute Robert Millikan, PhD, Professor, University of North Carolina, Chapel Hill Rachel Morello-Frosch, MPH, PhD, Associate Professor, Center for Environmental Studies, Department of Community Health, School of Medicine, Brown University Front Matter DRAFT 8/11/07 Page 3 California Breast Cancer Research Program Kirsten Moysich, PhD, Associate Professor, Roswell Park Cancer Institute Margaret Nosek, PhD, Professor, Baylor College of Medicine Sharon Perry, PhD, Senior Research Scientist, School of Medicine, Stanford University Blase N. Polite, MD, MPP, Instructor of Medicine, University of Chicago Anh-Thu Quach, MPH, Research Associate, Northern California Cancer Center Peggy Reynolds, PhD, Senior Research Scientist, Northern California Cancer Center Stephanie Robert, PhD, Associate Professor, School of Social Work, University of Wisconsin- Madison Ruthann Rudel, MS, Senior Scientist, Toxicologist, Silent Spring Institute Theresa M. Saunders, BA, Research Program Manager, Northern California Cancer Center Ted Schettler, MD, MPH, Science Director, Science & Environmental Health Network Richard Stevens, PhD, Cancer Epidemiologist, Department of Community Medicine and Health Care, University of Connecticut Joseph Thornton, PhD, Associate Professor, Center for Ecology & Evolutionary Biology, University of Oregon Julie Von Behren, MPH, Research Associate, Northern California Cancer Center David Wallinga, MD, MPA, Director of the Food and Health Program, Institute for Agriculture and Trade Policy Barbour Warren, PhD, Research Associate, Program on Breast Cancer & Environmental Risk Factors, Cornell University Tom Webster, DSc, Associate Professor, Environmental Health, School of Public Health, Boston University Mary Wolff, PhD, Professor, Mount Sinai Medical Center Staff and Consultants Janna Cordeiro, MPH, Coordinator of Special Projects Elizabeth Day, Program Assistant Judy Maclean, BA, Editorial Consultant Katherine McKenzie, PhD, Manager-External Relations; Biomedical Research Administrator Marj Plumb, DrPH, MNA, Senior Consultant, Plumbline Coaching and Consulting, Inc. Patrice Sutton, MPH, Technical Consultant Catherine Thomsen, MPH, Project Lead Front Matter DRAFT 8/11/07 Page 4 Identifying Gaps in Breast Cancer Research • To conduct research that will provide PREFACE recommendations to advocacy organizations and policy makers for • What role does the environment play in evidence-based change. breast cancer? • To stimulate more research into the • Why do some groups of women bear a environment-breast cancer connection and greater burden of this disease than others? the reasons why some groups of women The answers to these questions have thus far bear a greater burden of breast cancer. eluded scientists, yet answering them could lead to We plan to identify and involve California great progress against breast cancer. Recognizing organizations and institutions who can join forces the need for more research into these questions, and increase the resources available to conduct the California Breast Cancer Research Program this research. (CBCRP) is launching our Special Research Initiatives, a five-year effort to find answers that This report is not a comprehensive review of all will push breast cancer research forward. research on the environment-breast cancer connection or the reasons why some groups of We are setting aside 30 percent of our funds over women bear more of the burden of the disease. It five years for the Special Research Initiatives, is instead a review of existing research—gathered approximately $18 million. To select the research from widely scattered sources—pointed toward that will lead to the most progress against breast discovering research areas that show some cancer, we are following a carefully-crafted, two- connection with the disease, and recommending year, publicly-accessible strategy development further investigations that are likely to make the process. An initial step in the process is this most difference toward eliminating the death and report reviewing previous research. suffering caused by breast cancer. We are embarking on the Special Research The Need for This Research Initiatives because research has been conducted for decades, and yet too many women are being Breast cancer is a complex disease. Despite diagnosed with breast cancer, living with the decades of intensive research, its causes and basic threat of a recurrence, and dying. There is no biology remain unclear. From the 1940s until action women can take to assure they won't get very recently, the U.S. breast cancer rate has been breast cancer. Our goals are: rising, and this increase is not explained by better detection methods. • To initiate research that will point to actions that can be taken to reduce the Scientific studies have uncovered a number of risk burden of breast cancer factors for breast cancer. Some of these risk factors can be modified by individuals to lower Preface DRAFT 6/19/07 Page 1 California Breast Cancer Research Program their risk, and others cannot. One known risk population groups could not only lead to a factor is a family history of the disease, which decrease in inequality among groups of women raises a woman's risk. This can't be modified by with breast cancer, but also reveal crucial individuals. Another known risk factor is not information about the disease itself. having children or having children later in life. Although this can be modified by individuals,