A Bodacious Valentine’s Day

Be still my heart
 (Photo credit: EraPhernalia Vintage)

Yesterday, in honor of V-day, I had the pleasure of attending a ground-breaking panel on boobies. Because this is 2013, when the subject of breasts arises, so to speak, the topic of breast cancer isn’t far behind.

The purpose of the gathering was to announce publication of an important new report that — really for the first time — sets out an agenda for prevention of breast cancer and points to the significance of environmental factors like chemicals, instead of focusing almost exclusively on treatment. The 200+ page report was the result of two years of work by a group of academics, advocates and government scientists called the Interagency Breast Cancer and Environmental Research Coordinating Committee. (Oddly, the link to the report is not working on the government Website. The New York Times coverage is here. Update: Link fixed!)

In 2012, more than 200,000 women and 2,000 men will be diagnosed with breast cancer, and 40,00 women will die from it. A large majority of breast cancer cases — some 85 percent — occur in women with no family history of breast cancer. We know that some environmentally widespread chemicals — including PFOAs, dioxin, the pesticide Atrazine, DDT, flame retardants, and hormone disruptors like Bisphenol-A (BPA) — are linked to breast cancer.

We also know — most recently from shocking and sad reporting by the Center for Public Interest (CPI) of a published, peer reviewed study of plastics auto suppliers and other workers in Ontario that there is very strong evidence linking acute exposures to plastics and chemicals to cancer rates: women working in the auto supplier and canning jobs had cancer rates of 5 times the control group.

Here’s CPI’s summary of the report’s list of chemical exposures related to breasts:

At least 216 chemicals, including endocrine-disrupting substances like bisphenol A, have been associated with mammary gland tumors in animals. Endocrine-disrupting chemicals, or EDCs, are used to make plastics and pesticides and found in products such as furniture, metal food cans and cosmetics.

Ergo, it would nothing short of dunderheaded to talk about preventing cancer without looking at environmental factors in the mix, alongside genetic, diet and other risk factors. We badly need the kind of paradigm shift the report tees up, as well as the focused attention on environmental risks from regulators and researchers that it recommends.

The arrow on this mammogram points to a small ...

The arrow on this mammogram points to a small cancerous lesion. (Photo credit: Wikipedia)

In honor of the holiday, let’s get back to knockers for a sec. On the panel, author and reporter Florence Williams returned our attention to the physical facts by pointing out a number of novel features that uniquely describe the twin wonders on a woman’s chest.

She pointed out that breasts are among the fattiest organs in the body and that many chemicals are drawn (like men) to these fatty tissues, that breasts are filled with hormone receptors, and that they change over the course of women’s lives as biologically needed. Williams called them, rightly, a “sentinel organ,” noting that what happens to our breasts is an early signal for our overall environment and health. (I picked up a copy of Williams’ book, “Breasts: A Natural and Unnatural History,” and am excited to read it because she tests the level of flame retardants in her own breast milk, among other unpleasant but informative discoveries.)

Jeanne Rizzo, head of the Breast Cancer Fund, spoke next and highlighted the fact that we know that there are critical stages — called windows of susceptibility — that impact life-time risk for breast cancer, beginning in utero, and that due to the emerging science of epi-genetics, it’s now clear that genes and the environment interact throughout our lives in a complex dance of possibilities. Her wonderful op-ed is also well worth a read. (It’s for this reason that I do think a focus on reducing environmental risks for pregnant women and young children is important, and that consumers need help in this area.)

Linda Birnbaum, the Director of the National Institute of Environmental Health Sciences (NIEHS) of the National Institutes of Health (NIH), and National Toxicology Program (NTP) was also powerful. I was particularly struck by her description of an ongoing “sister study” pairing women who are diagnosed with breast cancer with their sisters who have not been.

As she pointed out, we may have been over-emphasizing genetic factors when we see diseases linked in families, because although it’s true that they share genes, siblings also tend to share environmental influences. This study will attempt to distinguish genetic factors from the other shared conditions, including chemical exposure levels, thus helpfully sorting out what we can fix, given sufficient political will, from what we really can’t.

This got me thinking about obesity as another confounding factor in the research. We all know — and it was reiterated by panelists — that obesity is major risk factor for breast cancer, heart disease, and basically every other major health problem. Yet we also know that mice exposed to a teensy amount of BPA get much fatter than other mice. As Nicholas Kristof noted:

Among chemicals identified as obesogens are materials in plastics, canned food, agricultural chemicals, foam cushions and jet fuel.

They’re everywhere, in other words. Yet the national report on obesity a big government panel issued last year barely mentioned the issue, instead focusing its major recommendations entirely on nutrition and exercise. Ditto with the President’s “Let’s Move” action plan.

Now, I’m not disputing that healthy foods and regular activity likely play an important role in obesity. But, as Jeanne Rizzo said the founder of the Breast Fund Center asked about breast cancer, I would still ask why we are so much fatter now than we used to be, and why Americans, who have far more chemicals in their diet and environment, are so much heavier than Europeans, when we eat basically the same types of foods.

The staggering rate of increase in obesity should be another indicator. A recent report found that adult obesity rates could exceed 60 percent in 13 states by 2030, and that:

If states’ obesity rates continue on their current trajectories, the number of new cases of type 2 diabetes, coronary heart disease and stroke, hypertension, and arthritis could increase 10 times between 2010 and 2020—and double again by 2030.

Then there’s the stunning increase in childhood incidence of Type 2 diabetes. From a September 2012 article in the Times:

Before the 1990s, this form of diabetes was hardly ever seen in children….There were about 3,600 new cases a year from 2002 to 2005, the latest years for which data is available.

What has changed from before the 1990s until now? As a child of the 1970s and ’80s, I can tell you: our diets were no paragon of health. We ate junk food, nutrient-poor school lunches, and canned green beans, white rice and pork chops for dinner. We binged on Halloween candy while playing Atari for hours. But this disease was for the full decade of my adolescent decadence still virtually unknown in kids. In fact, we know a lot more about healthy eating and healthier foods are much more widely available today, yet we’re still in deep trouble.

Researchers are basically at a loss to explain the obesity increase, as in this comically uninformative paper where they more or less throw in the towel. Could it be, instead, that the ubiquitous chemicals, drugs and fillers in food and industrial agriculture, along with the plastics that package virtually all of our foods, are at least in part to blame? That cheap calories from a degraded and ever-more industrialized food supply — eaten by people across the socioeconomic spectrum — come at a very high cost? What are those fat mice trying to tell us?

As in the breast cancer sister study, when we treat obesity as an inert risk factor — “don’t get fat, you!” — we are missing an opportunity to shift the paradigm to environmental health factors and instead substituting a far less helpful blame-the-victim mentality.

We should not fail to acknowledge obesogens may be a confounding factor in the data — that the same people who are obese are more likely to get breast cancer because the cause of both conditions could be related to the same chemical exposures (or chemical-epigenetic interactions that reflect a sensitivity to environmental influences). If it turns out this is right, and chemicals are a major factor in all of these kinds of health conditions, then the solutions are also shared, and the public health costs of inaction virtually incalculable.

Please don’t misunderstand me. I care deeply about preventing breast cancer, having seen its terrible toll on close family friends. And I am so excited for the publication of this major report that talks clearly and for the first time about the impact of chemicals on cancer rates, though I wish there was a least a small section on consumer can-dos, to counteract the doom and gloom.

But we also must be uncompromising as we outline the possible damage from toxins, and push this powerful new paradigm to its logical conclusions. To meaningfully address a host of public health threats, we will need one day soon to take the full measure of what our ongoing, uncontrolled experimentation with biology-altering chemicals has actually accomplished, in both our bodies and our brave, sentinel breasts.

Breast cancer. Image made by Itayba

Breast cancer. Image made by Itayba (Photo credit: Wikipedia)

Waiting for Supermom: The FDA’s Failure on BPA

Credit: Darren Higgins

Cross-posted from the Natural Resources Defense Council blog, On Earth, 4/18/2012.

When the New York Times ran a snarky story under a picture of my daughter, Maya, a few weeks ago describing my efforts to rid my home of toxic chemicals, you can bet the comments from readers were merciless. Readers accused me of trying to keep my child in a bubble and mocked me as yet another privileged, neurotic helicopter mom.

Truth be told, instead of a posh housewife, for years I was a cash-strapped public interest lawyer who roamed the halls of Congress with brokenhearted families after some federal agency had failed to protect them. I worked on the Ford-Firestone rollover tragedy and the discovery of lead in children’s toys from China, among other disasters for public health. So when I had my own child, it seemed important to think through the risks to her health for myself.

Still, the pointed comments got me thinking: are moms, and parents generally, bad or good at predicting risks to children? I’ve decided that while parents might not be perfect, we’re a good sight better than the Food and Drug Administration (FDA).

Contrary to stereotype, moms (and dads) are actually expert risk assessors. In fact, it’s no overstatement to say that risk assessment is a major part of the job. Parents constantly measure both the benefits and risks to their child, of say, crossing the street, eating that suspect ball-park hot dog, going to summer camp, or even, as at my house, playing on our splinter-filled back deck (allowed, but shoes required).

On the other hand, we have the FDA. Eleven states, and at least eight countries, including Canada, China, and the European Union, have already banned Bisphenol-A — a dangerous chemical added to plastic food containers and can linings — in some or all products. Hoping to head off more comprehensive rules, the chemical industry in the U.S. even asked regulators last September for a ban on BPA in baby bottles and sippy cups.

Nonetheless, the FDA recently decided to keep exposing all of us to BPA, which shows up in the urine of 93 percent of Americans. This was a big step backward from the agency’s public position in 2010, which said that BPA was of “some concern” with regard to health impacts like early puberty and prostate cancer. That statement was based on a 2008 report from the National Toxicology Program, which concluded that there is “some concern for effects on the brain, behavior, and prostate gland in fetuses, infants, and children at current human exposures to bisphenol A.”

Four long years later (a period which included the birth of my daughter in 2010), the FDA’s disappointing decision to punt left in its wake a dizzying array of contradictory messages for the public on the safety of BPA. While FDA said that its recent decision was not a final determination and that it would continue to study the issue, the chemical industry’s flacks said the decision meant that BPA “is safe for use in food-contact materials.”

The Department of Health and Human Services, meanwhile, states that “[i]t is clear that the government… need[s] more research to better understand the potential human health effects of exposure to BPA, especially when it comes to the impact of BPA exposure on young children.” HHS also provides recommendations to parents about “minimizing BPA exposure,” including helpful information on BPA levels in various types of containers for infant formula and the advantages of breastfeeding. This is in marked contrast to the cursory, lame non-guidance from the FDA, which states “FDA is not recommending that families change the use of infant formula or foods.”

Really? No changes? It’s shocking that in the face of health concerns that even the government has acknowledged, FDA won’t provide a shred of guidance for pregnant women and parents about how to minimize exposure for their baby. How about the obvious: families should avoid baby bottles with BPA in them, ready-to-use formulas and baby foods with BPA in the lining of lids, and canned foods with a BPA lining. Or that pregnant women, like the one working the cash register at my local café last week, should avoid handling receipts and money, which have been shown to be covered in unbound BPA?

In the face of such indifference to the risks, I’ll just point out the clear superiority of parents as deciders. In fact, parents generally make balanced — and protective — choices, weighing both benefits and risks. Kids can’t and shouldn’t live in a bubble, sure, so parents do the best they can with the information that they have. But when they think about the downsides, they also make a very precise accounting, a moral and ethical accounting, you might say, that reflects the place in their heart occupied by their own child.

Parents everywhere take note: this kind of protective approach should also be the yardstick used by government when it assesses the risks to its citizens. When I worked on the Ford-Firestone rollover disaster, accompanying the mother of a dead 18-year-old boy to her senator’s office to argue for more protective auto safety rules, what she expressed most poignantly, besides the devastating impact of her loss, was her profound, tragic heartbreak that she “didn’t know” about this risk — that she “didn’t know” that the government would allow things to be sold that were unsafe — that she assumed, in fact, that government would view the life and health of her child in the same loving, protective way she did.

If only it were so. When the FDA and White House play politics with our health and lives, when regulators admit a chemical in our food supply is unsafe yet refuse to even offer adequate guidelines for parents to protect their babies and children, and when a potential threat to our health is so impossible to avoid, we need a new, and far better, ethic for assessing risks and the safety of families.

We should enact laws that require products to be proven to be safe before our children and families can be exposed. And in the case of FDA, we shouldn’t tolerate these ridiculous waiting games. The agency should meet its legal obligation to protect the public from chemicals that can reach our food supply and have not been proven to be safe. That would be a government that only a mother could love.