Abstract
A federal report on breast cancer and the environment released in February makes 7 recommendations to accelerate the pace of breast cancer prevention research.
Breast cancer rates continue to rise in the United States, yet the federal government spends too few breast-cancer-research dollars on finding environmental causes of the disease and ways to prevent it, says a 270-page federal report released in February by the Interagency Breast Cancer and Environmental Research Coordinating Committee.
The report, “Breast Cancer and the Environment: Prioritizing Prevention,” mandated by the U.S. Congress in 2008, makes 7 recommendations. Among them: conduct research using a transdisciplinary approach; intensify the study of chemicals and physical agents; and bring together federal, state, and nongovernmental organizations to collaborate and accelerate the pace of prevention research.
The report broadly defines environmental factors as lifestyle behaviors, chemical exposures, radiation, and cultural and socioeconomic factors.
“If we want to reduce the personal, emotional, and financial burden of breast cancer, prevention must be a priority,” says epidemiologist Michele Forman, PhD, professor of nutritional sciences at the University of Texas at Austin and cochair of the 23-member committee made up of scientists, government officials, and breast cancer advocates. “Funds for breast cancer prevention must be at a level playing field with other areas of research.”
In recent years, environment and prevention studies accounted for only about 10% of breast cancer research funded by the NIH and the Department of Defense—the government agencies that spend the most on breast cancer, says the report.
“We don't even know how the environment affects normal breast development and when in life women are most susceptible to the environmental factors that can cause breast cancer. That could be one of the richest areas for prevention research,” Forman says.
Rowan Chlebowski, MD, PhD, chief of medical oncology and hematology at California's Harbor-UCLA Medical Center and a researcher at the Los Angeles Biomedical Research Institute, agrees that additional funds would be well spent on basic research into areas such as environmental insults on breast development early in life. However, he notes that the best place to start is with testing implementation strategies for interventions already proven safe and effective. Examples include weight loss and use of the aromatase inhibitor exemestane, says Chlebowski, who was not involved with the report.
“We know from the MAP.3 trial that exemestane can reduce breast cancer incidence by 65% in postmenopausal women. That had zero uptake because we haven't been interested in an implementation strategy for breast cancer risk reduction in the clinical practice setting,” says Chlebowski, an investigator on the MAP.3 trial, the results of which were published in the New England Journal of Medicine in 2011.
Forman calls for the secretary of the U.S. Department of Health and Human Services and other federal agencies to implement the committee's recommendations with benchmarks for progress.