1 Report of the Interagency Breast Cancer and Environmental Research Coordinating Committee (IBCERCC) 1 Breast Cancer and the Environment: Prioritizing Prevention FEBRUARY 2013 1 2 Breast Cancer and the Environment: Prioritizing Prevention Breast Cancer and the Environment Prioritizing Prevention Report of the Interagency Breast Cancer and Environmental Research Coordinating Committee (IBCERCC) February 2013 i Breast Cancer and the Environment: Prioritizing Prevention ii Breast Cancer and the Environment: Prioritizing Prevention Contents Chapter 1. Executive Summary 1-1 Committee Recommendations 1-2 Prioritize Prevention 1-2 Transform How Research Is Conducted 1-2 Intensify the Study of Chemical and Physical Factors 1-3 Plan Strategically Across Federal Agencies 1-4 Engage Public Stakeholders 1-4 Train Transdisciplinary Researchers 1-5 Translate and Communicate Science to Society 1-5 Conclusion 1-5 References 1-6 Chapter 2. Introduction 2-1 Legislation/Congressional Charge to This Committee 2-2 Defining the Environment 2-4 Preventing Breast Cancer 2-4 Concepts Considered Throughout the Report 2-5 IBCERCC and Related Reports 2-6 References 2-8 Chapter 3. Breast Cancer Burden 3-1 Introduction 3-1 Incidence and Mortality 3-1 How Breast Cancer Is Classified 3-2 Breast Cancer Risk and Mortality Varies Significantly by Race and Ethnicity 3-3 Survival, Recurrence, and Second Breast Cancers 3-5 Survivorship 3-5 Global Burden of Breast Cancer 3-6 The Importance of Surveillance in Monitoring the Cancer Burden 3-6 Conclusion 3-7 References 3-7 iii Breast Cancer and the Environment: Prioritizing Prevention Chapter 4. Major Advances in Breast Cancer Prevention, Diagnosis, and Treatment 4-1 Breast Cancer Prevention 4-1 Breast Cancer Diagnosis 4-2 Breast Cancer Treatment 4-2 Animal Research 4-3 Milestones by Advocacy Groups in Advancing Breast Cancer Research and Research on Breast Cancer and the Environment 4-4 References 4-7 Chapter 5. State of the Science: Part 1—Principles, Approach, and Mechanisms 5-1 Introduction 5-1 Principles for Reviewing the State of the Science 5-1 The Approach for Reviewing the Evidence 5-4 Breast Cancer Etiology 5-4 Conclusion 5-15 References 5-16 Chapter 6. State of the Science: Part 2—Evidence From Animal and Human Studies and Cross-Cutting Themes 6-1 Accepted Risk Factors for Breast Cancer Based on Human and Animal Data 6-1 Risk Factors with Some Evidence for Breast Cancer Based on Human and Animal Data 6-13 Overarching Themes, Research Directions, and Recommendations 6-29 Overview of Key Human and Animal Research Needs 6-38 Conclusion 6-40 References 6-41 Chapter 7. Research Process 7-1 Introduction 7-1 Analysis of Federal and Nonfederal Research Investments in Breast Cancer 7-1 Research Collaborations 7-16 Promoting Innovation 7-22 Increasing Diversity of the Research Workforce 7-24 Research to Accelerate Translation 7-25 Research Advocacy and Stakeholder Involvement in Research 7-25 Gaps and Recommendations 7-29 Conclusion 7-34 References 7-35 iv Breast Cancer and the Environment: Prioritizing Prevention CONTENTS Chapter 8. Translation, Dissemination, and Communication of Research Related to Breast Cancer and the Environment: From Science to Society and Back Again 8-1 Introduction 8-1 Importance of Public Participation 8-2 Research Translation, Dissemination, Communication 8-4 Examples of Research Translation, Dissemination, and Communication in Action 8-12 Gaps, Opportunities, and Recommendations for Improving Existing Research Programs 8-16 Policy Implications 8-20 Conclusion 8-24 References 8-25 Chapter 9: The Path Forward 9-1 Overarching Recommendations 9-2 Appendices A-1 Appendix 1. Interagency Breast Cancer and Environmental Research Coordinating Committee Charter A-3 Appendix 2. Endocrine Disrupting Chemicals (EDCs) A-7 Appendix 3. Environmental Chemical Carcinogens A-13 Appendix 4. Methodology for Identifying Relevant Funded Breast Cancer Research A-15 Appendix 5. Breast Cancer and Environmental Exposures Dissemination and Communication Toolkit A-17 Appendix 6. References A-22 Glossary A-26 Acronyms A-34 v Breast Cancer and the Environment: Prioritizing Prevention About the IBCERCC To reduce the burden of breast cancer on women and men of all ethnic groups, Congress passed Public Law 110-354, the Breast Cancer and Environmental Research Act, in 2008. The Act required the Secretary of the HHS to establish the IBCERCC. The IBCERCC was charged with: Reviewing federal research efforts concerning the environmental and genomic factors related to breast cancer. Identifying scientific advances in breast cancer research and outlining key research questions, methodologies, and knowledge gaps. Developing a comprehensive strategy for accelerating transdisciplinary, innovative, and collaborative research on breast cancer and the environment across federal agencies and in partnership with nonfederal organizations. Determining how to increase public participation in decisions about breast cancer research and the optimal mode of dissemination of information on research progress. The Committee, supported by staff from the NIEHS and NCI, was comprised of federal members from agen- cies involved in research on breast cancer and the environment including the NIEHS, NCI, EPA, the DoD, and the CDC; non-federal members from scientific and clinical communities; and non-federal members who repre- sent individuals with breast cancer. Disclaimer The views expressed in this report are those of the authors and may not reflect the official policy or position of the Centers for Disease Control and Prevention, the Department of the Army, Department of Defense, the National Institutes of Health, the United States Environ- mental Protection Agency, or the United States Government. vi Breast Cancer and the Environment: Prioritizing Prevention IBCERCC Members Chair and Subcommittee Chairs Michele R. Forman, Ph.D. Alice Chang Chair and State-of-the-Science Subcommittee Chair President David Bruton Centennial Professor Academy for Cancer Wellness (2010–2011) Associate Chair, Department of Nutritional Sciences Tucson, AZ University of Texas at Austin Austin, TX Ysabel Duron Founder and Executive Director Michael N. Gould, Ph.D. Latinas Contra Cancer Research Process Subcommittee Chair San Jose, CA Kelly H. Clifton Professor Department of Oncology Sandra Z. Haslam, Ph.D. McArdle Laboratory for Cancer Research Professor School of Medicine and Public Health Department of Physiology University of Wisconsin-Madison College of Human Medicine Madison, WI Michigan State University East Lansing, MI Jeanne Rizzo, R.N. Research Translation, Dissemination, and Policy Ronda S. Henry-Tillman, M.D., F.A.C.S. Implications Subcommittee Chair Professor of Surgery President and Chief Executive Officer Division of Breast Surgical Oncology Breast Cancer Fund University of Arkansas for Medical Sciences San Francisco, CA Little Rock, AR Non-Federal Members Karen J. Miller (2010–2012) President and Founder Janice M. Barlow, B.S.N., P.H.N., C.P.N.P. Huntington Breast Cancer Action Coalition, Inc. Executive Director Huntington, NY Zero Breast Cancer San Rafael, CA Laura Nikolaides, M.S. Director of Research and Quality Care Program Beverly Canin National Breast Cancer Coalition Vice President Washington, DC Breast Cancer Options, Inc. Kingston, NY vii Breast Cancer and the Environment: Prioritizing Prevention Kenneth M. Portier, Ph.D. Marcus G. Plescia, M.D., M.P.H. Managing Director Director Statistics and Evaluation Center Division of Cancer Prevention and Control American Cancer Society Centers for Disease Control and Prevention Atlanta, GA Atlanta, GA Cheryl Walker, Ph.D. (2010–2012) Gayle Vaday, Ph.D. Professor and Director Program Manager Institute for Biosciences and Technology Department of Defense Breast Cancer Research Center for Translational Cancer Research Program Texas A&M Health Science Center Congressionally Directed Medical Research Program Houston, TX Frederick, MD Federal Members Shelia H. Zahm, Sc.D. (2010–2011) Deputy Director Christine B. Ambrosone, Ph.D. Division of Cancer Epidemiology and Genetics (NCI Board of Scientific Advisors member) National Cancer Institute Professor of Oncology and Chair Bethesda, MD Department of Cancer Prevention and Control Roswell Park Cancer Institute Ex Officio Members Buffalo, NY Dale P. Sandler, Ph.D. Rachel Ballard-Barbash M.D., M.P.H. Chief Associate Director Epidemiology Branch Applied Research Program Division of Intramural Research Division of Cancer Control and Population Sciences National Institute of Environmental Health Sciences National Cancer Institute Research Triangle Park, NC Bethesda, MD Neeraja Sathyamoorthy, Ph.D. Suzanne E. Fenton, Ph.D. Program Director Group Leader Tumor Biology and Metastasis Branch Reproductive Endocrinology Division of Cancer Biology National Toxicology Program National Cancer Institute National Institute of Environmental Health Sciences Bethesda, MD Research Triangle Park, NC Executive Secretaries Sally Perreault Darney, Ph.D. Office of Research and Development Gwen W. Collman, Ph.D. U.S. Environmental Protection Agency Director Research Triangle Park, NC Division of Extramural Research and Training National Institute of Environmental Health Sciences Vivian Pinn, M.D. (2010–2011) Research Triangle Park, NC Director Office of Research on Women’s Health Deborah M. Winn, Ph.D. National Institutes of Health Deputy Director Bethesda, MD Division of Cancer Control and Population Sciences National Cancer Institute Bethesda, MD (Acting Executive Secretary) viii Breast