May/June 2008 Issue Guide

CABWHP publishes issue guides with thorough analyses of health policy issues addressing mental, emotional and physical health. Our Issue Guides are distributed via mail to Policy Advisory Group members and to over 1,000 colleagues and organizational collaborators.

Exploring the Link between the Environment and Cancer

• What role does the environment play in breast cancer?¹

• Why do some groups of women bear a greater burden of this disease than others?

The answers to these questions have thus far eluded scientists, yet answering them could lead to great progress against breast cancer. Recognizing the need for more research into these questions, the California Breast Cancer Research Program (CBCRP) recently launched its Special Research Initiatives, a seven year effort to find answers that will push breast cancer research forward. CBCRP has set aside 30 percent of its funds over the next several years for the Special Research Initiatives (SRI), totaling approximately $23 million dollars.

The goals of the SRI include:

• Initiating research that will point to actions that can be taken to reduce the burden of breast cancer;

• Conducting research that will provide recommendations to advocacy organizations and policymakers for evidence-based change; and

• Stimulating more research into the environment-breast cancer connection and the reasons why some groups of women bear a greater burden of breast cancer.

To select the research that will lead to the most progress against breast cancer, CBCRP has been following a carefully-crafted, two-year, publicly accessible strategy development process which has included: (1) stakeholder meetings throughout the state; (2) an online process soliciting input from researchers, advocates and the community; and (3) an external steering committee and strategy team to provide the guidance, expertise and vision to produce research to accomplish its mission.

Where Does The Research Money Currently Go?

Of those resources directed to cancer research, only a small amount of funding has been allocated to explore avoidable exposures to a wide range of occupational and environmental industrial carcinogens. In addition, money has not flowed to disparities research. Historically, breast cancer research has focused primarily on identifying targets for therapy and treatment as opposed to primary prevention research-related activities. The decline in cancer funding is further reducing progress in cancer prevention research. Funding of federal grant applications for cancer research has fallen from about 30 percent to about 9 percent.

One major reason that more research has not been done on the questions being addressed through the SRI is that they are difficult and complicated to research. There's no scientific consensus about where to begin.

What Questions Do We Need To Ask?

Institutional racism and prejudices impact what questions are asked and what knowledge is included in science. To address disparities, we must understand how the legacy of racism and prejudice in all of its manifestations interacts with social, physical and other factors to impact health. Such research challenges our notions of ourselves, our nation and our policies and practices that sustain inequalities and prejudices. The scientific infrastructure (the individuals and institutions that establish research priorities and disperse funding) are uncomfortable with this type of research.

How Do We Define the Environment?

How does the California Breast Cancer Research Program define environment? For the purposes of the Special Research Initiatives, the "environment" is defined as all of the non-genetic factors that might lead to breast cancer that are largely outside of an individual's control. This definition includes possible causes of breast cancer resulting from exposure to sources such as air pollution, second hand smoke, pharmaceuticals and the built environment.

Where Are We Now?

After convening over 300 leading experts and advocates from throughout California and across the nation, the California Breast Cancer Research Program has agreed upon three promising research areas that traditional privately and federally funded investigations have long given little attention. Funding is available for 10 ground breaking research initiatives to directly address some of the trickiest questions in breast cancer research. This represents California's first state-wide coordinated research effort in these areas.

Areas and initiatives include:

• Bringing breast cancer issues to the forefront of California's Green Chemistry Initiative by funding an expert working group to: (1) consider the biological pathways through which chemicals contribute to breast cancer; and (2) identify the best currently available chemical safety tests.

• Developing and evaluating the most comprehensive battery of accurate, reliable, rapid and cost-effective existing tests that can be performed on chemicals to see if they cause changes in the body that can contribute to breast cancer.

• Testing whether exposure to certain chemicals during the course of a woman's pregnancy may increase the risk of breast cancer for the child later in life.

• Determining whether the data from existing California studies can be combined in order to provide a more complex, birds-eye picture of why people from different racial and ethnic groups, who are diagnosed with breast cancer at the same stage, have different survival outcomes.

• Developing new statistical analysis strategies, using existing statistical methods, to better address how multiple environmental and social exposures across a woman's full life course may interact to affect her breast cancer risk.

Questions about chemical and environmental causes and ethnic and racial disparities have been unanswered for too long. The California Breast Cancer Research Program (the nation's largest state-funded breast cancer research effort) and the state of California are uniquely positioned to lead the effort to finding answers to these questions. This research has the potential to help ALL environmental and disparities health research and reshape how we think about and carry out research in the breast cancer prevention world and beyond. The CBCRP needs the support of the entire advocacy community as it moves forward in this bold new direction.

Events/Announcements

References

1Source: Research and materials prepared by the California Breast Cancer Research Program - www.CABreastCancer.org