Public Health Magazine: Winter 1995, Vol.5, No.1
Major study scrutinizes environmental carcinogens

CSPH to lead Long Island Breast Cancer Study Project

As a result of their advocacy, the U.S. Congress mandated a comprehensive population- based epidemiologic study of breast cancer and the environment among Long Island women. Columbia School of Public Health began the four-year study on April 1 of this year with a multi-million-dollar grant from the National Cancer Institute (NCI). The Long Island Breast Cancer Study Project will focus on whether certain environmental contaminants, including pesticides, increase the risk of breast cancer among women on Long Island. It will be the most comprehensive population-based epidemiologic study of breast cancer and the environment among Long Island women.

"The National Cancer Institute's support enables the Columbia School of Public Health and its consortium of collaborating institutions to develop the necessary tools and research procedures to conduct the study of breast cancer and the environment. We anticipate that the results of this study of Long Island women will allow us to provide substantive preventive advice to women everywhere," said Dean Allan Rosenfield, M.D., at a press conference earlier this year.

Approximately 1,600 women who are newly diagnosed with breast cancer will be compared with 1,600 randomly selected women from the community. Identification of cases will begin in 1996. "We will not be able to tell a woman what caused her breast cancer but we will be able to draw inferences from the statistics as to what environmental factors could be involved," said CSPH researcher Marilie Gammon, Ph.D., principal investigator of the study and one of the school's national authorities on the epidemiology of breast cancer.

Joining Gammon as co-principal investigator will be CSPH's Alfred Neugut, M.D., Ph.D., an epidemiologist; and Regina Santella, Ph.D., biomarker coordinator in charge of laboratory procedures.

The Long Island Breast Cancer Study Project builds on several earlier studies which suggested that certain environmental exposures, primarily some organochlorines commonly used as pesticides, may increase a woman's risk of breast cancer. Estrogen metabolism may be a route through which organochlorine compounds (OCC) affect breast cancer risk. Further studies have linked residence near hazardous waste sites or chemical facilities with breast cancer risk. Although the exact exposures have not been identified, agents derived from such exposures may include polycyclic aromatic hydrocarbons or PAH. PAHs are omnipresent mammary carcinogens that mimic estrogen in some in vitro test systems. The primary aim of the study is to determine whether OCC and PAH are associated with breast cancer risk among the women of Long Island's Nassau and Suffolk counties, where breast cancer rates are among the highest in the country.

Activists look forward to obtaining some long-sought answers, said Barbara Balaban, director of the Adelphi New York Statewide Breast Cancer Hotline and Support Program. Early research pointed to sub-populations of Long Island women known to have high risk for breast cancer, said the pioneering activist. "But those women accounted for fewer than half of the women with breast cancer," Balaban asserted. "Less was known about the majority than the minority. We know nothing about most of the people with breast cancer."

The Long Island Breast Cancer Network--an organization of some 30 local activist groups- -will be the community relations link in the project. Activists, like Karen Miller of the network's Huntington Breast Cancer Coalition, are encouraged that there will be a positive relationship between the local community and the science community. "The principal investigators have been forthright in an unprecedented manner," Miller said.

Taking the lead to involve women of color is Erima Vaughan, a member of the study's community advisory committee. She is program chair of the Long Island League to Abolish Cancer and also started a women of color task force within NOW's Nassau chapter. Through these organizations, Vaughan informs women of color about the study. "We are gearing up to raise awareness by filtering information through the work place, at beauty shops and other places frequented by women of color," said Vaughan.

Because this is a population-based study, representation of minority women will be proportional to the number in the population. "Approximately 7 percent of the control women will be black, reflective of the population in Nassau and Suffolk counties," said Gammon. She expects that, of the women who were newly diagnosed with breast cancer, at least 5 percent will be black.

Grassroots activism typified by Balaban, Miller, and Vaughan spurred legislators to support the research. Accordingly, local legislators shared activists' excitement at the news of the study's funding. "Having fought in Congress to ensure that this essential study received the authorization and funding it needed, I am deeply gratified by the awarding of this grant," said Senator Alfonse M. D'Amato (R--N.Y.). "It provides momentum as we seek answers to the questions surrounding breast cancer on Long Island that have plagued our community for far too long."

CSPH to lead 20 collaborators

The actual establishment of such a comprehensive endeavor involves coordinating the work of more than 20 major New York City and Long Island institutions, CSPH's project partners. Neugut explained that, "A few years ago, a group of metropolitan-area epidemiologists began to meet informally to foster collaboration. When NCI wanted a big study done, the group was in place, the forerunner of the consortium."

Cancer centers and Long Island scientists involved in the multi-disciplinary and laboratory- driven research include Mt. Sinai School of Medicine, the American Health Foundation, Strang-Cornell Cancer Research Laboratory, Albert Einstein College of Medicine, Memorial Sloan-Kettering Cancer Center, North Shore University Hospital, SUNY at Stony Brook, Long Island Jewish Medical Center, Winthrop University Hospital and the County of Suffolk Department of Health Services.

However, CSPH has overall responsibility for the study, Gammon points out, including study coordination and establishing the design and protocol for all aspects of the study in conjunction with partner institutions. Furthermore, CSPH will supervise development of all study instruments; case and control identification and recruitment; collection of subject blood and urine samples; in-person interviews; assays of blood, urine, soil, water, and dust; geographic modeling of historic exposure; coding of exposure assessment from the questionnaire; data management, analysis and interpretation; manuscript preparation; and community relations with lay and professional groups. The four-year study has a careful, long-term approach. Because traditional approaches may not provide answers, the program will be flexible to accommodate outstanding relevant scientific research.

Scientifically, the results of this study should greatly increase understanding of the possible relationship between environmental factors and breast cancer. The women activists are philosophical: they hope the research will help their daughters or granddaughters.