Laurie David investigates how your environment, including when you have children, may cause breast cancer
BY LAURIE DAVID | OCTOBER 21, 2011
About six months ago, I planned a dinner party at my Hollywood home for a new friend, Marisa Weiss. I’d come to know her when a close friend got breast cancer; everyone said Dr. Weiss was the person to talk to. A breast oncologist at Philadelphia’s Lankenau Medical Center and founder ofBreastcancer.org, she is herself a breast cancer survivor.
I was shocked by my friend’s case because she had absolutely no genetic precursors—no cancer in her family. But in fact, “only 5 to 10 percent of breast cancers are linked to the genes BRCA1 or BRCA2,” Marisa said at dinner that night. And only another 20 percent of cases occur where there’s a strong family history. Which means that for 70 percent of breast cancer, she told the TV producers, actresses, novelists, and screenwriters gathered around my table, there is no known hereditary link; the cancers are likely triggered by environmental factors or random mutations.
As a longtime environmental activist, this made some sense to me. I know that our exposure to chemicals in the products we use and foods we eat is growing exponentially and is shockingly unregulated. But I realized as she talked that environment also means that which we create in our bodies by the choices we make: delaying pregnancy, not exercising enough, drinking alcohol, and exposing ourselves to unnecessary hormones. These choices, Marisa told us, also can cause breast cancer.
I live in a town where millions of dollars have been raised to fight cancer. Never had I heard anyone assert that the causes of it had to do with the “environment.” But research—particularly a seven-year program of studies cosponsored by the National Institute of Environmental Health Sciences and the National Cancer Institute—is increasingly showing that breast and other cancers may well be caused by what we are eating, drinking, breathing, and applying to our skin. This was actually the first piece of good news I’d heard on the subject. It meant we could potentially decrease our chances of getting breast cancer. And it’s why Marisa and Joan Ruderman, PhD, the Nelson Professor of Cell Biology at Harvard Medical School, came up with Breastcancer.org’s campaign to educate and prevent: Think Pink, Live Green.
My friend and jewelry designer extraordinaire Chan Luu (you probably own one of her signature wrap bracelets) was there that night, mouth agape, just like me. “By the time dessert was served,” Chan says, “I had come up with the idea to make the bracelets.” She created three original styles ($20, $55, and $190), and 50 percent of the proceeds will benefit Breastcancer.org, the most-visited online resource for breast cancer information and support.
In June, I interviewed Marisa about her new initiative, how we can reduce our chances of getting breast cancer, and what we have to change in our lives to do so.
Laurie David: How long have we suspected that environmental factors are responsible for the rise of breast cancer?
Marisa Weiss: In the last 50 years, the incidence of breast cancer has continued to increase, even after the leveling off of screening practices. So, the increase was not just due to the major rise in women getting regular mammograms. What has changed is modern life, and it turns out that our lifestyles and environmental exposures are dangerous for breast tissue. Breast cancer incidence is highest in Western nations, where the vast majority of women are leading a modern lifestyle, and the United States has one of the highest incidences. We don’t get as much exercise as we did in the early twentieth century; we drink more alcohol, have children later or not at all, and are less likely to breast-feed. Our chemical exposures are greater: More women eat foods raised with pesticides and take pharmaceutical hormones for contraception and menopausal symptoms. Changing the environment in which you live can increase your risk; for example, breast cancer is on the rise among Asian immigrants to this country.
LD: Your statement that delayed pregnancy is associated with a higher risk of breast cancer might seem incendiary to some. It’s like we’re urging women to have babies younger—and for many women that means delaying or derailing careers.
MW: Here, it’s important to just stick to the facts. Pregnancy and breast-feeding help protect women from breast cancer. It’s all because of the unique biology of the breast. Our other organs—the heart, kidneys, lungs—are fully made and are working before or immediately after birth. But the breast is totally unique, requiring many more steps to fully mature and develop the capability to fulfill its primary job: to make milk. The breast takes nine months in utero and 10 years in adolescence to be built, and even then it can’t make milk until the first full-term pregnancy. So until that happens, if it happens, it remains an immature organ and very responsive to a whole host of chemicals that look like, smell like, taste like, or act like estrogen. Exposures to these and other hormones over time can lead to extra cell growth, including abnormal cell growth like cancer.
It’s important to let women know about the protective effects of a full-term pregnancy and breast-feeding as they strive to make the healthiest choices possible during each phase of their lives. If you’re planning to have children, and if your circumstances make it possible, then it may be worth considering pregnancy earlier rather than later.
Yes, it’s a sensitive subject, just like fertility. It’s a fact that fertility decreases over time. Women need to know this fact, too, as they plan out their lives.
LD: How important is eating organic to reducing breast cancer risk?
MW: One of our biggest exposures to pesticides and hormones is through food. This includes: bisphenol A, a synthetic estrogen found in food-can linings and in plastics stamped with the number 7; atrazine, a pesticide in the water supply that can turn on estrogen production; flame retardants in dust, which can get into foods during processing; and hormones used in raising beef and dairy cattle. If you buy organic, you can avoid most of these chemicals because the growers and producers have had to certify that their products are raised without them.
LD: In your “Think Pink, Live Green” booklet (available at Breastcancer.org), you list 31 things women should do to help prevent breast cancer. It’s a great list, but it might be an overwhelming number of changes for many of us to contemplate at once. Following the environmental movement’s “just do one thing” model as a way to get people to change behavior, can you recommend, say, five things we should do?
MW: Sure. Get to and stick to a healthy weight. Avoid taking extra hormones, such as hormone replacement therapy [after menopause] and possibly birth control pills. Get regular exercise; three to four hours a week can make a real difference, but five to seven hours can make an even bigger difference. Limit alcohol use;
restrict your intake to five or fewer drinks per week. Less is better. Any type of alcohol counts: beer, wine, hard liquor. And if you smoke, stop.
LD: Some of the advice on your list seems to contradict advice about other cancers—I’m thinking of “avoid hormones”—yet women in their forties and fifties are often urged to take birth control pills to help prevent ovarian cancer.
MW: Breast health is women’s health, and in fact, there is little conflict once you take a closer look and balance your goals. First, it’s important to keep in mind the relative risks: Breast cancer is the most common invasive cancer to affect women, sometimes in the prime of life. And it makes the most sense to minimize your maximum risk—the so-called “mini-max” strategy. Yes, birth control pills help reduce the risk of ovarian cancer, which is deadlier than breast cancer, but there are only 22,000 cases of it a year, versus 200,000 for breast cancer. And you have to take birth control for five years [overall, not consecutively] to get that protection.
LD: But aren’t birth control pills the most effective way to prevent unwanted pregnancy?
MW: Yes and no. The new IUDs have far fewer side effects than they used to and are equally reliable. And while it’s true there is no research to show that today’s lower-dose estrogen pills cause breast cancer, they’re still strong enough to overtake your body’s natural menstrual cycles. Plus, women tend to start them earlier and take them for much longer, and for reasons other than contraception: better skin, PMS management, regulating periods. We don’t yet know the safety of this broad and extended pattern of pill use.
LD: Okay, here’s a softball question: How do I get one of those beautiful bracelets?
MW: That’s easy! At Chanluu.com.