Breast Cancer and the Environment

I just received this newsletter and this is an excellent article. No link - so this is a direct copy

Breast Cancer and the Environment and Environmental Health Policy

by Susan Luck, Educational Director, Earthrose Institute 

In today’s world, many people experience unexplained symptoms that eventually drive them to our office seeking a diagnosis and treatment. Common complaints presented include unexplained onset of allergies, chronic fatigue and fibromyalgia, mood and behavioral changes, hormonal disruption, and immune and autoimmune issues.

Although environmental factors contribute to up to 80% of those seeking medical services, many practitioners do not have the information or tools to include an environmental assessment as part of their work up and therefore may be missing key information into the environmental triggers and what may be needed for an effective prevention strategy and treatment protocol.

It is estimated that currently there are 100,000 synthetic chemicals registered for commercial use in the world today with several thousand new ones being formulated every year. Few have been tested for human safety and while many are known to be potentially toxic and carcinogenic, new research is just beginning to show how low dose exposures over time impacts our health. We swallow, inhale, ingest, and absorb through our skin, plastics, pesticides, fire retardants, exhaust fumes, fragrances, and much more every day. They are ubiquitous and are in our homes, automobiles, cleaning products, cosmetics, clothing, children’s toys, and contribute to our continual exposure to many that have been classified  as endocrine disruptor chemicals or EDCs.

A growing pandemic of endocrine-related disorders, including ADHD, Parkinsons, Alzheimers, diabetes, obesity, early puberty, infertility and other reproductive disorders, and childhood and adult cancers, is seriously undermining the health and wealth of our nation. Recent data from the National Institute of Environmental Health Sciences (NIEHS) shows that all of these diseases can be caused by developmental exposure to EDCs in animal models.

Epidemiological evidence increasingly suggests that environmental exposures during critical windows of development including in utero, play a role in susceptibility to disease later in life, including breast and testicular cancers, and can be passed on through subsequent generations. Epigenetic modifications provide a link between the environment and alterations in gene expression that might lead to disease phenotypes.

Last month, the Center for Disease Control (CDC) issued their Fourth National Report on Human Exposure to Environmental Chemicals and concluded that Americans of all ages carry a body burden of at least 148 chemicals, some of them banned for decades. This  is the most comprehensive assessment to date on the exposure of the U.S. population to chemicals in our environment. The CDC measured 212 chemicals in people's blood or urine-75 of which have never before been measured in the U.S. population. The new chemicals tested include acrylamide, arsenic, environmental phenols, including bisphenol A and triclosan, and perchlorate.

Although the full impact of exposures to endocrine disruptors is still to come, there can be no denying that we are witnessing a spike in breast cancer, testicular, and prostate cancers along with a huge increase in infertility in both men and women.
Children, particularly vulnerable, continue to have rising rates of autism, childhood cancers, chemical sensitivities, allergies, asthma, and ADHD. Scientists and advocacy groups are leading the way to informing the public, urging health policy actions, and confronting industry on this urgent issue.

Banned in Europe, and defended in the US by the chemical industry, Bisphenol A is an example of a known endocrine disruptor originally developed to replace DES. Today, it permeates our products and our bodies and is commonly found in umbilical cord blood. For the first time, research indicates that early exposure to PBA is a predictor for breast cancer later in life.

Today, women in the United State face a greater lifetime risk of breast cancer than any previous generation, having tripled during the past 40 years, with estimates of one in six women having a diagnosis in their lifetime. Only about 5 percent of women diagnosed with breast cancer have a link to the “breast cancer gene”. This means that the vast majority of women never know what “caused” their diagnosis.

Currently, 216 estrogen disruptor chemicals have been identified. Global research estimates that women’s cumulative exposures to estrogenic compounds, both exogenous and endogenous, may be responsible for up to 50% percent of all breast cancers today.
Known environmental factors that contribute to the increase breast cancer risk include: exposure to radiation from chest x-rays in childhood, hormone replacement therapy, alcohol, tobacco and second hand smoke. Breast cancer rates are higher in women who are obese, and women who gain excess weight during adulthood. In a surprising reversal, at the annual meeting of the Radiological Society of North America this past month, a study was presented associating low-dose radiation from annual mammography screening  with an increase in breast cancer risk in women with genetic or familial predisposition to breast cancer.

The degree of alarm within the scientific community concerning the dangers of radiation and hormone disrupting environmental pollutants is also apparent in a report recently released by the Health and Environment Alliance (HEAL), a European umbrella group of non-governmental research organizations. This report directly questions the growing tendency to label breast cancer a lifestyle and genetic disease and states, "We will not be able to reduce the risk of breast cancer without addressing preventable causes, particularly exposure to chemicals."

To compound the problem of our toxic environment, we have refined away much of the nutritional value of our food supply, and replaced it with imitation foods lacking essential elements and protective phyonutrients. Our modern poor quality diet, combined with agricultural pesticides and animals being raised on antibiotics, chemical feed, and growth hormones, may have predisposed many of us to experience a toxic body burden, stressing our body’s ability to detoxify and eliminate these substances.

The good news is that cancer can be reduced by avoiding or lowering exposures to environmental toxicants as well as by optimizing our immune surveillance systems and cellular energy metabolism with nutritional intervention strategies.

As part of an integrative wellness assessment, and to be more effective in our outcomes, asking our patients about possible environmental exposures in the workplace, home, community, diet, and personal care products, can assist us in addressing how cumulative toxic exposures can impact our health, immune system, and genes and guide our intervention strategies.

There has been no public health policy campaign to address these environmental issues until last month, when the Endocrine Disruption Prevention Act, legislation introduced by Congressman Jim Moran of Northern Virginia and Senator John Kerry of Massachusetts, (HB 4190) and (S2828) proposed a bill to explore links between hormone disrupting chemicals in the environment and everyday products. This legislation also emphasizes the dramatic increase of autism, hyperactivity, diabetes, obesity, breast cancer, prostate cancer and other hormone related disorders.

As citizens and as practitioners, we now have a tremendous opportunity to impact environmental health policy by contacting our U.S. Senators and Representatives and asking them to cosponsor this bill. We need to share this with our colleagues, patients, and community to take action for changing current environmental health policy.

Participate in Susan Luck's discussion about conducting environmental assesments and environmental healthcare policy.
For more information, including sign on letters, click here.

Additional Websites
www.ewg.org
www.earthroseinstitute.org
www.breastcancerfund.org
www.safecosmetics.org
http://www.cdc.gov/exposurereport/ 

First Breast Ultrasound Imaging System Approved

This is good news for those who require Ultrasound for dense breast tissue.

The FDA approved U-Systems Inc.'s somo-v Automated Breast Ultrasound System (ABUS), the first ultrasound device for use in combination with a standard mammography in women with dense breast tissue who have a negative mammogram and no symptoms of breast cancer. Dense breast tissue may obscure smaller tumors, which could delay detection of breast cancer.
http://www.chemotherapyadvisor.com/first-breast-ultrasound-imaging-system-approved/article/259776/?DCMP=EMC-CTA_Front&Visitor_ID=&cpn=cta_sutinl&spMailingID=4912796&spUserID=MTI0ODg0NTY1NTIS1&spJobID=55116620&spReportId=NTUxMTY2MjAS1

Thermography and DCIS

With use of mammography as the 'gold standard' imaging - more and more women are being diagnosed with DCIS   "Ductal Carcinoma In Situ".

This is, however, a double-edge sword.

Early diagnosis of breast cancer is the ONLY reason that women are willing to submit to mammography.  But along with early detection – are we truly identifying those who have a ‘true breast  cancer’ or  are we willing to sacrifice women with a general diagnosis of DCIS and commit them to surgery, radiation and possibly chemotherapy – in the chance they will – in the future –convert to invasive breast cancer?

The diagnosis of DCIS – is rarely discussed in terms of ‘not yet a breast cancer’.

Following the call-back after a diagnostic mammogram – the patient is usually in a state of shock – and presents with a ‘deer in the headlights’ condition.  Is this really the best time for a discussion to take place?  However – whether it is the ‘optimal’ time or not --- the only words women appear to hear is ‘breast cancer’.   There is no IN SITU explanation what-so-ever.

When all patients with ductal carcinoma in situ are considered, the overall

mortality from breast cancer is extremely low, only about 1–2%. When conservative treatment fails, approximately 50% of all local recurrences are invasive breast cancer. In spite of this, the mortality rate following invasive local recurrence is relatively low, about 12% with eight years of actuarial follow-up.

The management of ductal carcinoma in situ of the breast: Endocrine-Related Cancer (2001) 8 33–45 K A Skinner and M J Silverstein

92% of all newly diagnosed patients had nonpalpable lesions, most of which were detected mammographically [4]. High-quality mammography is capable of finding a range of nonpalpable, asymptomatic, noninvasive lesions, many smaller, of lower nuclear grade, and with subtler mammographic findings than had been seen in the past. The concept of DCIS as a single disease entity is clearly not valid. DCIS is a heterogeneous group of lesions with diverse malignant potential.

Ductal Carcinoma In Situ of the Breast: Controversial Issues. Melvin J. Silverstein. 1998  The Oncologist.

Until recently --- there is usually an opportunity for the woman to receive an MRI with and without contrast.  The MRI conducted in this manner would help to identify if the IN SITU identified by mammography was, in fact, the only area of potential abnormal cells or if there are other areas of ‘DCIS’ in the same or potentially both breasts that mammography did not detect.

I say until recently --- because a recent study sends the message that the MRI may not be needed.  “ Pre-op MRI ineffective in preventing further breast cancer surgery”     September 19, 2012 | By Susan D. Hall

But – the question that I pose is “not necessary” according to whom?

MRI with contrast not only identifies those areas of suspicious cells – but aids in the detection of neoangiogenic support.  According to most if not all medical literature – cancer is unable to grow without the expression of angiogenesis.  Mammography is UNABLE   to detect the presence and or the absence of neoangiogenesis for any mammographic abnormality.  The utilization of Doppler Ultrasound usually follows a questionable mammogram to identify blood flow associated with the questionable area.  If we are denied the Ultrasound and now denied the MRI prior to biopsy or surgery --- how is the extent of the cancer determined prior to the “first cut”?

The primary issue regarding the diagnosis of DCIS – is this: DCIS MUST BE IDENTIFIED BY THE CELL TYPE AND THE STAGE... Without this information and the education related to these facts the woman is making a treatment decision based on fear alone.  The radiologist or the surgeon that does not educate the patient with regard to the current cell status and the true potential for future invasive cancer is being deceptive.  They are treating DCIS as an invasive cancer when it very well may not have the propensity for conversion.

Prior to mammographic detection of DCIS – pre 1990’s almost all DCIS was treated by mastectomy.  The true reason for this is most women who presented with what was diagnosed as DCIS already displayed palpable lesions.  Most of the “DCIS” was growing and more than likely was already an invasive disease.  But with mammographic detection of non-palpable lesions, the only true way to discern the potential threat is by Grade and cell type. The biopsy will provide this information.  Ask about the Grade and the 'comedo subtype'.

“Danish studies estimated that about 25% of all women will develop in situ carcinomas, predominantly in the form of DCIS.  Only a fraction of these lesions will evolve into a clinical manifest form”

WOMEN – educate yourself about DCIS prior to getting a mammogram.  Statistically -- one in four women will be given this diagnosis.  Be prepared and ask questions – don’t be driven by fear.

Thermography is currently the only non-invasive way to detect the pattern of neoangiogenesis in an abnormal thermogram.  DCIS with no neoangiogenesis present has a higher probability of being Low Grade or benign. MRI with contrast will help identify the presence and extent of neoangiogenesis in the breast. 

Thermography as a monitoring tool can aide in identifying early changes that are potentially breast cancers.  MRI is currently the only definitive test for localization of neoangiogenesis within the structure of the breast. 

Next Blog: Detection of DCIS by Thermograpy: True or False?

Don't Be Fooled

I've recently received a publication that included this article on health insurance (Understanding Medical Loss Ratio by Leon Kircik, MD).  I'm not a fan of insurance -- as it's legalized gambling;  but DIYD-DIYD (darned it you do and darned if you don't) participate. I frequently hear disparaging comments about the Affordable Care Act - "Obama Care"  -- as if this is some horrible 'Government Controlled' imposition.  But often I believe most people are only listening to propaganda created by insurance companies to over-rule or dismantle the potential of this Act. We, the people, are losing ground in our ability to fight against corporations who are only concerned with profit and not in the business for the general good. Government was created for the purpose of aiding 'the people'.  We are all - 'the people'.
Do you know that insurance companies are 'businesses"? Everything businesses do is designed to create profit -- and to the greatest extent.  Therefore -- whatever they (insurance companies) pay out for your health-related costs -- is money they have lost.  The difference between what we as consumers pay for premiums and what the insurance companies pay to cover our care is classified as 'medical loss ratio' . There is great incentive to NOT PAY. What they don't pay for our care - becomes a profit.
The Affordable Care Act has set limits to the percent of money insurance companies can hold back from paying. This law states insurance companies need to pay out 90% of our premiums toward our care.  If this Act is impaired, or worse yet - dismantled, then you and I will receive less and less for the premiums we pay and insurance companies will profit more and more.  With no restrictions or regulation on the amount of profit from dollars we pay, individuals will have little ability to demand changes in this profit structure. Is this what you really want? Profit is the only incentive for any business operation. But reasonable profits, not exploitation. Is "Government intervention" in exploitation really evil? I think if you're an insurance company or own stock in these firms it is -- but if you're looking for financial assistance to cover huge medical costs -- perhaps it's not. Remember, everything we evaluate is based on our perspective.  Why not look at the Affordable Care Act from many angles before you criticize what "Obama Care" might mean for all.