THE TRUTH ABOUT BREAST CANCER--PART 4

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RACHEL'S ENVIRONMENT & HEALTH WEEKLY #574 .

 

.. ---November 27, 1997--- .

 

.. HEADLINES: .

 

.. THE TRUTH ABOUT BREAST CANCER--PART 4 .

 

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THE TRUTH ABOUT BREAST CANCER--PART 4

 

 

 

Late last month the NEW ENGLAND JOURNAL OF MEDICINE (NEJM)

 

published a study (by David J. Hunter) comparing the levels of

 

DDE and PCBs in the blood of two groups of women, one group with

 

breast cancer, the other without.[1] The Hunter study failed to

 

find a positive relationship between breast cancer and DDE or

 

PCBs in the blood. DDE is a breakdown product of the

 

organochlorine pesticide DDT, which was banned in the U.S. in the

 

mid-1970s; PCBs are a group of 209 chlorinated industrial

 

chemicals, also banned in the U.S. The Hunter study is the

 

largest of its kind to date, comparing 236 pairs of women for DDE

 

and 230 pairs for PCBs.

 

 

 

The NEW ENGLAND JOURNAL OF MEDICINE put a far-reaching title on

 

the new study: " Plasma Organochlorine Levels and the Risk of

 

Breast Cancer. " (Plasma is the part of the blood that contains

 

fat-soluble chemicals such as organochlorines.) The title seemed

 

to suggest that a study of two chemicals --DDE and PCBs --could

 

tell us something definitive about all of the 15,000 different

 

organochlorine compounds in relation to breast cancer.

 

 

 

In case we missed the message, the editors of the JOURNAL

 

provided an editorial that spelled it out. The editorial, by

 

Stephen H. Safe, a Texas researcher whose work is often funded by

 

the Chemical Manufacturers Association, had a slightly different

 

though equally far-reaching title: " Xenoestrogens and Breast

 

Cancer. " (Xenoestrogens are industrial chemicals that interfere

 

with normal sex hormones such as estrogen.)

 

 

 

Dr. Safe's editorial in NEJM began, " Chemophobia, the

 

unreasonable fear of chemicals, is a common public reaction to

 

scientific or media reports suggesting that exposure to various

 

environmental contaminants may pose a threat to health. " Surely

 

this is an odd message from a scientist. He is saying, if you

 

fear chemicals because scientific reports indicate that they

 

might harm your health, you are suffering from an irrational

 

phobia. Perhaps Dr. Safe did not write the editorial in his

 

capacity as a scientist.

 

 

 

Dr. Safe concludes his chemophobia editorial saying it is time we

 

all stopped worrying about organochlorines and breast cancer. He

 

writes, " The results of Hunter along with those of other recent

 

studies should reassure the public that weakly estrogenic

 

organochlorine compounds such as PCBs, DDT and DDE are not a

 

cause of breast cancer. " [2] Estrogenic organochlorine compounds

 

such as DDT, DDE and PCBs are not a cause of breast cancer. Case

 

closed.

 

 

 

If we still didn't get the point, Gina Kolata of the NEW YORK

 

TIMES interviewed Dr. Safe, giving him an opportunity to amplify

 

his message. Dr. Safe told Ms. Kolata it is time to quit

 

researching the relationship between organochlorine chemicals and

 

breast cancer: " For advocates [of the idea that the two are

 

connected], it's never ending. But for other people, there may be

 

times when we want to spend our money on other things, " Dr. Safe

 

said.[3] No more research needed. Case closed.

 

 

 

Three days later in the Sunday TIMES, Gina Kolata delivered the

 

message once again, summarizing the Hunter study this way: " One

 

more environmental scare bit the dust last week as scientists

 

from the Harvard School of Public Health reported that their

 

large and meticulous study found no evidence that exposure to the

 

chemicals DDT and PCB's [sic] are linked to breast cancer. " [4]

 

Another scare bit the dust. Case closed.

 

 

 

Including the recent Hunter study, there are now 11 published

 

studies of organochlorine compounds (DDE, PCBs, methoxychlor,

 

beta-hexachlorocyclohexane, and chlordane --the last 3 being

 

pesticides) in relation to breast cancer. Four studies, including

 

the largest two of the 11, have shown no relationship between

 

DDE, PCBs and breast cancer.[1,5,6,7] Six smaller studies have

 

indicated a positive relationship, suggesting that some

 

organochlorines may be implicated somehow in breast

 

cancer.[8,9,10,11,12,13] One additional study was equivocal,

 

subject to differing interpretations.[14]

 

 

 

The equivocal study was by led by Nancy Krieger, who examined DDE

 

and PCB levels in the blood of 150 women with breast cancer and

 

150 women without breast cancer. The 300 women were chosen to

 

represent racial/ethnic groups: 100 whites, 100 African-Americans

 

and 100 Asian-Americans. Taken together, the 300 women showed no

 

statistically-significant relationship between DDE, PCBs and

 

breast cancer. However, when the racial/ethnic groups were

 

studied individually, the whites and the African-Americans with

 

breast cancer showed elevated levels of DDE in the blood,

 

compared to whites and African-Americans without breast

 

cancer.[14] Asian and recently-immigrated Asian-American women

 

tend to have a much lower incidence of breast cancer than white

 

Americans, perhaps because of a protective effect from their

 

diet.[15,16] Omitting the Asian-Americans from the Krieger study

 

essentially reverses the study's conclusions.

 

 

 

Thus out of 11 studies, 4 are negative and 7 show elevated levels

 

of organochlorines of one kind or another in tissues of women

 

with breast cancer. One of those seven were not statistically

 

signficant. Is it time to close the book on this inquiry?

 

 

 

Stephen Safe and Gina Kolata obviously want us to think so. Dr.

 

Safe and Ms. Kolata both try to make us believe that recent work

 

has revealed that breast cancer can be completely explained by

 

" known risk factors. " Listen to Dr. Safe: " Robbins and coworkers

 

recently showed that the high incidence of breast cancer in women

 

from the San Francisco Bay area can be accounted for by known

 

risk factors, including parity [how many children they've had],

 

age at first full-term pregnancy, months of breast-feeding, age

 

at menopause, age at menarche [when a woman's period commences],

 

and alcohol consumption. " [2] Ms. Kolata takes the argument even

 

further: " Dr. Hunter said that perhaps it was time to question

 

the assumption that much breast cancer is caused by unknown

 

environmental agents. A recent study, for example, found that the

 

high rate of breast cancer in the San Francisco Bay area can be

 

completely attributed to known risk factors like a woman's age

 

when she start to menstruate, has a first child, and when she

 

begins menopause. "

 

 

 

Dr. Safe and Ms. Kolata both make it sound as if this new study

 

of women in San Francisco has revealed that all breast cancer can

 

be explained by " known risk factors. " If true, this is important

 

news.

 

 

 

In fact the Robbins study of women in the San Francisco Bay area

 

did not even try to explain the origins of all breast cancer.[17]

 

Robbins observed that white women near San Francisco Bay have a

 

14% higher incidence of breast cancer than the national average

 

(and African-American women in the Bay area are 10% above the

 

national average), and he set out to see if he could explain the

 

14% and 10% increases. He and his coworkers found that women in

 

San Francisco tend to have fewer children, have them later in

 

life, breast feed them less, and so forth, thus explaining the

 

14% and 10% increases by " known risk factors. " The 50% to 70% of

 

breast cancer that can't be explained anywhere else in the U.S.

 

also can't be explained in San Francisco --despite the false

 

impression that Dr. Safe and Ms. Kolata managed to create.

 

 

 

What about Stephen Safe's conclusion (amplified by Ms. Kolata),

 

that, based on four negative studies of DDE and PCBs, we should

 

stop trying to find the links between environmental estrogenic

 

chemicals and breast cancer?

 

 

 

Stephen Safe knows that DDE is not estrogenic. DDT is

 

estrogenic, but DDE is not. DDE is a potent anti-androgen (it

 

blocks the action of male hormones).[18] DDE DOES interfere with

 

sex hormones, but it doesn't mimic estrogen and there's no good

 

reason to think it would make a major contribution to breast

 

cancer. Likewise, many PCBs are not estrogenic --on the

 

contrary, they are ANTI-estrogenic. Dr. Safe's own research has

 

shown this again and again.[19] Thus there is no good reason to

 

think that DDE and a randomly-selected group of mixed PCBs will

 

cause breast cancer. Listen once more to Dr. Safe's editorial

 

(titled " Xenoestrogens and Breast Cancer " ). He writes, " The

 

results of Hunter along with those of other recent studies should

 

reassure the public that weakly estrogenic organochlorine

 

compounds such as PCBs, DDT and DDE are not a cause of breast

 

cancer. " But DDE is not estrogenic, and neither are many PCBs.

 

This is a false argument and Dr. Safe --and the editors of the

 

NEW ENGLAND JOURNAL OF MEDICINE --know it.

 

 

 

There are good, strong reasons to think that many

 

estrogen-mimicking chemicals, some of them organochlorines, might

 

be associated with breast cancer, and these should be carefully

 

examined. But DDE and mixed PCBs are not in that category. They

 

have been studied because they are convenient to study, not

 

because they are particularly estrogenic. When Stephen Safe tells

 

Gina Kolata we might want to end research on organochlorines and

 

breast cancer based on studies of DDE and mixed PCBs, Dr. Safe is

 

sounding like a camp follower of the Chemical Manufacturers

 

Association, not like a scientist.

 

--Peter Montague

 

(National Writers Union, UAW Local 1981/AFL-CIO)

 

 

 

===============

 

[1] David J. Hunter and others, " Plasma Organochlorine Levels and

 

the Risk of Breast Cancer, " NEW ENGLAND JOURNAL OF MEDICINE Vol.

 

337, No. 18 (October 30, 1997), pgs. 1253-1258. Studied 236

 

pairs of women for DDT levels and 230 pairs of women for PCB

 

levels.

 

 

 

[2] Stephen H. Safe, " Xenoestrogens and Breast Cancer, " NEW

 

ENGLAND JOURNAL OF MEDICINE Vol. 337, No. 18 (October 30, 1997),

 

pgs. 1303-1304.

 

 

 

[3] Gina Kolata, " Study Discounts DDT Role in Breast Cancer, " NEW

 

YORK TIMES October 30, 1997, pg. 26.

 

 

 

[4] Gina Kolata, " DDT and Breast Cancer, " NEW YORK TIMES November

 

2, 1997, pg. 2.

 

 

 

[5] M. Unger and others, " Organochlorine compounds in human

 

breast fat from deceased with and without breast cancer in a

 

biopsy material from newly diagnosed patients undergoing breast

 

surgery, " ENVIRONMENTAL RESEARCH Vol. 34 (1984), pgs. 24-28.

 

Studied 32 cases and 56 controls.

 

 

 

[6] Pieter van't Veer and others, " DDT (dicophane) and

 

postmenopausal breast cancer in Europe: case-control study, "

 

BRITISH JOURNAL OF MEDICINE Vol. 315 (July 12, 1997), pgs. 81-85.

 

Studied 265 cases and 341 controls.

 

 

 

[7] Lizbeth Lopez-Carrillo and others,

 

" Dichlorodiphenyltrichloroethane Serum Levels and Breast Cancer

 

Risk: A Case Control Study from Mexico, " CANCER RESEARCH Vol. 57

 

(September 1, 1997), pgs. 3728-3732. Studied 141 cases & 141

 

controls; 562 ppb for cases, 505 for controls, but not

 

statistically significant.

 

 

 

[8] Frank Falck, Jr. and others, " Pesticides and Polychlorinated

 

Biphenyl Residues in Human Breast Lipids and Their Relation to

 

Breast Cancer, " ARCHIVES OF ENVIRONMENTAL HEALTH Vol. 47 No. 2

 

(March/April, 1992), pgs. 143-146. Studied 20 cases and 20

 

controls. A dose-response relationship was observed.

 

 

 

[9] Mary S. Wolff and others, " Blood Levels of Organochlorine

 

Residues and the Risk of Breast Cancer, " JOURNAL OF THE NATIONAL

 

CANCER INSTITUTE Vol. 85, No. 8 (April 21, 1993), pgs. 648-652.

 

Studied 58 cases and 341 controls. A dose-response relationship

 

was observed.

 

 

 

[10] Mirjana V. Djordjevic and others, " Assessment of chlorinated

 

pesticides and polychlorinated biphenyls in adipose breast tissue

 

using a supercritical fluid extraction method, " CARCINOGENESIS

 

Vol. 15, No. 11 (1994), pgs. 2581-2585. Found elevated levels of

 

DDE, PCBs, chlordane, oxychlordane and transnonachlor in breast

 

tissue of 5 women with breast cancer vs. 5 women without rhe

 

disease.

 

 

 

[11] H. Mussalo-Rauhamas and others, " Occurrence of

 

Beta-Hexachlorocyclohexane in Breast Cancer Patients, " CANCER

 

Vol. 66, No. 10 (November 15, 1990), pgs. 2124-2128. Studied 44

 

cases and 33 controls. Found that Finnish women with elevated

 

levels of beta-hexachlorocyclohexane, a breakdown product of the

 

pesticide Lindane, in their breast tissue had a 10-fold increased

 

risk of breast cancer. See also, Rosemary Steinmetz and others,

 

" Novel Estrogenic Action of the Pesticide Residue

 

Beta-Hexachlorocyclohexane in Human Breast Cancer Cells, " CANCER

 

RESEARCH Vol. 56 (December 1, 1996), pgs. 5403-5409.

 

 

 

[12] Eric Dewailly, " High Organochlorine Body Burden in Women

 

With Estrogen Receptor-Positive Breast Cancer, " JOURNAL OF THE

 

NATIONAL CANCER INSITUTE Vol. 86, No. 3 (February 2, 1994), pgs.

 

232-234. Studied 20 cases and 17 controls. Found a nine-fold

 

increased risk of breast cancer among women with

 

estrogen-responsive breast tumors

 

 

 

[13] M. Wassermann and others, " Organochlorine Compounds in

 

Neoplastic and Adjacent Apparently Normal Breast Tissue, "

 

BULLETIN OF ENVIRONMENTAL CONTAMINATION & TOXICOLOGY Vol. 15, No.

 

4 (1976), pgs. 478-484. Organochlorine compounds (DDT and PCBs)

 

were higher in 9 breast cancer patients than in 5 controls, and

 

in cancer patients the cancerous tissue contains significantly

 

more organochlorines than adjacent normal tissues.

 

 

 

[14] Nancy Krieger and others, " Breast Cancer and Serum

 

Organochlorines: A Prospective Study Among White, Black and Asian

 

Women, " JOURNAL OF THE NATIONAL CANCER INSTITUTE Vol. 86, No. 8

 

(April 20, 1994), pgs. 589-599. In the same issue, see the

 

editorial, pgs. 572-573 and " DDT and Breast Cancer: The Verdict

 

Isn't In, " pgs. 576-577.

 

 

 

[15] A.H. Wu and others, " Tofu and risk of breast cancer in

 

Asian-Americans, " CANCER EPIDEMIOLOGY, BIOMARKERS AND PREVENTION

 

Vol. 5, No. 11 (November 1996), pgs. 901-906.

 

 

 

[16] Herman Adlercreutz, " Phytoestrogens: Epidemiology and a

 

Possible Role in Cancer Protection, " ENVIRONMENTAL HEALTH

 

PERSPECTIVES Vol. 103, Supplement 7 (October 1995), pgs. 103-112.

 

 

 

[17] Anthony S. Robbins and others, " Regional Differences in

 

Known Risk Factors and theHigher Incidence of Breast Cancer in

 

San Francisco, " JOURNAL OF THE NATIONAL CANCER INSTITUTE Vol. 89,

 

No. 13 (July 2, 1997), pgs. 960-965.

 

 

 

[18] William R. Kelce and others, " Persistent DDT metabolite

 

p,p'-DDE is a potent androgen receptor antagonist, " NATURE Vol.

 

375 (June 15, 1995), pgs. 581-585.

 

 

 

[19] For example, see M. Moore, S. Safe, and others,

 

" Antiestrogenic Activity of Hydroxylated Polychlorinated Biphenyl

 

Congeners Identified in Human Serum, " TOXICOLOGY AND APPLIED

 

PHARMACOLOGY Vol. 142 (1997), pgs. 160-168.

 

 

 

Descriptor terms: new england journal of medicine; breast cancer;

 

dde; ddt; pcbs; david j. hunter; studies; estrogen;

 

organochlorines; stephen h. safe; chemical manufacturers

 

association; gina kolata; methoxychlor;

 

beta-hexachlorocyclohexane; chlordane; nancy krieger;

 

 

 

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