Breast Cancer Action’s Response to the Interagency Breast Cancer and Environmental Research Coordinating Committee (IBCERCC)’s Report: “Breast Cancer and the Environment: Prioritizing Prevention.”
After nearly three years of dedicated work, today the Interagency Breast Cancer and Environmental Research Coordinating Committee (IBCERCC) issued their report, “Breast Cancer and the Environment: Prioritizing Prevention.” As the title highlights, the report calls for a national breast cancer prevention strategy followed by specific recommendations for implementation, including urgent and necessary changes in how the federal government prioritizes and funds research into the environmental causes of breast cancer. Breast Cancer Action (BCAction) recognizes the work of the committee—which includes many partners and allies, each of whom worked tirelessly on this report—as well as acknowledges the countless advocates and researchers whose work is reflected in the recommendations.
The “Prioritizing Prevention” report opens with the recognition of the deep and lasting toll that breast cancer takes on women’s lives and our economy. The report recognizes limitations in our current research methods and paradigms and makes strong and concrete recommendations for improved environmental monitoring, development of new research models, engagement of diverse stakeholders, development of a comprehensive federal research strategy and more funding into primary prevention. And the report acknowledges and highlights the role of advocates—past, present, and future—to create change and the need that diverse communities be integrated at every level of research and dissemination.
The recommendations of the report call for coordinated and targeted research to identify environmental causes of breast cancer will generate new data that will require additional areas for action to protect public health. “Prioritizing Prevention” underscores much of what is already known about environmental causes of breast cancer and we’re pleased to see it affirm many of the specific areas of research called for in Breast Cancer Action’s own 2012 Mandate for Government Action. We believe that these recommendations provide the basis for, but do not yet themselves, directly mitigate the environmental causes of breast cancer.
In our own call for comprehensive research into environmental causes of breast cancer, BCAction recognizes that research and data collection are essential and necessary but not sufficient to ensure that women are protected from harmful chemicals and physical factors that increase the risk of breast cancer. Sufficiently strong and comprehensive research is the backbone to appropriate and effective regulation. However, there is currently strong scientific evidence of specific environmental links to breast cancer and yet regulation of such environmental causes lags behind existing data. In order to turn back the current breast cancer epidemic, any call for research must be coupled with a commitment to a precautionary principle which acts upon evidence of known and suspected harms to protect public health and end the breast cancer epidemic.
We must act now to prevent exposure to harmful chemicals, based on the compelling evidence of environmental links to breast cancer that already exists. And I do not mean acting as concerned consumers, striving to purchase non-toxic products to keep ourselves and our families safe. We must demand that the agencies tasked with protecting public health—specifically the Environmental Protection Agency and the Food and Drug Administration—do a better job of acting now on the data we already have. Like the IOM’s report “Breast Cancer and the Environment: A Life Course Approach”, this report does not address the question of where the burden of proof lies and how we implement and act upon research to “prioritize prevention”.
Both “Prioritizing Prevention” and the IOM report on breast cancer and the environment include lifestyle and societal factors—such as diet, weight, BMI, physical activity—together with chemical and physical factors in their definition of the environment. BCAction believes that this overly broad definition does a disservice to the very real need to prioritize the study of the physical and chemical environment. By confusing and conflating the issues, the everyday meaning of “the environment” loses significance and diverts attention from those external factors over which we have little if any control. While it may be perfectly appropriate to investigate societal factors and lifestyle as risk factors for breast cancer, such research should be done under appropriate auspices. One of the problems of conflating multiple factors that increase our breast cancer risk is that it inhibits our ability to identify appropriate interventions to prevent breast cancer. Telling a woman she should maintain a healthy weight is a very different sort of recommendation than recommending the federal government effectively regulate obesogens, chemicals which are linked to obesity. When it comes to the physical and chemical environment, BCAction is committed to policy level regulations that protects the health of all women, regardless o f where they live, work and play.
While “Prioritizing Prevention” acknowledges the complex ways in which different communities and racial/ethnic groups are unequally affected by the breast cancer epidemic and calls specifically for default safety factors that protect the most susceptible and populations that are under researched, we believe that more clearly understanding the connections between social and economic inequities and health disparities is necessary to remedy the inequities. Because the focus of the report is more on disparities than the inequities, it jumps to assertions that include assigning later stage diagnosis in non-white women primarily to less access to screening, and health insurance, missing an opportunity to focus on root causes of inequities.
“Prioritizing Prevention” reviews the state of research on breast cancer and the environment and makes seven important recommendations that will improve the current state of breast cancer and the environment research. While we support each of the committee’s recommendations, we recognize that the report alone will not prevent breast cancer without a commitment to regulation based on a precautionary principle and to acting upon the research that the report recommends. Furthermore, we believe that we cannot afford to wait for the recommendations of this report to be implemented and must act now, using the data we already possess, to ensure that current and future generations of women and girls are not exposed to currently known chemicals and physical agents which increase the risk of breast cancer. As the breast cancer epidemic rages on, we cannot afford to wait.